title: National outbreak of Salmonella Enteritidis phage type 14b in England, September to December 2009: case-control study.
abstract: We conducted an unmatched retrospective case–control study to investigate an upsurge of non-travel-related sporadic cases of infection with Salmonella enterica subsp. enterica serotype Enteritidis phage type 14b with antimicrobial resistance to nalidixic acid and partial resistance to ciprofloxacin (S. Enteritidis PT 14b NxCp(L)) that was reported in England from 1 September to 31 December 2009. We analysed data from 63 cases and 108 controls to determine whether cases had the same sources of infection as those found through investigation of 16 concurrent local foodborne outbreaks in England and Wales. Multivariable logistic regression analysis adjusting for age and sex identified food consumption at restaurants serving Chinese or Thai cuisine (odds ratio (OR): 4.4; 95% CI: 1.3–14.8; p=0.02), egg consumed away from home (OR: 5.1; 95% CI: 1.3–21.2; p=0.02) and eating vegetarian foods away from home (OR: 14.6; 95% CI: 2.1–99; p=0.006) as significant risk factors for infection with S. Enteritidis PT 14b NxCp(L). These findings concurred with those from the investigation of the16 outbreaks, which identified the same Salmonella strain in eggs from a specified source outside the United Kingdom. The findings led to a prohibition of imports from this source, in order to control the outbreak.
authors.affiliation: Health Protection Agency, Centre for Infections, London, United Kingdom. Kulsum@doctors.org.uk
authors.forename: K
authors.initials: K
authors.lastname: Janmohamed
authors.forename: D
authors.initials: D
authors.lastname: Zenner
authors.forename: C
authors.initials: C
authors.lastname: Little
authors.forename: C
authors.initials: C
authors.lastname: Lane
authors.forename: J
authors.initials: J
authors.lastname: Wain
authors.forename: A
authors.initials: A
authors.lastname: Charlett
authors.forename: B
authors.initials: B
authors.lastname: Adak
authors.forename: D
authors.initials: D
authors.lastname: Morgan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D002648:Child; D014676:Diet, Vegetarian / Q000009:adverse effects; D004196:Disease Outbreaks; D004531:Eggs / Q000506:poisoning; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012147:Restaurants / Q000592:standards; D012189:Retrospective Studies; D012478:Salmonella Food Poisoning / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D012483:Salmonella Phages / Q000302:isolation & purification*; D012477:Salmonella enteritidis / Q000302:isolation & purification / Q000821:virology; D055815:Young Adult