A foodborne outbreak of Salmonella infection due to overproduction of egg-containing foods for a festival

Food handling practices and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia

INTRODUCTION

foodborne disease (FBD) is a major public health problem globally. Inadequate food workers' knowledge, attitude, and low level of food handling practices (FHPs) may all contribute to the possibility of FBD outbreaks in public food service establishments. This study aimed to assess FHPs and associated factors among food handlers working in public food and drink service establishments in Woldia town, Northeast Ethiopia.

METHODS

an institutional-based cross-sectional study was conducted from 01 to 29, January 2017. A total of 288 food handlers were recruited through a simple random selection method. A structured interviewer-administered questionnaire and observation checklists were used to collect the respondents' socio-demographic characteristics, knowledge status on FHPs, and food handling working practices data. Descriptive statistics, bivariate and multivariate logistic regression analysis were employed using SPSS version 20 software. Those variables with a p< 0.05 were considered statistically significant.

RESULTS

out of 288 participants, 91.7% were female, and 82.3% were single, while 69.8% were literate. One hundred eighty-four (63.9%) of them were under 15-25 years of age, with a median age of 23.3 years. The proportion of good FHP was (n=134, 46.5%) (95% CI: 41.00-52.4%). Advanced age (adjusted odds ratio (AOR) =12.01, 95% CI: 1.96-73.52), education (participants who attend grades 7-12 (AOR=2.33, 95% CI: 1.14-4.79), and above secondary education (AOR=2.29, 95% CI: 1.05-4.61), work experience above six years (AOR=2.43, 95% CI: 2.08-3.17), received formal training (AOR=1.79, 95% CI: 1.68-4.71), and inspection visits by a concerned body (AOR=2.24, 95% CI: 1.05-3.09) were factors positively associated with handling practices.

CONCLUSION

the study revealed that FHP in the study area was low. Age, education, service year, training received and sanitary inspection visits by the regulatory personnel were factors significantly associated with FHPs. This finding highlights the importance of employing regular sanitary inspection visits to public food service establishments by the concerned authority to ensure that all food handlers have the knowledge and the skill to provide safe food.

Rapid Detection of Pathogenic Bacteria by the Naked Eye

Escherichia coli O157:H7 and Staphylococcus aureus are common pathogens. Gram-negative bacteria, such as E. coli, contain high concentrations of endogenous peroxidases, whereas Gram-positive bacteria, such as S. aureus, possess abundant endogenous catalases. Colorless 3,5,3',5'-tetramethyl benzidine (TMB) changes to blue oxidized TMB in the presence of E. coli and a low concentration of H2O2 (e.g., ~11 mM) at pH of 3. Moreover, visible air bubbles containing oxygen are generated after S. aureus reacts with H2O2 at a high concentration (e.g., 180 mM) at pH of 3. A novel method for rapidly detecting the presence of bacteria on the surfaces of samples, on the basis of these two endogenous enzymatic reactions, was explored. Briefly, a cotton swab was used for collecting bacteria from the surfaces of samples, such as tomatoes and door handles, then two-step endogenous enzymatic reactions were carried out. In the first step, a cotton swab containing bacteria was immersed in a reagent comprising H2O2 (11.2 mM) and TMB for 25 min. In the second step, the swab was dipped further in H2O2 (180 mM) at pH 3 for 5 min. Results showed that the presence of Gram-negative bacteria, such as E. coli with a cell number of ≥ ~105, and Gram-positive bacteria, such as S. aureus with a cell number of ≥ ~106, can be visually confirmed according to the appearance of the blue color in the swab and the formation of air bubbles in the reagent solution, respectively, within ~30 min. To improve visual sensitivity, we dipped the swab carrying the bacteria in a vial containing a growth broth, incubated it for ~4 h, and carried out the two-stage reaction steps. Results showed that bluish swabs resulting from the presence of E. coli O157: H7 with initial cell numbers of ≥ ~34 were obtained, whereas air bubbles were visible in the samples containing S. aureus with initial cell numbers of ≥ ~8.5 × 103.

