05 June 2014
Letter to the editor: Salmonella Stanley outbreaks – a prompt to reevaluate existing food regulations
To the editor: In a recent Eurosurveillance issue, Kinross et al.  describe a cross-border outbreak of Salmonella Stanley in the European Union, which could be traced back to a contamination in the turkey production chain. The aetiological clone is mono-resistant to nalidixic acid and characterised by a novel pulsed-field gel electrophoresis (PFGE) type. We agree with Kinross et al. that the exchange of molecular data has to be improved to speed up outbreak investigations. However, although control measures were adequate to contain the multistate outbreak, they were not sufficient to eradicate the new clone, seeing as two outbreaks that occurred in Germany 12 months and Austria 16 months later  were caused by kebab contaminated with the newly described Salmonella Stanley outbreak clone. Rather, there is a considerable risk that the clone will become endemic in the turkey or poultry production chain in Europe.
In an editorial on this outbreak report, Hugas and Beloeil from the European Food Safety Agency conclude: If sufficient information becomes available to reliably identify particular strains of public health significance, the inclusion of such strains as part of the EU-wide targets should be considered . In Austria we are already observing rising infection rates with Salmonella Stanley, with nine documented human infections in 2010 versus 101 documented infections in 2013. Moreover, the problem of antibiotic resistance inherent to the Salmonella Stanley outbreak clone was not addressed in this editorial. During the recent outbreak in Austria, we isolated three strains from infected humans that had developed resistance even against third generation cephalosporins and gentamicin. All strains harboured a CTX-M-15 extended-spectrum beta-lactamase, rendering standard therapy regimens ineffective. To prevent further evolution and spread of Salmonella Stanley, countries must undertake every effort to eradicate this outbreak clone in the poultry production chain in Europe now.
Although European regulations have contributed substantially to reducing Salmonella infections, the recent Salmonella Stanley outbreaks should be seen as an opportunity to re-evaluate existing regulations in view of efficient risk management and consistency. According to Regulation (EC) No 178/2002 , food shall not be placed on the market if it is unsafe. Regulation (EC) No 2073/2005  further specifies that Salmonella has to be absent in minced meat and meat preparations made from poultry meat. However, in 2011, Regulation 1086/2011  set a food safety criterion for fresh poultry meat that unfortunately only covers Salmonella Enteritidis and Salmonella Typhimurium, leaving food inspectors in the difficult situation that safety criteria for meat preparations differ from those for raw meat. Further, in our opinion, Regulation 1086/2011 weakened the stricter standards originally intended by part E of Annex II to Regulation No 2160/2003  specifying that fresh poultry meat may not be placed on the market for human consumption when contaminated with Salmonella.
Along with harmonisation and refinement of food safety criteria, inclusion of Salmonella Stanley in the community targets for the reduction of the prevalence of zoonoses and zoonotic agents should be implemented to efficiently support control measures.
- Kinross P, van Alphen L, Martinez Urtaza J, Struelens M, Takkinen J, Coulombier D, et al. Multidisciplinary investigation of a multicountry outbreak of Salmonella Stanley infections associated with turkey meat in the European Union, August 2011 to January 2013. Euro Surveill. 2014;19(19):pii=20801.
- European Centre for Disease Prevention and Control (ECDC), European Food Safety Authority (EFSA). Multi-country outbreak of Salmonella Stanley infections – Third update, 8 May 2014. Stockholm and Parma: ECDC/EFSA; 2014. Available from: http://www.ecdc.europa.eu/en/publications/Publications/salmonella-stanley-multi-country-outbreak-assessment-8-May-2014.pdf
- Hugas M, Beloeil PA. Controlling Salmonella along the food chain in the European Union - progress over the last ten years. Euro Surveill. 2014;19(19):pii=20804.
- Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety. Official Journal of the European Union. Luxembourg: Publications Office of the European Union; 2002. L 31/1. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2002:031:0001:0024:EN:PDF
- Commission Regulation (EC) No 2073/2005 of 15 November 2005 on microbiological criteria for foodstuffs. Official Journal of the European Union. Luxembourg: Publications Office of the European Union; 2005. L 338. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CONSLEG:2005R2073:20071227:EN:PDF
- Commission Regulation (EU) No 1086/2011 of 27 October 2011 amending Annex II to Regulation (EC) No 2160/2003 of the European Parliament and of the Council and Annex I to Commission Regulation (EC) No 2073/2005 as regards salmonella in fresh poultry meat. Official Journal of the European Union. Luxembourg: Publications Office of the European Union; 2011. L 281/7. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/PDF/?uri=CELEX:32011R1086&from=EN
- Regulation (EC) No 2160/2003 of the European Parliament and of the Council of 17 November 2003 on the control of salmonella and other specified food-borne zoonotic agents. Official Journal of the European Union. Luxembourg: Publications Office of the European Union; 2003. L 325/1. Available from: http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003:325:0001:0015:EN:PDF