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Salmonellosis-Related Mortality in the United States, 1990–2006
Abstract
Despite the recognition of nontyphoidal Salmonella as an important foodborne infection, few data exist on salmonellosis as a cause of death in the United States. To provide a quantitative assessment of the burden of Salmonella-related mortality in the United States, we examined national multiple-cause-of-death data for the years 1990-2006. Crude and age-standardized rates of salmonellosis mortality and 95% confidence intervals (CI) were computed for race, sex, age, state of residence, and year. A matched case-control analysis, using non-Salmonella deaths as controls, was conducted to determine whether certain diseases were more likely to be listed as comorbid conditions for Salmonella-related death. Salmonellosis was reported as an underlying or associated cause of death among 1316 persons, with an average annual age-adjusted mortality rate of 0.03 per 100,000 person-years. Salmonellosis mortality rates were higher among blacks and Asian/Pacific Islanders with an age-adjusted rate ratio of 2.61 (95% CI, 2.43-2.81) and 2.48 (95% CI, 2.30-2.67), respectively. Rates were also higher in males with an age-adjusted rate ratio of 1.84 (95% CI, 1.68-2.03). The highest frequency of deaths occurred among adults age 75-84 (n = 329; 25% of all cases). A declining trend in salmonellosis-related deaths was observed over the study period. Several comorbid conditions were associated with Salmonella deaths, including HIV and connective tissue disorders, with matched odds ratios of 7.44 (95% CI, 5.04-10.97) and 3.69 (95% CI, 1.88-7.25), respectively. Despite declining trends, salmonellosis continues to be an important cause of preventable death especially among selected subgroups, underscoring the need for expanded prevention efforts.
... n=45 deaths). The variance between deaths and incidence, in terms of trends over the past decade show that deaths have decreased (Cummings PL et al., 2010), but incidence has increased (CDC, 2011). This difference could potentially be the result of better medical treatment or other contributing factors accounting for the decline in deaths. ...
... While whites had the highest absolute number of deaths (n = 893), they had the lowest age-adjusted mortality rate (0.023 per 100,000 population; 95% CI, 0.021-0.024). Reasons for disparities in Salmonella mortality based on gender and race/ethnicity have been discussed in a previously published paper (Cummings PL et al., 2010). California and New York had the highest number of deaths (n=219 and n=105, respectively), but relatively low age-adjusted mortality rates (0.04 per 100,000 population, 95% CI, 0.04-0.05 ...
... n=8, respectively). Methods used in this updated analysis are similar to those previously described in Cummings PL et al., 2010. Briefly, years of potential life lost (YPLL) were calculated by subtracting the age in years at the time of death from 75 years (Gardner, 1990). ...
... Our finding is in accordance with previous reports showing that, among opportunistic infections of AIDS defined illness, urinary tract infections accounts for 60% [28]. The high positivity of enteric bacteria in blood of HIV-positive individuals compared to HIV-negative ones seem to be real, since among HIV-positive subjects the most prevalent enteric infection such as salmonellosis and shigellosis develops in more than 40 [29] and 50% [30] of cases respectively into bacteremia. Bloodstream infection (BSI) is a frequent complication found in HIV-positive individuals and is usually associated with a poor prognosis, responsible for the immediate cause of death in up to 32% of HIVpositive individuals [31]. ...
... Additionally, 66.7% of the overall Salmonella spp isolates were recorded from HIVpositive individuals. Our findings correlated with previous reports that HIV-positive individuals have a higher risk of salmonellosis than healthy individuals [29]. The present rate of Salmonella infection among HIV-positive individuals (1.9%) is similar to that reported in Peru (1%) [36] and Southern Ethiopia (2.8%) [33], but rather lower than a result from Southern Ethiopia (5.1%) [34] and Uganda (8.1%) [37]. ...
... The presence of bacteraemia among HIV infected individual compared to non-infected ones is not unexpected, since individuals with HIV infections are prone to salmonellosis and shigellosis which develops into bacteremia in more than 40 [27] and 50% [28] of cases respectively. Bloodstream infection (BSI) is a frequent complication found in HIV-infected patients and is usually associated with a poor prognosis, responsible for the immediate cause of death in up to 32% of HIV-infected patients [29]. ...
... Our ndings correlated with previous reports that individuals with HIV infections have a 20-to 100-fold higher risk of salmonellosis than healthy individuals [27]. The present rate of Salmonella infection (4.16%) is similar to that reported in Southern Ethiopia (5.1%) [31], but was higher than a nding in Peru (1%) [33], and Southern Ethiopia (2.8%) [38], but rather lower than a result from Uganda (8.1%) [34]. ...
Background: In Cameroon, studies on the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (E-ESBLs) and carbapenemase-producing Enterobacteriaceae (CPE) among HIV infected individuals has not been investigated despite the progressively risen prevalence of HIV infection. The present study is intended determinate the magnitude of ESBL-E and CPE carriage among HIV-infected individuals.
Methods: Accordingly, 152 urine, 29 stool, 8 blood, 105 vaginal exudates and 14 wound swab sample were collected from 204 HIV negative and 104 HIV positive patients attending the Regional Hospital of Bafoussam-Cameroon from September 2016 to June 2017. From these specimen, Enterobacteriaceae were isolated based on their morphological features, Gram staining and biochemical characteristics using API 20E galleries (Biomerieux, France). For each HIV infected patient, the CD4 lymphocytes were measured using cytometric technique. The antimicrobial susceptibility was determined by Kirby-Bauer disc diffusion test against 11 antibiotics from β-lactam class. ESBL and CP in suspected strains was confirmed by double disk synergy test and combination disk test.
Results: The prevalence of Enterobacteriaceae infection among HIV positive patients was 46.15% versus 27.47% among HIV-negative ones (P=0.0014). Among HIV positive patients, urine (47.91%), vaginal exudates (31.25%) and blood (4.16%) specimens were mostly colonialized and Escherichia coli (37.5%) the predominant species. The rate of Enterobacteraceae infection according to CD4 count range was 20.83%, 37.5%, 35.42% and 6.25% respectively for patients with CD4 T lymphocyte range up to 500, ]300-500], ]100-300] and < 100 cells/mm³. The overall resistance rates were 27.72 and 34.66% respectively among isolates from HIV negative and positive patients. The prevalence of ESBL, AmpC and carbapenemase producing Enterobacteriaceae infection was 16.34, 12.5, and 4.81% respectively among HIV infected patients versus 8.62, 8.65 and 0% among HIV uninfected patients (p = 0.0055).
Conclusion: Our findings showed that HIV positive patients are significantly more affected by Enterobacteriaceae infection than negative ones and that the rate of these bacterial infection likely increases with decrease CD4 counts. The present study also indicates that HIV positive patients are more likely to be infected by highly resistant organisms and had the highest carriage rate of ESBL, AmpC and carbapenemase producing Enterobacteriaceae compared to uninfected individuals in Western-Cameroon.
... A lthough deaths from nontyphoidal Salmonella spp. infection have declined in the past decade, this foodborne illness remains a substantial burden in the United States (Mead et al., 1999;Cummings et al., 2010;CDC, 2011;Scallan et al., 2011;Cummings et al., 2012). According to the Foodborne Diseases Active Surveillance Network (FoodNet), annual incident cases of Salmonella enterica, serotype Enteritidis (the most common serotype) have risen by 44% since the late 1990s, from a mean of 1.9 cases per 100,000 population to 2.8 cases per 100,000 population in 2008 (Chai et al., 2012). ...
... Covariates were chosen based on biologic plausibility and information found in the literature that supports their relationships to the outcome(s) of interest for all four models (Han et al., 1967;Samra et al., 1986;Shimoni et al., 1999;Brown and Eykyn, 2000;Anderson and Horvath, 2004;Gordon, 2008;Dhanoa and Fatt, 2009;Cummings et al., 2010Cummings et al., , 2012Freid et al., 2012). Factors known to affect risk, such as age, were included in the model regardless of statistical significance. ...
