Source attribution of campylobacteriosis in Australia, 2017-2019.

Campylobacter jejuni and Campylobacter coli infections are the leading cause of foodborne gastroenteritis in high-income countries. Campylobacter colonizes a variety of warm-blooded hosts that are reservoirs for human campylobacteriosis. The proportions of Australian cases attributable to different animal reservoirs are unknown but can be estimated by comparing the frequency of different sequence types in cases and reservoirs. Campylobacter isolates were obtained from notified human cases and raw meat and offal from the major livestock in Australia between 2017 and 2019. Isolates were typed using multi-locus sequence genotyping. We used Bayesian source attribution models including the asymmetric island model, the modified Hald model, and their generalizations. Some models included an "unsampled" source to estimate the proportion of cases attributable to wild, feral, or domestic animal reservoirs not sampled in our study. Model fits were compared using the Watanabe-Akaike information criterion. We included 612 food and 710 human case isolates. The best fitting models attributed >80% of Campylobacter cases to chickens, with a greater proportion of C. coli (>84%) than C. jejuni (>77%). The best fitting model that included an unsampled source attributed 14% (95% credible interval [CrI]: 0.3%-32%) to the unsampled source and only 2% to ruminants (95% CrI: 0.3%-12%) and 2% to pigs (95% CrI: 0.2%-11%) The best fitting model that did not include an unsampled source attributed 12% to ruminants (95% CrI: 1.3%-33%) and 6% to pigs (95% CrI: 1.1%-19%). Chickens were the leading source of human Campylobacter infections in Australia in 2017-2019 and should remain the focus of interventions to reduce burden.

Campylobacter-associated hospitalisations in an Australian provincial setting.

BACKGROUND: Campylobacter spp. infections are a globally important cause of enterocolitis, causing substantial morbidity. Capturing accurate information on hospitalisations is challenging and limited population-level data exist to describe the clinico-epidemiological characteristics of hospitalised cases. METHODS: Hospital administrative and laboratory datasets were linked to identify Campylobacter-associated hospitalisations between 2004 and 2013. Accuracy of morbidity coding was assessed using laboratory diagnosis as a gold standard, with health department surveillance data used to calculate population-based rates. Additional patient-level data were collected via review of medical records. Descriptive statistics were used to assess changes in rates and proportions and to assess relationships between key variables including age, length of stay, comorbidity and complications. RESULTS: In total 685 Campylobacter-associated hospital admissions were identified, with the sensitivity of morbidity coding 52.8% (95% CI 48.9-56.7%). The mean annual rate of hospitalisation was 13.6%. Hospitalisation rates were higher for females across most age-groups, while for both genders marked increases were observed for those aged ≥60 years. Median admission age was 39.5 years, with an average length of stay of 3.5 days. Comorbidities were present in 34.5% (237/685) of admissions, with these patients more likely to develop electrolyte disturbances, hypotension, renal impairment or acute confusion (all p < 0.001). Bacteraemia and acute kidney injury were observed in 4.1% (28/685) and 3.6% (23/685) of admissions, respectively. Inpatient mortality was low (0.15%). CONCLUSION: Under reporting of Campylobacter-associated hospitalisations is substantial but can be improved through data linkage. We observed demographic differences among those hospitalised but further work is needed to determine risk factors and predictors for hospitalisation.

Bacteraemia, antimicrobial susceptibility and treatment among Campylobacter-associated hospitalisations in the Australian Capital Territory: a review.

BACKGROUND: Campylobacter spp. cause mostly self-limiting enterocolitis, although a significant proportion of cases require hospitalisation highlighting potential for severe disease. Among people admitted, blood culture specimens are frequently collected and antibiotic treatment is initiated. We sought to understand clinical and host factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. METHODS: Using linked hospital microbiology and administrative data we identified and reviewed Campylobacter-associated hospitalisations between 2004 and 2013. We calculated population-level incidence for Campylobacter bacteraemia and used logistic regression to examine factors associated with bacteraemia, antibiotic treatment and isolate non-susceptibility among Campylobacter-associated hospitalisations. RESULTS: Among 685 Campylobacter-associated hospitalisations, we identified 25 admissions for bacteraemia, an estimated incidence of 0.71 cases per 100,000 population per year. Around half of hospitalisations (333/685) had blood culturing performed. Factors associated with bacteraemia included underlying liver disease (aOR 48.89, 95% CI 7.03-340.22, p < 0.001), Haematology unit admission (aOR 14.67, 95% CI 2.99-72.07, p = 0.001) and age 70-79 years (aOR 4.93, 95% CI 1.57-15.49). Approximately one-third (219/685) of admissions received antibiotics with treatment rates increasing significantly over time (p < 0.05). Factors associated with antibiotic treatment included Gastroenterology unit admission (aOR 3.75, 95% CI 1.95-7.20, p < 0.001), having blood cultures taken (aOR 2.76, 95% CI 1.79-4.26, p < 0.001) and age 40-49 years (aOR 2.34, 95% CI 1.14-4.79, p = 0.02). Non-susceptibility of isolates to standard antimicrobials increased significantly over time (p = 0.01) and was associated with overseas travel (aOR 11.80 95% CI 3.18-43.83, p < 0.001) and negatively associated with tachycardia (aOR 0.48, 95%CI 0.26-0.88, p = 0.02), suggesting a healthy traveller effect. CONCLUSIONS: Campylobacter infections result in considerable hospital burden. Among those admitted to hospital, an interplay of factors involving clinical presentation, presence of underlying comorbidities, complications and increasing age influence how a case is investigated and managed.

