title: An epidemiological review of gastrointestinal outbreaks associated with Clostridium perfringens, North East of England, 2012-2014.
abstract: An anecdotal increase in C. perfringens outbreaks was observed in the North East of England during 2012-2014. We describe findings of investigations in order to further understanding of the epidemiology of these outbreaks and inform control measures. All culture-positive (>105 c.f.u./g) outbreaks reported to the North East Health Protection Team from 1 January 2012 to 31 December 2014 were included. Epidemiological (attack rate, symptom profile and positive associations with a suspected vehicle of infection), environmental (deficiencies in food preparation or hygiene practices and suspected vehicle of infection) and microbiological investigations are described. Forty-six outbreaks were included (83% reported from care homes). Enterotoxin (cpe) gene-bearer C. perfringens were detected by PCR in 20/46 (43%) and enterotoxin (by ELISA) and/or enterotoxigenic faecal/food isolates with indistinguishable molecular profiles in 12/46 (26%) outbreaks. Concerns about temperature control of foods were documented in 20/46 (43%) outbreaks. A suspected vehicle of infection was documented in 21/46 (46%) of outbreaks (meat-containing vehicle in 20/21). In 15/21 (71%) identification of the suspected vehicle was based on descriptive evidence alone, in 5/21 (24%) with supporting evidence from an epidemiological study and in 2/21 (10%) with supporting microbiological evidence. C. perfringens-associated illness is preventable and although identification of foodborne outbreaks is challenging, a risk mitigation approach should be taken, particularly in vulnerable populations such as care homes for the elderly.
authors.affiliation: Public Health England,Field Epidemiology Services,North East England,UK.
authors.forename: G P
authors.initials: GP
authors.lastname: Dolan
authors.affiliation: Public Health England Centre,North East England,UK.
authors.forename: K
authors.initials: K
authors.lastname: Foster
authors.affiliation: Public Health England Centre,North East England,UK.
authors.forename: J
authors.initials: J
authors.lastname: Lawler
authors.affiliation: Public Health England,Gastrointestinal Bacteria Reference Unit,LondonUK.
authors.forename: C
authors.initials: C
authors.lastname: Amar
authors.affiliation: Public Health England,Gastrointestinal Bacteria Reference Unit,LondonUK.
authors.forename: C
authors.initials: C
authors.lastname: Swift
authors.affiliation: Public Health England,Food, Water and Environmental Microbiology Laboratory,York,UK.
authors.forename: H
authors.initials: H
authors.lastname: Aird
authors.affiliation: Public Health England,Field Epidemiology Services,North East England,UK.
authors.forename: R
authors.initials: R
authors.lastname: Gorton
mesh_terms: D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D003016:Clostridium perfringens / Q000502:physiology*; D004196:Disease Outbreaks; D004739:England / Q000453:epidemiology; D005260:Female; D005516:Food Microbiology; D005517:Foodborne Diseases / Q000453:epidemiology* / Q000382:microbiology; D006801:Humans; D008297:Male
keywords: Clostridium perfringens; epidemiology; food poisoning; outbreaks