Hospitalized salmonellosis patients with concurrent chronic conditions may be at increased risk for adverse outcomes, increasing the costs associated with hospitalization. Identifying important modifiable risk factors for this predominantly foodborne illness may assist hospitals, physicians, and public health authorities to improve management of these patients. The objectives of this study were to (1) quantify the burden of salmonellosis hospitalizations in the United States, (2) describe hospitalization characteristics among salmonellosis patients with concurrent chronic conditions, and (3) examine the relationships between salmonellosis and comorbidities by four hospital-related outcomes. A retrospective analysis of salmonellosis discharges was conducted using the Agency for Healthcare Research and Quality's Nationwide Inpatient Sample for 2011. A supplemental trend analysis was performed for the period 2000-2011. Hospitalization characteristics were examined using multivariable regression modeling, with a focus on four outcome measures: in-hospital death, total amount billed by hospitals for services, length of stay, and disease severity. In 2011, there were 11,032 total salmonellosis diagnoses; 7496 were listed as the primary diagnosis, with 86 deaths (case-fatality rate = 1.2%). Multivariable regression analyses revealed a greater number of chronic conditions (≥4) among salmonellosis patients was associated with higher mean total amount billed by hospitals for services, longer length of stay, and greater disease severity (p ≤ 0.05). From 2000 to 2011, hospital discharges for salmonellosis increased by 27.2%, and the mean total amount billed by hospitals increased nearly threefold: 29,690 (2011). Observed increases in hospitalizations indicate the burden of salmonellosis remains substantial in the United States. The positive association between increased number of chronic conditions and the four hospital-related outcomes affirms the need for continual healthcare and public health investments to prevent and control this disease in vulnerable groups.
... Incidence alone is not enough for the determination of SoCs because most cases of salmonellosis are self-limiting with at-home care, and to improve human health we need to target the most "dangerous" types of Salmonella. Similarly, including death in the SoC definition may also bias results because salmonellosis is usually not the only factor contributing to a death outcomecomorbidities are often present (Cummings et al., 2010). Therefore, we instead propose the inclusion of a measurement of disease severity (i.e., hospitalization to infection ratio) or another metric of pathogenicity other than death in SoC definitions. ...
There is an increasing awareness in the field of Salmonella epidemiology that focusing control efforts on those serotypes which cause severe human health outcomes, as opposed to broadly targeting all Salmonella, will likely lead to the greatest advances in decreasing the incidence of salmonellosis. Yet, little guidance exists to support validated, scientific selection of target serotypes. The goal of this perspective is to develop an approach to identifying serotypes of greater concern and present a case study using meat- and poultry-attributed outbreaks to examine challenges in developing a standardized framework for defining target serotypes.
... Enteric bacterial pathogens, such as species of Salmonella (particularly enterica serotypes), Shigella, Campylobacter and Escherichia coli, are the most common [9,10]. Individuals with HIV infections are estimated to be at 20-to 100-fold increased risk of salmonellosis and associated bacteraemia, in more than 40% of cases [11]. In immunocompetent individuals, gastroenteritis with Shigella rarely develops into bacteraemia, whereas up to 50% of AIDS patients with shigellosis become bacteraemic [12]. ...
In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and enteroparasites in human immunodeficiency virus (HIV)-infected individuals with diarrhoea. Hence, this study aims to assess the prevalence of enteric bacteria and enteroparasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhoea, who visited the Anti-Retroviral Therapy Clinic of the Arba Minch General Hospital between 1 March and 31 August 2019. Data pertaining to sociodemographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV-infected individuals with diarrhoea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analysed using SPSS software. A total of 180 individuals were included in the stool collection process. The prevalence rates of enteric bacteria and enteroparasites were 8.3% and 36.1%, respectively. Parasitic infections were more frequent than bacterial infections in these HIV-infected individuals; commonly identified enteroparasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Campylobacter sp. was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella (1.1%) species. CD4 counts <200 cells/μL was significantly associated with both bacterial infections (adjusted OR 9.55, 95% CI 1.54-59.3, p 0.015) and parasitic infections (adjusted OR 3.53, 95% CI 1.3-17.9, p 0.03). Multidrug resistance was also detected in 100%, 75% and 60% of Shigella, Campylobacter and Salmonella sp., respectively. We found that enteroparasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T-cell counts <200 cells/μL, quality of drinking water sources, hand washing habits after toilet and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.
... Enteric bacterial pathogens, such as species of Salmonella (particularly enterica serotypes), Shigella, Campylobacter and Escherichia coli, are the most common [9,10]. Individuals with HIV infections are estimated to be at 20-to 100-fold increased risk of salmonellosis and associated bacteraemia, in more than 40% of cases [11]. In immunocompetent individuals, gastroenteritis with Shigella rarely develops into bacteraemia, whereas up to 50% of AIDS patients with shigellosis become bacteraemic [12]. ...
In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and entero-parasites in Human Immunodeficiency Virus (HIV) patients with diarrhea. Hence, this study is aimed to assess the prevalence of enteric bacteria, entero-parasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhea, who visited the Anti-Retroviral Therapy (ART) Clinic of the Arba Minch General Hospital (AMGH) between March 01 and August 31, 2019. Data pertaining to the socio-demographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV patients with diarrhea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby-Bauer disc diffusion technique. Data were analyzed using the Statistical Package for Social Sciences Software. Totally 180 patients were included in the stool collection process. The prevalence rates of enteric bacteria and entero-parasites were 8.3% and 36.1% respectively. Parasitic infections were more frequent than bacterial infections in these HIV patients and the commonly identified entero-parasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Species of Campylobacter was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella species (1.1%). CD4 counts <200 was significantly associated with both bacterial [AOR: 9.55 (95% CI: 1.54–59.3), p-value= 0.015], and parasitic infections [AOR: 3.53 (95% CI: 1.3–17.9) p-value= 0.03]. Multi-drug resistance was also detected in 100%, 75%, and 60% of Shigella, Campylobacter and, Salmonella sp. respectively. We found that entero-parasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T cell counts <200, quality of drinking water sources, hand washing habits after toilet, and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.
... The pathogenic bacteria and fungi cause a wide array of diseases in both plants and animal [7,33,36]. The rapid emergence of resistant strains in these micro-organisms has urged the need for developing novel therapeutics that can inhibit the growth of such pathogens. ...
This study was performed to evaluate the competency of transgenic plants expressing Medicago sativa defensin (MsDef1) towards developing self-resistance against the attack of pathogens. We raised fifteen lines of T2 transgenic tobacco plants expressing MsDef1 under the control of a strong constitutive promoter (M24) and transgene integration was confirmed. Plant-derived enriched MsDef1 at a concentration of 0.6 μg/μl showed 78, 53 and 71% anti-bacterial activities against Pseudomonas aeruginosa, Ralstonia solanacearum and Xanthomonas campestris respectively; alongside it demonstrated 53, 65 and 52% anti-fungal activity against Aspergillus niger, Pyricularia oryzae and Rhizoctonia solani respectively, at a concentration of 0.8 μg/μl in vitro. In addition, plant-derived MsDef1 showed significant anti-bacterial activity against Pseudomonas syringae pv tabaci. The LD50 values obtained from in vitro analyses clearly indicated the efficacy of MsDef1 against the above mentioned phyto-pathogens. The in vivo studies employing R. solanacearum and A. niger showed that transgenic plants could withstand the invasion of these virulent pathogens. Under this nascent study, we demonstrated the activity of plant-derived MsDef1 against plant pathogens; both in vitro and in vivo.
