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Outbreaks Open Access
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Abstract

Between November and December 2021, the first ever recorded outbreak of enteroinvasive in Denmark occurred at national scale. We describe the investigation of this outbreak, which was initially recognised in early December 2021. A total of 88 cases (58 female; 30 male) with a median age of 52 years (range: 0–91) were detected by PCR-based diagnostic methods. Case ascertainment was complicated by current culture-free diagnostic procedures, with only 34 cases confirmed by culture, serotyping and whole genome sequencing. Isolates from cases grouped into two serotypes (O136:H7 and O96:H19), which was supported by whole-genome-sequence-phylogeny, also yielding two clusters. Interviews of 42 cases and traceback investigation pointed towards consumption of ready-to-eat salads as the outbreak cause. While the ready-to-eat salads comprised different vegetables, imported spring onions were the only common ingredient and thus the likely source. Environmental investigations failed to recover outbreak strains. This report highlights the value of fast typing (here O-typing) to confirm cases in an outbreak situation. Timely communication and data sharing are also important, and were facilitated by the national collaboration between relevant laboratories, the public health institute and the veterinary and food administration. High hygiene standards for imported fresh vegetables intended for ready-to-eat products are essential.

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/content/10.2807/1560-7917.ES.2023.28.15.2200572
2023-04-13
2024-06-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2023.28.15.2200572
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References

