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An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study

Roan Pijnacker 1, * Timothy Dallman 2 Aloys Tijsma 3 Gillian Hawkins 4 Lesley Larkin 2 Saara Kotila 5 Giusi Amore 6 Ettore Amato 7 Pamina Suzuki 7 Sarah Denayer 8 Sofieke Klamer 8 Judit Pászti 9 Jacquelyn Mccormick 2 Hassan Hartman 2 Gareth J Hughes 2 Lin C.T Brandal 10 Derek Brown 11 Joel Mossong 12 Cecilia Jernberg 13 Luise Müller 14 Daniel Palm 5 Ettore Severi 5 Joannna Gołębiowska 15 Blaženka Hunjak 16 Slawomir Owczarek 17 Simon Le Hello 18 Patricia Garvey 19 Kirsten Mooijman 7 Ingrid Friesema 1 Coen van Der Weijden 3 Menno van Der Voort 3 Valentina Rizzi 6 Eelco Franz 1 Sophie Bertrand 20 Martine Brennan Lynda Brown 21 Ryan Bruce Vera Cantaert Marie Chattaway John Coia Sarah Couper Tjaša Žohar Čretnik Daniel Daniel Anna Maria Dionisi 22 Laetitia Fabre 23 Ife Fitz-James Karolina Florek Martina Florianová Eithne Fox Tatjana Frelih Eva Grilc Vera Katalinic Jankovic Nathalie Jourdan 24 Renata Karpíšková Hans van den Kerkhof Sjoerd Kuiling Sanja Kurečić Filipović Valeska Laisnez Heidi Lange Niall Delappes Judit Leblanc Ida Luzzi 22 Georgia Mandilara Henry Mather 25 Wesley Mattheus Kassiani Mellou Deborah Morgan Elizabeth de Pinna 2 Catherine Ragimbeau Margrethe Hovda Røed Saara Salmenlinna Robert Smith 26 Alison Palm Michaela Špačková Mia Torpdahl Marija Trkov Lin Trönnberg Myrsini Tzani Lara Utsi Dariusz Wasyl 27 Pierre Weicherding 
Abstract : Background Salmonella spp are a major cause of food-borne outbreaks in Europe. We investigated a large multi-country outbreak of Salmonella enterica serotype Enteritidis in the EU and European Economic Area (EEA). Methods A confirmed case was defined as a laboratory-confirmed infection with the outbreak strains of S Enteritidis based on whole-genome sequencing (WGS), occurring between May 1, 2015, and Oct 31, 2018. A probable case was defined as laboratory-confirmed infection with S Enteritidis with the multiple-locus variable-number tandem repeat analysis outbreak profile. Multi-country epidemiological, trace-back, trace-forward, and environmental investigations were done. We did a case-control study including confirmed and probable cases and controls randomly sampled from the population registry (frequency matched by age, sex, and postal code). Odds ratios (ORs) for exposure rates between cases and controls were calculated with unmatched univariable and multivariable logistic regression. Findings 18 EU and EEA countries reported 838 confirmed and 371 probable cases. 509 (42%) cases were reported in 2016, after which the number of cases steadily increased. The case-control study results showed that cases more often ate in food establishments than did controls (OR 3·4 [95% CI 1·6–7·3]), but no specific food item was identified. Recipe-based food trace-back investigations among cases who ate in food establishments identified eggs from Poland as the vehicle of infection in October, 2016. Phylogenetic analysis identified two strains of S Enteritidis in human cases that were subsequently identified in salmonella-positive eggs and primary production premises in Poland, confirming the source of the outbreak. After control measures were implemented, the number of cases decreased, but increased again in March, 2017, and the increase continued into 2018. Interpretation This outbreak highlights the public health value of multi-country sharing of epidemiological, trace-back, and microbiological data. The re-emergence of cases suggests that outbreak strains have continued to enter the food chain, although changes in strain population dynamics and fewer cases indicate that control measures had some effect. Routine use of WGS in salmonella surveillance and outbreak response promises to identify and stop outbreaks in the future.
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Submitted on : Tuesday, June 11, 2019 - 4:17:23 PM
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Roan Pijnacker, Timothy Dallman, Aloys Tijsma, Gillian Hawkins, Lesley Larkin, et al.. An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study. The Lancet Infectious Diseases, 2019, 19 (7), pp.778-786. ⟨10.1016/S1473-3099(19)30047-7⟩. ⟨hal-02152665⟩



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