Outbreak of Uncommon O4 Non-Agglutinating Salmonella Typhimurium Linked to Minced Pork, Saxony-Anhalt, Germany, January to April 2013
Creators: name: Alt, Katja
name: Simon, Sandra
name: Helmeke, Carina
name: Kohlstock, Claudia
name: Prager, Rita
name: Tietze, Erhard
name: Rabsch, Wolfgang
name: Karagiannis, Ioannis
name: Werber, Dirk
name: Frank, Christina
name: Fruth, Angelika
Publisher: name: Robert Koch-Institut, Infektionskrankheiten / Erreger; Robert Koch-Institut, Infektionsepidemiologie
Year: 2015
Subjects: subject: Humans
subject: Male
subject: Adult
subject: Aged
subject: Germany/epidemiology
subject: Middle Aged
subject: Young Adult
subject: Phenotype
subject: Disease Outbreaks
subject: Case-Control Studies
subject: Salmonella Food Poisoning/epidemiology
subject: Salmonella Food Poisoning/microbiology
subject: Food Handling
subject: Food Safety
subject: Red Meat/microbiology
subject: Salmonella typhimurium/isolation &amp; purification
subject: Salmonella typhimurium/physiology
subject: 610 Medizin

description: Introduction: In January 2013, the National Reference Centre for Salmonella (NRC) detected a salmonellosis cluster in Saxony-Anhalt, Germany, caused by uncommon O4 non-agglutinating, monophasic Salmonella (S.) Typhimurium DT193. Circulating predominant monophasic S. Typhimurium DT193 clones typically display resistance phenotype ASSuT. We investigated common exposures to control the outbreak, and conducted microbiological investigations to assess the strains’ phenotype. Methods: We conducted a case-control study defining cases as persons living or working in Saxony-Anhalt diagnosed with the O4 non-agglutinating strain between January and March 2013. We selected two controls contemporarily reported with norovirus infection, frequency-matched on residence and age group, per case. We interviewed regarding food consumption, especially pork and its place of purchase. We calculated odds ratios (ORs) with 95% confidence intervals (95% CI) using logistic regression. The NRC investigated human and food isolates by PCR, SDS-PAGE, MLST, PFGE, MLVA and susceptibility testing. Results: Altogether, 68 O4 non-agglutinating human isolates were confirmed between January and April 2013. Of those, 61 were assigned to the outbreak (median age 57 years, 44% female); 83% cases ≥ 60 years were hospitalized. Eating raw minced pork from butcheries within 3 days was associated with disease (31 cases, 28 controls; OR adjusted for sex: 3.6; 95% CI: 1.0-13). Phage type DT193 and MLST ST34 were assigned, and isolates’ lipopolysaccharide (LPS) matched control strains. Isolates linked to Saxony-Anhalt exhibited PFGE type 5. ASSuT- and ACSSuT phenotype proportions were 34 and 39% respectively; 54% were resistant to chloramphenicol. Three pork isolates matched the outbreak strain. Discussion: Raw minced pork was the most likely infection vehicle in this first reported outbreak caused by O4 non-agglutinating, mostly chloramphenicol-resistant S. Typhimurium DT193. High hospitalization proportions demand awareness on the risk of consumption of raw pork among elderly. LPS analysis indicated O4 expression; therefore, testing with antisera from different lots is recommendable in unexpected agglutination reactions.