  1. Park J, Kim JS, Kim S, Shin E, Oh KH, Kim Y, et al. A waterborne outbreak of multiple diarrhoeagenic Escherichia coli infections associated with drinking water at a school camp. Int J Infect Dis. 2018;66:45-50.  https://doi.org/10.1016/j.ijid.2017.09.021  PMID: 29031605 
  2. Herzig CTA, Fleischauer AT, Lackey B, Lee N, Lawson T, Moore ZS, et al. Notes from the Field: Enteroinvasive Escherichia coli Outbreak Associated with a Potluck Party - North Carolina, June-July 2018. MMWR Morb Mortal Wkly Rep. 2019;68(7):183-4.  https://doi.org/10.15585/mmwr.mm6807a5  PMID: 30789875 
  3. Müller S. Ethelberg, F. Scheutz. Shigellosis 2014-2016. EPINEWS. Nr. 48, 2017. Available from: https://en.ssi.dk/news/epi-news/2017/no-48---2017
  4. Lagerqvist N, Löf E, Enkirch T, Nilsson P, Roth A, Jernberg C. Outbreak of gastroenteritis highlighting the diagnostic and epidemiological challenges of enteroinvasive Escherichia coli, County of Halland, Sweden, November 2017. Euro Surveill. 2020;25(9):1900466.  https://doi.org/10.2807/1560-7917.ES.2020.25.9.1900466  PMID: 32156328 
  5. Escher M, Scavia G, Morabito S, Tozzoli R, Maugliani A, Cantoni S, et al. A severe foodborne outbreak of diarrhoea linked to a canteen in Italy caused by enteroinvasive Escherichia coli, an uncommon agent. Epidemiol Infect. 2014;142(12):2559-66.  https://doi.org/10.1017/S0950268814000181  PMID: 24534429 
  6. Newitt S, MacGregor V, Robbins V, Bayliss L, Chattaway MA, Dallman T, et al. Two Linked Enteroinvasive Escherichia coli Outbreaks, Nottingham, UK, June 2014. Emerg Infect Dis. 2016;22(7):1178-84.  https://doi.org/10.3201/eid2207.152080  PMID: 27314432 
  7. Scheutz F, Espenhain L, Ethelberg S, Kjelsø C, Mølbak K, Olsen KEP, et al. F. Schønning J. Prag, T. Ejlertsen Jensen, M. Tvede, P. Kjældgaard. Diarrhoeagenic E. coli 2000-2012. EPINEWS. Nr. 10, 2014. Available from: https://en.ssi.dk/news/epi-news/2014/no-10---2014
  8. Michelacci V, Tozzoli R, Arancia S, D’Angelo A, Boni A, Knijn A, et al. Tracing Back the Evolutionary Route of Enteroinvasive Escherichia coli (EIEC) and Shigella Through the Example of the Highly Pathogenic O96:H19 EIEC Clone. Front Cell Infect Microbiol. 2020;10:260.  https://doi.org/10.3389/fcimb.2020.00260  PMID: 32582565 
  9. Parks DH, Chuvochina M, Reeves PR, Beatson SA, Hugenholtz P. Reclassification of Shigella species as later heterotypic synonyms of Escherichia coli in the Genome Taxonomy Database. bioRxiv preprint doi:  https://doi.org/10.1101/2021.09.22.461432  https://doi.org/10.1101/2021.09.22.461432 
  10. Sethabutr O, Venkatesan M, Murphy GS, Eampokalap B, Hoge CW, Echeverria P. Detection of Shigellae and enteroinvasive Escherichia coli by amplification of the invasion plasmid antigen H DNA sequence in patients with dysentery. J Infect Dis. 1993;167(2):458-61.  https://doi.org/10.1093/infdis/167.2.458  PMID: 8421181 
  11. Engberg J, Vejrum LK, Madsen TV, Nielsen XC. Verification of analytical bacterial spectrum of QIAstat-Dx® GI V2 and Novodiag® Bacterial GE+ V2-0 diagnostic panels. J Antimicrob Chemother. 2021;76(Suppl 3):iii50-7.  https://doi.org/10.1093/jac/dkab242  PMID: 34555154 
  12. Hannet I, Engsbro AL, Pareja J, Schneider UV, Lisby JG, Pružinec-Popović B, et al. Multicenter evaluation of the new QIAstat Gastrointestinal Panel for the rapid syndromic testing of acute gastroenteritis. Eur J Clin Microbiol Infect Dis. 2019;38(11):2103-12.  https://doi.org/10.1007/s10096-019-03646-4  PMID: 31352670 
  13. Brandal LT, Lindstedt BA, Aas L, Stavnes TL, Lassen J, Kapperud G. Octaplex PCR and fluorescence-based capillary electrophoresis for identification of human diarrheagenic Escherichia coli and Shigella spp. J Microbiol Methods. 2007;68(2):331-41.  https://doi.org/10.1016/j.mimet.2006.09.013  PMID: 17079041 
  14. J. Engberg, K. Schønning, F. Scheutz, A. Friis-Møller. Evaluation of a modified octaplex PCR assay for the detection of major diarrhoeagenic Escherichia coli. Poster, 18th ECCMID, Barcelona, Spain, 19-22 April 2008.
  15. Persson S, Olsen KE, Scheutz F, Krogfelt KA, Gerner-Smidt P. A method for fast and simple detection of major diarrhoeagenic Escherichia coli in the routine diagnostic laboratory. Clin Microbiol Infect. 2007;13(5):516-24.  https://doi.org/10.1111/j.1469-0691.2007.01692.x  PMID: 17331124 
  16. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters, version 10.0, 2020. Växjö: EUCAST. Available from: http://www.eucast.org/clinical_breakpoints/.
  17. Kauffmann F. The serology of the coli group. J Immunol. 1947;57(1):71-100.  https://doi.org/10.4049/jimmunol.57.1.71  PMID: 20264689 
  18. Scheutz F, Cheasty T, Woodward D, Smith HR. Designation of O174 and O175 to temporary O groups OX3 and OX7, and six new E. coli O groups that include Verocytotoxin-producing E. coli (VTEC): O176, O177, O178, O179, O180 and O181. Acta Pathol Microbiol Scand Suppl. 2004;112(9):569-84.  https://doi.org/10.1111/j.1600-0463.2004.apm1120903.x  PMID: 15601305 
  19. Joensen KG, Tetzschner AM, Iguchi A, Aarestrup FM, Scheutz F. Rapid and Easy In Silico Serotyping of Escherichia coli Isolates by Use of Whole-Genome Sequencing Data. J Clin Microbiol. 2015;53(8):2410-26.  https://doi.org/10.1128/JCM.00008-15  PMID: 25972421 
  20. Bortolaia V, Kaas RS, Ruppe E, Roberts MC, Schwarz S, Cattoir V, et al. ResFinder 4.0 for predictions of phenotypes from genotypes. J Antimicrob Chemother. 2020;75(12):3491-500.  https://doi.org/10.1093/jac/dkaa345  PMID: 32780112 
  21. Achtman M, Zhou Z, Alikhan NF, Tyne W, Parkhill J, Cormican M, et al. Genomic diversity of Salmonella enterica -The UoWUCC 10K genomes project. Wellcome Open Res. 2020;5:223.  https://doi.org/10.12688/wellcomeopenres.16291.2  PMID: 33614977 
  22. Alikhan NF, Zhou Z, Sergeant MJ, Achtman M. A genomic overview of the population structure of Salmonella. PLoS Genet. 2018;14(4):e1007261.  https://doi.org/10.1371/journal.pgen.1007261  PMID: 29621240 
  23. Joensen KG, Kiil K, Gantzhorn MR, Nauerby B, Engberg J, Holt HM, et al. Whole-Genome Sequencing to Detect Numerous Campylobacter jejuni Outbreaks and Match Patient Isolates to Sources, Denmark, 2015-2017. Emerg Infect Dis. 2020;26(3):523-32.  https://doi.org/10.3201/eid2603.190947  PMID: 32091364 
  24. European Centre for Disease Prevention and Control (ECDC). EU protocol for harmonised monitoring of antimicrobial resistance in human Salmonella and Campylobacter isolates – June 2016. Stockholm: ECDC; 2016. Available from: https://www.ecdc.europa.eu/en/publications-data/eu-protocol-harmonised-monitoring-antimicrobial-resistance-human-salmonella-and-0
  25. Jenkins C, Griffiths P, Hoban A, Bardsley M, Brown C, Garner J, et al. Foodborne outbreak of extended spectrum beta lactamse producing Shigella sonnei associated with contaminated spring onions. J Food Prot. (forthcoming).
  26. Anonymous. 2021. Annual Report on Zoonoses in Denmark 2020, National Food Institute, Technical University of Denmark.
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