title: A prolonged outbreak of Salmonella Typhimurium infection related to an uncommon vehicle: hard cheese made from raw milk.
abstract: In 2006, in The Netherlands, an outbreak of Salmonella Typhimurium phage type 561 (STM DT7, corresponding to the rare DT7 in the international typing scheme) was detected, accumulating to over 200 cases. By telephone interviews, data were collected from all laboratory-confirmed cases. In addition, in August 2006, a case-control study was performed in a subset of cases. Environmental and microbiological investigation was performed on a suspected dairy farm. In the case-control study (51 cases, 105 matched controls), hard cheese purchased from a farm, specifically farm X, and from a market stall were found to be associated with infection. The dairy production room of farm X tested STM DT7-positive in August. However, it was only in November, after earlier unsuccessful attempts, that a low-level contamination was confirmed in the hard farmhouse cheese, triggering control measures. A timely and adequate response was hampered during this outbreak for several reasons. Measures for improvement in handling future similar incidents are discussed.
authors.affiliation: Centre for Infectious Disease Control Netherlands, National Institute of Public Health and the Environment (RIVM/CIb), Bilthoven, The Netherlands. y.van.duynhoven@rivm.nl
authors.forename: Y T H P
authors.initials: YT
authors.lastname: Van Duynhoven
authors.forename: L D
authors.initials: LD
authors.lastname: Isken
authors.forename: K
authors.initials: K
authors.lastname: Borgen
authors.forename: M
authors.initials: M
authors.lastname: Besselse
authors.forename: K
authors.initials: K
authors.lastname: Soethoudt
authors.forename: O
authors.initials: O
authors.lastname: Haitsma
authors.forename: B
authors.initials: B
authors.lastname: Mulder
authors.forename: D W
authors.initials: DW
authors.lastname: Notermans
authors.forename: R
authors.initials: R
authors.lastname: De Jonge
authors.forename: P
authors.initials: P
authors.lastname: Kock
authors.forename: W
authors.initials: W
authors.lastname: Van Pelt
authors.forename: O
authors.initials: O
authors.lastname: Stenvers
authors.forename: J
authors.initials: J
authors.lastname: Van Steenbergen
mesh_terms: D000818:Animals; D001434:Bacteriophage Typing; D016022:Case-Control Studies; D002417:Cattle; D002611:Cheese / Q000382:microbiology*; D003612:Dairying; D004196:Disease Outbreaks; D005525:Food-Processing Industry; D006801:Humans; D008892:Milk / Q000382:microbiology*; D009426:Netherlands / Q000453:epidemiology; D012478:Salmonella Food Poisoning / Q000453:epidemiology; D012481:Salmonella Infections, Animal / Q000635:transmission; D012486:Salmonella typhimurium / Q000145:classification / Q000302:isolation & purification*