BMJ 1996;313:1107-1109 (2 November)

Papers

International epidemiological and microbiological study of outbreak of Salmonella agona infection from a ready to eat savoury snack--II: Israel

Tamy Shohat, deputy director,a Manfred S Green, director,a Dafna Merom, senior researcher,a O Noel Gill, deputy director (information),b Avi Reisfeld, director, National Salmonella Centre,c Abraham Matas, director,c Dvora Blau, director, Salmonella Unit,d Nitsa Gal, director, Enteric Diseases Section,d Paul E Slater, director e

a Israel Centre for Disease Control, Israel Ministry of Health, Schneider Children's Medical Centre of Israel, PO Box 559, Petach Tikva, Israel 49202, b Public Health Laboratory Service, Communicable Disease Surveillance Centre, London NW9 5EQ, c Department of Central Laboratories, Public Health Services, Jerusalem, Israel, d Central Microbiology Laboratory, Kupat Holim Clalit, Haifa, Israel, e Department of Epidemiology, Israel Ministry of Health, Jerusalem

Correspondence to: Dr Shohat.

Abstract

Objectives: To explain an increase in the incidence of salmonellosis caused by Salmonella agona in Israel between October 1994 and January 1995 in the light of an outbreak of S agona phage type 15 infection in England and Wales caused by consumption of a ready to eat savoury snack produced in Israel.
Design: Epidemiology of S agona in 1994-5 was analysed and two consecutive, case-control studies of 32 and 26 case-control pairs were performed. Phage typing and molecular methods were used to characterise strains of S agona isolated from cases and samples of the snack in Israel and England and Wales.
Results: The increase in the incidence of S agona between October 1994 and January 1995 was countrywide. Cases of infection with group B salmonella increased from 60% to 80% in children under 5 years old. In both case-control studies, cases consumed more of the snack than did controls (4.25 v 2.94 packets per week in the first study (P=0.086) and 4.04 v 2.37 packets per week in the second study (P=0.034)). When the two studies were combined there was a significant dose-response relation for the number of packets consumed weekly. Compared with consumption of less than two packets, the odds ratio was 1.43 for between two and six packets and 3.37 for seven or more packets ({chi}2 for trend=5.27, P=0.02) S agona phage type 15 was isolated from a packet of the snack sold in Israel, and the strain was identical with those isolated from packets and cases in Israel and England and Wales.
Conclusions: This outbreak of S agona was caused by the contamination of a snack produced in Israel. Even under modern operating conditions, large, widespread international outbreaks of foodborne disease can occur. The success of this investigation resulted from excellent international collaboration between public health authorities.

Key messages

  • Surveillance and control of an outbreak of salmonella infection is compromised by any delay in obtaining data on salmonella serotypes

  • Effective ongoing communication between pub- lic health authorities in different countries can play a key part in the prompt identification of the source of unusual outbreaks


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