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Salmonella is a bacteria commonly transmitted to humans by eating contaminated foods of animal origin such as meat, poultry, milk or eggs. In the UK, Salmonella Enteritidis infections in humans have been frequently associated with consumption of poultry meat and hen's eggs. Surveillance provides early warning of livestock disease threats and analysis of how diseases spread. Control and eradication of diseases at their source has the potential to protect livestock in other areas of the world. Biosecurity measures address isolation of new/sick animals, movement of people/animals/equipment, and cleaning/disinfection procedures.
Salmonella is a bacteria commonly transmitted to humans by eating contaminated foods of animal origin such as meat, poultry, milk or eggs. In the UK, Salmonella Enteritidis infections in humans have been frequently associated with consumption of poultry meat and hen's eggs. Surveillance provides early warning of livestock disease threats and analysis of how diseases spread. Control and eradication of diseases at their source has the potential to protect livestock in other areas of the world. Biosecurity measures address isolation of new/sick animals, movement of people/animals/equipment, and cleaning/disinfection procedures.
Salmonella is a bacteria commonly transmitted to humans by eating contaminated foods of animal origin such as meat, poultry, milk or eggs. In the UK, Salmonella Enteritidis infections in humans have been frequently associated with consumption of poultry meat and hen's eggs. Surveillance provides early warning of livestock disease threats and analysis of how diseases spread. Control and eradication of diseases at their source has the potential to protect livestock in other areas of the world. Biosecurity measures address isolation of new/sick animals, movement of people/animals/equipment, and cleaning/disinfection procedures.
Salmonella Infections Name of t!e "riter# Name of t!e Institution# Salmonella Infections 2 SALMONELLA INFECTIONS IN $% Introduction Salmonella generall& li'es in t!e gut of animals( including )irds* Salmonella is usuall& transmitted to !umans )& eating foods contaminated +it! animal faeces* T!ese contaminated foods are t&,icall& from animal origin suc! as )eef( ,oultr&( mil- or eggs )ut all foods( including 'egeta)les( ma& )e contaminated* T!e )acteria are commonl& found in ra+ eggs and undercoo-ed c!ic-en and eggs* .erson/to/,erson s,read is ,ossi)le in close contact( usuall& during t!e acute diarr!eal ,!ase of t!e illness Epidemiology of Salmonella Enteritidis in the United Kingdom E,idemiologic in'estigations of out)rea-s and s,oradic cases re,eatedl& s!o+ed t!at Salmonella Enteritidis .T0 infection in !umans +as fre1uentl& associated +it! consum,tion of ,oultr& meat and !ens2 eggs on )ot! sides of t!e Atlantic 34567#* In nearl& 3488 food )orne disease out)rea-s re,orted to t!e $% Healt! .rotection Agenc& )et+een 7993 and 388:( Salmonella s,ecies accounted for 0;< of all out)rea-s( 0=< of cases( ;8< of !os,ital admissions( and ;=< of deat!s* Salmonella Enteritidis .T0 +as t!e causati'e organism in 47< of all t!e Salmonella out)rea-s t!roug!out t!e sur'eillance ,eriod )ut t!e ,ercentage of out)rea-s caused )& Salmonella Enteritidis .T0 declined from t!e late 7998s on+ard* At least one food 'e!icle +as identified in ;4< of out)rea-s re,orted( and ,oultr& meat +as t!e 'e!icle most often im,licated >79< of out)rea-s?* Desserts +ere also im,licated commonl& >77< of out)rea-s?