An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study
An international outbreak of Salmonella enterica serotype Enteritidis linked to eggs from Poland: a microbiological and epidemiological study
复制标题
DOI：
10.1016/s1473-3099(19)30047-7
复制
发表时间：
2019-07-01
影响因子：
56.3
通讯作者：
Weicherding, Pierre
中科院分区：
文献类型：
--
作者：
Pijnacker, Roan;Dallman, Timothy J.;Weicherding, Pierre
背景沙门氏菌属是欧洲食源性疫情的主要原因。我们调查了2015年5月1日至2018年10月31日期间发生在欧盟和欧洲经济区（EEA）的肠道沙门氏菌血清型肠炎大规模多国暴发疫情。方法确诊病例定义为基于全基因组测序（WGS）的实验室确认的肠炎沙门氏菌暴发菌株感染。可能病例定义为实验室确认的肠炎沙门氏菌感染，具有多位点可变数目串联重复序列分析暴发特征。进行了多国流行病学、追溯、追溯和环境调查。我们进行了一项病例对照研究，包括从人口登记处随机抽样的确诊病例和可能病例以及对照（按年龄、性别和邮政编码匹配的频率）。使用不匹配的单变量和多变量逻辑回归计算病例和对照之间暴露率的比值比（OR）。结果18个欧盟和欧洲经济区国家报告了838例确诊病例和371例疑似病例。2016年报告了509例（42%）病例，此后病例数量稳步上升。病例对照研究结果显示，病例比对照组更常在食品店用餐（OR 3.4 [95%CI 1.6-7.3]），但未发现特定的食品。对在食品机构用餐的病例进行的基于食谱的食品追溯调查发现，来自波兰的鸡蛋是2016年10月的感染媒介。系统发育分析在人类病例中发现了两种沙门氏菌菌株，随后在波兰沙门氏菌阳性鸡蛋和初级生产场所中发现了这两种菌株，证实了疫情的来源。在实施控制措施后，病例数有所下降，但在2017年3月再次增加，并持续到2018年。解读此次疫情凸显了多国共享流行病学、追溯和微生物学数据的公共卫生价值。病例的重新出现表明，暴发菌株继续进入食物链，尽管菌株种群动态的变化和病例的减少表明控制措施取得了一定效果。在沙门氏菌监测和疫情应对中常规使用WGS有望在未来发现和阻止疫情。
Background Salmonella spp are a major cause of food-borne outbreaks in Europe. We investigated a large multicountry 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, traceback, 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.