Foodborne disease surveillance and outbreak investigations in Western Australia, second quarter 2015

OzFoodNet, Communicable Disease Control Directorate

Enhancing foodborne disease surveillance across AustraliaCommunicable Disease Control Directorate

Acknowledgments

Acknowledgement is given to the following people for their assistance with the activities

described in this report: Mr Damien Bradford, Ms Lyn O’Reilly, Ms Jenny Green, Dr Niki

Foster and the staff from the enteric, PCR and food laboratories at PathWest Laboratory

Medicine WA; staff from the Food Unit of the Department of Health, Western Australia;

Public Health Nurses from the metropolitan and regional Population Health Units; and

Local Government Environmental Health Officers.

Contributors/Editors

Barry Combs and Nevada Pingault

Communicable Disease Control DirectorateDepartment of Health, Western AustraliaPO Box 8172Perth Business CentreWestern Australia 6849

Email: OzfoodnetWA@health.wa.gov.au

Telephone: (08) 9388 4999

Facsimile: (08) 9388 4877

Web: OzFoodNet WA Health www.public.health.wa.gov.au/3/605/2/ozfoodnet_enteric_infections_reports.pmOzFoodNet Department of Healthwww.ozfoodnet.gov.au/

Disclaimer:

Every endeavour has been made to ensure that the information provided in this document

was accurate at the time of writing. However, infectious disease notification data are

continuously updated and subject to change.

This publication has been produced by the Department of Health, Western Australia.

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Executive summary During the second quarter of 2015, the Western Australian (WA) OzFoodNet team

conducted surveillance of enteric diseases, undertook investigations into outbreaks and

was involved with ongoing enteric disease research projects.

The most common notifiable enteric infections in WA were campylobacteriosis (n=651),

salmonellosis (n=383), rotavirus (n=235) and cryptosporidiosis (n=58). Notifications of

campylobacteriosis, salmonellosis and rotavirus were higher than the five-year second

quarter mean, while cryptosporidiosis notifications were lower.

Three foodborne outbreaks, three clusters of salmonellosis, and one cluster of Yersinia

infection were investigated in the second quarter, while the investigation into the increase

in S. Typhimurium PFGE 0001 cases continued.

OzFoodNet also conducted surveillance of 28 non-foodborne outbreaks. Of these, the

most common mode of transmission was person-to-person (23 outbreaks), with a total of

412 people ill. Norovirus was the most common agent responsible for infection (identified

in eight outbreaks), and most outbreaks were in residential care facilities.

Figure 1 Notifications of the four most common enteric diseases by quarter from 2010 to 2015, WA

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Table of Contents

Executive summary.......................................................................................2

1 Introduction..............................................................................................5

2 Incidence of notifiable enteric infections..............................................6

2.1 Methods..................................................................................................................62.2 Campylobacteriosis.................................................................................................62.3 Salmonellosis..........................................................................................................72.4 Rotavirus infection...................................................................................................82.5 Cryptosporidiosis.....................................................................................................92.6 Other enteric diseases and foodborne illness.......................................................10

3 Foodborne and suspected foodborne disease outbreaks.................11

3.1 Café, Salmonella Typhimurium PFGE 0001 outbreak (outbreak code 042-2015-003) 113.2 Restaurant, Salmonella Typhimurium PFGE 0001 outbreak (outbreak code 042-2015-004).......................................................................................................................123.3 Prison, Salmonella Typhimurium PFGE 0003 outbreak (outbreak code 042-2015-001) 12

4. Cluster investigations...........................................................................13

4.1. S. Typhimurium PFGE 0001, phage type 9...........................................................134.2. Salmonella Mbandaka...........................................................................................134.3. Yersiniosis.............................................................................................................144.4. Salmonella Newport..............................................................................................144.5. Salmonella Typhimurium PFGE 0043...................................................................14

5. Non-foodborne disease outbreaks and outbreaks with an unknown mode of transmission..................................................................................14

