title: Outbreaks of Shigella sonnei infections in Denmark and Australia linked to consumption of imported raw baby corn.
abstract: We investigated an outbreak of Shigella sonnei infections in Denmark and Australia associated with imported baby corn from one packing shed in Thailand. We reviewed nationwide surveillance and undertook case finding, food trace-back and microbiological investigation of human, food and environmental samples. A recall of baby corn and sugar snaps was based on descriptive epidemiological evidence. In Denmark, we undertook a retrospective cohort study in one workplace. In total, 215 cases were laboratory-confirmed in Denmark, and 12 in Australia. In a multivariable analysis, baby corn was the only independent risk factor. Antibiotic resistance and PFGE outbreak profiles in Denmark and Australia were indistinguishable, linking the outbreaks. Although we did not detect S. sonnei in baby corn, we isolated high levels of other enteric pathogens. We identified a packing shed in Thailand that supplied baby corn to Denmark and Australia, and uncovered unhygienic practices in the supply chain. This outbreak highlights the importance of international communication in linking outbreaks and pinpointing the source.
authors.affiliation: Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: H C
authors.initials: HC
authors.lastname: Lewis
authors.forename: S
authors.initials: S
authors.lastname: Ethelberg
authors.forename: K E P
authors.initials: KE
authors.lastname: Olsen
authors.forename: E M
authors.initials: EM
authors.lastname: Nielsen
authors.forename: M
authors.initials: M
authors.lastname: Lisby
authors.forename: S B
authors.initials: SB
authors.lastname: Madsen
authors.forename: J
authors.initials: J
authors.lastname: Boel
authors.forename: R
authors.initials: R
authors.lastname: Stafford
authors.forename: M
authors.initials: M
authors.lastname: Kirk
authors.forename: H V
authors.initials: HV
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Tikumrum
authors.forename: A
authors.initials: A
authors.lastname: Wisetrojana
authors.forename: A
authors.initials: A
authors.lastname: Bangtrakulnonth
authors.forename: J
authors.initials: J
authors.lastname: Vithayarungruangsri
authors.forename: P
authors.initials: P
authors.lastname: Siriarayaporn
authors.forename: K
authors.initials: K
authors.lastname: Ungchusak
authors.forename: J
authors.initials: J
authors.lastname: Bishop
authors.forename: K
authors.initials: K
authors.lastname: Mølbak
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004405:Dysentery, Bacillary / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D005506:Food Contamination; D005511:Food Handling; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012764:Shigella sonnei / Q000302:isolation & purification*; D013785:Thailand; D003313:Zea mays / Q000382:microbiology*