title: Outbreak of Salmonella Thompson infections linked to imported rucola lettuce.
abstract: On November 15, 2004, a cluster of three cases of Salmonella Thompson infection was registered by the Norwegian reference laboratory. In the following days further cases occurred, prompting a case-control study among the first 13 cases and 26 matched controls. By December 31, 21 cases had been reported, with the first onset on October 24. Consumption of rucola lettuce (Eruca sativa, also known as rocket salad or arugula) (OR 8,8 [1,2-infinity]) and mixed salad (OR 5,0 [1,0-infinity]) was associated with illness. On November 26, Swedish authorities notified the finding of Salmonella Thompson in rucola lettuce through the EU Rapid Alert System for Food and Feed. Later, several countries reported finding this and other Salmonella serovars and Campylobacter in rucola produced in Italy. In response to our alert through the international Enter-net surveillance network, Sweden and England also reported an increase of cases. Salmonella Thompson isolates from products and patients from several countries showed high similarity by pulsed-field gel electrophoresis, but some isolates showed significant differences. We think that the outbreak in Norway reflected a larger international outbreak caused by rucola imported from one Italian producer. Findings of other pathogens indicate a massive contamination, possibly caused by irrigation with nonpotable water. Rapid international information exchange is invaluable when investigating outbreaks caused by internationally marketed products.
authors: Norwegian Institute of Public Health, Oslo, Norway. karin.nygard@fhi.no
authors: Karin
authors: K
authors: Nygård
authors: Jørgen
authors: J
authors: Lassen
authors: Line
authors: L
authors: Vold
authors: Yvonne
authors: Y
authors: Andersson
authors: Ian
authors: I
authors: Fisher
authors: Sven
authors: S
authors: Löfdahl
authors: John
authors: J
authors: Threlfall
authors: Ida
authors: I
authors: Luzzi
authors: Tansy
authors: T
authors: Peters
authors: Michael
authors: M
authors: Hampton
authors: Mia
authors: M
authors: Torpdahl
authors: Georg
authors: G
authors: Kapperud
authors: Preben
authors: P
authors: Aavitsland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D005516:Food Microbiology; D006801:Humans; D007223:Infant; D018545:Lactuca / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance; D012475:Salmonella / Q000145:classification / Q000302:isolation & purification*; D012478:Salmonella Food Poisoning / Q000453:epidemiology*