title: Large outbreak of Salmonella enterica serotype paratyphi B infection caused by a goats' milk cheese, France, 1993: a case finding and epidemiological study.
abstract: OBJECTIVE
  To assess the magnitude of a nationwide outbreak of infection with Salmonella enterica serotype paratyphi B and identify the vehicle and source of infection.
  
  
  METHODS
  A case finding study of S paratyphi B infection between 15 August and 30 November 1993; a pair matched case-control study; an environmental investigation at a processing plant that produced a raw goats' milk cheese incriminated in the outbreak; phage typing and genotyping of food and human S paratyphi B isolates.
  
  
  METHODS
  France, 15 August to 30 November 1993.
  
  
  METHODS
  273 patients with S paratyphi B infection; 59 pairs of cases and controls matched for age, sex, and city of residence.
  
  
  METHODS
  Numbers of cases and incidence rates by region of residence and age; matched odds ratios for dairy food preferences.
  
  
  RESULTS
  Among the 273 cases there was one death; 203 (78%) strains belonged to phage type 1 var 3. The incidence of infection was greatest in the region where goats' milk cheese is commonly produced. Comparison of cases and controls showed a 12-fold greater risk of illness (95% confidence interval 1.6 to 92.3) from eating brand A unpasteurised goats' milk cheese. S paratyphi B isolates of phage type 1 var 3 were recovered from cheese A, goats' milk at the plant processing cheese A, and goats' milk supplied to the plant by a single farm. Genotypic IS 200 typing of food and human 1 var 3 phage type isolates showed a common IS 200 pattern.
  
  
  CONCLUSIONS
  This outbreak emphasises the potential health hazards of widely distributed unpasteurised milk products in France and the need for their close bacterial monitoring.
authors.affiliation: Réseau National de Santé Publique, Saint-Maurice, France.
authors.forename: J C
authors.initials: JC
authors.lastname: Desenclos
authors.forename: P
authors.initials: P
authors.lastname: Bouvet
authors.forename: E
authors.initials: E
authors.lastname: Benz-Lemoine
authors.forename: F
authors.initials: F
authors.lastname: Grimont
authors.forename: H
authors.initials: H
authors.lastname: Desqueyroux
authors.forename: I
authors.initials: I
authors.lastname: Rebière
authors.forename: P A
authors.initials: PA
authors.lastname: Grimont
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D016022:Case-Control Studies; D002611:Cheese / Q000009:adverse effects / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005525:Food-Processing Industry; D005602:France / Q000453:epidemiology; D006041:Goats; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D008892:Milk / Q000009:adverse effects / Q000382:microbiology*; D010284:Paratyphoid Fever / Q000453:epidemiology*; D012478:Salmonella Food Poisoning / Q000453:epidemiology*; D012484:Salmonella paratyphi B / Q000302:isolation & purification