Salmonella Recurrent Trends Prof Eric Bolton Health Protection

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

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

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 positive Salmonella serotypes and S. Enteritidis phage types UK(Lion Quality) 349 0 None found UK (not Lion Quality) 274 2 S. Enteritidis PT 4, PT 6 USA 60 0 None found France 45 0 None found Spain 468 24 S. Enteritidis PT 1, PT 5 c, PT 6 a, PT 6 d, PT 12, PT 13 a, PT 14 b, PT 58 Not known (not Lion Quality) 200 17 S. Enteritidis PT 4, PT 6 a S. Altona, S. Cerro, S. Infantis, S Livingstone, S. Ohio

Salmonella Infections England 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 Wales Source: HPA Salmonella Dataset (Labbase 2) 1981 onwards

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

Mode of Transmission in Outbreaks of Gastrointestinal Infection - England & Wales 1992 - 2000. 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* * Provisional data Department of Gastrointestinal and Emerging Zoonotic Infections Health Protection Agency Centre for Infections

Food-borne Outbreaks Associated with Salmonella Enteritidis 2000 – 2008 (E&W) Year All Salmonellas S Ent PT 4 S Ent non PT 4 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 U 313 Eggs, rice, duck S. Enteritidis PT 4 Kiwi Parfait S. Enteritidis PT 4 Tiramisu S. Typhimurium DT 104 Beef Biltong S. Typhimurium PT 193 Egg mayo sandwiches (non Lion branded eggs) Salmonella (Awaiting serotype) Eating raw eggs S. Enteritidis PT 4 Chicken Donner

Places Associated with Salmonella Outbreaks in England & Wales 2004 – 2006 and 2008 Location 2004 2006 2008 Restaurants 52 12* Shops/retail 10 4 Residential 7 3 Hotels 4 1 catering 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 PT 4. • Restaurants are the major location associated with outbreaks

Salmonella Montevideo: Cumulative Weekly Totals for England & Wales

Epidemic curve of Human Salmonella Montevideo cases in England 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 (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

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 prepacked 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 nontravel related Nx. Cpl resistant Salmonella Enteritidis PT 14 b to week 45, 2009

Nx. Cpl resistant Salmonella Enteritidis PT 14 b, 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 14 b, and five have been hospitalized. • Deaths have been reported in two elderly cases infected with S. Enteritidis PT 14 b,

Nx. Cpl resistant Salmonella Enteritidis PT 14 b, 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,

Nx. Cpl resistant Salmonella Enteritidis PT 14 b, 2009 • S. Enteritidis PT 14 b Nx. Cpl 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).