... Chicken diseases have contributed significantly to increase in mortality rate and economic losses in the chicken industry (Oguttu et al., 2008). Globally, food borne infection and intoxications have been estimated that one billion cases of acute diarrhea occurs annually in children under the age of 5years in African, Asia and Latin America, approximately 5 million of these cases were proved fatal (Cummings et al., 2010). Poultry has been widely acknowledged to be a reservoir for enteric bacteria. ...
This study focused on molecular characterization of enterotoxigenicity profiles of enteric bacteria isolated from different brands of commercially produced chicken feeds sold in Anambra State. A total of 1,536 different chicken feed samples (starter, growers, finisher and layers) were collected from the consumers, retailers and wholesalers and screened for the presence of enteric bacteria using pour plate technique. The isolates were characterized and identified using their colony descriptions, biochemical and molecular characteristics. Presence of enterotoxins among the isolates was detected using Polymerase Chain Reaction (PCR) amplification of Ltx1 and Ltx2 genes. The result of this study revealed that Escherichia coli O157:H7 SS52 (EC), Salmonella serovar Typhimurium U288 (ST), Escherichia coli SEC470 (ES), Salmonella serovar Enteritidis YU39 (SY) and Salmonella serovar Enteritidis FM366 (SE) were isolated from the feed samples. The PCR results showed significant (P<0.05) amplification of heat labile-1 (Ltx1) and heat labile-2(Ltx2) enterotoxin genes from EC, SE and ST of which EC showed most pronounced results. Thus, this study has shown that EC, ST, ES, EY and SE were detected from the studied chicken feed samples. The PCR results have revealed regions that contained heat labile enterotoxins, of which this region was most significant in EC.
... Globally, food borne infection and intoxications have been estimated that one billion cases of acute diarrhea occur annually in children under the age of 5years in African, Asia and Latin America, approximately 5 million of these cases were proved fatal (Cummings et al., 2010). Poultry has been widely acknowledged to be a reservoir for Salmonella. ...
This study was carried out to investigate the enterotoxigenic potentials of Salmonella enterica serovar Typhimurium from different food samples in suckling albino mice. A total of 27 food samples comprising sample A (9), sample B(9) and Sample C(9) were collected randomly from different markets in Uli community and screened for the presence of Salmonella enterica serovar Typhimurium using pour plate technique. The isolates obtained were characterized and identified using their colonial descriptions, morphological and biochemical characteristics. Intragastric method in suckling mice was used to evaluate the enterotoxigenicity potententials of the isolates using gut/body ratio (G/B) and fluid accumulation ratio (FAR). Salmonella enterica serovar Typhimurium (ST1,ST2,ST3,ST4,ST5,ST6) was detected in 14(51.85) food samples out of 27 food samples screened, of which the isolate was discovered mostly in sample B. ST5 was significant (P<0.05) for enterotoxin after 4 h exposure and ST2, ST3, ST5 and ST6 were significant (P<0.05) after 24 h. It was observed that most of the strains of Salmonella enterica serovar Typhimurium tested, were positive to enterotoxin mainly after 24 h, of which ST5 proved to be most enterotoxigenic after 4 h and 24 h.
... Nevertheless, such interior egg yolk contamination is theoretically unlikely (Strokes et al., 2000) even under natural conditions, the rate of infection was very small (0.6%). In a study of naturally contaminated eggs (Humphrey et al., 2010) and 30% among artificially and heavily infected hens (Gast et al., 2007) in 2010, an analysis of deaths from older adults and those who were immune compromised (Cummings et al., 2010). ...
Water is a chemical compound with the chemical formula H 2 0. A water molecule contains one oxygen and two hydrogen atoms connected by covalent bonds. The existence of liquid water and to a lesser extent its gaseous and solid forms, on earth are vital to the existence of life on earth as we know it. Safe drinking water is essential to humans and other life forms even though it provides no calories or organic nutrients. Access to safe drinking water has improved over the last decades in almost every part of the world, but approximately one billion people still lack access to safe water and over 2.5 billion lack accesses to adequate sanitation. Due to growing populations and expanding land use, sources of pathogen contaminated wastes steadily increase hence also raising the potential pollution of groundwater reservoirs with infectious agents all around the world. The quality of many source waters will depend upon geology, soil type, natural vegetation, climate and runoff characteristics. Ideally, drinking water should be clear and acceptable to the palate. Water can dissolve many different substances, giving it varying tastes and odours. The use of indicator organisms, in particular the Coliform group, as a means of checking the potential presence of water-borne pathogens has been paramount to protecting public health. Frequent examinations of faecal indicator organisms remain the most sensitive way of assessing the hygienic conditions of water. Indicator organisms of faecal pollution include the Coliform group as a whole and particularly Escherichia coli, Streptococcus faecalis and some thermo tolerant organisms such as Clostridium perfringes.
... Our patient was immunocompromised by her steroids received postoperatively. In an analysis of 1,316 deaths related to Salmonella infections, most occurred among the immunocompromised and the elderly [5]. ...
Salmonella is an uncommon cause of meningitis, especially after neurosurgery. Here, we present a case of Salmonella meningitis after craniotomy, likely due to physical contact with a snake after surgery, with contiguous spread from the patient’s hand to her wound. The purpose of this report is to serve as a reminder that patients undergoing neurosurgery should avoid contact with pets, including snakes and other reptiles, in the postoperative period and practice good hand hygiene.
... Esta enfermedad bacteriana causa un amplio número de manifestaciones clínicas: salmonelosis tifoidal: fiebre entérica y salmonelosis no tifoidal: gastroenteritis, bacteremia, infección focal extra intestinal y estado portador crónico (Langridge et al., 2008). La gastroenteritis o enterocolitis agudas es la forma de presentación más común en humanos; los síntomas aparecen generalmente 6 a 48 horas posteriores al consumo de alimentos contaminados e incluyen diarrea, cefalea, dolor abdominal, náuseas, vómito, fiebre y deshidratación, afectando principalmente niños menores de 5 años y adultos mayores de 65 años de edad (Cummings et al., 2010). ...
Salmonella is a bacterial disease having worldwide distribution; it has an important effect on public health, being one of the diseases which is frequently found in humans and animals, causing large-scale economic loses in the pig-farming sector. The present report was aimed at raising awareness of the current situation regarding Salmonella spp. seroprevalence in the Tolima department. Nine pig-farms distributed throughout the department were thus analysed. Individual blood samples (n=420) were randomly taken from animals in different production phases (initiation, weaning, fattening, reproductive adults), regardless of gender, to be serologically evaluated using commercially available tests (indirect ELISA). The sampled animals did not have clinical signs which were compatibles with salmonella. Salmonella seroprevalence was 36.09%.
... Our study of a large population of infants adds to the literature on racial and ethnic patterns by detailing incidence variations across the first year of age. Previous studies have shown increased risk of salmonellosis and invasive salmonellosis among blacks and Asians in general [5,[7][8][9]. We have shown that generally similar patterns exist among infants. ...
Background. Infants have increased risk for salmonellosis; but epidemiologic information is limited. Methods. We reviewed Foodborne Diseases Active Surveillance Network reports of laboratory-confirmed non-Typhi Salmonella infections in infants from 1996-2008.We calculated incidence, estimated relative risks, and assessed trends over the duration of the study period, using the first 3 years as reference. Results. Average annual incidence of salmonellosis per 100 000 infants was 177.8 (95% confidence interval [CI], 152.7-202.8) in blacks, 129.7 (95% CI, 94.8-164.7) in Asians, and 81.1 (95% CI, 70.2-92.0) in whites. Our analysis of ethnicity independent of race showed salmonellosis incidence of 86.7 (95% CI, 74.6-98.9) in Hispanics and 69.4 (95% CI, 54.8-84.1) in non-Hispanics. Salmonellosis was invasive more often in blacks (9.4%) and Asians (6.4%) than whites (3.6%, P <.001 and P = .01, respectively). Asian infants with salmonellosis were older (median, 31 weeks [range, 0-52]) than black (24 weeks [range, 0-52], P < .001) or white infants (23 weeks [range, 0-52], P < .001). Incidence of all salmonellosis remained stable for whites from 1996-1998 through 2008, but blacks had a sustained decrease, with relative risk of 0.48 (95% CI, .37-.63) in 2008 compared with 1996-1998. However, 2008 incidence remained highest among blacks (141.0 of 100 000 vs 113.5 of 100 000 among whites and 109.9 of 100 000 among Asians). Conclusion. Black infants had a greater risk of salmonellosis and invasive disease than other racial groups, and despite the greatest decrease in incidence over the study period, they continued to have the highest incidence of salmonellosis. The decrease in salmonellosis in black infants suggests that future improvements may be possible for other population subgroups. © The Author 2013. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved.