Mass Gatherings and Diarrheal Disease Transmission Among Rural Communities in Coastal Ecuador

Mass gatherings exacerbate infectious disease risks by creating crowded, high-contact conditions and straining the capacity of local infrastructure. While mass gatherings have been extensively studied in the context of epidemic disease transmission, the role of gatherings in incidence of high-burden, endemic infections has not been previously studied. Here, we examine diarrheal incidence among 17 communities in Esmeraldas, Ecuador, in relation to recurrent gatherings characterized using ethnographic data collected during and after the epidemiologic surveillance period (2004-2007). Using distributed-lag generalized estimating equations, adjusted for seasonality, trend, and heavy rainfall events, we found significant increases in diarrhea risk in host villages, peaking 2 weeks after an event's conclusion (incidence rate ratio, 1.21; confidence interval, adjusted for false coverage rate of ≤0.05: 1.02, 1.43). Stratified analysis revealed heightened risks associated with events where crowding and travel were most likely (2-week-lag incidence rate ratio, 1.51; confidence interval, adjusted for false coverage rate of ≤0.05: 1.09, 2.10). Our findings suggest that community-scale mass gatherings might play an important role in endemic diarrheal disease transmission and could be an important focus for interventions to improve community health in low-resource settings.

Nanostructured Electrochemical Biosensors for Label-Free Detection of Water- and Food-Borne Pathogens

The emergence of nanostructured materials has opened new horizons in the development of next generation biosensors. Being able to control the design of the electrode interface at the nanoscale combined with the intrinsic characteristics of the nanomaterials engenders novel biosensing platforms with improved capabilities. The purpose of this review is to provide a comprehensive and critical overview of the latest trends in emerging nanostructured electrochemical biosensors. A detailed description and discussion of recent approaches to construct label-free electrochemical nanostructured electrodes is given with special focus on pathogen detection for environmental monitoring and food safety. This includes the use of nanoscale materials such as nanotubes, nanowires, nanoparticles, and nanosheets as well as porous nanostructured materials including nanoporous anodic alumina, mesoporous silica, porous silicon, and polystyrene nanochannels. These platforms may pave the way toward the development of point-of-care portable electronic devices for applications ranging from environmental analysis to biomedical diagnostics.

Diversity and Antimicrobial Resistance Genotypes in Non-Typhoidal Salmonella Isolates from Poultry Farms in Uganda

Non-typhoidal Salmonella (NTS) are foodborne pathogens of global public health significance. The aim of this study was to subtype a collection of 85 NTS originating from poultry farms in Uganda, and to evaluate a subgroup of phenotypically resistant isolates for common antimicrobial resistance genes and associated integrons. All isolates were subtyped by pulsed-field gel electrophoresis (PFGE). Phenotypically resistant isolates (n = 54) were screened by PCR for the most relevant AMR genes corresponding to their phenotypic resistance pattern, and all 54 isolates were screened by PCR for the presence of integron class 1 and 2 encoding genes. These genes are known to commonly encode resistance to ampicillin, tetracycline, ciprofloxacin, trimethoprim, sulfonamide and chloramphenicol. PFGE revealed 15 pulsotypes representing 11 serotypes from 75 isolates, as 10 were non-typable. Thirty one (57.4%) of the 54 resistant isolates carried at least one of the seven genes (blaTEM-1,cmlA, tetA, qnrS,sul1,dhfrI,dhfrVII) identified by PCR and six (11%) carried class 1 integrons. This study has shown that a diversity of NTS-clones are present in Ugandan poultry farm settings, while at the same time similar NTS-clones occur in different farms and areas. The presence of resistance genes to important antimicrobials used in human and veterinary medicine has been demonstrated, hence the need to strengthen strategies to combat antimicrobial resistance at all levels.

Communicable diseases as health risks at mass gatherings other than Hajj: what is the evidence?

Mass gatherings are characterized by the concentration of people temporally and spatially, and may lead to the emergence of infectious diseases due to enhanced transmission between attendees. This is well-demonstrated in the context of the Hajj and Umrah pilgrimages in Saudi Arabia. The goal of this review was to present the available evidence on outbreaks associated with a variety of pathogens, or also the lack thereof, as assessed by thorough surveillance at any mass gatherings with the exception of those in Saudi Arabia. A systematic search for relevant articles in the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixty-eight studies were identified. Although outbreaks have not been reported frequently in or after mass gatherings outside the Hajj and Umrah pilgrimages, they have sometimes occurred at Muslim, Christian, and Hindu religious events, at sports events, and at large-scale open air festivals. In this review it was found that the most common outbreaks at these mass gatherings involved vaccine preventable diseases, mainly measles and influenza, but also mumps and hepatitis A. Meningococcal disease has rarely been recorded. Additionally it was found that the transmission of various communicable diseases that may not be prevented by vaccination has been recorded in association with mass gatherings. These were mainly gastrointestinal infections, caused by a variety of pathogens. It was also noted that some outbreaks occurring at mass gatherings have resulted in the international spread of communicable diseases.

