Salmonella Enteritidis outbreak related to Polish eggs 22 nd EURL-Salmonella workshop 29-30 May 2017, Zaandam Pamina M. Suzuki, DG SANTE-G4 Food hygiene
OUTLINE Background published ROA Human data Info on food and enviromental investigations Conclusions
Assessment ECDC: human data, inquiries, advice for treatments EFSA: to assess food/animal data, Consumers' advice, investigation to source Techn. support Multinational Outbreak investigations Joint Rapid Outbreak Assessment EURL network: analytical methods, molecular testing Techn. support Management DG SANTE: Based on assessment: measures, trade restrictions, negociations with third countries Molecular Typing database TESSy Data sharing EWRS RASFF MEMBER STATES' BODIES
EU outbreak case definition A laboratory-confirmed Salmonella Enteritidis case with symptoms onset on or after 1 May 2016 (date of sampling or date of receipt by the reference laboratory if date of onset is not available) AND [Confirmed] Fulfilling the following laboratory criterion: with a strain sharing the same t5-level SNP address as one of the defined UK outbreak clusters based on WGS analysis (1.2.3.175.175.175.% or 1.2.3.18.359.360.%). [Probable] Fulfilling the following laboratory criterion: with a strain matching the MLVA profile 2-9-7-3-2 or 2-9-6-3-2 corresponding to the MLVA protocol with 5 loci.
EU outbreak case definition - historical A historical confirmed case: A Salmonella Enteritidis strain sharing the same t5 level SNP address as one of the defined UK outbreak clusters based on WGS analysis and date of disease onset from February 2012 to April 2016 (date of sampling or date of receipt by the reference laboratory if date of onset is not available). A historical probable case: A laboratory-confirmed Salmonella Enteritidis case with MLVAtype 2-9-7-3-2 or 2-9-6-3-2 and date of disease onset from February 2012 to April 2016 (date of sampling or date of receipt by the reference laboratory if date of onset is not available).
EU outbreak case definition - excluded Cases with travel history outside of the EU/EEA Secondary cases defined as those confirmed cases that have had person-to-person contact with a confirmed case and no exposure to a common source Cases infected with MLVA-type 2-9-7-3-2 or 2-9-6-3-2, but not sharing the t5-level SNP address as one of the defined UK outbreak clusters based on WGS analysis (1.2.3.175.175.175.% or 1.2.3.18.359.360.%)
Distribution of outbreak cases by reporting country, case classification and genetic cluster (n=606) EU/EEA 2012-2017 as of 05/05/2017 Historical Confirmed Confirmed Historical Country Probable Total Total Cluster Cluster Cluster Cluster - Probable _175 _360 _175 _360 BE 12 2 119 133 0 0 0 0 DK 5 1 0 6 0 0 0 0 EL 0 0 2 2 0 0 0 0 FI 0 0 1 1 1 0 0 1 FR 3 2 0 5 0 0 0 0 HR 4 0 0 4 0 0 0 0 HU 0 0 5 5 0 0 0 0 IT 1 0 0 1 0 0 0 0 LU 1 3 0 4 0 0 0 0 NL 55 18 98 171 2 13 5 20 NO 9 2 14 25 0 0 19 19 SE 7 3 0 10 2 0 0 2 SI 2 1 0 3 0 0 0 0 UK 82 19 4 105 40 49 0 89 Total 181 49 245 475 45 62 24 89
S. Enteritidis multicountry outbreak cases by week of statistics* and case classification (n=606), EU/EEA 2015-2017, as of 05/05/2017 60 50 40 Confirmed Historical - Conf Probable Historical - Probable 30 20 10 0 2015-01 2015-04 2015-07 2015-10 2015-13 2015-16 2015-19 2015-22 2015-25 2015-28 2015-31 2015-34 2015-37 2015-40 2015-43 2015-46 2015-49 2015-52 2016-02 2016-05 2016-08 2016-11 2016-14 2016-17 2016-20 2016-23 2016-26 2016-29 2016-32 2016-35 2016-38 2016-41 2016-44 2016-47 2016-50 2017-01 2017-04 2017-07 2017-10 *Week of onset, or week of sampling or week of received date at reference lab level
S. Enteritidis 2-9-7-3-2: historical confirmed and confirmed cases by week of statistics and genetic cluster (n=337), EU/EEA 2015-2017, as of 05/05/2017 20 18 16 14 12 10 20 18 16 14 12 10 8 6 4 2 0 8 6 4 2 0 Cluster_175 (n=223) 2015-01 2015-03 2015-05 2015-07 2015-09 2015-11 2015-13 2015-15 2015-17 2015-19 2015-21 2015-23 2015-25 2015-27 2015-29 2015-31 2015-33 2015-35 2015-37 2015-39 2015-41 2015-43 2015-45 2015-47 2015-49 2015-51 2015-53 2016-02 2016-04 2016-06 2016-08 2016-10 2016-12 2016-14 2016-16 2016-18 2016-20 2016-22 2016-24 2016-26 2016-28 2016-30 2016-32 2016-34 2016-36 2016-38 2016-40 2016-42 2016-44 2016-46 2016-48 2016-50 2016-52 2017-02 2017-04 2017-06 2017-08 2017-10 2017-12 2015-01 2015-03 2015-05 2015-07 2015-09 2015-11 2015-13 2015-15 2015-17 2015-19 2015-21 2015-23 2015-25 2015-27 2015-29 2015-31 2015-33 2015-35 2015-37 2015-39 2015-41 2015-43 2015-45 2015-47 2015-49 2015-51 Cluster_360 (n=103) 2016-02 2016-04 2016-06 2016-08 2016-10 2016-12 2016-14 2016-16 2016-18 2016-20 2016-22 2016-24 2016-26 2016-28 2016-30 2016-32 2016-34 2016-36 2016-38 2016-40 2016-42 2016-44 2016-46 2016-48 2016-50 2016-52 2017-02 2017-04 2017-06 2017-08 2017-10 2017-12