... In the US, about 40,000 Salmonella infection cases are reported each year. From 1990From to 2006deaths in the US were identified to be related to Salmonella infection [1]. It has been discussed that up to 30% Salmonella infections to human beings are related to the consumption of pork or pork products [2,3]. ...
Pork and pork products have been identified as a significant source of Salmonella infection, which is a major public health concern. The contamination of Salmonella on pork can happen both on farms (before slaughter) and at abattoirs (after slaughter). Salmonella isolates were collected from both feces on farms and lymph nodes in the abattoir to determine if contamination at abattoirs can be linked back to the farms of origin. Molecular subtyping of the isolated Salmonella was performed using amplified fragment length polymorphism (AFLP), a Polymerase chain reaction-based, high-throughput, relatively inexpensive method. In this paper, we develop a permutation test for the genetic association of Salmonella isolated on-farm and at-abattoir using the AFLP data. Simulation studies show that the proposed permutation test controls the type I error rate appropriately as well as possesses high power. An application of the proposed permutation test to the real Salmonella ALFP data results in a p-value of 0.038 which shows strong evidence of association between Salmonella isolated on-farm and at-abattoir.
... Esta enfermedad bacteriana causa un amplio número de manifestaciones clínicas: salmonelosis tifoidal: fiebre entérica y salmonelosis no tifoidal: gastroenteritis, bacteremia, infección focal extra intestinal y estado portador crónico (Langridge et al., 2008). La gastroenteritis o enterocolitis agudas es la forma de presentación más común en humanos; los síntomas aparecen generalmente 6 a 48 horas posteriores al consumo de alimentos contaminados e incluyen diarrea, cefalea, dolor abdominal, náuseas, vómito, fiebre y deshidratación, afectando principalmente niños menores de 5 años y adultos mayores de 65 años de edad (Cummings et al., 2010). ...
Titulo en ingles: Determining Salmonella spp. seroprevalence on pig-farms in the Tolima departmentTitulo en portugues: Determinação da seroprevalencia de Salmonella spp. em granjas porcinas do departamento do TolimaResumen: La salmonelosis es una enfermedad bacteriana de distribución mundial, importante en salud pública, siendo una de las patologías que se presenta frecuentemente en humanos y animales, causante de grandes pérdidas económicas en el sector porcícola. El presente reporte busca visualizar la situación actual de la seroprevalencia de la Salmonella spp. En el Departamento del Tolima. Para tal fin se analizaron un total de 9 granjas porcinas distribuidas en el Departamento. Recolectando de manera aleatoria muestras individuales (n=420) de sangre de animales en diferentes fases productivas (iniciación, levante, ceba, adultos reproductores), sin distinción de sexo; para ser evaluadas por medio de pruebas serológicas (ELISA indirecto) comercialmente disponibles. Los animales muestreados no presentaron signos clínicos compatibles con salmonelosis. La seroprevalencia de Salmonella hallada fue de 36.09%.Palabras clave: cerdos, Salmonella, seroprevalencia, ETAs.Abstract: Salmonella is a bacterial disease having worldwide distribution; it has an important effect on public health, being one of the diseases which is frequently found in humans and animals, causing large-scale economic loses in the pig-farming sector. The present report was aimed at raising awareness of the current situation regarding Salmonella spp. seroprevalence in the Tolima department. Nine pig-farms distributed throughout the department were thus analysed. Individual blood samples (n=420) were randomly taken from animals in different production phases (initiation, weaning, fattening, reproductive adults), regardless of gender, to be serologically evaluated using commercially available tests (indirect ELISA). The sampled animals did not have clinical signs which were compatibles with salmonella. Salmonellaseroprevalence was 36.09%.Key words: pigs, Salmonella, seroprevalence, ETA.Resumo: A salmonela é uma doença bacteriana do mundo de distribuição, importante em saúde pública, sendo uma das patologias que muitas vezes ocorre em humanos e animais, causando grandes prejuízos económicos no sector da carne de porco. Este relatório pretende exibir o status atual da prevalência de Salmonella spp. no departamento de Tolima. Um total de 9 criações de porcos em todo o departamento foram analisadas para o efeito. Recolha de forma aleatória, amostras individuais (n = 420) sangue de animais em diferentes fases produtivas (iniciação, elevação, engorda, adultos reprodutores), sem distinção de sexo; a ser avaliada por meio de testes sorológicos (ELISA indireta) comercialmente disponíveis. Amostra de animais não apresentaram sinais clínicos compatíveis com salmonelose. A prevalência encontrada que Salmonella foi 36.09%.Palavras chave: suínos, Salmonella, soroprevalência, ETAs.
... Although highly active antiretroviral therapy (HAART) is frequently successful at controlling viral reproduction, some patients spend months and sometimes years with a low CD4 cell count despite control of their viral load [2,3]. The morbidity and mortality experienced by persons living with AIDS may also be greater than that experienced by persons without immune system impairment as evidenced by cerebral toxoplasmosis, recurrent Salmonella bacteremia, and listeriosis [4][5][6][7][8][9][10]. ...
Persons living with AIDS are highly vulnerable to foodborne enteric infections with the potential for substantial morbidity and mortality. Educational materials about foodborne enteric infections intended for this immunocompromised population have not been assessed for their efficacy in improving knowledge or encouraging behavior change.
AIDS patients in four healthcare facilities in Chicago, New Orleans, and Puerto Rico were recruited using fliers and word of mouth to healthcare providers. Those who contacted research staff were interviewed to determine food safety knowledge gaps and risky behaviors. A food safety educational comic book that targeted knowledge gaps was created, piloted, and provided to these patients who were instructed to read it and return at least 2 weeks later for a follow-up interview. The overall food safety score was determined by the number of the 26 knowledge/belief/behavior questions from the survey answered correctly. Among 150 patients who participated in both the baseline and follow-up questionnaire, the intervention resulted in a substantial increase in the food safety score (baseline 59%, post-intervention 81%, p<0.001). The intervention produced a significant increase in all the food safety knowledge, belief, and behavior items that comprised the food safety score. Many of these increases were from baseline knowledge below 80 percent to well above 90%. Most (85%) of the patients stated they made a change to their behavior since receiving the educational booklet.
This comic book format intervention to educate persons living with AIDS was highly effective. Future studies should examine to what extent long-term behavioral changes result.
... The extremely low case fatality found in this study (one reported Salmonella-related death) precluded analysis of the impact of infection with bovine-associated subtypes. Such low mortality is a reflection of current standards of care, and it coincides with the decreasing salmonellosis case fatality reported in other studies over time (MacCready et al., 1957;Saphra and Winter, 1957;Jones et al., 2008;Cummings et al., 2010;Ruzante et al., 2011). ...
