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Eurosurveillance, Volume 7, Issue 35, 28 August 2003
Articles

Citation style for this article: O'Brien S, Ward LR, Little C, Surman S. Increase in Salmonella Enteritidis outbreaks in England and Wales. Euro Surveill. 2003;7(35):pii=2281. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2281

Increase in Salmonella Enteritidis outbreaks in England and Wales

Sarah O’Brien1 (sarah.obrien@hpa.org.uk), Linda Ward2, Christine Little1, and Susanne Surman3

1Health Protection Agency Communicable Disease Surveillance Centre, 2Health Protection Agency Laboratory of Enteric Pathogens, 3Health Protection Agency Food Water & Environmental Laboratory, London, England

Twenty two outbreaks of Salmonella Enteritidis in England and Wales have been reported to the Health Protection Agency’s Communicable Disease Surveillance Centre (CDSC) between 1 June and 27 August 2003, compared with 14 in the same period in 2002 (1). A variety of S. Enteritidis phage types is involved: PT 1 resistant to nalidixic acid and low level susceptibility to ciprofloxacin (Nx, CpL) three outbreaks; PT 1e one outbreak; PT3 (Nx, CpL) one outbreak; PT4 three outbreaks; PT6 three outbreaks; PT6a one outbreak; PT6a (Nx, CpL) one outbreak; PT8 two outbreaks; PT12 one outbreak; PT14b one national outbreak including three local outbreaks; PT21 (Nx, CpL) one outbreak; PT24 resistant to tetracycline (T) one outbreak; PT53 one outbreak; PT56 one outbreak. In total 356 people are known to have been affected. The largest outbreak is a national outbreak of S. Enteritidis PT14b so far affecting 117 people and an analytical study is underway to identify a contaminated food vehicle(s). In seven outbreaks, microbiological evidence of contaminated food vehicles has been found. Twelve outbreaks have been linked to Chinese restaurants, three to bakeries, and one has occurred in a hospital. In response to the recent outbreaks and increased incidence of S. Enteritidis, food items such as raw shell eggs, raw chicken, raw duck should be considered for sampling as part of the local outbreak investigations. In addition, a public health investigation of eggs has been initiated.

Between September and December 2002, 23 outbreaks of S. Enteritidis were reported to CDSC, compared with 36 in the whole of 2001. In these outbreaks over 1000 people were affected and 17 people infected with S. Enteritidis died, although most of the deaths were not attributed directly to salmonella infection (1). Three outbreaks, affecting over 450 people, were national. Based on the epidemiological evidence two investigations into eggs in use in the catering trade were initiated. As part of a public health investigation in late 2002, 8501 shell eggs were sampled. Salmonella spp. was isolated from 5.1% of imported Spanish eggs used in catering premises (4), which compares unfavourably with salmonella levels of 0.3% found in eggs (mostly produced in the United Kingdom (UK)) tested in a study of 34 296 eggs used in catering premises during April to May 2003 (5).

Advice issued by the UK Food Standards Agency re-iterating the need for proper cooking of raw shell eggs (2), especially for vulnerable groups, and suggesting that all importers and wholesalers heat treat eggs imported from Spain (3) are still in force.

References:
  1. Health Protection Agency. National increase in Salmonella Enteritidis outbreaks. Commun Dis Rep CDR Wkly 2003; 13 (35): news. (http://www.phls.co.uk/publications/cdr/index.html)
  2. White J, O’Brien S, Ward L, Lopman B, Reacher M, Fenton. Communicable Disease and Health Protection Quarterly Review: October to December 2002. J Publ Hlth Med 2003; 25: 177-182.
  3. Food Standards Agency. Salmonella outbreaks prompt Agency to issue hygiene alert. News, 15 October 2002. (http://www.food.gov.uk/news/newsarchive/salmonellaoutbreaknews) [accessed 28 August 2003 ]
  4. Food Standards Agency. Agency re-emphasises egg advice. News, 29 October 2002. (http://www.food.gov.uk/news/newsarchive/97067) [accessed 28 August 2003 ]
  5. Public Health Laboratory Service. Public health investigation of Salmonella Enteritidis in raw shell eggs. Commun Dis Rep CDR Wkly 2003; 13 (2): news. (http://www.phls.org.uk/publications/cdr/PDFfiles/2003/cdr0203.pdf)
  6. LACORS/Health Protection Agency Co-ordinated Food Liaison Group. Microbiological examination of raw shell eggs and their use in catering premises. Sampling protocol. London: LACORS/HPA, 2003.

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