ROA on multi-country outbreak due to S.Enteritidis Multi-country outbreak of S. Enteritidis PT 8 with multiple locus variable-number tandem repeat analysis (MLVA) profiles 2-9-7-3-2 and 2-9-6-3-2, linked to eggs, is ongoing in the EU/EEA. Based on WGS, isolates are part of two distinct but related genetic clusters (cluster_175 and cluster_360). ECDC and EFSA liaised with relevant authorities in the Member States and at the EU level to facilitate the coordination of investigation and response measures. Joint EFSA-ECDC ROA on Multi-country outbreak of Salmonella Enteritidis phage type 8, MLVA type 2-9-7-3-2 and 2-9-6-3-2 infections published on 27 October 2016. Link between the multi-country outbreak and a egg packing centre (B) in Poland, pointing at eggs as the most likely vehicle of infection for at least part of the outbreak cases
ROA on multi-country outbreak due to S.Enteritidis Microbiological & environmental investigations on food Country information on food and environmental investigations related to this outbreak: Reported to RASFF (as of 1 March 2017) food tracing Additional information reported by the national authorities of the interested Member States to EFSA (as of 1 March 2017) The food safety authorities in Belgium, Croatia, Hungary, the Netherlands, Poland and United Kingdom carried out extensive environmental and food investigations to identify the source of this outbreak Main food tracing and testing information visualised in a graph
ROA update: NL [tracing-back investigation*] Cluster of 19 human cases 5 000 eggs sampled and analysed in pools of 10 (500 samples of egg-shell and 500 from egg-content) 70 pools of egg-shells positive for Salmonella, of which 66 pools positive for S. Enteritidis MLVA: 62 isolates: 2-9-7-3-2 2 isolates 2-10-8-3-2 1 isolate 2-9-6-3-2 1 isolate 2-10-7-3-2 WGS (10 isolates) (3) 2-9-7-3-2 = C_175 (5) 2-9-7-3-2= C_360 (1) 2-9-6-3-2= C_360 (1) 2-10-8-3-2= out 16 restaurants 11 wholesares *carried out by the Netherlands Food and Product Safety Authority (NVWA) and the National Institute for Public Health and the Environment (RIVM)
ROA update: NL [tracing-forward investigation] Suspected eggs were further distributed to ~2200 FBOs within the Netherlands, mainly Asian restaurants Furthermore, the suspect eggs and (unpasteurised) egg products were shipped to the following 8 EU Member States: Belgium, Denmark, France, Germany, Italy, Poland, Sweden, and the United Kingdom. Suspected batches of eggs were also distributed to 8 third countries: Angola, Bahrein, Congo, Gambia, Oman, Sierra Leone, Qatar and United Arab Emirates
ROA update: HU [tracing-back investigation] Official investigations carried out to investigate the potential source of infection for two clusters of S. Enteritidis human cases Human cases occurred in August 16: associated with consumption of prepared meal containing eggs in a summer holiday resort Human cases occurred in September 16: associated with consumption of eggs in a restaurant Resort: samples from prepared meals containing eggs from Polish farm A Packing centre E did not distribute contaminated eggs originating from the mentioned Polish farms to other countries Packing centre A: pooled of egg-shells (15 pieces) originated from a Polish farm not included in the list of the Polish laying hen farms
ROA update: BE [tracing-back investigation] At the end of September 2016, the Federal Agency for the Safety of the Food Chain (FASFC) in Belgium investigated two butchers associated with a cluster of cases. N samples N pos S. Enteritidis N isolates WGS WGS cluster 51 food samples for both butchers 20 positive samples MLVA 2-9-7-3-2 [minced beef/pork (containing eggs), spaghetti sauce (with minced meat), vole au vent (contains raw eggs), pork chop and filet americain (with minced meat)] 6 isolates MLVA 2-9-7-3-2 (successfully performed WGS) - 4 isolates (from minced beef/pork meat, spaghetti sauce, vol-au-vent, and pork chop) belonged to WGS cluster_175-2 isolates (from steak tartare and unspecified meat products) belonged to WGS cluster_360
ROA update: HR [tracing-back investigation] Sampling stage N samples tested Positive for S.E. Family house: remaninig eggs Retail outlet where family bought the eggs Wholesaler J MLVA - WGS 22 eggs (content) 2 Not available Eggs-shell and content 1 070 samples of egg-shell and eggcontent analysed in pools of 10 0 9 pooled samples 9 isolates MLVA 2-9-7-3-2: - 5 isolates belong to WGS cluster_175-3 isolates belong to WGS cluster_175-1 isolate out
ROA update: UK [tracing-back investigation] Investigation of a national outbreak of S. Enteritidis PT 8 MLVA 2-9-7-3-2 (WGS clusters_175 and 360) Human cases linked to restaurants Interviews of cases in England and Wales did not identify any common exposures or exposure settings so no targeted egg supply investigations were carried out in England and Wales. In Scotland: exposure to eggs tracing back investigation
ROA update: PL [food&enviroment investigations] NL HU BE UK HR
ROA update: PL [tracing-forward investigation] Contaminated eggs were further distributed to Poland and to the following EU/EEA 18 countries: Austria, Belgium, Bulgaria, Croatia, the Czech Republic, Denmark, Germany, Greece, France, Hungary, Ireland, Italy, the Netherlands, Norway, Romania, Slovakia, Sweden and the United Kingdom Batches of eggs from positive farms were also distributed from Poland to 8 third countries: Angola, Djibouti, Gambia, Hong Kong, Iraq, Liberia, Oman and United Arab Emirates.