Multinational outbreak of Salmonella Enteritidis infection during an international youth ice hockey competition in Riga, Latvia, preliminary report, March and April 2015

A multinational outbreak of salmonellosis linked to the Riga Cup 2015 junior ice-hockey competition was detected by the Finnish health authorities in mid-April and immediately notified at the European Union level. This prompted an international outbreak investigation supported by the European Centre for Disease Prevention and Control. As of 8 May 2015, seven countries have reported 214 confirmed and suspected cases, among which 122 from Finland. The search for the source of the outbreak is ongoing.

A follow-up study of hygiene in catering premises at large-scale events in the United Kingdom

AIMS

To investigate food hygiene practices at large events by assessing the microbiological quality of ready-to-eat food, drinking water, food preparation surfaces, cleaning cloths and wristbands worn by food handlers for event security purposes.

METHODS AND RESULTS

Over a 7-month period, 1662 samples were collected at 153 events and examined for microbiological contamination. Eight per cent of food samples were of an unsatisfactory quality. A further one per cent contained potentially hazardous levels of human pathogenic bacteria. 27% of water samples, 32% of swabs and 56% of cloths were also unsatisfactory. These results represented an improvement in hygiene compared to a previous study carried out 12 months previously. A fifth of food handler wristbands were contaminated with Enterobacteriaceae, Escherichia coli and/or coagulase-positive staphylococci, with those bands made from fabric being more frequently contaminated than those made from plastic or other materials.

CONCLUSIONS

This study provides evidence that the food hygiene at large-scale events may have improved. However, there is still a need for continued efforts to maintain an ongoing improvement in cleaning regimes and food hygiene management.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study was part of an ongoing focus on large events in the lead-up to the London 2012 Olympics. Lessons learnt here will be important in the planning of future large events.

Pulsed-field gel electrophoresis diversity of human and bovine clinical Salmonella isolates

Pulsed-field gel electrophoresis (PFGE) characterization of 335 temporally and spatially matched clinical, bovine, and human Salmonella enterica subsp. enterica isolates revealed 167 XbaI PFGE patterns. These isolates were previously classified into 51 serotypes and 73 sequence types, as determined by multilocus sequence typing. Discriminatory power of PFGE (Simpson's index, D = 0.991) was considerably higher than that of multilocus sequence typing (D = 0.920) or serotyping (D = 0.913). Although 128 PFGE types each only represented a single isolate, 8 PFGE types represented >4 isolates, including (i) three serotype Enteritidis and Heidelberg patterns that were only identified among human isolates, (ii) two PFGE patterns (each representing serotypes Bardo and Newport) that were significantly more common among bovine isolates as compared with human isolates; (iii) two PFGE types that each includes two serotypes (4,5,12:i:- and Typhimurium; Thompson and 1,7:-:1,5); and (iv) one PFGE type that includes eight Typhimurium isolates from humans and cattle. Characterization of isolates collected over multiple farm visits indicated that given specific PFGE types persisted over time on 11 farms. On an additional seven farms, isolates with a given sequence type represented multiple PFGE type, which typically only differed by <3 bands, suggesting PFGE type diversification during strain persistence. Sixteen PFGE types were isolated from 2 or more farms, including two widely distributed serotype Newport-associated PFGE types each found on 10 farms. In six instances two or three human isolates collected in the same county in the same or consecutive months represented the same subtypes, suggesting small human case clusters. PFGE-based characterization and surveillance of human and animal isolates can provide improved understanding of Salmonella diversity and epidemiology, including identification of possible host-associated and common, widely distributed PFGE types.

An outbreak of gastroenteritis of unknown origin in Tehran, July 2003

Aim of this study was to determine the causative agent and source of a large gastroenteritis outbreak occurred in a national financial center (CBIRI) in July 2003. A patient definition was defined staff were interviewed in the clinic of the Bank and their information were collected by means of a standardized questionnaire. A total of 110 fecal specimens were collected within 48 h of symptom onset from 100 patients with symptoms of gastroenteritis and 10 restaurant staff. The specimens were processed within 12 h to detect ova and parasites by direct microscopy and common bacteria by standard methods. The outbreak started on 22 July 2003 lasted 4 days. From a total of 1300 staff. 535 persons experienced a severe gastrointestinal illness. None but one of tested fecal samples were positive for bacterial enteric pathogens. S. paratyphi B was isolated from the positive case. Definitive association between illness and isolated S. paratyphi B remained to be determined since it was isolated only from one case. There is a need, however, for increased awareness among both professionals and the public to implement appropriate prevention measures and monitoring of food and water.