( and ra+ s!ell eggs +ere used as an ingredient in ;8< of t!ese desserts* Eggs +ere Salmonella Infections 3 im,licated se,aratel& in an additional =< of out)rea-s* Anal&sis of out)rea- data also s!o+ed t!at nearl& 48< of food )orne Salmonella out)rea-s occurred in t!e food ser'ice@catering sector* Salmonella Aallinarum and Salmonella .ullorum !ad )een t!e dominant Salmonella ser'ers in $% ,oultr& until t!e earl& 79;8s* T!ese strains )ot! caused clinical disease in t!e )irds and +ere 'irtuall& eradicated )& a com)ination of slaug!tering of sero,ositi'e !ens and 'accination* Ho+e'er( t!e ecological nic!e left )& t!ese 3 ser'ers +as filled )& Salmonella Enteritidis* Com,lete genome se1uencing of a !ost/,romiscuous Salmonella Enteritidis .T0 isolate and a c!ic-en/restricted Salmonella Aallinarum isolate !as indicated t!at Salmonella Aallinarum is a recentl& e'ol'ed descendent of Salmonella Enteritidis* Im,ortantl&( Salmonella Enteritidis infects ,oultr& +it!out causing o'ert disease( +!ic! ,ro)a)l& facilitated its ra,id s,read internationall&* Anot!er -e& feature of Salmonella Enteritidis is coloniBation of t!e re,roducti'e tissues leading to t!e ,roduction of eggs +it! Salmonella/,ositi'e contents and( in some eggsC t!e num)ers of organisms can )e 'er& !ig!* Disease Prevention T!e E$ Animal Healt! Strateg&( D.re'ention is )etter t!an cureE( outlines )ot! ,re'ention and control measures to )e im,lemented during a disease out)rea-* Some of t!ese measures( suc! as 'accines and antimicro)ials( can )e used for )ot! ,re'ention and control* Surveillance Sur'eillance ,ro'ides earl& +arning and ,rom,t detection of li'estoc- disease t!reats( toget!er +it! anal&sis of t!e +a& diseases s,read* Sur'eillance +it!in t!e $% de,ends on disease identification and re,orting )& li'estoc- -ee,ers and 'eterinarians and ena)les disease ,atterns to )e monitored* Monitoring of international disease at Defra +as intensified in t!e +a-e Salmonella Infections 4 of t!e 3887 Foot and Mout! Disease >FMD? out)rea-( to identif& ne+ t!reats to $% li'estoc-* Defra uses official disease re,orts from t!e OIE ( E$( Foreign and Common+ealt! Office( $% la)oratories and researc! articles to monitor disease ris- and trends in ne+ and emerging diseases* It ,roduces mont!l& re,orts outlining t!e main eFotic disease t!reats and mont!l& and 1uarterl& re,orts on t!e domestic disease situation* Control at Source Li'estoc- disease is a glo)al ,ro)lem* Emerging diseases( c!anging ,atterns of disease and increasing glo)aliBation mean t!at glo)al disease t!reats also ,ut t!e $% at ris-* Control( and ultimatel& eradication( of diseases else+!ere in t!e +orld !a'e t!e ,otential to ,rotect animals in t!e $%* For instance Rinder,est( a disease of cattle( is on sc!edule to )e eradicated +orld+ide )&* Ho+e'er( t!e eFtent to +!ic! ot!er diseases can )e tac-led in t!is +a& is uncertain* Bio security Aood )io securit& means ensuring good !&giene ,ractices are in ,lace* It is a 'ital ,art of -ee,ing disease a+a& from li'estoc-( ,re'enting an& s,read )et+een li'estoc- and( for Boonoses( minimiBing t!e transfer to !umans* Gio securit& measures address isolation of ne+ and diseased animalsC mo'ement of ,eo,le( animals and e1ui,mentC and ,rocedures for cleaning and disinfecting facilities and 'e!icles* Gio securit& must )e maintained in farms( mar-ets( during trans,ort and at slaug!ter* Traceability Geing a)le to trace li'estoc- mo'ements ena)les disease s,read to )e monitored* Currentl&( indi'idual identification can )e ac!ie'ed( for eFam,le in cattle( using a ,a,er/)ased s&stem of animal ,ass,orts and !olding registers com)ined +it! national identification Salmonella Infections 5 data)ases* T!e E$ is im,lementing a s&stem across mem)er states re1uiring all s!ee, 73 mont!s or older to )e electronicall& tagged* T!e introduction of afforda)le electronic identification could im,ro'e efficienc& and lead to an integrated E$ electronic s&stem* Ho+e'er( ot!er li'estoc- suc! as ,oultr& are not currentl& co'ered )& suc! arrangements* Import/Trade controls Legal and illegal im,orts of li'e animals and animal ,roducts are ,otential sources of disease ris-* Non/animal ,roducts can also )e ,otential* For instance im,orted car t&res can !ar)our mos1uito lar'ae* Wildlife Control/Management Se'ent& t+o ,ercent of diseases transferred )et+een li'estoc- and !umans are also ,resent in +ildlife* Vaccination Haccination and culling of +ildlife can )e used to ,re'ent t!e s,read from +ildlife to li'estoc-* For instance( 'arious trials !a'e s!o+n t!at culling )adgers reduces )o'ine TG incidence +!ere t!e culling occurs( )ut can also increase )o'ine TG in t!e surrounding area* Defra is consulting on +!et!er to licence )adger culling in t+o different locationsC culling !as )een o,,osed )& some animal +elfare and conser'ation grou,s* Haccines stimulate an immune res,onse to ,rotect animals against later infection +it! a s,ecific disease* T!e& are +idel& and routinel& used to control endemic diseases suc! as Salmonella in ,oultr&* Haccines could ,otentiall& )e used to ,re'ent diseases suc! as )o'ine TG( alt!oug! no effecti'e cattle 'accine is currentl& a'aila)le for t!is disease* Husbandry/Production System Salmonella Infections 6 Animals t!at are cared for a,,ro,riatel& and in accordance +it! eFisting +elfare standards are less li-el& to contract or s,read disease and tend to )e !ealt!ier* Additionall&( different ,roduction s&stems are associated +it! differing disease ris-s* For eFam,le( intensi'e( indoor s&stems can significantl& reduce contact +it! certain diseases* Ho+e'er( stress associated +it! intensi'e ,roduction ma& increase susce,ti)ilit& to disease and its su)se1uent s,read* Con'ersel&( animals !oused in eFtensi'e s&stems mig!t )e more li-el& to come into contact +it! disease( )ut t!e ris- of contracting and s,reading it ma& )e lo+er* enetic Modification and Cloning Aenetic modification >AM? could )e used to introduce no'el genes t!at confer resistance to infection* For instance in 3877( scientists at t!e Roslin Institute used AM to ,re'ent c!ic-ens transmitting A'ian InfluenBa* Animal cloning is used to generate an indi'idual t!at !as t!e same DNA as anot!er indi'idual* Scientists !a'e alread& cloned animals to eFtend t!eir )reeding and ,roduction ,otential( and ma& in future )e a)le to clone animals +it! reduced susce,ti)ilit& to disease* Some consumer grou,s !a'e eF,ressed safet& concerns a)out AM and cloned animals( +!ereas ot!er grou,s o,,ose suc! ,rocedures on animal +elfare grounds* Food from cloned animals must )e aut!orised under t!e E$ No'el Foods Regulation )efore it can )e sold* Ho+e'er( t!ere !a'e )een no a,,lications in t!e E$ to date* In No'em)er 3878( t!e Ad'isor& Committee on No'el Foods and .rocesses concluded t!at meat and mil- from cloned cattle and t!eir offs,ring +ere unli-el& to ,resent a food safet& ris-( )ut noted t!at consumers ma& +is! to see effecti'e la)elling* E$ negotiations on amendments to t!e no'el foods regulations )ro-e do+n in Marc! 3877* T!e Commission is li-el& to ,ro,ose ne+ legislation s,ecificall& on cloning )ut t!e timing is unclear* Salmonella Infections 7 Disease Control Follo+ing a disease out)rea-( additional measures can )e im,lemented to control its s,read* For some notifia)le diseases( t!e Euro,ean Commission ,ro!i)its eF,ort of animals and animal ,roducts from t!e affected s,ecies until disease/free status !as )een ac!ie'ed* !ntimicrobials Antimicro)ials >or anti)iotics? destro& or in!i)it t!e gro+t! of )acteria* T!e& ma& )e used )ot! to treat disease in infected animals and to ,re'ent disease in t!ose at ris- or -no+n to )e susce,ti)le* All li'estoc- medicines are su)Iect to strict regulation* "!ile t!e controlled use of antimicro)ials )& 'eterinarians is necessar& to limit infections in animals( eFcessi'e or ina,,ro,riate use ma& contri)ute to t!e de'elo,ment of antimicro)ial resistant organisms* T!ere is concern t!at t!e irres,onsi)le use of antimicro)ials in animals mig!t com,romise t!e effecti'eness of related medicines in !umans* Culling of "ivestoc# Anot!er control measure is to slaug!ter and dis,ose of infected animals( and animals t!at !a'e )een in contact +it! t!em or in t!eir 'icinit&* Accurate sur'eillance information a)out t!e geogra,!ical