5.1. Person-to-person outbreaks..................................................................................155.2. Outbreaks with unknown mode of transmission....................................................16

6. Site activities..........................................................................................16

7. References.............................................................................................17

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List of Tables

Table 1 Number of campylobacteriosis notifications, 2nd quarter 2015, WA, by region..................7Table 2 Number of salmonellosis notifications, 2nd quarter 2015, WA, by region...........................7Table 3 Number of rotavirus notifications, 2nd quarter 2015, WA, by region................................9Table 4 Number of cryptosporidiosis notifications, 2nd quarter 2015, WA, by region..................10Table 5 Summary of WA enteric notifiable diseases in the second quarter 2015 compared to historical means....................................................................................................................11Table 6 Outbreaks with non-foodborne transmission, 2nd quarter 2015, WA................................15

List of Figures Figure 1 Notifications of the four most common enteric diseases by quarter from 2010 to 2015, WA............................................................................................................................................. 2Figure 2 Notifications of Salmonella Typhimurium PFGE 0001 in WA......................................13

Notes:

1. All data in this report are provisional and subject to future revision.

2. To help place the data in this report in perspective, comparisons with other reporting periods are provided. As no formal statistical testing has been conducted, some caution should be taken with interpretation.

Copyright to this material is vested in the State of Western Australia unless otherwise indicated. Apart from any fair dealing for the purposes of private study, research, criticism or review, as permitted under the provisions of the Copyright Act 1968, no part may be reproduced or re-used for any purposes whatsoever without written permission of the State of Western Australia.

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1 IntroductionIt has been estimated that there are 5.4 million cases of foodborne illness in Australia

each year at a cost of $1.2 billion per year1. This is likely to be an underestimate of the

total burden of gastrointestinal illness as not all enteric infections are caused by foodborne

transmission. Other important modes of transmission include person-to-person, animal-to-

person and waterborne transmission. Importantly, most of these infections are preventable

through interventions at the level of primary production, commercial food handling,

households and institution infection control.

This report describes enteric disease surveillance and investigations carried out during the

second quarter of 2015 by OzFoodNet WA, other WA Department of Health (WA Health)

agencies and local governments. Most of the data are derived from reports to WA Health

of 16 notifiable enteric diseases by doctors and laboratories. In addition, outbreaks caused

by non-notifiable enteric infections are also documented in this report, including norovirus,

which causes a large burden of illness in residential care facilities (RCF) and the general

community.

OzFoodNet WA is part of the Communicable Disease Control Directorate (CDCD) within

WA Health, and is also part of the National OzFoodNet network funded by the

Commonwealth Department of Health2. The mission of OzFoodNet is to enhance

surveillance of foodborne illness, including investigating and determining the cause of

outbreaks. OzFoodNet also conducts applied research into associated risk factors and

develops policies and guidelines related to enteric disease surveillance, investigation and

control. The OzFoodNet site, based in Perth, is responsible for enteric disease

surveillance and investigation in WA.

OzFoodNet WA regularly liaises with staff from Public Health Units (PHUs), the Food Unit

in the Environmental Health Directorate of WA Health; and the Food Hygiene, Diagnostic

and Molecular Epidemiology laboratories at PathWest Laboratory Medicine WA.

PHUs are responsible for public health activities, including communicable disease control,

within their respective administrative regions. The PHUs monitor RCF gastroenteritis

outbreaks and provide infection control advice. The PHUs also conduct follow-up of single

cases of important enteric diseases including typhoid, paratyphoid and hepatitis A.

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The Food Unit liaises with Local Government (LG) Environmental Health Officers (EHO)

during the investigation of food businesses. The Food Hygiene, Diagnostic and Molecular

Epidemiology laboratories at PathWest Laboratory Medicine WA provide public health

laboratory services for the surveillance and investigation of enteric disease.

