Salmonella: Recurrent Salmonella: Recurrent Trends Trends

Prof Eric Bolton

Health Protection Agency

Manchester

November 2009

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Cryptosporidium

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Campylobacters

Salmonellas

Shigellas

Topics - Salmonella

•Gastro-intestinal infections and Food-borne illness

•Major Serotypes and Phage types of Salmonella associated with sporadic infections

•Outbreaks Associated with Salmonella

Selected GI Pathogens, E & W

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CampylobactersSalmonellasCryptosporidiumRotavirusShigellas

Results of a Public Health Investigation into the Use of Raw Eggs in the UK Catering Industry 2002

Salmonella from Raw Shell Eggs Used in Catering

Country of origin Number of pooled samples

Number of pooled samples positive

Salmonella serotypes and S. Enteritidis phage types

UK(Lion Quality)

349 0 None found

UK (not Lion Quality)

274 2 S. Enteritidis PT4, PT6

USA 60 0 None found

France 45 0 None found

Spain 468 24 S. Enteritidis PT1, PT5c, PT6, PT6a, PT6d, PT12, PT13a, PT14b, PT58

Not known (not Lion Quality)

200 17 S. Enteritidis PT4, PT6a S. Altona, S.Cerro, S. Infantis, S Livingstone, S. Ohio

Salmonella InfectionsEngland and Wales, 2000-2008

Year Total

2000 14463

2001 16041

2002 14442

2003 14954

2004 13135

2005 11447

2006 12521

2007 11998

2008 10066

Top Ten Salmonella Serotypes, England & Wales 2008

Serotype Number Percentage

Salmonella Enteritidis 4357 43.3

Salmonella Typhimurium 1916 19.0

Salmonella Virchow 289 2.9

Salmonella Agona 228 2.3

Salmonella Newport 197 2.0

Salmonella Stanley 147 1.5

Salmonella Kentucky 124 1.2

Salmonella Infantis 114 1.1

Salmonella Java 113 1.1

Salmonella Anatum 108 1.1

Total of Top Ten serotypes 7593 75.5

Total of all serotypes 10066

Salmonella Enteritidis phage types, England and Wales

                                                                                                                                                                        

Source: HPA Salmonella Dataset (Labbase2) 1981 onwards

Emergence of Salmonella Enteritidis Phage Type 8 - Guess What !!!

Mode of Transmission in Outbreaks of Gastrointestinal Infection - England & Wales 1992 - 2000.

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Foodborne

Foodborne & personto person

868 208 113 82 1878

Food-borne General Outbreaks by Year 2000 – 2008 (E&W)

Year Number of outbreaks

2000 98

2001 91

2002 71

2003 71

2004 55

2005 81

2006 58

2007 41

2008 65*

Department of Gastrointestinal and Emerging Zoonotic InfectionsHealth Protection Agency Centre for Infections

* Provisional data

Food-borne Outbreaks Associated with Salmonella Enteritidis 2000 – 2008 (E&W)

YearAll

SalmonellasS Ent PT4 S Ent non PT4

2000 35 24 17

2001 35 26 10

2002 32 25 10

2003 44 39 8

2004 31 27 8

2005 33 26 10

2006 24 4 17

2007 21 2 15

2008 31 6 8

Salmonella Food-borne Outbreaks 2004 to 2008

2004 2005 2006 2007 2008

Total Number of outbreaks 28 38 24 21 31

Salmonella Enteritidis 25 27 21 17 14

Salmonella Typhimurium 1 5 1 2 7

Other Salmonella serotypes 2 6 2 2 10

*Provisional data, HPA - Centre for Infections

Food-borne Sources of Salmonella Outbreaks - 2008

Salmonella serotype Food source

S. Typhimurium U313 Eggs, rice, duck

S. Enteritidis PT4 Kiwi Parfait

S. Enteritidis PT4 Tiramisu

S. Typhimurium DT104 Beef Biltong

S. Typhimurium PT193 Egg mayo sandwiches (non Lion branded eggs)

Salmonella (Awaiting serotype) Eating raw eggs

S. Enteritidis PT4 Chicken Donner

Places Associated with Salmonella Outbreaks in England & Wales 2004 – 2006 and 2008

Location 2004 -2006

2008

Restaurants 52 12*

Shops/retail

catering

10 4

Residential 7 3

Hotels 4 1

University, College, School

4 1

Others 12 3**

*8 were associated with Chinese restaurants** National outbreaks

Conclusions for 2008

•There was a 16% decrease in the number of cases of Salmonella infection in 2008 compared to the previous year

•Salmonella Enteritidis (SE) is still the predominant cause of disease (43.3%)

•The predominant cause of outbreaks are Salmonella Enteritidis of Phage types other than PT4.

•Restaurants are the major location associated with outbreaks

Salmonella Montevideo: Cumulative Weekly Totals for England & Wales

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Epidemic curve of Human Salmonella Montevideo cases in England and Wales

Salmonella Senftenberg 2007:Human Cases

• At the beginning of 2007 there were 49 isolates from human cases sent to the HPA Laboratory of Enteric pathogens

•Most of these were seen after week 15 (8th of April)

•Cases had been reported from laboratories in in all regions and Wales

•Cases were followed up and molecular testing done on isolates

Salmonella Senftenberg 2007: Food Microbiology

•At the time of the increase in human cases there was a LACORS/HPA microbiological study of fresh herbs in progress

•Initially 7 samples of pre-packed Basil were positive for Salmonella Senftenberg

•Isolates were sent to LEP for Molecular typing

Molecular typing of Salmonella Senftenberg

Pulsed Field Gel Electrophoresis Plasmid profiling

Salmonella Senftenberg 2007

•Isolates from humans and the Basil had indistinguishable PFGE and Plasmid profiles

•The Basil originated from Israel

•The strain was isolated from cases in England, Wales and Scotland, from individuals who have reported travel to Tenerife and Morocco and a case was reported from Denmark

Cumulative incidence (weekly) of non-travel related NxCpl resistant Salmonella Enteritidis PT 14b to week 45, 2009

NxCpl resistant Salmonella Enteritidis PT 14b, 2009: Cases

•A total of 138 cases have been associated with the 12 outbreaks, which have ranged in size from 2 to 68 cases.

•Eighty five cases have been confirmed as having S. Enteritidis PT 14b, and five have been hospitalized.

• Deaths have been reported in two elderly cases infected with S. Enteritidis PT 14b,

NxCpl resistant Salmonella Enteritidis PT 14b, 2009: Outbreaks

•All of the outbreaks have been investigated by the HPA or Wales NPHS (in one instance):

•Six have been linked to oriental (Chinese or Thai) restaurants, five were linked to other restaurant establishments, and one took place in a care home.

•Preliminary investigations have suggested putative links to chicken and/or eggs in some outbreaks,

NxCpl resistant Salmonella Enteritidis PT 14b, 2009

• S. Enteritidis PT 14b NxCpl has been detected in two of 80 pooled samples of 6 eggs

• Eggs collected from catering premises (3 oriental restaurants, 2 cafes) in five of the outbreaks had the same origin (country Spain) and farm as indicated by the egg stamp mark on egg shells).