International outbreak of SalmonellaOranienburg due to German chocolate

BMC Infectious Diseases - Tập 5 - Trang 1-10 - 2005
Dirk Werber1, Johannes Dreesman2, Fabian Feil2, Ulrich van Treeck3, Gerhard Fell4, Steen Ethelberg5, Anja M Hauri6, Peter Roggentin7, Rita Prager8, Ian ST Fisher9, Susanne C Behnke1, Edda Bartelt10, Ekkehard Weise10, Andrea Ellis11, Anja Siitonen12, Yvonne Andersson13, Helmut Tschäpe6, Michael H Kramer1, Andrea Ammon1
1Department of Infectious Disease Epidemiology, Robert Koch-Institut, Berlin, Germany
2Niedersächsisches Landesgesundheitsamt, Hannover, Germany
3Landesinstitut für den öffentlichen Gesundheitsdienst, Nordrhein-Westfalen, Germany
4Institute for Hygiene and Environment, Center for Infectious Disease Epidemiology, Germany
5Department of Bacteriology, Mycology, and Parasitology, Statens Serum Institut, Copenhagen, Denmark
6Government Health Service Institute, Dillenburg, Germany
7National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Institute for Hygiene and Environment Hamburg, Germany
8National Reference Centre for Salmonella and other Bacterial Enteric Pathogens, Robert Koch-Institut, Wernigerode, Germany
9Enter-net surveillance hub, HPA Communicable Disease Surveillance Centre, London, United Kingdom
10Federal Institute for Risk Assessment, Berlin, Germany
11Foodborne, Waterborne and Zoonotic Diseases Division, PPHB Health, Canada
12Laboratory of Enteric Pathogens, Department of Microbiology, Helsinki, Finland
13Swedish Institute for Infectious Disease Control, Stockholm, Sweden

Tóm tắt

This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3–26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2–23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1–47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks.

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