Abstract The objective of this study was to identify patient symptoms and case outcomes that were more likely to occur as a result of Salmonella infections caused by bovine-associated subtypes (isolates that matched contemporary bovine isolates from New York by serovar and pulsed-field gel electrophoresis pattern), as compared to salmonellosis caused by non-bovine-associated subtypes. Data were collected in 34 counties of New York that comprise the Foodborne Diseases Active Surveillance Network (FoodNet) catchment area of the Centers for Disease Control and Prevention Emerging Infections Program. Patients with specimen collection dates between March 1, 2008 and March 1, 2010 were included. Symptoms and outcomes of 40 cases infected with bovine-associated Salmonella subtypes were compared to those of 379 control-cases infected with Salmonella isolates that were not bovine-associated. Cases were significantly more likely to have invasive salmonellosis (odds ratio, 3.8; p-value=0.02), after adjusting for age group, gender, and race. In addition, there was a marginal association between case status and the presence of blood in the stool (p-value=0.1) while ill. These findings might have implications for patient management, as a history of consuming undercooked foods of bovine origin or having direct contact with cattle in the few days prior to illness could be useful for suggesting a more proactive diagnostic approach as well as close monitoring for the need to implement more aggressive therapy.
... Furthermore, these cause 580 deaths annually even in the United States (World Health Organization, 2005). Infections are often associated with selected subgroups as elderly or patients suffering from HIV and connective tissue disorders (Cummings et al., 2010). ...
The infectious intracellular lifestyle of Salmonella enterica relies on the adaptation to nutritional conditions within the Salmonella-containing vacuole (SCV) in host cells. We summarize latest results on metabolic requirements for Salmonella during infection. This includes intracellular phenotypes of mutant strains based on metabolic modeling and experimental tests, isotopolog profiling using ¹³C-compounds in intracellular Salmonella, and complementation of metabolic defects for attenuated mutant strains towards a comprehensive understanding of the metabolic requirements of the intracellular lifestyle of Salmonella. Helpful for this are also genomic comparisons. We outline further recent studies and which analyses of intracellular phenotypes and improved metabolic simulations were done and comment on technical required steps as well as progress involved in the iterative refinement of metabolic flux models, analyses of mutant phenotypes, and isotopolog analyses. Salmonella lifestyle is well-adapted to the SCV and its specific metabolic requirements. Salmonella metabolism adapts rapidly to SCV conditions, the metabolic generalist Salmonella is quite successful in host infection.
Background
Despite the declining trend, salmonellosis is still an important preventable cause of death in Iran and the world, especially in certain age and occupational subgroups, and the need for preventive measures, especially raising awareness of at-risk groups, is necessary.
Methods
Data were obtained from the Ministry of Health covering the years 2013 to 2019. The data were then stratified by year, season, month, and province of death as well as sex, age group, belonging to rural vs. urban communities and cause of death and were then analyzed using SPSS to report differences in age, sex, seasonal patterns, and spatial distribution.
Results
Non-typhoid salmonellosis (NTS) and typhoid were recorded as the cause of 800 and 32 deaths, respectively, with the highest number in 2015 and 2013. Septicemia was the cause of 87.3% of deaths due to NTS, whereas typhoid was the cause of 62.5% of its respective cases. The highest percentage of death related to both occurred in spring (P<0.001). NTS mortality rates were higher in the 70–80 and 80–90 age groups, while typhoid mortality was greatest in the under 10 yr age group. NTS mortality was higher in urban while typhoid mortality was higher in rural areas (P<0.001). Most deaths occurred in Ardabil, Sistan and Baluchistan and Khorasan Razavi provinces and Sistan and Baluchistan, West Azerbaijan and Khorasan Razavi related to NTS and typhoid, respectively.
Conclusion
Salmonella remains a preventable cause of death, especially among the elderly and children, the data gathered in this study provides important information for priority setting in specific subpopulations and food safety policy.
Background:
Research and reporting of mortality indicators typically focus on a single underlying cause of death selected from multiple causes recorded on a death certificate. The need to incorporate the multiple causes in mortality statistics - reflecting increasing multimorbidity and complex causation patterns - is recognized internationally. This review aims to identify and appraise relevant analytical methods and practices related to multiple causes.
Methods:
We searched Medline, PubMed, Scopus and Web of Science from their inception to December 2020 without language restrictions, supplemented by consultation with international experts. Eligible articles analyzed multiple causes of death from death certificates. The process identified 4,080 items of which we reviewed 434 full-text articles.
Results:
Most articles we reviewed (76%, n=332) were published since 2001. The majority examined mortality by "any mention" of cause of death (87%, n=377) and assessed pairwise combinations of causes (57%, n=245). Since 2001, applications of methods emerged to group deaths based on common cause patterns using, for example, cluster analysis (2%, n=9), and application of multiple-cause weights to re-evaluate mortality burden (1%, n=5). We describe multiple-cause methods applied to specific research objectives for approaches emerging recently.
Conclusion:
This review confirms rapidly increasing international interest in the analysis of multiple causes of death and provides the most comprehensive overview, to our knowledge, of methods and practices to date. Available multiple-cause methods are diverse but suit a range of research objectives. With greater availability of data and technology, these could be further developed and applied across a range of settings.
Background/Aim: The registered salmonella cases are estimated to constitute 1-10% of the real frequency of this disease. The aim of the research was to analyze epidemiological salmonella characteristics in Belgrade population for the period 1994-2013. Methods: The data on the number of salmonella cases regarding gender, age and municipalities for the given period were taken from the City Institute of Public Health in Belgrade and used to calculate crude, age-specific and standardized incidence rates were used. For estimating the incidence trend joinpoint regression analysis was used. Results: In the given 20-year period there were 12,452 salmonellosis cases, and female infected persons were more present (53.5%) than males (46.5%). In both sexes, the highest average age-specific rates were found in age group 0-4, and the lowest for people age 70 and older. According to joinpoint regression analysis there is a significant incidence decline in men from the age group 15-19 and further on, while in women that decline starts with the age group 10-14. The average standardized salmonellosis incidence rate (per 100,000) was 61.6 (61.7 for men and 61.4 for women). The most frequent Salmonella serotypes isolated from human material were S. enteritidis (81.6%), S. typhimurium (7.7%) and S. infantis (2.6%). Conclusion: The decline in salmonellosis noticed in our study suggests better farming control, better control of meat production and turnover and application of hygienic and sanitary measures in these processes as well as the greater presence of the HACCP standard for the health safety of food in Belgrade.
Salmonella are widely found in the poultry industry, which subsequently may pose a risk to animal and human health. The aim of this review is to highlight strategies for the prevention and control of Salmonella at each stage in the poultry production chain by monitoring risks from the farm to the retailer. Among the primary approaches for control of Salmonella at the farm level includes the administration of synthetic and natural compounds to live chickens (vaccination and antibiotic), litter management as well as fortification of feed and acidification of drinking water. In the poultry processing plant, multiple hurdle technology and different chilling conditions to reduce Salmonella were discussed. In the retail level, an effective monitoring program to control Salmonella contamination by good manufacturing practices and hazard analysis and critical control points has been reviewed. Overall, we conclude that these approaches play a role in reducing the dissemination of Salmonella in the poultry industry. However, there is no published data related to logistic scheduling of poultry processing.
Objective
This review collates the published reports that focus on microbial and viral illnesses that can be transmitted by breast milk, donor milk and powdered infant formula (PIF). In this context, we attempt to define a risk framework encompassing those hazards, exposure scenarios, vulnerability and protective factors.
Design
A literature search was performed for reported cases of morbidity and mortality associated with different infant feeding modes.
Setting
Exclusive breast-feeding is the recommended for infant feeding under 6 months, or failing that, provision of donated human milk. However, the use of PIF remains high despite its intrinsic and extrinsic risk of microbial contamination, as well as the potential for adverse physiological effects, including infant gut dysbiosis.
Results
Viable pathogen transmission via breast-feeding or donor milk (pasteurised and unpasteurised) is rare. However, transmission of HIV and human T-cell lymphotropic virus-1 is a concern for breast-feeding mothers, particularly for mothers undertaking a mixed feeding mode (PIF and breast-feeding). In PIF, intrinsic and extrinsic microbial contamination, such as Cronobacter and Salmonella , remain significant identifiable causes of infant morbidity and mortality.