2 Incidence of notifiable enteric infections2.1 Methods

Enteric disease notifications were extracted from the Western Australian Notifiable

Infectious Diseases Database (WANIDD) by optimal date of onset (ODOO) for the time

period 1st April 2010 to 30th June 2015. The ODOO is a composite of the ‘true’ date of

onset provided by the notifying doctor or obtained during case follow-up, the date of

specimen collection for laboratory notified cases, and when neither of these dates is

available, the date of notification by the doctor or laboratory, or the date of receipt of

notification, whichever is earliest. Rates were calculated using estimated resident

population data for WA from Rates Calculator version 9.5.5 (WA Health, Government of

Western Australia), which is based on 2011 census data. Rates calculated for this report

have not been adjusted for age.

2.2 Campylobacteriosis

Campylobacteriosis was the most commonly notified enteric disease in WA during the

second quarter of 2015 (2Q15), with 651 notifications (Table 1) and a rate of 125 per 100

000 population per year. There was a 36% increase in Campylobacter notifications in the

2Q15 compared with the five year 2nd quarterly mean (2QM). The increase appeared to be

due to sporadic disease, as there were no identified Campylobacter outbreaks during the

2Q15. At least some of the increase is likely to be due to the introduction by one large

private pathology laboratory of polymerase chain reaction (PCR) testing of faecal

specimens, which has greater sensitivity than culture techniques.

The place of acquisition of infection was reported for 63% (n=410) of cases, of which 70%

(289 cases) were locally acquired and 26% were acquired overseas (108 cases).

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Table 1 Number of campylobacteriosis notifications, 2nd quarter 2015, WA, by region

Region 2015 2nd Quarter 5 Year Mean for 2nd Quarter

2nd Quarter % change*

North Metro 283 205 38South Metro 236 163 44South West 46 39 19Midwest 23 10 130Great Southern 17 13 31Pilbara 17 6 204Wheatbelt 11 17 -35Kimberley 9 9 0Goldfields 8 13 -38WA address not specified 1 3 NATotal 651 478 36© WA Department of Health 2015

Number of notifications

*Percentage change in the number of notifications in the current quarter compared to the historical 5-year mean for the same quarter. Positive values indicate an increase when compared to the historical 5-year mean of the same quarter. Negative values indicate a decrease when compared to the historical 5-year mean of the same quarter.NA: Not applicable

2.3 Salmonellosis

Salmonellosis was the second most commonly notified enteric disease in WA in the 2Q15,

with 383 notifications (Table 2) and a rate of 74 per 100 000 population per year. The

number of salmonellosis notifications in the 2Q15 was 24% higher than the 2QM (n=308).

Table 2 Number of salmonellosis notifications, 2nd quarter 2015, WA, by region

Region 2015 2nd Quarter

5 Year Mean for 2nd Quarter

2nd Quarter % change*

North Metro 140 120 17South Metro 132 96 38South West 19 21 -9Midwest 19 11 79Great Southern 9 5 73Pilbara 13 16 -19Wheatbelt 13 11 18Kimberley 28 22 30Goldfields 10 5 85WA address not specified 0 2 -100Total 383 308 24© WA Department of Health 2015

Number of notifications

*Percentage change in the number of notifications in the current quarter compared to the 5QM. Positive values indicate an increase when compared to the historical 5QM. Negative values indicate a decrease when compared to the 5QM.NA: Not applicable

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Place of acquisition of infection was reported for 72% (n=277) of cases, of which 68%

(n=187) were locally acquired, 29% (n=81) were acquired overseas and 3% (n=9) were

acquired interstate.

The most commonly reported Salmonella serotype was S. Typhimurium (STM) (n=140),

and of those cases with information on place of acquisition (n=98, 70%), 84 cases (86%)

were locally acquired. Pulsed-field gel electrophoresis (PFGE) is used in WA for the

subtyping of STM and the most common PFGE types were type 0001 (n=66, 47%) and

type 0003 (n=15, 11%). Cases with type 0001 were interviewed as part of an on-going

cluster investigation (see section 4); and cases with type 0003 were investigated as part of

a prison outbreak (see section 3).

