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Salmonella: Recurrent Trends Prof Eric Bolton Health Protection Agency Manchester November 2009.

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Presentation on theme: "Salmonella: Recurrent Trends Prof Eric Bolton Health Protection Agency Manchester November 2009."— Presentation transcript:

1 Salmonella: Recurrent Trends Prof Eric Bolton Health Protection Agency Manchester November 2009

2 Topics - Salmonella Gastro-intestinal infections and Food-borne illness Major Serotypes and Phage types of Salmonella associated with sporadic infections Outbreaks Associated with Salmonella

3 Selected GI Pathogens, E & W

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

5 Salmonella from Raw Shell Eggs Used in Catering Country of originNumber of pooled samples Number of pooled samples positive Salmonella serotypes and S. Enteritidis phage types UK(Lion Quality) 3490None found UK (not Lion Quality) 2742S. Enteritidis PT4, PT6 USA600None found France450None found Spain46824S. Enteritidis PT1, PT5c, PT6, PT6a, PT6d, PT12, PT13a, PT14b, PT58 Not known (not Lion Quality) 20017S. Enteritidis PT4, PT6a S. Altona, S.Cerro, S. Infantis, S Livingstone, S. Ohio

6 Salmonella Infections England and Wales, 2000-2008 YearTotal 200014463 200116041 200214442 200314954 200413135 2005 11447 200612521 200711998 200810066

7 Top Ten Salmonella Serotypes, England & Wales 2008 SerotypeNumberPercentage Salmonella Enteritidis4357 43.3 Salmonella Typhimurium1916 19.0 Salmonella Virchow289 2.9 Salmonella Agona228 2.3 Salmonella Newport197 2.0 Salmonella Stanley147 1.5 Salmonella Kentucky124 1.2 Salmonella Infantis114 1.1 Salmonella Java113 1.1 Salmonella Anatum108 1.1 Total of Top Ten serotypes759375.5 Total of all serotypes10066

8 Salmonella Enteritidis phage types, England and Wales Source: HPA Salmonella Dataset (Labbase2) 1981 onwards

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

11 Mode of Transmission in Outbreaks of Gastrointestinal Infection - England & Wales 1992 - 2000. 868 208113821878

12 Food-borne General Outbreaks by Year 2000 – 2008 (E&W) YearNumber of outbreaks 200098 200191 200271 200371 200455 200581 200658 200741 200865* Department of Gastrointestinal and Emerging Zoonotic Infections Health Protection Agency Centre for Infections * Provisional data

13 Food-borne Outbreaks Associated with Salmonella Enteritidis 2000 – 2008 (E&W) Year All Salmonellas S Ent PT4S Ent non PT4 2000352417 2001352610 2002322510 200344398 200431278 2005332610 200624417 200721215 20083168

14 Salmonella Food-borne Outbreaks 2004 to 2008 2004200520062007 2008 Total Number of outbreaks2838242131 Salmonella Enteritidis2527211714 Salmonella Typhimurium 1 5 1 2 7 Other Salmonella serotypes 2 6 2 210 *Provisional data, HPA - Centre for Infections

15 Food-borne Sources of Salmonella Outbreaks - 2008 Salmonella serotypeFood source S. Typhimurium U313Eggs, rice, duck S. Enteritidis PT4Kiwi Parfait S. Enteritidis PT4Tiramisu S. Typhimurium DT104Beef Biltong S. Typhimurium PT193Egg mayo sandwiches (non Lion branded eggs) Salmonella (Awaiting serotype)Eating raw eggs S. Enteritidis PT4Chicken Donner

16 Places Associated with Salmonella Outbreaks in England & Wales 2004 – 2006 and 2008 Location2004 - 2006 2008 Restaurants5212* Shops/retail catering 104 Residential73 Hotels41 University, College, School 41 Others123** *8 were associated with Chinese restaurants ** National outbreaks

17 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

18 Salmonella Montevideo: Cumulative Weekly Totals for England & Wales

19 Epidemic curve of Human Salmonella Montevideo cases in England and Wales

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22 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 (8 th of April) Cases had been reported from laboratories in in all regions and Wales Cases were followed up and molecular testing done on isolates

23 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

24 Molecular typing of Salmonella Senftenberg Pulsed Field Gel Electrophoresis Plasmid profiling

25 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

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

27 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,

28 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,

29 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).


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