Conclusions
Disease transmission through breast-feeding or donor human milk is rare, most likely owing to its complex intrinsically protective composition of human milk and protection of the infant gut lining. Contamination of PIF and the morbidity associated with this is likely underappreciated in terms of community risk. A better system of safe donor milk sharing that also establishes security of supply for non-hospitalised healthy infants in need of breast milk would reduce the reliance on PIF.
African Americans of low socioeconomic status are often at risk of foodborne illnesses because of food preferences and exposure to a disproportionately high number of risk factors. We developed a culturally-appropriate food safety photonovella and determined its efficacy in improving food safety knowledge and behavior in low socioeconomic status African Americans in Chicago. A pre- and post-intervention food safety score was calculated based on responses to 9 weighted questions directly addressed within the photonovella. A maximum score of 12 points was possible. Among 149 participants, the overall mean baseline food safety score rose from 7.80 (SD 2.51] to 8.98 (SD 2.21) (P< 0.01). Ninety-seven (65%) respondents reported making at least one change in their food safety behavior since exposure to the photonovella. Thirty-five percent and 16% of the participants, respectively, said that someone they lived with and someone who doesn't live with them also read the photonovella. Among 43 who cooked or prepared chitterlings, 27 reported pre-intervention that they did not boil chitterlings for 5 minutes before cleaning, and 10 of those reported changing their behavior post-intervention. A photonovella focused on a thematic area within food safety may be an effective way to improve knowledge, influence behavior, and encourage communication of food safety information to others. Copyright © 2015, International Association for Food Protection 6200 Aurora Ave., Suite 200W, Des Moines, IA 50322-2864.
Foodborne illness caused by Salmonella and Campylobacter is a concern for consumers, and there is evidence that minority racial-ethnic populations experience greater rates of illness because of these pathogens. The limited body of research concerning food safety knowledge and practices among minority consumers has focused more on general food safety knowledge than on culturally specific food handling practices. The purpose of the research reported here was to explore food handling behaviors of minority racial-ethnic consumers through in-depth discussions in focus group settings. In this way, we hoped to identify potential unique, previously unidentified food handling practices among these consumers. Nine focus groups were held in Philadelphia, PA. Three focus groups were conducted with African American consumers, three with Hispanic consumers, and three with Asian consumers. In all, 56 consumers participated. Data were recorded, transcribed, and analyzed for unique and potentially unsafe food handling behaviors. Potentially unsafe food handling practices identified among all three groups included extended time to transport food from retail to home and washing of raw poultry. Culturally unique behaviors within groups included (i) using hot water (Asian, Hispanic) or acidic solutions (African American, Hispanic) to clean raw poultry, (ii) purchasing live poultry (Asian, Hispanic), (iii) cooking poultry overnight (African American), and (iv) preparing bite-size pieces of meat prior to cooking (Asian, Hispanic). To have focus groups include a limited number of participants and nonrandom sampling means that these themes and trends cannot be extrapolated to represent food mishandling among these populations in general. Results presented here allow modification of an existing food safety survey to identify the prevalence of these food handling practices among consumers of different demographics.
In this work, we demonstrate a new classification machine based on multivariate adaptive embedding (MAE) that is capable of a robust identification of potential bacterial biological warfare agents (BWA). By employing Raman spectroscopy, this method proves to be reliable in application, easy to use and while retaining spectral quality, it is much faster than the often used support vector machines (SVM) and other supervised multivariate statistical classification machines. The multivariate adaptive embedding multi-species classification ability was developed in order to serve as a real-time detection method for biological threat detection and pathogen identification. A mean classification accuracy of 99.25±0.45% could be achieved with a representative set of biological warfare agents and simulant bacteria as a first approach for a user-friendly and fieldable classification application for first responders and researchers.
About 1.4 million Salmonella infections, a common food-borne illness, occur in the U.S. annually; the elderly (aged 65 or above) are most susceptible. In 1997, the USDA introduced the Pathogen Reduction and Hazard Analysis and Critical Control Points Systems (PR/HACCP) which demands regular Salmonella testing in various establishments processing meat products, such as broiler chickens. Impact evaluations of PR/HACCP on hospitalizations related to Salmonella are lacking.
Hospitalization records of the U.S. elderly in 1991-2004 were obtained from the Centers of Medicare and Medicaid Services. Harmonic regression analyses were performed to evaluate the long-term trends of Salmonella-related hospitalizations in pre- and post-HACCP periods. Seasonal characteristics of the outcome in the nine Census divisions of the contiguous U.S. were also derived and contrasted.
Predicted rates decreased in most divisions after 1997, except South Atlantic, East South Central, and West South Central. These three divisions also demonstrated higher overall hospitalization rates, pronounced seasonal patterns, and consistent times to peak at about 32nd to 34th week of the year.
The impact of HACCP was geographically different. South Atlantic, East South Central, and West South Central divisions should be targeted in further Salmonella preventive programs. Further research is needed to identify the best program type and timing of implementation.
Non-typhoidal Salmonella (NTS) is increasingly recognized as an important pathogen associated with bacteraemia especially in immunosuppressed patients. However, there is limited data specifically describing the clinical characteristics and outcome amongst the immunosuppressed patients.
A total of 56,707 blood culture samples and 5,450 stool samples were received by the microbiology laboratory at a tertiary referral hospital in Malaysia, during a 4-year study period. Out of these samples, 55 non-duplicate NTS isolates were identified from blood and 121 from stool. A retrospective analysis of the 55 patients with NTS bacteraemia was then conducted to determine the predominant NTS serovars causing bacteraemia and its' blood invasive potential, epidemiological data, clinical characteristics and antimicrobial susceptibility. Patients were then grouped as immunosuppressed and non-immunosuppressed to determine the association of severe immunosuppression on clinical features. Data was analyzed using the Statistical Package for Social Sciences (SPSS version 15.0) using the non-parametric Mann-Whitney test, Fisher's exact test or Chi-squared test. The odds ratio (OR) and its 95% confidence intervals (CI) were calculated. The P-value < 0.05 (two-tailed) was taken as the level of significance.
Out of 55 NTS bacteraemia cases identified, 81.8% (45/55) were community-acquired. Salmonella enterica serovar Enteritidis had the highest blood invasiveness. An extra-intestinal focus of infection was noted in 30.9% (17/55) of the patients, most commonly involving the lungs and soft tissue. 90.9% (50/55) of the patients had an underlying disease and 65.5% (36/55) of the patients had severe clinical immunosuppressive condition with malignancy and HIV being the most common. Immunosuppressed patients had higher mortality (P = 0.04), presented more commonly with primary bacteraemia (P = 0.023), leukopenia (P = 0.001) and opportunistic infections (P = 0.01). In contrast, atherosclerotic conditions (P = 0.015), mycotic aneurysms (0.037) and gastroenteritis (P = 0.03), were significantly more common in the non-immunosuppressed patients. The non-immunosuppressed group also had a higher proportion of older patients (>50 years) with a significantly higher median age (64 versus 36.5 years; p = 0.005).
Patients with severe clinical immunosuppression had higher mortality, presented more commonly with primary bacteraemia, leukopenia and opportunistic infections and absence of gastroenteritis. Early identification and prompt medical treatment can be life saving because of the high mortality and morbidity associated with this disease especially in the immunosuppressed patients.
To obtain reference ranges for each of the main antioxidant enzymes (AOE) and analyze the influence of sex, age, and cigarette smoking on AOE activity in human blood.
We investigated superoxide dismutase (SOD), catalase (CAT), and seleno-dependent glutathione peroxidase (GSH-Px) activities in the whole blood from 103 healthy subjects, from 18-67 years old (51 males and 52 females).
