Open Access Research article

Serological cross-sectional studies on salmonella incidence in eight European countries: no correlation with incidence of reported cases

Gerhard Falkenhorst1*, Jacob Simonsen1, Tina H Ceper2, Wilfrid van Pelt3, Henriette de Valk4, Malgorzata Sadkowska-Todys5, Lavinia Zota6, Markku Kuusi7, Cecilia Jernberg8, Maria Cristina Rota9, Yvonne THP van Duynhoven3, Peter FM Teunis103, Karen A Krogfelt11 and Kåre Mølbak1

Author Affiliations

1 Division of Epidemiology, Statens Serum Institut, Copenhagen, Denmark

2 Department of Microbiological Diagnostics, Statens Serum Institut, Copenhagen, Denmark

3 Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

4 Infectious Diseases Department, Institut de Veille Sanitaire, Saint Maurice, France

5 Department of Epidemiology, National Institute of Public Health – National Institute of Hygiene, Warsaw, Poland

6 National Center for Surveillance and Control of Communicable Diseases, National Institute of Public Health, Bucharest, Romania

7 National Institute for Health and Welfare, Helsinki, Finland

8 Department of Preparedness, Swedish Institute for Communicable Disease Control (SMI), Solna, Sweden

9 Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Roma, Italy

10 Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

11 Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark

For all author emails, please log on.

BMC Public Health 2012, 12:523  doi:10.1186/1471-2458-12-523

Published: 16 July 2012



Published incidence rates of human salmonella infections are mostly based on numbers of stool culture-confirmed cases reported to public health surveillance. These cases constitute only a small fraction of all cases occurring in the community. The extent of underascertainment is influenced by health care seeking behaviour and sensitivity of surveillance systems, so that reported incidence rates from different countries are not comparable. We performed serological cross-sectional studies to compare infection risks in eight European countries independent of underascertainment.


A total of 6,393 sera from adults in Denmark, Finland, France, Italy, Poland, Romania, Sweden, and The Netherlands were analysed, mostly from existing serum banks collected in the years 2003 to 2008. Immunoglobulin A (IgA), IgM, and IgG against salmonella lipopolysaccharides were measured by in-house mixed ELISA. We converted antibody concentrations to estimates of infection incidence (‘sero-incidence’) using a Bayesian backcalculation model, based on previously studied antibody decay profiles in persons with culture-confirmed salmonella infections. We compared sero-incidence with incidence of cases reported through routine public health surveillance and with published incidence estimates derived from infection risks in Swedish travellers to those countries.


Sero-incidence of salmonella infections ranged from 56 (95% credible interval 8–151) infections per 1,000 person-years in Finland to 547 (343–813) in Poland. Depending on country, sero-incidence was approximately 100 to 2,000 times higher than incidence of culture-confirmed cases reported through routine surveillance, with a trend for an inverse correlation. Sero-incidence was significantly correlated with incidence estimated from infection risks in Swedish travellers.


Sero-incidence estimation is a new method to estimate and compare the incidence of salmonella infections in human populations independent of surveillance artefacts. Our results confirm that comparison of reported incidence between countries can be grossly misleading, even within the European Union. Because sero-incidence includes asymptomatic infections, it is not a direct measure of burden of illness. But, pending further validation of this novel method, it may be a promising and cost-effective way to assess infection risks and to evaluate the effectiveness of salmonella control programmes across countries or over time.

Salmonella; Europe; Epidemiology; Serology; Modelling; Surveillance; Human