Antimicrobial resistance and phage and molecular typing of Salmonella strains isolated from food for human consumption in Spain

The aims of this study were to ascertain the population structure and antimicrobial susceptibility of Salmonella enterica serovars isolated in 2002 from food in 16 Spanish regions. Serovars were characterized by serotyping, phage typing, antimicrobial susceptibility, and pulsed-field gel electrophoresis (PFGE) typing, and 264 nonrelated strains were selected for further analysis. The main sources were eggs and their derivatives (21.6% of strains), poultry and related products (16.6%), and seafood (16.3%). High serotype diversity was detected (51 serotypes); the most common were Enteritidis (n = 96, 36.3%) and Typhimurium (n = 53, 20.1%), followed by a miscellaneous group of 49 different serotypes (n = 115, 43.5%). A 15% increase in Salmonella Enteritidis isolation was observed. Common phage types for Salmonella Enteritidis were PT1 (41.6% of isolates), PT4 (9.4%), PT6 (9.4%), and PT6a (9.4%), and common types for Salmonella Typhimurium were DTU302 (18.8%), DT104 (15.1%), and DT104B (13.2%). Salmonella Enteritidis strains were categorized into eight PFGE types with a similarity of 81 to 96%, and 73.9% of the strains were grouped into just one cluster. Salmonella Typhimurium isolates were divided into 13 PFGE types with a similarity of 64 to 86%, and one predominant clone contained 41.5% of the strains. Resistance rates for Salmonella Enteritidis, Salmonella Typhimurium, and the miscellaneous group were, respectively, 8.3, 69.8, and 13.9% for ampicillin, 3.1, 52.8, and 59% for streptomycin, 40.6, 22.6, and 10.4% for nalidixic acid, 15.6, 71.7, and 31.1% for tetracycline, 7.3, 18.8, and 9.5% for trimethoprim-sulfamethoxazole, 0, 50.9, and 4.3% for chloramphenicol, and 6.2, 71.7, and 17.4% for multiple (at least four) antimicrobials. All the strains remained susceptible to other beta-lactams and fluoroquinolones. Surveillance of S. enterica isolated from food is strongly recommended to reduce community exposure to antimicrobial resistant strains.

Isolation of Salmonella typhimurium from outbreak-associated cake mix

During May and June of 2005, 26 persons in several states were infected by a single strain (isolates indistinguishable by pulsed-field gel electrophoresis) of Salmonella enterica serotype Typhimurium after eating cake batter ice cream. The cake mix used to prepare the cake batter in the ice cream was implicated by epidemiologic investigation as the source of Salmonella contamination. Initial tests did not detect Salmonella in cake mix collected during the outbreak investigation. The objective of this study was to evaluate different procedures to isolate Salmonella from the implicated cake mix, cake, and ice cream. All outbreak-associated food samples (14 samples) were collected during the outbreak investigation by health departments of several of the states involved. Different combinations of Salmonella isolation procedures, including sample size, preenrichment broth, enrichment broth, enrichment temperature, and isolation medium, were used. Salmonella Typhimurium was isolated from two cake mix samples; the food isolates were indistinguishable from the outbreak pattern by pulsed-field gel electrophoresis subtyping. Universal preenrichment broth was substantially better than was lactose broth for preenrichment, and tetrathionate broth was better than was Rappaport-Vassiliadis broth for isolating Salmonella from the two positive cake mix samples. Although more typical Salmonella colonies were observed on plates from enrichment cultures grown at 35 degrees C, more confirmed Salmonella isolates were obtained from plates of enrichment cultures grown at 42 degrees C. Brilliant green agar, xylose lysine tergitol 4 agar, xylose lysine desoxycholate agar, Hektoen enteric agar, and bismuth sulfite agar plates were equally effective in isolating Salmonella from cake mix. The best combination of preenrichment-enrichment conditions for isolating the outbreak strain of Salmonella was preenrichment of cake mix samples in universal preenrichment broth at 35 degrees C for 24 h, followed by enrichment in tetrathionate broth at 42 degrees C for 24 h.