The epidemiology of extraintestinal non-typhoid Salmonella in Israel: The effects of patients' age and sex

Infectious Diseases Unit, Assaf Harofeh Medical Center, Zerifin, Israel.
European Journal of Clinical Microbiology (Impact Factor: 2.67). 09/2010; 29(9):1103-9. DOI: 10.1007/s10096-010-0968-1
Source: PubMed


Extraintestinal disease occurs in 5-8% of non-typhoid Salmonella enterica (NTS) infections and is more likely to be associated with hospitalization and death. The study examined the epidemiology of extraintestinal NTS infections in Israel and the possible effects of patients' age and sex. NTS isolates passively submitted to the National Salmonella Reference Center during 1996-2006 were the source for the study cohort. Poisson regression models were used to assess incidence trends over the study years and to evaluate the effects of patients' age and sex on the incidence of extraintestinal NTS manifestations. A total of 36,822 stool and 1,415 (3.7%) patient-unique NTS isolates from blood (74.1%), urine (18.3%), and other sources (3.7%) were studied. Serotypes Enteritidis, Virchow, and Typhimurium accounted for 66.3% of the isolates. Analysis showed a highly significant quadratic (U-shaped) relationship between patients' age and the incidence of extraintestinal isolation (p < 0.001), with increasing risk in the two extremes of age. Differences between the incidence of blood and urine sources were significant in patients <10 and >or=60 years old (relative risk [RR] = 5.88, 95% confidence interval [CI] 3.36-10.30, p < 0.001 and RR = 1.66, 95% CI 1.09-2.53, p = 0.017, respectively). Males >or=60 years of age were more likely than females of the same age to have bacteremia (RR = 1.90, 95% CI 1.39-2.61, p > 0.001) and less likely to have urinary NTS isolation (RR = 0.50, 95% CI 0.28-0.89, p = 0.018). Serotype Virchow had the highest incidence in patients <10 years of age, while serotype Enteritidis had the highest incidence in patients >or=60 years old. The study revealed a complex effect of patients' age and sex on the epidemiology of extraintestinal NTS manifestations.

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    • "Our study demonstrated that young children 0–4 years of age had the highest S. Enteritidis infection IRRs, which is in agreement with results of other studies from developed countries [29,30,42,49,50]. Previous studies identified several risk factors for S. Enteritidis infections for this age group, including international travel [51,52], riding in shopping carts and exposure to raw meat and poultry products [53], and contact with reptiles [43,52,54] and cats [43]. "
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    ABSTRACT: Background In Canada, surveillance systems have highlighted the increasing trend of Salmonella enterica serovar Enteritidis (S. Enteritidis) human infections. Our study objectives were to evaluate the epidemiology of S. Enteritidis infections in Ontario using surveillance data from January 1, 2007 through December 31, 2009. Methods Annual age-and-sex-adjusted incidence rates (IRs), annual and mean age-adjusted sex-specific IRs, and mean age-and-sex-adjusted IRs by public health unit (PHU), were calculated for laboratory-confirmed S. Enteritidis cases across Ontario using direct standardization. Multivariable Poisson regression with PHU as a random effect was used to estimate incidence rate ratios (IRRs) of S. Enteritidis infections among years, seasons, age groups, and sexes. Results The annual age-and-sex-adjusted IR per 100,000 person-years was 4.4 [95% CI 4.0-4.7] in 2007, and 5.2 [95% CI 4.8-5.6] in both 2008 and 2009. The annual age-adjusted sex-specific IRs per 100,000 person-years ranged from 4.5 to 5.5 for females and 4.2 to 5.2 for males. The mean age-adjusted sex-specific IR was 5.1 [95% CI 4.8-5.4] for females and 4.8 [95% CI 4.5-5.1] for males. High mean age-and-sex-adjusted IRs (6.001-8.10) were identified in three western PHUs, one northern PHU, and in the City of Toronto. Regression results showed a higher IRR of S. Enteritidis infections in 2009 [IRR = 1.18, 95% CI 1.06-1.32; P = 0.003] and 2008 [IRR = 1.17, 95% CI 1.05-1.31; P = 0.005] compared to 2007. Compared to the fall season, a higher IRR of S. Enteritidis infections was observed in the spring [IRR = 1.14, 95% CI 1.01-1.29; P = 0.040]. Children 0–4 years of age (reference category), followed by children 5–9 years of age [IRR = 0.64, 95% CI 0.52-0.78; P < 0.001] had the highest IRRs. Adults ≥ 60 years of age and 40–49 years of age [IRR = 0.31, 95% CI 0.26-0.37; P < 0.001] had the lowest IRRs. Conclusions The study findings suggest that there was an increase in the incidence of S. Enteritidis infections in Ontario from 2007 to 2008–2009, and indicate seasonal, demographic, and regional differences, which warrant further public health attention.
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