location of disease and its s,read can )e used to construct models to inform culling ,olic&* $mergency vaccination Haccination can )e used to control an out)rea- of disease once it !as )een detected* For eFam,le( it +as successfull& used to control a $% Gluetongue out)rea- in 388;( and Defra is currentl& trialling a )adger 'accine as a control measure for )o'ine TG* Ho+e'er( 'accination !as its dra+)ac-s* For instance( fe+ 'accines gi'e 788< ,rotection and 'accines !a'e not &et )een de'elo,ed for all diseases* For some diseases( use of 'accination during an out)rea- can Salmonella Infections 8 ma-e it difficult to distinguis! )et+een animals t!at !a'e )een 'accinated and t!ose t!at are infected* T!is ma-es it !ard to ascertain +!en t!e disease !as )een eliminated and disease/free status !as )een ac!ie'ed* T!e de'elo,ment of DIHA >Differentiating Infected and Haccinated Animals? tests is ongoing and is li-el& to ma-e 'accination a more attracti'e o,tion* !nimal Movement Controls During an out)rea- of a contagious notifia)le disease( ,re'enting t!e mo'ement of animals )et+een farms( mar-ets and slaug!ter!ouses can limit disease s,read* Critical evaluation of current legislation Salmonella concerning UK Com,elling e'idence t!at t!e decline in Salmonella is real is deri'ed from 6 sources* T!e first com,rises 3 ,o,ulation/)ased ,ros,ecti'e co!ort studies of infectious intestinal disease >IID? in t!e communit& conducted more t!an a decade a,art* T!e ,rimar& outcome measures in )ot! studies +ere estimates of t!e incidence of IID in t!e communit&( ,resenting to ,rimar& !ealt!care and re,orted to national sur'eillance* T!e& +ere conducted using identical stud& designs and case definitions and em,lo&ed similar micro)iological met!ods( t!e eFce,tion )eing t!at molecular micro)iological tec!ni1ues +ere used alongside traditional micro)iolog& in t!e second stud& of infectious intestinal disease >IID3?* In t!e first stud& of infectious intestinal disease >IID7? in 79965799=( t!e incidence of non/t&,!oidal Salmonella in t!e communit& in England +as 3*3 cases ,er 7888 ,erson/&ears >94< confidence inter'al CI#( 7*750*6? )ut )& 388:53889 t!is !ad fallen to 8*; cases ,er 7888 ,erson/&ears >94< CI( *356*8?* For non/ t&,!oidal Salmonella cases ,resenting to ,rimar& care in England( t!e incidence rate !ad fallen from 7*= cases ,er 7888 ,erson/&ears >94< CI( 7*353*7? in IID7 to 8*3 cases ,er 7888 ,erson/ &ears >94< CI( *75*4? in IID3* T!e decline in incidence in t!e communit& +as not statisticall& Salmonella Infections 9 significant )ecause in IID3 t!e stud& ,o+er +as insufficient to detect statisticall& significant c!anges in organism/s,ecific incidenceJto do t!is +ould !a'e re1uired K788 888 ,erson/&ears of follo+/u,( )ased on incidence rates in IID7* Ne'ert!eless( t!e reduction in ,resentations to ,rimar& !ealt!care +as statisticall& significant* Second( t!ere !as )een a su)stantial fall in la)orator&/confirmed Salmonella cases re,orted to national sur'eillance .!age t&,ing of Salmonella Enteritidis +as im,lemented from 79:7 as an addition to t!e centraliBed( national ser'ice alread& in eFistence for confirmation and furt!er t&,ing( and all clinical diagnostic la)oratories !a'e continued to refer all Salmonella isolates to t!e national reference la)oratories since t!at date* At t!e )eginning of 7993( 3 se,arate national Salmonella data)ases +ere merged to form a single national dataset( +!ic! )ecame ,atient/)ased rat!er t!an isolate/)ased( t!us eliminating ,otential du,lication if ,eo,le +ere tested more t!an once* La)orator& testing met!ods !a'e remained constant since t!en and re,orting algorit!ms !a'e not c!anged( suggesting t!at t!e reduction in Salmonella is real* "!en Salmonella Enteritidis .T0 ,ea-ed in 7996 in t!e $nited %ingdom( K7: 888 la)orator&/confirmed cases of illness +ere recorded in national sur'eillance statistics( &et )& 3878 .T0 isolations !ad fallen to Iust 049 