We found a large and highly significant interindividual variability in the activity of all the AOE studied (p < 0.001). The interindividual coefficients of variation were 13.5% for SOD, 21.0% for CAT, and 36.2% for GSH-Px, indicating that GSH-Px exhibits the highest interindividual variability. Females showed higher SOD (p < 0.001) and CAT (p < 0.001) activities but lower GSH-Px (p < 0.05) activity than males. We found a significant effect of age on SOD activity (p < 0.001), showing that in human blood it decreases with age and that this decrease is not linear, beginning at 28 years of age. We also observed a linear effect of age on GSH-Px activity indicating that the activity of this enzyme increases with age (p < 0.01). No effect of age on CAT activity was observed (p > 0.05). AOE activity in smokers was found not to be significantly different from that observed in non-smokers (p > 0.05) except in the case of CAT activity in females, which was found to be lower in smokers than in non-smokers (p < 0.05). In addition, we determined reference ranges for the activity of each antioxidant enzyme studied.
Our results confirm that AOE activity in human blood exhibits a wide interindividual variability and suggest that this variability may be ascribed, at least in part, to the sex and age of the individuals. Moreover, our results suggest that cigarette smoking does not influence AOE activity in human blood. Accordingly, it is suggested that for clinical purposes it may be necessary to consider the sex and age of the subjects involved in the study.
The characteristics of 214 episodes of invasive bacterial infection among 176 patients with homozygous sickle cell (SS) disease were examined. Streptococcus pneumoniae occurred in 81 episodes, Salmonella spp in 70, Haemophilus influenzae type b in 30, Escherichia coli in 24, and Klebsiella spp in nine. The cumulative incidence showed that S pneumoniae and H influenzae occurred predominantly before 5 years of age and were uncommon thereafter, Salmonella spp increased almost linearly with age, and Klebsiella spp and E coli predominated in patients over 10 years of age. Escherichia coli had a different epidemiology-it was found in older children, almost entirely girls. Excluding this organism from an analysis of recurrent bacterial infections, the standardised incidence rates for second and third infections were 4.8 and 15.8 times greater, respectively, than the SS population average. This implies that the susceptibility to infection is characteristic of a subgroup of patients with SS disease and that sick patients with previous bacteraemia should be investigated early and aggressively for further infection.
To better quantify the impact of foodborne diseases on health in the United States, we compiled and analyzed information from multiple surveillance systems and other sources. We estimate that foodborne diseases cause approximately 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year. Known pathogens account for an estimated 14 million illnesses, 60, 000 hospitalizations, and 1,800 deaths. Three pathogens, Salmonella, Listeria, and Toxoplasma, are responsible for 1,500 deaths each year, more than 75% of those caused by known pathogens, while unknown agents account for the remaining 62 million illnesses, 265,000 hospitalizations, and 3,200 deaths. Overall, foodborne diseases appear to cause more illnesses but fewer deaths than previously estimated.
We studied serotypes and phage types of Salmonella strains isolated from humans and animals in The Netherlands over the period 1984 to 2001. All human strains (n = 59,168) were clinical isolates. The animal strains (n = 65,567) were from clinical and nonclinical infections. All isolates were serotyped, and Salmonella enterica serovar Typhimurium and serovar Enteritidis strains were further phage typed. The most prevalent serotypes were as follows:
in humans, serovars Typhimurium and Enteritidis; in cattle, serovars Typhimurium and Dublin; in pigs, serovar Typhimurium;
and in chickens, serovars Enteritidis, Infantis, and Typhimurium. Serovar Enteritidis phage type 4 (pt 4) was the most common
phage type in humans and chickens. Serovar Typhimurium pt 510 was the most prevalent serovar Typhimurium phage type in humans
and pigs, pt 200 was the most prevalent serovar Typhimurium phage type in cattle, and pt 150 was the most prevalent serovar
Typhimurium phage type in chickens. Analysis of the distribution of sero- and phage types during the study period indicated
that types shifted over time in humans and animals. Serovar Typhimurium DT 104 emerged in 1991 in humans, cattle, pigs, and
chickens and became the most common serovar Typhimurium phage type in 2001. In general, similar sero- and phage types were
found in humans and animals, although distinct types were more common in animals. Between the animal species, the sero- and
phage type distributions varied considerably.
Gender differences in health behaviors have been reported in many studies but casual mechanisms have been neglected.
This study examines 4 food choice behaviors in a large sample of young adults from 23 countries and tests 2 possible explanatory mechanisms for the gender differences-women's greater likelihood of dieting and women's greater beliefs in the importance of healthy diets.
Women were more likely than men to report avoiding high-fat foods, eating fruit and fiber, and limiting salt (to a lesser extent) in almost all of the 23 countries. They were also more likely to be dieting and attached greater importance to healthy eating. Dieting status explained around 22% of fiber choices, and 7% of fruit, but none of the gender difference in salt. Health beliefs explained around 40% of the differences in each of the dietary behaviors and together they explained almost 50%. Gender differences in food choices therefore appear to be partly attributable to women's greater weight control involvement and partly to their stronger beliefs in healthy eating.
Further research is needed to understand the additional factors that could promote men's participation in simple healthy eating practices.
Invasive Salmonella infections are severe and can be life threatening. We analyzed population-based data collected during 1996–1999 by the Foodborne
Diseases Active Surveillance Network (FoodNet), to determine the incidences, infecting serotypes, and outcomes of invasive
Salmonella infection. We found that the mean annual incidence of invasive salmonellosis was 0.9 cases/100,000 population and was highest
among infants (7.8 cases/100,000). The incidence was higher among men than women (1.2 vs. 0.7 cases/100,000; P < .001) and higher among blacks, Asians, and Hispanics than among whites (2.5, 2.0, and 1.3 cases/100,000 population, respectively,
vs. 0.4 cases/100,000; all P < .001). Seventy-four percent of cases were caused by 8 Salmonella serotypes: Typhimurium, Typhi, Enteritidis, Heidelberg, Dublin, Paratyphi A, Choleraesuis, and Schwarzengrund. Of 540 persons
with invasive infection, 386 (71%) were hospitalized and 29 (5%) died; 13 (45%) of the deaths were among persons aged ⩾60
years. Invasive Salmonella infections are a substantial health problem in the United States and contribute to hospitalizations and deaths.
Death rarely results from only one cause, and it can be caused by a variety of factors. Multiple cause-of-death data files can list as many as 20 contributing causes of death in addition to the reported underlying cause of death. Analysis of multiple cause-of-death data can provide information on associations between causes of death, revealing common combinations of events or conditions which lead to death. Additionally, physicians report the causal train of events through which they believe that different conditions or events may have led to each other and ultimately caused death. In this paper, the authors discuss methods used in studying associations between reported causes of death and in investigating commonly reported causal pathways between events or conditions listed on the death certificate.
With the emergence of multidrug-resistant nontyphoidal (NT) Salmonella, knowledge of resistance patterns is critical for appropriate presumptive treatment. This report describes the prevalence and trends of NT Salmonella antimicrobial susceptibility within the New York State (NYS) Foodborne Diseases Active Surveillance Network (FoodNet). The NYS Department of Health, Wadsworth Center Public Health Laboratory tested all Salmonella isolates from the NYS FoodNet catchment area between May 2003 and December 2007 for antimicrobial susceptibility to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, tetracycline, nalidixic acid, and ciprofloxacin. Isolate susceptibility results were linked to their corresponding demographic and clinical data and analyzed. Multidrug-resistant isolates were defined as resistant to ampicillin, chloramphenicol, streptomycin, sulfisoxazole, and tetracycline (R-type ACSSuT). Antimicrobial susceptibility for 2189 FoodNet cases (98.5% of total cases) showed 79.6% pansusceptible, 6.9% R-type ACSSuT, and 13.5% resistant to at least one antimicrobial agent but not R-type ACSSuT. Four (0.2%) isolates were resistant to ciprofloxacin. From 2004 to 2007, cases with R-type ACSSuT significantly decreased from 8.7% (37/424) to 4.8% (24/499) (p < 0.01). Serotypes with the highest proportion of R-type ACSSuT included Salmonella Typhimurium 17.9% (79/444), and Salmonella Newport 29.1% (51/175). Among Salmonella Typhimurium isolates, over 40% of the African-American cases (19/46) had R-type ACSSuT isolates, compared with 15.7% of the Caucasian cases (58/369) (p < 0.01). R-type ACSSuT Salmonella Typhimurium cases were hospitalized (41.8%) more frequently than pansusceptible Salmonella Typhimurium cases (24.9%), after controlling for age (p < 0.05). Length of hospitalization was not significantly different. Although R-type ACSSuT NT Salmonella has decreased since 2003 within the NYS FoodNet catchment area, monitoring resistance patterns remains important in identifying emerging resistant strains, vulnerable populations, and determining appropriate presumptive treatment regimens. The higher rate of R-type ACSSuT among the African-American cases requires further study.
