Bad, naughty, naughty parents: Outbreak of Salmonella saintpaul in a Scottish childcare facility: The influence of parental under-reporting

Salmonella outbreaks in childcare facilities are relatively rare, most often occurring secondary to contaminated food products or poor infection control practices. We report an outbreak of Salmonella Saintpaul at a pre-school facility in Ayrshire, Scotland with atypical clinical and epidemiological features.

(me learning to drive a tractor, about 4-years-old)

Methods

Following notification of the initial two cases, the multi-disciplinary Incident Management Team initiated enhanced active case finding and two environmental inspections of the site, including food preparation areas. Parent and staff interviews were conducted by the Public Health department covering attendance, symptomatology and risk factors for all probable and confirmed cases. Microbiological testing of stool samples and the facility water tank was conducted. Whole Genome Sequencing (WGS) was performed for positive stool samples at the national reference laboratory. Infection control measures were introduced iteratively due to the atypical progression of the outbreak.

Results

There were 15 confirmed cases and 3 children admitted to hospital during the outbreak. However, 35.7% of cases reported extremely mild symptoms. The attack rate was 15.2%, and age of affected children ranged from 18 to 58 months (mean 35 months). All cases were the same Multilocus Sequence Type (MLST50). Epidemiological investigation strongly suggested person-to-person spread within the facility. Existing infection control practices were found to be of a high standard, but introduction of additional evidence-based control measures was inadequate in halting transmission. Facility staff reported concerns about lack of parental disclosure of gastrointestinal symptoms, particularly where these were mild, with 50.0% of cases having attended while symptomatic against public health advice. Voluntary two-week closure of the facility was implemented to halt transmission, following which there were no new cases. WGS results were unavailable until after the decision was taken to close the facility.

Conclusions

This is the first reported instance of a Salmonella Saintpaul outbreak at a childcare facility, or where person-to-person transmission is indicated. Clinicians should consider the influence of parental under-reporting on gastrointestinal outbreaks in childcare settings, particularly where perceived severity is low and financial or social pressures to attend work may reduce compliance. WGS cannot yet replace conventional microbiological techniques during short, localised outbreaks due to delays receiving results.

71 now sick from Salmonella in Sweden linked to tomatoes

Outbreak News Today reports Swedish health authorities, or Folkhalsomyndigheten are reporting 17 additional Salmonella Typhimurium cases in the current outbreak, bringing the total outbreak cases to 71 since August.

The Swedish National Food Agency and the Public Health Agency continue to investigate the outbreak to identify the source of the infection. The investigation shows that small tomatoes are the likely source of the outbreak. The tomatoes are no longer left in grocery stores, the outbreak has subsided and the risk of being infected is very small.

Uh-huh.

Size does not matter: 21 sick from Salmonella linked to pet turtles

I want a new drug, or approach or message, rather than CDC sending out yet another warning about yet another Salmonella outbreak from kids kissing their pet turtles.

(And I can’t believe I’m quoting Huey Lewis and the News, one of my 1982 university room mates’ favorite bands, along with Hall and Oates).

The U.S. Centers for Disease Control reports:

21 people infected with the outbreak strain of Salmonella Oranienburg have been reported from 13 states.

7 hospitalizations have been reported. No deaths have been reported.

Epidemiologic and traceback evidence indicate that contact with pet turtles is the likely source of this outbreak.

In interviews, 12 (71%) of 17 ill people reported contact with a turtle.

This investigation is ongoing and CDC will provide updates when more information is available.

Turtles can carry Salmonella germs in their droppings while appearing healthy and clean. These germs can easily spread to their bodies, tank water, and habitats. People can get sick after they touch a turtle or anything in their habitats.

People who own or come in contact with turtles should take steps to stay healthy around their pet:

Wash your hands.

Always wash hands thoroughly with soap and water right after touching, feeding, or caring for a turtle or cleaning its habitat.

Adults should supervise handwashing for young children.

Play safely.

Don’t kiss or snuggle turtles, because this can spread Salmonella germs to your face and mouth and make you sick.

Don’t let turtles roam freely in areas where food is prepared or stored, such as kitchens.

Clean habitats, toys, and pet supplies outside the house when possible.

Avoid cleaning these items in the kitchen or any other location where food is prepared, served, or stored.

Pick the right pet for your family.

CDC and public health officials in several states are investigating a multistate outbreak of human Salmonella Oranienburg infections linked to contact with pet turtles.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using a standardized laboratory and data analysis method called whole genome sequencing (WGS). CDC PulseNet manages a national database of these sequences that are used to identify possible outbreaks. WGS gives investigators detailed information about the bacteria causing illness. In this investigation, WGS showed that bacteria isolated from ill people were closely related genetically. This means that people in this outbreak are more likely to share a common source of infection.

Ill people reported contact with red-eared sliders and other turtles that were larger than four inches in length. Previous Salmonella outbreaks have been linked to turtles with a shell length less than four inches. Due to the amount of Salmonella illnesses related to these small turtles, the U.S. Food and Drug Administration banned the sale and distributionexternal icon of turtles with shells less than four inches long as pets.

Regardless of where turtles are purchased or their size, turtles can carry Salmonella germs that can make people sick. Pet owners should always follow steps to stay healthy around their pet.

This investigation is ongoing, and CDC will provide updates when more information becomes available.