Characteristics of Campylobacter Gastroenteritis Outbreaks in Australia, 2001 to 2016.

Campylobacter spp. are a globally important cause of bacterial gastroenteritis, with Australia experiencing higher rates of illness than many comparable high-income countries. Despite the high disease incidence, outbreaks of campylobacteriosis in Australia are infrequently detected and reported. We examined the epidemiology of Campylobacter outbreaks in Australia, with particular emphasis on assessing transmission routes and evidence as reported during public health investigations. A national register of enteric and foodborne disease outbreaks was used to summarize data on all Campylobacter outbreaks reported in Australia between 2001 and 2016. Outbreak data were reviewed and analyzed for trends over time. Additional information was sought from state and territory epidemiologists, to validate transmission routes. A total of 84 Campylobacter outbreaks were reported, with 51 (61%) being classified as foodborne. Specific food vehicles were identified for 33 (65%) outbreaks, with 28 (85%) implicating chicken or chicken-containing dishes. Although no increase in the proportion of foodborne Campylobacter outbreaks was observed, examination of specific food vehicles demonstrated a significant increase in outbreaks because of poultry-liver containing foods (p = 0.04). One quarter of all 1042 outbreak-associated cases occurred in aged-care facilities (ACFs), including 17 associated hospitalizations and three deaths. After review of evidence data, 23 outbreaks (27%) were determined to have an unknown route of transmission, including 10 (43%) outbreaks occurring in ACFs. Campylobacter spp. remain a less commonly reported cause of gastroenteritis outbreaks in Australia. Although many reported outbreaks can be linked to foodborne transmission, over a quarter were unable to identify either a food vehicle or transmission source, particularly for outbreaks occurring in aged care. Increased efforts to improve evidence collection and understanding of transmission dynamics for outbreaks of campylobacteriosis, particularly in aged care, are required.

Epidemiology of non-typhoid Salmonella infection in the Australian Capital Territory over a 10-year period.

AIM: To describe the epidemiology of non-typhoid Salmonella (NTS) infection in the Australian Capital Territory (ACT), including factors associated with hospitalisation. METHODS: This was a retrospective descriptive and observational study of culture-confirmed NTS infections using data collected from ACT public health, public pathology and hospital services in the period 2003-2012. Outcome measures include incidence and NTS serotype for total reported and hospitalised cases and focus of infection, complications and antibiotic susceptibility for hospitalised cases. RESULTS: In total, 1469 cases of NTS infection were reported, with the crude annual incidence increasing from 24.4 to 61.3 cases per 100 000 population; 14% were hospitalised, representing an incidence of 5.9 hospitalisations per 100 000 population, without significant change over time. Hospitalisation incidence peaked at the extremes of age. Comorbid disease and age ≥ 80 years were associated with complications during hospitalisation. Salmonella serotype Typhimurium was the most common serotype, accounting for 64% of NTS. Independent risk factors for invasive disease included non-S. Typhimurium serotype (aRR 5.46, 95%CI 1.69-17.65 P = 0.005), ischaemic heart disease (aRR 4.18, 95%CI 1.20-14.60 P = 0.025) and haematological malignancy (aRR 6.93, 95%CI 2.54-18.94 P < 0.001). Among hospitalised patients, resistance to ampicillin, ceftriaxone, trimethoprim-sulfamethoxazole and quinolones was 9.9%, 0%, 4.4% and 2.5% respectively. CONCLUSIONS: NTS notifications in the ACT have increased over time, with outbreaks of food-borne disease contributing to this increase. Crude age-specific incidence is highest in the very young, while rates of hospitalisation are highest in the elderly. Comorbid disease and infection with a non-S. Typhimurium serotype were associated with complicated NTS disease course. Antimicrobial resistance in NTS is low and has not increased over time.

First case report of myopericarditis linked to Campylobacter coli enterocolitis.