S. Enteritidis was the second most common Salmonella serotype (n=46), and of those

cases with information on place of acquisition (n=45, 98%), nearly all (n=44, 98%)

acquired their infection overseas, primarily after travel to Indonesia (n=27, 61%), and

almost exclusively to Bali.

The next most commonly notified Salmonella serotypes were S. Saintpaul (n=16) and S.

Paratyphi B bv Java (n=14), which were predominantly acquired in WA and overseas,

respectively.

2.4 Rotavirus infectionIn the 2Q15 there were 235 notifications of rotavirus infection (45 per 100 000 population

per year) (Table 3). There was a 197% increase in rotavirus notifications in the 2Q15

compared with the mean of the previous three years. This increase was in all Western

Australian regions. The cases were mainly (n=204, 87%) non-Aboriginal people with an

average age of 18 years (range <1 years to 96 years). There were two outbreaks in

childcare centres and three outbreaks in residential care facilities due to rotavirus (see

section 5).

The place of acquisition of infection was reported for 60% of cases (n=141) of which 98%

(138 cases) were locally acquired.

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Table 3 Number of rotavirus notifications, 2nd quarter 2015, WA, by region

Region 2015 2nd Quarter

3 Year Mean for 2nd Quarter**

2nd Quarter % change*

South Metro 101 25 311North Metro 74 36 104Goldfields 15 2 582Pilbara 11 4 175South West 9 4 137Midwest 8 2 300Kimberley 7 3 133Wheatbelt 6 2 150Great Southern 4 1 300WA address not specified 0 0 NATotal 235 79 197© WA Department of Health 2015

Number of notifications

*Percentage change in the number of notifications in the current quarter compared to the historical three-year mean for the same quarter. Positive values indicate an increase when compared to the historical three year mean of the same quarter. Negative values indicate a decrease when compared to the historical three-year mean of the same quarter.NA: Not applicable**Rotavirus: comparison is only to 3 years (2012-2014) of data because changes in laboratory testing practices (increased use of more specific PCR over antigen testing) over the period 2009 to 2011 complicate comparison to 5-year data.

2.5 Cryptosporidiosis

In the 2Q15, there were 58 cryptosporidiosis notifications (11 per 100 000 population per

year), which was a 23% decrease compared to the 2QM (Table 4). However, large

increases in notifications were seen in the Kimberley and Pilbara regions. The cases in the

Pilbara were mainly (7/8) non-Aboriginal people with average age of 18 years; and the

Kimberley cases had an average age of 8 years and most (12/19) were Aboriginal children

from <1 to 4 years of age.

The place of acquisition of infection was reported for 69% of cases (n=40) of which 90%

(36 cases) were locally acquired and 10% (n=4) were overseas acquired.

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Table 4 Number of cryptosporidiosis notifications, 2nd quarter 2015, WA, by region

Region 2015 2nd Quarter

5 Year Mean for 2nd Quarter

2nd Quarter % change*

Kimberley 19 5 265South Metro 14 23 -38Pilbara 8 3 208North Metro 7 26 -73South West 6 7 -19Great Southern 2 3 -33Midwest 1 3 -64Wheatbelt 1 3 -67Goldfields 0 3 NAWA address not specified 0 2 NATotal 58 76 -23© WA Department of Health 2015

Number of notifications

*Percentage change in the number of notifications in the current quarter compared to the historical 5-year mean for the same quarter. Positive values indicate an increase when compared to the historical 5-year mean of the same quarter. Negative values indicate a decrease when compared to the historical 5-year mean of the same quarter.NA: Not applicable

2.6 Other enteric diseases and foodborne illness

During the 2Q15, other enteric disease notifications included:

Shigellosis: There were 21 shigellosis notifications in 2Q15 (see Table 5) that were

culture positive, which was 1.4 times the 2QM (n=15.2). The only Shigella species

notified was S. sonnei and the most common type (76%) was S. sonnei biotype A.

