International epidemiological and microbiological study of outbreak of Salmonella agona infection from a ready to eat savoury snack—I: England and Wales and the United States

• Published in: BMJ Vol. 313; no. 7065; pp. 1105 - 1107
• Main Authors: Killalea, D, Ward, L R, Roberts, D, de Louvois, J, Sufi, F, Stuart, J M, Wall, P G, Susman, M, Schwieger, M, Sanderson, P J, Fisher, I S T, Mead, P S, Gill, O N, Bartlett, C L R, Rowe, B
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 02.11.1996; British Medical Association; BMJ Publishing Group LTD; BMJ Publishing Group; BMJ Group
• Edition: International edition
• Subjects: Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacteriophages; Biological and medical sciences; Case-Control Studies; Child, Preschool; Children; Communication; Disease Outbreaks; Diseases; England - epidemiology; Environmental laboratories; Epidemiology; Food Microbiology; Food Preservation; Human bacterial diseases; Humans; Infant; Infections; Infectious diseases; International Cooperation; International relations-US; Medical sciences; Product recalls; Public health; Salmonella; Salmonella Food Poisoning - epidemiology; Salmonella Food Poisoning - microbiology; Savory; Snacking; United States - epidemiology; Wales - epidemiology; England; United States; Wales; Great Britain; Europe; America; United Kingdom; North America; Canada; Israel; UK; US; Human; Salmonella; Epidemiology; Contamination; Feeding; Infection; Microbiological investigation; Food poisoning; Bacteriosis; Digestive diseases; Bacteria; Salmonellosis; Sanitary surveillance; Public health; Enterobacteriaceae
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.313.7065.1105

Abstract Objectives: To identify the source of an international outbreak of food poisoning due to Salmonella agona phage type 15 and to measure how long the underlying cause persisted. Design: Case-control study of 16 primary household cases and 32 controls of similar age and dietary habit. Packets of the implicated foodstuff manufactured on a range of days were examined for salmonella. All isolates of the epidemic phage type were further characterised by pulsed field gel electrophoresis. Results: 27 cases were identified, of which 26 were in children. The case-control study showed a strong association between infection with S agona phage type 15 and consumption of a peanut flavoured ready to eat kosher savoury snack imported from Israel. S agona phage type 15 was isolated from samples of this snack. The combined food sampling results from the United Kingdom, Canada, the United States, and Israel showed that contaminated snacks were manufactured on at least seven separate dates during a four month period between October 1994 and February 1995. Voluntary recalls of the product successfully interrupted transmission. Conclusions: Rapid international exchanges of information led to the identification of the source of a major outbreak of S agona in Israel and of associated cases in North America. The outbreak showed the value of the Salm-Net surveillance system and its links outside Europe, both for increasing case ascertainment and for improving the information on the duration of the fault at the manufacturing plant. Key messages International surveillance networks can strength- en infection control When a foodstuff is contaminated it is important to examine as many batches as possible to show the duration of the production fault