30#* T!us( t!e decline in non/t&,!oidal Salmonellosis +itnessed in t!e $nited %ingdom in recent &ears reflects t!is maIor contraction in re,orts of Salmonella Enteritidis .T0* Finall&( out)rea-s of Salmonellosis !a'e declined* StandardiBed re,orting of out)rea-s of gastrointestinal infection +as introduced in 7993 in England and "ales and in 799= in Scotland ,artl& in res,onse to t!e increase in non/t&,!oidal Salmonellosis* A food )orne out)rea- is defined in Euro,ean legislation as Dan incidence( o)ser'ed under gi'en circumstances( of t+o of more !uman cases of t!e same disease and@or infection( or a situation in +!ic! t!e o)ser'ed Salmonella Infections 10 num)er of !uman cases eFceeds t!e eF,ected num)er and +!ere t!e cases are lin-ed( or are ,ro)a)l& lin-ed( to t!e same sourceE* Get+een 7993 and 388:( food )orne Salmonella out)rea-s re,orted to national sur'eillance fell from nearl& 748 ,er &ear to Iust o'er 38 annuall&( and t!e ,attern of decline closel& mirrors t!at of la)orator&/confirmed case* Ethical Issues with Management of Salmonella T!ese organisms cause enteric fe'er and ,arat&,!oid fe'er res,ecti'el&( +!ic! is a se'ere illness t!at can )e fatal in t!e a)sence of medical treatment* It is -no+n to )e eas& to ,ass on and t!ere ma& )e ,rolonged( intermittent eFcretion of )acteria after s&m,toms sto,* It is most common in less de'elo,ed countries and so in food )usinesses +ill most li-el& )e associated +it! ,eo,le +!o !a'e tra'elled a)road or +!o !a'e come to +or- in t!e $%* An&one +!o sus,ects t!e& are suffering from t!is illness or !as !ad it in t!e ,ast( or +!o !as a lot of contact +it! someone +!o !as it s!ould )e eFcluded from food !andling and food !andling areas until cleared to return to +or- )& a medical ,rofessional* T!e in'estigation and management of t!eir case s!ould )e referred to t!e local aut!orit& and !ealt! ,rofessionals +!o s!ould see- ad'ice from t!e Healt! .rotection Agenc&* If t!e ,erson is confirmed as )eing infected or is a carrier of t!e )acteria( t!e eFclusion ,eriod could )e lengt!&( t!ree mont!s or more( to allo+ for treatment and confirmation of clearance of infection t!roug! faecal testing* Conclusion T!e nature of ,u)lic !ealt! inter'entions often means t!at e'aluating t!eir im,act is com,leF as t!e& are often im,lemented in com)ination and@or simultaneousl&* It is interesting to reflect on t!e fact t!at t!e 'arious legislati'e measures in t!e $nited %ingdom in t!e late 79:8s Salmonella Infections 11 and earl& 7998s a,,ear to !a'e slo+ed do+n t!e increase in Salmonella Enteritidis .T0( +!ereas t!e decrease in la)orator&/confirmed !uman cases coincides 1uite closel& +it! t!e introduction of 'accination ,rograms in )roiler/)reeder and la&ing floc-s and ,rior to muc! of t!e E$ legislation )eing im,lemented* It is ,ro)a)le t!at no single measure contri)uted to t!e decline in Salmonella Enteritidis .T0 and t!at t!e com)ination of measures +as successful( )ut t!e tem,oral relations!i, )et+een 'accination ,rograms and t!e reduction in !uman disease is com,elling and suggests t!at t!ese ,rograms !a'e made a maIor contri)ution to im,ro'ing ,u)lic !ealt!* T!ere !as also )een a reduction in re,orted !uman Salmonellosis cases across t!e E$ >on a'erage 73< ,er &ear )et+een 3884 and 3889?* T!e Euro,ean Commission and Euro,ean Food Safet& Aut!orit& are attri)uting t!is( at least in ,art( to successful control of Salmonella in )roiler( la&ing( and )reeding !en floc-s and eggs* If success in ,u)lic !ealt! is defined )& illnesses a'erted( t!en t!e stor& of Salmonella Enteritidis .T0 in t!e $nited %ingdomC +!ic! !as come do+n and sta&ed do+n is good ne+s* Ho+e'er( !istor& teac!es us t!at somet!ing else ma& come along to ta-e its ,lace* Ro)ust sur'eillance( incor,orating state/of/t!e/art micro)iological( e,idemiological( and )io statistical met!ods( and maintaining a ,rom,t and com,re!ensi'e res,onse to out)rea-s is Iust as im,ortant no+ as it e'er +as*