Aboriginal people and non-Aboriginal people consitituted 52% and 48% of

notifications, respectively. The place of acquisition of infection was reported for 71%

(n=15) of cases and most (n=14) of these cases were locally acquired infections.

Most cases (n=15) were in rural regions.

Hepatitis A infection: Three hepatitis A cases were notified in 2Q15, who acquired

their infection overseas. The cases contracted their infection in Iraq (n=2) and South

Africa (n=1).

Yersiniosis: There were six yersiniosis notifications in 2Q15 that were culture

positive with an average age of 23 years (range <1 years to 58 years). Aboriginality

status was known for five of the six cases and all these cases were non-Aboriginal.

Paratyphoid fever: Single case was a 48 year old female who had travelled to

India.

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Typhoid fever: Three cases, all males aged 2, 32 and 48 years and all had

acquired their infections in India.

Vibrio parahaemolyticus infection: Single case was a 48 year old female who had

acquired their infection in Indonesia.

There were no notifications for botulism, cholera, hepatitis E, Listeria or shiga toxin E. coli,

in this quarter.

Table 5 Summary of WA enteric notifiable diseases in the second quarter 2015 compared to historical means

Notifiable Disease Notified Cases Q2 2015 5yr mean Q2 (2010-2014)

Botulism 0 0Campylobacteriosis 651 478Cholera 0 0Cryptosporidiosis 58 76HUS 0 0Hepatitis A 3 5Hepatitis E 0 1Listeriosis 0 1Paratyphoid 1 3Salmonellosis 383 308Shigellosis 21 15STEC/VTEC 0 2Typhoid 3 3Yersiniosis 6 1V. parahaemolyticus 1 3Total 1127 971© WA Department of Health 2015

3 Foodborne and suspected foodborne disease outbreaks

There were three foodborne disease outbreaks investigated in this quarter.

3.1 Café, Salmonella Typhimurium PFGE 0001 outbreak (outbreak code 042-2015-003)

Cases of STM PFGE 0001 reported independently eating at the same café. In total there

were nine confirmed cases and one unconfirmed (not diagnosed) case. The cases had

visited the café from 6/4/2015 to 19/4/2015 with a median incubation period of 2 days.

Most cases (8/10) had eaten breakfast meals containing eggs and two cases only had fruit

smoothies. Cases reported that the eggs were undercooked. The café food handlers had

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changed their method of cooking eggs. One egg sample from the implicated egg brand

was positive for STM PFGE 0001. Environmental samples (eggs and faecal material) from

the implicated egg farm were negative for Salmonella.

3.2 Restaurant, Salmonella Typhimurium PFGE 0001 outbreak (outbreak code 042-2015-004)

Cases of STM PFGE 0001 reported independently eating at the same restaurant. In total

there were three confirmed cases and two unconfirmed (not diagnosed) cases. The cases

had visited the café from 29/3/2015 to 2/4/2015 with a median incubation period of one

day. Food eaten that was common to cases was semifreddo that contained raw egg. Egg

samples from the implicated egg brands were negative for Salmonella. There was more

than one egg brand used at the restaurant so environmental investigations were not

carried out on egg farms.

3.3 Prison, Salmonella Typhimurium PFGE 0003 outbreak (outbreak code 042-2015-001)

Salmonella outbreaks associated with WA prisons were reported in the 1Q15 report and

further Salmonella outbreaks in WA prisons were investigated in the 2Q15. In April, a

prison farm reported a gastroenteritis outbreak with eight prisoners ill and three prisoners

were positive for STM PFGE 0003. In May, a metropolitan prison reported a gastroenteritis

outbreak with four prisoners ill, and three prisoners were positive for STM PFGE 0003.

Prisoners reported drinking raw egg milkshakes. A further sporadic case of STM PFGE

0003 from a prison farm was notified in June. Extensive environmental and egg sampling

was undertaken at the prison egg production facility in July. Multiple environmental

samples were positive for STM PFGE 0003. The DOH Food Unit and local government

EHOs are working with the farm to modify practices to help minimise Salmonella

contamination of eggs.