168 kindergarteners hit by possible salmonella in China

Cal Rolston of NCTY News reports 168 children were sent to hospital with possible Salmonella food poisoning in Dongguan, Guangdong Province prompting health authorities to shut down a kindergarten on Monday for two days. 

One hundred and three people, including 99 children, remained in hospitals in the city and neighboring Shenzhen, according to statements released by the Dongguan Health Bureau.

Nobody died or was critically ill as of Sunday midnight, the bureau said.

Just ill enough to go to the hospital.

Cherry tomatoes may be lined to Salmonella outbreaks in Sweden

SVT reports people have been sick with diarrhea between August 29 and September 14 with Salmonella Typhimurium. Anders Enocksson, infection prevention consultant at Region Halland.

In all, 11 counties are affected. Most cases are in Halland together with Dalarna, Jönköping and Västra Götaland, which P4 Halland was the first to tell . The infected are in all age groups, but just over half are 60 years or older. There are slightly more women than men.

The source of infection is not yet known, but there is suspicion of tomatoes, and cherry tomatoes. It is unclear where they come from. The investigation is allowed to show if it is correct, says Anders Enocksson.

9 sick from Salmonella: Not sure about source but throw out hummus

The Maryland Department of Health (MDH) is investigating a cluster of salmonella infections in individuals who all reported eating at Moby Dick House of Kabob restaurant, which has multiple locations in Maryland, Virginia and the District of Columbia.

Since September 10, nine confirmed cases have been reported in Maryland. The exact cause of the infections has not been determined and the investigation is ongoing, but eight of nine cases reported consuming Moby Dick House of Kabob hummus.

At this time, Moby Dick House of Kabob has voluntarily suspended sale of hummus and MDH recommends that consumers discard hummus purchased from any Moby Dick House of Kabob. Individuals who have recently eaten food from Moby Dick House of Kabob and are experiencing any adverse medical symptoms should seek medical attention.

How about Sweden: 36 stricken by Salmonella

Outbreak News Today reports that Swedish Public Health officials (Folkhalsomyndigheten) are reporting (computer translated) an outbreak of Salmonella Typhimurium since the beginning of the month.

To date, 36 cases from 10 counties have been linked with whole-genome sequencing. Most cases have been reported from Västra Götaland, Jönköping, Halland and Dalarna. Ill persons are found in all age groups, both among children and the elderly, and slightly more women (22) than men (14) have become sick.

The Swedish National Food Agency and the Public Health Authority together are investigating the outbreak to identify the source of the infection that is suspected to be a food that has been widely distributed in Sweden.

Next up: 200 sickened from Salmonella in tartar sauce causes outbreak in Belgian hotel school

Fresh tartar sauce is the source of the salmonella outbreak in the Bruges hotel school Spermalie in early September.

EN 24 News reports on Friday Sept. 6 and the following days, 200 pupils and teachers fell ill at the Spermalie hotel and tourism school in Bruges. Laboratory testing of stool languages ​​soon showed that Spermalie was affected by an outbreak of salmonella. The samples of the meals that were served in the school restaurant were then analyzed. An online survey of students and teachers was also launched to find out who had eaten what in which restaurant.

“All these elements together make us decide that the tartar sauce and perhaps more specifically the eggs used are at the source of this outbreak. Further research and typing of the salmonella strains will bring even more clarity on this, “says Liesbeth Van de Voorde, spokesperson for the FASFC food agency.

15 sick: Salmonella in raw egg hollandaise shutters Dubai restaurant

Sajila Saseendran of Gulf News writes Dubai Municipality has shut down an American restaurant after 15 people fell ill following a food poisoning outbreak recently.

The Food Safety Department of the civic body ordered the outlet to close and held its chef and Person-In-Charge (PIC) of food safety responsible for the salmonella infection that caused the outbreak, the municipality stated.

The department has downgraded the food safety rating of the outlet and revoked its PIC certificate.

The outlet in a Jumeirah mall will be under strict monitoring for the next six months once it will be allowed to reopen after the closure period to corrective measures.

The team collected samples and conducted internationally accepted tests following which they traced the infection to raw eggs used in hollandaise sauce, officials said.

It was found that the chef had used raw eggs in violation of the food safety rules.

Following this, the department issued a fresh alert to eateries preparing food with eggs reminding them about its ban on using raw eggs in ready-to-eat products.

In 2012, the municipality barred Dubai eateries from using raw eggs in ready-to-eat products after authorities found them as a cause of many salmonella infections reported here.

New regulations that restrict the use of raw and under-cooked eggs were introduced and it was also made mandatory to declare their use in food labels or menus.

4 sick: Salmonella outbreak at local kindergarten in Latvia

The Baltic Times reports the Sigulda Regional Council turned to the State Police (VP) about the infection of four kindergarten children with salmonella, Sindija Brikmane, deputy head of the Public Relations Department of Sigulda Municipality, informed LETA.

Investigating the causes of the disease, the Center for Disease Prevention and Control (CDPC) has received information from a laboratory that four children from local kindergartens in Sigulda Region have been diagnosed with the salmonella bacterium.

The municipality has previously announced that if the responsible authorities confirm that the caterer is guilty of causing the disease, the municipality will immediately terminate the contract with SIA Baltic Restaurants Latvia.

The Sigulda Regional Council promises to continue to monitor the inspection services and inform the public and the parents of the children about the current situation and the results of the bacterial samples taken.