title: International outbreak investigation of Salmonella Heidelberg associated with in-flight catering.
abstract: Rapid and wide dispersal of passengers after flights makes investigation of flight-related outbreaks challenging. An outbreak of Salmonella Heidelberg was identified in a group of Irish travellers returning from Tanzania. Additional international cases sharing the same flight were identified. Our aim was to determine the source and potential vehicles of infection. Case-finding utilized information exchange using experts' communication networks and national surveillance systems. Demographic, clinical and food history information was collected. Twenty-five additional cases were identified from Ireland, The Netherlands, Norway, USA and Canada. We conducted a case-control study which indicated a significant association between illness and consumption of milk tart (OR 10.2) and an egg dish (OR 6) served on-board the flight. No food consumed before the flight was associated with illness. Cases from countries other than Ireland provided supplementary information that facilitated the identification of likely vehicles of infection. Timely, committed international collaboration is vital in such investigations.
authors.affiliation: European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.
authors.forename: J
authors.initials: J
authors.lastname: Rebolledo
authors.affiliation: Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: Garvey
authors.affiliation: Department of Public Health Medicine, HSE-West (Northwest), Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Ryan
authors.affiliation: Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: J
authors.initials: J
authors.lastname: O'Donnell
authors.affiliation: National Salmonella Shigella and Listeria Reference Laboratory, Galway, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Cormican
authors.affiliation: Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: S
authors.initials: S
authors.lastname: Jackson
authors.affiliation: Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: F
authors.initials: F
authors.lastname: Cloak
authors.affiliation: Department of Public Health Medicine, HSE-West (Northwest), Ireland.
authors.forename: L
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: Swaan
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: B
authors.initials: B
authors.lastname: Schimmer
authors.affiliation: Infectious Disease Control, Public Health Service Kennemerland, Schippol, The Netherlands.
authors.forename: R W
authors.initials: RW
authors.lastname: Appels
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Nygard
authors.affiliation: Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Finley
authors.affiliation: Division of Foodborne, Waterborne and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
authors.forename: N
authors.initials: N
authors.lastname: Sreenivasan
authors.affiliation: Surveillance and Response Support Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Lenglet
authors.affiliation: Surveillance and Response Support Unit, European Centre for Disease Prevention and Control, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Gossner
authors.affiliation: Health Protection Surveillance Centre, Dublin, Ireland.
authors.forename: P
authors.initials: P
authors.lastname: McKeown
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D064870:Air Travel; D000704:Analysis of Variance; D015331:Cohort Studies; D004196:Disease Outbreaks; D005511:Food Handling; D005516:Food Microbiology; D006801:Humans; D038622:Internationality; D007494:Ireland; D008875:Middle Aged; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D013636:Tanzania; D055815:Young Adult
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