Trace forward - withdrawal RASFF info on 12/12/16
Distribution from PL
Distribution Europe and Third Countries 18 MSs: BE, BG, HR, CZ, DE, DK, FR, EL, HU, IT, NL, NO, PL, RO, UK, SK, IE, SE 12 Third countries: Angola, Djibouti, Liberia, Oman, United Arab Emirates, Hong Kong, Bahrain, Congo, Sierra Leone, Qatar, Gambia, Iraq
ROA Update: threat assessment & conclusions A multi-country outbreak of S. Enteritidis has been confirmed by WGS analysis on isolates belonging to MLVA type 2-9-7-3-2 and 2-9-6-3-2. By WGS, the human isolates split into two distinct genetic clusters WGS cluster_175 and WGS cluster_360. Outbreak still ongoing with cases reported since May 2016 by 14 EU/EEA MSs Number of confirmed and probable cases increased steadily from May 2016 to the first week of October 2016 (peak with 60 new reported cases) plateau (about 15 cases/week) decrease from last week of Nov to first week of May(<5cases/week) Decline in number of cases is encouraging
ROA Update: conclusions Available evidence from epidemiological, WGS, environmental and tracing investigations identified eggs originating from three Polish packing centres as the vehicle of infection in this outbreak. 18 S. Enteritidis positive farms reported by Poland According with the information provided by Polish authorities, no S. Enteritidis positive breeding flocks was detected in 2016. Based on the assessment of the current evidences, the source of infection of this outbreak is very likely to be at laying hen farm level
ROA Update: conclusions The outbreak peaked in Oct 2016, when the vehicle of infection was identified & control measures implemented at farm and distribution level decrease in human cases In order to monitor the public health impact of control measures, an enhanced surveillance period has been established by the international outbreak investigation team. MS were recommended to perform WGS on any human isolate characterised by the MLVA profile 2-9-7-3-2 or 2-9-6-3-2. All countries identifying new confirmed or probable cases should also consider timely interviewing the new cases EU/EEA countries should also consider performing WGS of non-human isolates when isolates are found to have a link to Polish eggs/farms
S. Enteritidis 2-9-7-3-2: cases by country, and week of statistics (n=606), EU/EEA 2015-2017, as of 05/05/2017 60 50 40 BE DK EL FI FR HU IT LU NL NO SE SI UK_E&W UK-Scot 30 20 10 0 2015-01 2015-03 2015-05 2015-07 2015-09 2015-11 2015-13 2015-15 2015-17 2015-19 2015-21 2015-23 2015-25 2015-27 2015-29 2015-31 2015-33 2015-35 2015-37 2015-39 2015-41 2015-43 2015-45 2015-47 2015-49 2015-51 2016-01 2016-03 2016-05 2016-07 2016-09 2016-11 2016-13 2016-15 2016-17 2016-19 2016-21 2016-23 2016-25 2016-27 2016-29 2016-31 2016-33 2016-35 2016-37 2016-39 2016-41 2016-43 2016-45 2016-47 2016-49 2016-51 2016-53 2017-02 2017-04 2017-06 2017-08 2017-10 2017-12 *Week of onset, or week of sampling or week of received date at reference lab level
Conclusions Example of successful multi-sectorial approach and collaboration between public health authorities (follow-up of human cases), food safety authorities (investigations to source), laboratories and risk assessors Systems and network in place to manage foodborne outbreaks Important role of molecular typing data supported by epidemiological and traceability information Strong collaboration between EC, EFSA, ECDC, EURLs at EU level + similar approach observed at national level of countries involved
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