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4. Cluster investigationsThere was one ongoing and four new cluster investigations during the second quarter of 2015.

4.1. S. Typhimurium PFGE 0001, phage type 9

There has been an ongoing community wide increase of STM PFGE 0001 (Figure 2).

There were 65 cases of PFGE type 0001 infection notified, with specimen dates between

1/4/15 and 27/6/15 and of these, 12 cases were part of outbreaks (see section 3). The

remaining 53 cases comprised 34% males and 66% females, ranged in age from <1 to 89

years (average 34 years), and most (83%) resided in the Perth metropolitan area. Retail

chicken meat sampled in September 2014 was also positive for PFGE type 0001. Previous interviews of cases supported the hypothesis that the cause of illness was

consumption of free range eggs and/or chicken meat. From the 25/2/15 onwards, non-

outbreak cases have been investigated as part of a case-control study of community

acquired STM PFGE 0001 illness, with 66 cases enrolled. The investigation is ongoing.

Figure 2 Notifications of Salmonella Typhimurium PFGE 0001 in WA

4.2. Salmonella Mbandaka

A cluster of S. Mbandaka cases was identified, with 15 cases reported in March (n=11)

and April (n=4). The five year historical average was 1 case/month. For the 15 cases, the

average age was 38 years (range <1 years to 83), 33% were male and 67% were female

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and apart from one case, all cases resided in metropolitan Perth. Hypothesis-generating

interviews were conducted with eight cases. No common venues were identified, and no

hypothesis for the cause of illness was identified.

4.3. Yersiniosis

An increase of yersiniosis cases was identified, with 10 cases reported in March (n=7) and

April (n=3). The five year historical average was <1 case/month. All cases were diagnosed

by one laboratory who use both culture and PCR for diagnosis. If specimens are PCR

positive, and culture negative, then culture is repeated. This suggests that the increase is

likely due to enhanced screening of stool specimens using PCR. For the 10 cases, the

average age was 24 with 50% males and 50% females. Six cases were interviewed and

no hypothesis for the cause of illness could be established.

4.4. Salmonella Newport

An increase in S. Newport was identified, with nine cases reported in March (n=4), April

(n=3) and May (n=2). The 2QM for the same period is four cases. For the nine cases, the

average age was 33 years (range 1 -60 years), with 44% males and 56% females. Three

cases resided in metropolitan Perth, four in the Pilbara region and one each in the

Wheatbelt and Great Southern regions. Six cases were interviewed and no hypothesis for

the cause of illness could be established.

4.5. Salmonella Typhimurium PFGE 0043

An increase in STM PFGE 0043 was identified, with 13 cases reported in April (n=6) and

May (n=7). The historical five year average for the same period was two cases. For the 13

case, 79% lived in metropolitan Perth, the average age was 32 years (range 7-79 years),

with 54% male and 46% females. Five cases were interviewed and no hypothesis for the

cause of illness could be established.

5. Non-foodborne disease outbreaks and outbreaks with an unknown mode of transmission

There were 28 outbreaks of enteric disease in this quarter that appeared to be non-

foodborne (Table 6). Of these, 23 outbreaks were ascribed to person-to-person

transmission and five outbreaks had an unknown mode of transmission.