In children, a male predominance in the incidence of symptomatic disease has been reported for some infectious agents and not for others. Not only are the factors underlying these sex differences poorly understood, but it is also not clear why the differences are described only for selected infectious diseases. In this study of sex-and age-specific incidence of infectious diseases in children, a possible explanation for the inconsistencies in the literature was explored.
The sex ratio in reported disease incidence in Israel during a period of about 20 years was examined for various viral and bacterial infections. In addition, an hypothetical mathematical model was developed which assumes increased susceptibility to infectious disease (such as in relative immune deficiency) in a proportion of males.
In children aged under 4 years, a higher incidence among males was consistently observed for all diseases, and the sex ratio varied between 1.16(95% confidence interval (CI): 1.13–1.18) for shigellosis to 1.98(95% CI: 1.79–2.17) for viral meningitis. The highest ratios were associated with the diseases which tend to present asymptomatically most often, which is consistent with the predictions of the model.
The male excess in symptomatic disease appears to be present for most infectious diseases and this should be taken into account in studies comparing observed disease incidence between groups with different sex ratios. The incon sistencies in reports on the excess male morbidity for infectious diseases may be due to variations in symptomatic to asymptomatic infection ratios.
To determine the patterns and possible explanations for gender differences in food choices, nutrient intakes and status indices, especially for micronutrients, in a representative sample of older people living in Britain, who participated in the National Diet and Nutrition Survey of people aged 65 y and over during 1994-95.
The Survey procedures included a health-and-lifestyle interview, a four-day weighed diet record, anthropometric measurements and a fasting blood sample for biochemical indices.
Eighty randomly-selected postcode sectors from mainland Britain.
Of 1556 older people not living in institutions who were interviewed, 80% agreed to provide a complete four-day diet record and 63% agreed to give a blood sample for status index measurements.
None.
The most highly significant gender differences in food choices were that women ate more butter, full-fat milk and certain beverages, cakes, apples, pears and bananas, whereas men ate more eggs, sugar, certain meat products and drank more alcoholic drinks, especially beer and lager. When adjusted for energy intakes, the younger women (65-79 y) had higher intakes than the younger men, of fat, retinol, vitamin C and calcium. The older women (80+ y) had higher intakes than older men, of fat and vitamin E, but lower intakes of protein, zinc and beta-carotene. The younger women had better status indices than the younger men: for alpha- and beta-carotenes, beta-cryptoxanthin and vitamin C. Women had higher plasma concentrations of cholesterol and HDL cholesterol, phosphate and copper, but lower indices of iron and vitamin D status, than men. These gender differences in status were not altered by inclusion of the corresponding nutrient intakes in the model.
There are gender differences in food choices, in energy and nutrient intakes and in nutritional blood status indices in older British people, especially those aged 65-79 y. Some of the status differences are attenuated in the age group of 80 y and older, whereas others are enhanced. The relationships between the quantity and type of foods or nutrients consumed, and nutrient status, are complex. With respect to suspected risk and protective factors for vascular disease, women aged 65-79 y had significantly better status for plasma alpha- and beta-carotene, ascorbate, HDL-cholesterol and homocysteine; but, in contrast, they had lower blood haemoglobin concentrations and higher concentrations of total and non-HDL-cholesterol.
Rates of hospitalization due to septicemia (International Classification of Diseases, Ninth Revision, Clinical Modification, code 038) in the US elderly population for 1986–1997 were examined, using Medicare
administrative data. Age group-, sex-, and race-adjusted rates more than doubled from 1986 through 1997, from 3.42 to 7.42
per 1000 beneficiaries. The 1997 rates of septicemia increased with age, from 4.47 per 1000 beneficiaries among persons 65–74
years old to 18.1 per 1000 beneficiaries among persons ⩾85 years old. The rates of septicemia were slightly greater among
men (7.46 per 1000 beneficiaries) than among women (7.39 per 1000 beneficiaries) and were higher among blacks (13.61 per 1000
beneficiaries) than among whites (6.89 per 1000 beneficiaries). The most likely sites of the origin of the septicemia were
the urinary tract (40.1%) and lungs (15.3%). Escherichia coli and Staphylococcus species were the most frequently reported organisms. Diabetes was listed as a comorbidity in 24.5% of the hospitalizations.
We estimate that the cost to Medicare for septicemia hospitalizations in 1997 was >$1.8 billion.
Salmonella is a common cause of bacterial foodborne illness in the United States. The epidemiology and costs of nontyphoidal salmonellosis in California from 1990 through 1999 are described using surveillance, hospitalization, and death data. Trends in Salmonella rates and factors associated with prolonged hospitalization were evaluated using Poisson and linear regression models, respectively. There were 56,660 reported cases, 11,102 hospitalizations, and 74 deaths attributed to Samonella. Reported case and hospital discharge rates have decreased since 1996. Among reported cases, infants had the highest rate (121 cases per 10(5) person-years), followed by children 1-4 years of age (40 cases per 10(5) person-years). The highest hospitalization rates were among the elderly and young children. Most deaths occurred among persons aged 65 or more years (59%). Among hospitalizations, gastroenteritis (61%) and septicemia (23%) were the most common Salmonella diagnoses. Salmonella pneumonia patients were the oldest (median age, 55 years) and Salmonella meningitis patients the youngest (median age, 0.3 years). These two diagnoses were the costliest, approaching 30,000 dollars (median) per hospitalization. Having an acquired immunodeficiency syndrome diagnosis or multiple Salmonella diagnoses was independently associated with prolonged hospitalization. The estimated 10-year hospitalization costs for Salmonella were $200 million. Salmonellosis is a costly disease that disproportionately affects the young and elderly.
Nontyphoidal Salmonella causes a higher proportion of food-related deaths annually than any other bacterial pathogen in the United States. We reviewed
4 years (1996–1999) of population-based active surveillance data on laboratory-confirmed Salmonella infections from the Emerging Infections Program's Foodborne Diseases Active Surveillance Network (FoodNet), to determine
the rates of hospitalization and death associated with Salmonella infection. Overall, 22% of infected persons were hospitalized, with the highest rate (47%) among persons aged >60 years.
Fifty-eight deaths occurred, for an estimated annual incidence of 0.08 deaths/100,000 population. These deaths accounted for
38% of all deaths reported through FoodNet from 1996 through 1999, and they occurred primarily among adults with serious underlying
disease. Although Salmonella infection was seldom listed as a cause of death on hospital charts and death certificates, our chart review suggests that
Salmonella infection contributed to these deaths.
Hospitalizations and deaths due to Salmonella infections, FoodNet
- Kennedy M R Villar
- Vugia
- Dj
Kennedy M, Villar R, Vugia DJ, et al. Hospitalizations and deaths due to Salmonella infections, FoodNet, 1996–1999. Clin Infect Dis 2004;38:S142–S148.