BACKGROUND: Campylobacter spp. are a common cause of mostly self-limiting enterocolitis. Although rare, pericarditis and myopericarditis have been increasingly documented as complications following campylobacteriosis. Such cases have occurred predominantly in younger males, and involved a single causative species, namely Campylobacter jejuni. We report the first case of myopericarditis following Campylobacter coli enterocolitis, with illness occurring in an immunocompetent middle-aged female. CASE PRESENTATION: A 51-yo female was admitted to a cardiology unit with a 3-days history of chest pain. The woman had no significant medical history or risk factors for cardiac disease, nor did she report any recent overseas travel. Four days prior to the commencement of chest pain the woman had reported onset of an acute gastrointestinal illness, passing 3-4 loose stools daily, a situation that persisted at the time of presentation. Physical examination showed the woman's vital signs to be essentially stable, although she was noted to be mildly tachycardic. Laboratory testing showed mildly elevated C-reactive protein and a raised troponin I in the absence of elevation of the serum creatinine kinase. Electrocardiography (ECG) demonstrated concave ST segment elevations, and PR elevation in aVR and depression in lead II. Transthoracic echocardiogram (TTE) revealed normal biventricular size and function with no significant valvular abnormalities. There were no left ventricular regional wall motion abnormalities. No pericardial effusion was present but the pericardium appeared echodense. A diagnosis of myopericarditis was made on the basis of chest pain, typical ECG changes and troponin rise. The chest pain resolved and she was discharged from hospital after 2-days of observation, but with ongoing diarrhoea. Following discharge, a faecal sample taken during the admission, cultured Campylobacter spp. Matrix assisted laser desorption ionization time-of-flight (Bruker) confirmed the cultured isolate as C. coli. CONCLUSION: We report the first case of myopericarditis with a suggested link to an antecedent Campylobacter coli enterocolitis. Although rare, myopericarditis is becoming increasingly regarded as a complication following campylobacteriosis. Our report highlights potential for pericardial disease beyond that attributed to Campylobacter jejuni. However uncertainty regarding pathogenesis, coupled with a paucity of population level data continues to restrict conclusions regarding the strength of this apparent association.

Salmonella Typhimurium and Outbreaks of Egg-Associated Disease in Australia, 2001 to 2011.

INTRODUCTION: Salmonellosis is a significant public health problem, with eggs frequently identified as a food vehicle during outbreak investigations. Salmonella enterica serovar Typhimurium and Salmonella enterica serovar Enteritidis are the two most frequently identified causes of egg-associated disease in industrialized countries. In Australia, a comprehensive review of egg-associated outbreaks has not been previously undertaken. METHODS: Using a national register of foodborne outbreaks, we undertook a descriptive review of egg-associated outbreaks between 2001 and 2011. Included in our review was additional detail from the findings of trace back investigations conducted to the farm level. Evidence classifications were developed and applied to each outbreak based on descriptive and analytical epidemiology, food safety investigations, and microbiological testing of clinical, food, and trace back-derived samples. RESULTS: Over the study period, the proportion of foodborne Salmonella outbreaks linked to eggs increased significantly (p < 0.001). In total, 166 outbreaks were identified, with 90% caused by Salmonella Typhimurium. The majority of outbreaks were linked to commercial food providers, with raw egg use the major contributing factor. These events resulted in more than 3200 cases, more than 650 hospitalizations, and at least 4 deaths. Fifty-four percent of investigations used analytical epidemiology, food microbiology, and trace back microbiology to demonstrate links between human illness and eggs. Trace back investigations identified S. enterica indistinguishable from outbreak-associated clinical or food samples on 50% of sampled egg farms. CONCLUSION: Effective control of egg-associated salmonellosis remains a challenge in Australia, with Salmonella Typhimurium dominating as the causative serotype in outbreak events. Although outbreaks predominantly occur in the settings of restaurants, the high recovery rate of indistinguishable Salmonella on epidemiologically implicated egg farms suggests that further efforts to minimize infection pressure at the primary production level are needed in Australia.

An outbreak of gastroenteritis linked to a buffet lunch served at a Canberra restaurant.

