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Open Access Research article

Molecular and epidemiologic analysis of a county-wide outbreak caused by Salmonella enterica subsp. enterica serovar Enteritidis traced to a bakery

Po-Liang Lu12, In-Jane Hwang2, Ya-Lina Tung2, Shang-Jyh Hwang1, Chun-Lu Lin3 and LK Siu4*

Author Affiliations

1 Department of Internal Medicine, Kaohsiung Medical University Hospital, 100 Tzyou 1st Rd., Kaohsiung, Taiwan

2 Infection Control Committee, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shan-Ming Road, 812 Kaohsiung, Taiwan

3 Department of Laboratory Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, 482 Shan-Ming Road, Kaohsiung, Taiwan

4 Division of Clinical Research, National Health Research Institute, 128 Yen-Chiu-Yuan Road, Sec 2, Taipei, Taiwan

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BMC Infectious Diseases 2004, 4:48  doi:10.1186/1471-2334-4-48

Published: 15 November 2004

Abstract

Background

An increase in the number of attendees due to acute gastroenteritis and fever was noted at one hospital emergency room in Taiwan over a seven-day period from July to August, 2001. Molecular and epidemiological surveys were performed to trace the possible source of infection.

Methods

An epidemiological investigation was undertaken to determine the cause of the outbreak. Stool and blood samples were collected according to standard protocols per Center for Disease Control, Taiwan. Typing of the Salmonella isolates from stool, blood, and food samples was performed with serotyping, antibiotypes, and pulsed field gel electrophoresis (PFGE) following XbaI restriction enzyme digestion.

Results

Comparison of the number of patients with and without acute gastroenteritis (506 and 4467, respectively) during the six weeks before the outbreak week revealed a significant increase in the number of patients during the outbreak week (162 and 942, respectively) (relative risk (RR): 1.44, 95% confidence interval (CI): 1.22–1.70, P value < 0.001). During the week of the outbreak, 34 of 162 patients with gastroenteritis were positive for Salmonella, and 28 of these 34 cases reported eating the same kind of bread. In total, 28 of 34 patients who ate this bread were positive for salmonella compared to only 6 of 128 people who did not eat this bread (RR: 17.6, 95%CI 7.9–39.0, P < 0.001). These breads were produced by the same bakery and were distributed to six different traditional Chinese markets., Salmonella enterica subsp. enterica serovar Enteritidis (S. Enteritidis) was isolated from the stool samples of 28 of 32 individuals and from a recalled bread sample. All S. Enteritidis isolates were of the same antibiogram. PFGE typing revealed that all except two of the clinical isolates and the bread isolates were of the same DNA macrorestriction pattern.

Conclusions

The egg-covered bread contaminated with S. Enteritidis was confirmed as the vehicle of infection. Alertness in the emergency room, surveillance by the microbiology laboratory, prompt and thorough investigation to trace the source of outbreaks, and institution of appropriate control measures provide effective control of community outbreaks.