 |
|
|
|
| EPI-NEWS |
National surveillance of communicable diseases
Dept. of Epidemiology
Editor: Tove Rønne |
|
|
|
|
| Tel.: +45 3268 3038 - Fax: +45 3268 3874 |
|
- ISSN: 1396-4796 |
|
|
|
|
| HOUSEHOLD OUTBREAK OF SALMONELLOSIS IN VEJLE COUNTY |
On 2 January 2000 the Medical Office of Health in Vejle County was contacted in relation to two unexpected deaths within a single family. The first patient, a 44-year-old man, developed gastroenteritis with violent diarrhoea, vomiting, abdominal pains and fever on 29 December 1999. The symptoms persisted till 31 December, when the patient had a cardiac arrest following a short period of dyspnoea. Resuscitation was unsuccessful and the patient was dead on arrival at the local hospital. The other patient had an even shorter clinical course. This was the first patient's 18-year-old son, who started vomiting on New Year's Eve and developed diarrhoea and fever on New Year's Day. About 26 hours after the father's death, the son lost consciousness and was brought in dead to the hospital. In addition to these two cases, milder cases of gastroenteritis have been reported in three other members of the family. Samples taken at forensic autopsy showed growth of Salmonella enteritidis from both faeces and blood, and Salmonella enteritidis has also been demonstrated in another member of the family. It is thought that the most probable source of the outbreak is a cake containing raw egg, which the family had eaten between Christmas and New Year. Remnants of this cake are being analysed for salmonella. The Vejle Regional Food Inspectorate, the Food Directorate, the State Veterinary Serum Laboratory and Statens Serum Institut are cooperating in the further tracing of the infective source. An overall report with results of supplementary analyses will be published later.
Salmonella enteritidis infection
Salmonella enteritidis usually produces a self-limiting gastroenteritis. A minority of patients develop septicaemia, as has presumably happened in the two reported cases. Untreated salmonella septicaemia has a mortality of around 25%. However, such a rapid clinical course with a fatal outcome is rare in healthy younger patients. The commonest source of Salmonella enteritidis is raw egg and dishes prepared from raw or partially raw egg.
Figure 1 shows the number of Salmonella enteritidis cases registeredby the laboratory-based surveillance system during the period 1980-1998, together with the estimated figure for 1999. It will be seen that the curve peaked in 1997, when 3674 cases were registered. In 1998 the number fell to 2607 and about 1900 infective episodes are expected to be registered in 1999. This considerable reduction in the number of cases is principally due to the plan of action for the control of salmonella in chicken stocks producing eggs for consumption. Despite the declining occurrence of salmonella in laying hens, there is still a risk of salmonella infection from the ingestion of raw eggs. It is relevant to point out that Salmonella enteritidis organisms may be present inside the egg. The household remedy of quickly scalding the eggs before use thus provides no security against Salmonella enteritidis infection.
(A. Poulstrup, MOH, Vejle County, K. Mølbak, Dept. of G-I Inf.)
INFLUENZA
Sentinel surveillance is showing an increased incidence of influenza, which could be interpreted as a possible incipient epidemic (see page 2). The figures cover the whole country and any differences in incidence between counties cannot be assessed. Most other European countries are also reporting an increased incidence with localized outbreaks. During the present winter season up to week 52 inclusive, a total of 48 specimens have been received via the sentinel system. Seven influenza A isolates have been found, all subtyped as influenza A/Moscow/10/99- (H3N2)-like. A second round of specimen-taking programme by 20 new sentinel physicians has just been initiated. The influenza A isolates found are closely related to one of the strains in the current vaccine: A/Sydney/5/ 97-(H3N2)-like. The vaccine for 1999/2000 should therefore also provide immunity against the influenza strain that is now being isolated.
(P.C. Grauballe, Dept. of Virol., S. Glismann, Dept. of Epidemiol.)
5 January 2000
See table: Patients with positive cultures of pathogenic intestinal bacteria in 1999, by county
See table: Sentinel surveillance of Influenzaactivity |
|
|
|
|
|
|
|
|
|
