title: A prolonged outbreak of Salmonella Infantis associated with pork products in central Germany, April-October 2013.
abstract: One of the largest and longest Salmonella outbreaks in Germany within the last 10 years occurred in central Germany in 2013. To identify vehicles of infection, we analysed surveillance data, conducted a case-control study and food traceback. We identified 267 cases infected with Salmonella Infantis with symptom onset between 16 April and 26 October 2013 in four neighbouring federal states. Results of our study indicated that cases were more likely to have eaten raw minced pork from local butcher's shops [odds ratio (OR) 2·5, 95% confidence interval (CI) 1·1-5·8] and have taken gastric acid-reducing or -neutralizing medication (OR 3·8, 95% CI 1·3-13) than controls. The outbreak was traced back to contaminated raw pork products found in different butcher's shops supplied by one slaughterhouse, to pigs at one farm and to an animal feed producer. Characterization of isolates of human, food, animal, feed, and environmental origin by phage-typing and pulsed-field gel electrophoresis confirmed the chain of infection. Insufficient hygiene standards in the slaughterhouse were the most probable cause of the ongoing transmission. We recommend that persons taking gastric acid suppressants should refrain from consuming raw pork products. Improving and maintaining adequate hygiene standards and process controls during slaughter is important to prevent future outbreaks.
authors.affiliation: Thuringian State Authority for Consumer Protection,Bad Langensalza,Germany.
authors.forename: S
authors.initials: S
authors.lastname: Schroeder
authors.affiliation: European Programme for Intervention Epidemiology Training (EPIET),European Centre for Disease Prevention and Control (ECDC),Stockholm,Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Harries
authors.affiliation: Robert Koch Institute,Branch Wernigerode,Germany.
authors.forename: R
authors.initials: R
authors.lastname: Prager
authors.affiliation: Thuringian State Authority for Consumer Protection,Bad Langensalza,Germany.
authors.forename: A
authors.initials: A
authors.lastname: Höfig
authors.affiliation: Thuringian State Authority for Consumer Protection,Bad Langensalza,Germany.
authors.forename: B
authors.initials: B
authors.lastname: Ahrens
authors.affiliation: Thuringian State Authority for Consumer Protection,Bad Langensalza,Germany.
authors.forename: L
authors.initials: L
authors.lastname: Hoffmann
authors.affiliation: Robert Koch Institute,Branch Wernigerode,Germany.
authors.forename: W
authors.initials: W
authors.lastname: Rabsch
authors.affiliation: Governmental Institute of Public Health of Lower Saxony,Hannover,Germany.
authors.forename: E
authors.initials: E
authors.lastname: Mertens
authors.affiliation: Thuringian State Authority for Consumer Protection,Bad Langensalza,Germany.
authors.forename: D
authors.initials: D
authors.lastname: Rimek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D001434:Bacteriophage Typing; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005516:Food Microbiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006920:Hygiene; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000069466:Red Meat / Q000382:microbiology*; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000382:microbiology; D019779:Salmonella enterica / Q000302:isolation & purification*; D034421:Sus scrofa; D055815:Young Adult
keywords: Epidemiology; Salmonella; foodborne infections; outbreaks; public health