title: A 2010 Austrian Salmonella enteritidis PT4 outbreak associated with a laying hen holding previously involved in an S. enteritidis PT4 cluster: pitfalls of regulatory responses in risk management.
abstract: We report on an outbreak caused by Salmonella enteritidis phage type 4 (PT4) among 143 participants at a soccer camp in Austria in August 2010. The outbreak affected 34 persons, including 24 epidemiologically related cases and 10 laboratory-confirmed cases. Food-specific cohort analyses revealed spaetzle (homemade noodles) (relative risks (RR): 2.68; 95% CI: 1.13-6.45), hamburger (RR: 2.70; 95% CI: 1.13-6.45) and potato salad (RR: 2.91; 95% CI: 1.69-5.02) as the most biologically plausible infection sources. Eggs used as ingredients were considered to be the vehicle of infection for the outbreak strain. The sole egg producer supplying the hotel that housed the soccer camp participants with table eggs operated two flocks. One flock had been epidemiologically and microbiologically related to a previous S. enteritidis PT4 outbreak affecting the same Austrian province in the four months preceding the August outbreak. We hypothesize that eggs from this flock, already condemned for industrial use only, were falsely declared table eggs and sold among eggs from the non-banned flock causing the subsequent outbreak. In Austria, the illegal distribution of eggs designated for industrial use (i.e., false declaration of these eggs as table eggs) has been previously documented. Our findings underscore the potential of proper epidemiological outbreak investigation to identify the pitfalls of regulatory responses in risk management.
authors.affiliation: Österreichische Agentur für Gesundheit und Ernährungssicherheit-AGES, Vienna, Austria.
authors.forename: Yu-Lun
authors.initials: YL
authors.lastname: Liu
authors.forename: Daniela
authors.initials: D
authors.lastname: Schmid
authors.forename: Astrid Salgado
authors.initials: AS
authors.lastname: Voss
authors.forename: Sabine
authors.initials: S
authors.lastname: Kasper
authors.forename: Heimo
authors.initials: H
authors.lastname: Lassnig
authors.forename: Oksana
authors.initials: O
authors.lastname: Ableitner
authors.forename: Christian
authors.initials: C
authors.lastname: Kornschober
authors.forename: Ursula
authors.initials: U
authors.lastname: Karnthaler
authors.forename: Franz
authors.initials: F
authors.lastname: Allerberger
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001317:Austria / Q000453:epidemiology; D001434:Bacteriophage Typing; D002645:Chickens; D002648:Child; D004196:Disease Outbreaks; D004531:Eggs / Q000382:microbiology*; D005243:Feces / Q000382:microbiology; D005260:Female; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D012308:Risk Management / Q000379:methods*; D012480:Salmonella Infections / Q000453:epidemiology* / Q000382:microbiology; D012477:Salmonella enteritidis / Q000145:classification / Q000302:isolation & purification*; D055815:Young Adult