title: Pediatric Epidemic of Salmonella enterica Serovar Typhimurium in the Area of L'Aquila, Italy, Four Years after a Catastrophic Earthquake.
abstract: A Salmonella enterica epidemic occurred in children of the area of L'Aquila (Central Italy, Abruzzo region) between June 2013 and October 2014, four years after the catastrophic earthquake of 6 April 2009.
  
  
  
  Clinical and laboratory data were collected from hospitalized and ambulatory children. Routine investigations for Salmonella infection were carried out on numerous alimentary matrices of animal origin and sampling sources for drinking water of the L'Aquila district, including pickup points of the two main aqueducts.
  
  
  
  Salmonella infection occurred in 155 children (83 females: 53%), aged 1 to 15 years (mean 2.10). Of these, 44 children (28.4%) were hospitalized because of severe dehydration, electrolyte abnormalities, and fever resistant to oral antipyretic and antibiotic drugs. Three children (1.9%) were reinfected within four months after primary infection by the same Salmonella strain. Four children (2.6%), aged one to two years, were coinfected by rotavirus. A seven-year old child had a concomitant right hip joint arthritis. The isolated strains, as confirmed in about the half of cases or probable/possible in the remaining ones, were identified as S. enterica serovar Typhimurium [4,5:i:-], monophasic variant. Aterno river, bordering the L'Aquila district, was recognized as the main responsible source for the contamination of local crops and vegetables derived from polluted crops.
  
  
  
  The high rate of hospitalized children underlines the emergence of a highly pathogenic S. enterica strain probably subsequent to the contamination of the spring water sources after geological changes occurred during the catastrophic earthquake.
authors.affiliation: Pediatric Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila 67100, Italy. nigrogio@libero.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Nigro
authors.affiliation: Pediatric Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila 67100, Italy. gabriellabottone@gmail.com.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Bottone
authors.affiliation: Pediatric Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila 67100, Italy. daniela.maiorani82@gmail.com.
authors.forename: Daniela
authors.initials: D
authors.lastname: Maiorani
authors.affiliation: Pediatric Unit, University of L'Aquila, San Salvatore Hospital, L'Aquila 67100, Italy. fabiana_t@alice.it.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Trombatore
authors.affiliation: Department of Clinical Pathology, San Salvatore Hospital, L'Aquila 67100, Italy. silvana.falasca@alice.it.
authors.forename: Silvana
authors.initials: S
authors.lastname: Falasca
authors.affiliation: Department of Clinical Pathology, San Salvatore Hospital, L'Aquila 67100, Italy. supergiaf@gmail.com.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Bruno
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D055866:Earthquakes; D005260:Female; D006801:Humans; D007223:Infant; D007558:Italy / Q000453:epidemiology; D008297:Male; D012480:Salmonella Infections / Q000453:epidemiology*; D019779:Salmonella enterica / Q000302:isolation & purification*; D012486:Salmonella typhimurium / Q000302:isolation & purification; D065288:Serogroup
keywords: Salmonella enterica serovar typhimurium; Salmonella epidemic; Salmonella reinfection; water survey stations