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Table 6 Outbreaks with non-foodborne transmission, 2nd quarter 2015, WA

Mode of transmission Setting Exposed

Agent responsible

Number of outbreaks

Number of cases

Number hospitalised

1 Number died

Person to person Aged care Norovirus 6 177 0 1

Aged care Rotavirus 3 47 4 0

Aged care Unknown 2 22 1 0

Aged care total 11 246 5 1

Child care Norovirus 1 17 0 0

Rotavirus 2 20 1 0

Unknown 7 116 2 0

Child care total 10 153 3 0

Hospital Norovirus 1 9 0 0

School Unknown 1 4 0 0

Total 23 412 8 1

Unknown Aged care Unknown 4 41 0 0

Hospital Unknown 1 5 0 0

Total 5 46 0 0

Grand total 28 458 8 1© WA Department of Health 2015

Outbreaks with non-foodborne transmission

1 Deaths temporally associated with gastroenteritis, but contribution to death not specified

5.1. Person-to-person outbreaksIn the 23 non-foodborne outbreaks that were suspected to be due to person-to-person

transmission, 11 outbreaks (48%) occurred in RCFs, 10 were in child care centres (43%),

and one each occurred in a hospital and school. The causative agent for eight (35%)

outbreaks was confirmed as norovirus and five (22%) outbreaks were confirmed as

rotavirus. The remaining 10 (43%) outbreaks had unknown aetiology, as specimens were

either not collected (n=8) or were negative for common viral and bacterial pathogens

(n=2).

A total of 412 people were affected in these 23 outbreaks, with eight hospitalisations and

one associated death. The number of person-to-person outbreaks in the 2Q15 was the

same as the second quarter mean (n=23).

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5.2. Outbreaks with unknown mode of transmissionThere were five outbreaks in RCFs in this quarter with an undetermined mode of

transmission, with 46 people ill and no reported hospitalisations or deaths. The most

common symptom reported in these outbreaks was diarrhoea, while vomiting was reported

infrequently, which is not typical of norovirus outbreaks in RCF settings. In four outbreaks.

stool specimens were collected and tested, but were negative for common bacterial and

viral pathogens; and no specimens were collected for one outbreak.

6. Site activitiesDuring the second quarter of 2015, the following activities were conducted at the WA OzFoodNet site:

Ongoing surveillance of foodborne disease in WA. Monitoring culture-independent nucleic acid amplification diagnostic testing in

private laboratories and impact on notification rates. Investigation of three foodborne outbreaks. Investigation and monitoring of 23 person to person gastroenteritis outbreaks and

five outbreaks with unknown mode of transmission. Investigation of one ongoing Salmonella cluster, three new clusters of Salmonella

infection and one cluster of Yersinia. Responded to national OzFoodNet enteric disease surveillance requests. Attendance at the OzFoodNet face-to-face meeting in Adelaide in June and

presented a talk on national Salmonella Enteritidis notifications. Presentations:

o “Gastroenteritis outbreaks in WA aged care facilities” and “Gastroenteritis outbreak management for aged care facilities” at the Contemporary Issues in Infection Control for South West Residential Aged Care Facility Staff forum in Busselton in April

o “Enteric disease in Kimberley/Pilbara regions” at the Kimberley Aboriginal Environmental Health Working Group Forum in June at Broome.

o “Gastroenteritis outbreaks in WA, 2014” at the Healthcare Associated Infection Surveillance Western Australia quarterly update in June.

Interviewing Salmonella Enteritidis cases regarding travel status and attempting to identify risk factors in locally acquired cases.

Continuing to work with PathWest on the introduction in WA of MLVA typing of S. Typhimurium isolates and PCR testing of bloody stools for STEC.

Chairing the Series of National Guidelines (SoNG) working group for Listeria infection.

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Membership of OzFoodNet working groups on:o National STEC surveillanceo Outbreak registero Foodborne disease tool kito Egg-related outbreakso Culture-independent testing

Participation in monthly national OzFoodNet teleconferences.

7. References1 Hall G, Kirk MD, Becker N, Gregory JE, Unicomb L, Millard G, et al. Estimating

foodborne gastroenteritis, Australia. Emerg Infect Dis 2005;11(8):1257-1264.2 OzFoodNet Working Group. A health network to enhance the surveillance of

foodborne diseases in Australia. Department of Health and Ageing 2013. www.ozfoodnet.gov.au/internet/ozfoodnet/publishing.nsf/Content/Home-1 [14/03/2012].

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