In 2013, an outbreak of gastrointestinal illness occurred following a buffet lunch at a restaurant in Canberra. An investigation was conducted to identify the cause of illness and to implement appropriate public health measures to prevent further disease. We conducted a retrospective cohort study via telephone interviews, using a structured questionnaire developed from the restaurant buffet menu. A case was defined as someone who ate the buffet lunch at the restaurant on the implicated date and developed any symptoms of gastrointestinal illness (such as diarrhoea, abdominal pain and nausea) following the consumption of food. A total of 74% (225/303) of known attendees were interviewed, of whom 56% (125/225) had become ill. The median incubation period and duration of illness were 13 and 19 hours respectively. The most commonly reported symptoms were diarrhoea (94%, 118/125) and abdominal pain (82%, 103/125). A toxin-mediated gastrointestinal illness was suspected based on the incubation period, duration of illness and the symptoms. The environmental health investigation identified a lack of designated hand washing facilities in the kitchen, an absence of thermometers for measuring food temperatures and several maintenance and minor cleaning issues. A number of food samples were taken for microbiological analysis. Multivariable analysis showed that illness was significantly associated with consuming curried prawns (OR 18.4, 95% CI 8.6-39.3, P < 0.001) and Caesar salad (OR 3.6, 95% CI 1.8-7.5, P 0.001). Enterotoxin-producing Staphylococcus aureus and Bacillus cereus were identified in leftover samples of cooked buffet food, but this food was not epidemiologically implicated. The investigation suggested that a breakdown in cleanliness, temperature control and food handling practices may have resulted in contamination of the buffet food. In order to prevent such outbreaks in the future, caterers and restaurateurs need to ensure they have the appropriate facilities and procedures in place if planning to cater for large groups.

Genomic and clinical characteristics of campylobacteriosis in Australia.

Campylobacter spp. are a common cause of bacterial gastroenteritis in Australia, primarily acquired from contaminated meat. We investigated the relationship between genomic virulence characteristics and the severity of campylobacteriosis, hospitalisation, and other host factors.We recruited 571 campylobacteriosis cases from three Australian states and territories (2018-2019). We collected demographic, health status, risk factors, and self-reported disease data. We whole genome sequenced 422 C. jejuni and 84 C. coli case isolates along with 616 retail meat isolates. We classified case illness severity using a modified Vesikari scoring system, performed phylogenomic analysis, and explored risk factors for hospitalisation and illness severity.On average, cases experienced a 7.5 day diarrhoeal illness with additional symptoms including stomach cramps (87.1 %), fever (75.6 %), and nausea (72.0 %). Cases aged ≥75 years had milder symptoms, lower Vesikari scores, and higher odds of hospitalisation compared to younger cases. Chronic gastrointestinal illnesses also increased odds of hospitalisation. We observed significant diversity among isolates, with 65 C. jejuni and 21 C. coli sequence types. Antimicrobial resistance genes were detected in 20.4 % of isolates, but multidrug resistance was rare (0.04 %). Key virulence genes such as cdtABC (C. jejuni) and cadF were prevalent (>90 % presence) but did not correlate with disease severity or hospitalisation. However, certain genes (e.g. fliK, Cj1136, and Cj1138) appeared to distinguish human C. jejuni cases from food source isolates.Campylobacteriosis generally presents similarly across cases, though some are more severe. Genotypic virulence factors identified in the literature to-date do not predict disease severity but may differentiate human C. jejuni cases from food source isolates. Host factors like age and comorbidities have a greater influence on health outcomes than virulence factors.

An outbreak of Salmonella Typhimurium phage type 135a gastroenteritis linked to eggs served at an Australian Capital Territory café.

Salmonella is an important foodborne pathogen, with eggs and egg-containing foods being frequently implicated in causing outbreaks of disease. In April 2012, an investigation was commenced after a number of cases of salmonellosis were linked to a Canberra café. The investigation sought to identify the cause of illness and to introduce public health measures to prevent further disease. A case control study was undertaken using the café's booking list to identify potential cases and controls. A structured questionnaire was developed using the café's menu, with information collected via telephone interview or email. A case was defined as any person who ate at the implicated café on 25 April 2012 and subsequently developed gastroenteritis. A total of 20 cases and 22 controls were recruited into the study. All 20 cases had faecal cultures positive for Salmonella Typhimurium phage type 135a (STm 135a). Eating eggs Benedict (odds ratio 63.00, 95% confidence interval 6.08-2771.66 P > 0.001) was significantly associated with illness. While no microbiological evidence of STm 135a was obtained from foods sampled from the café, STm 135a was recovered from swabs taken from the kitchen environment. This report illustrates an ongoing trend in Australia, where raw and minimally cooked egg-containing foods are identified as the responsible vehicles in a high proportion of foodborne Salmonella outbreaks.

A mild outbreak of gastroenteritis in long-term care facility residents due to Clostridium perfringens, Australia 2009.

INTRODUCTION: Clostridium perfringens food poisoning is a commonly cited cause of gastroenteritis outbreaks among elderly long-term care facility (LTCF) residents, yet little is known about the natural history of disease in this vulnerable group. In July 2009, an investigation into diarrheal illness among LTCF residents was commenced. METHODS: An environmental health investigation and retrospective cohort study were undertaken to confirm the outbreak, to identify a source and mode of transmission, and to implement public health measures to prevent further cases. Menu listings and food safety program details were obtained and food-handling practices were observed. Clinical notes of all residents were reviewed. A possible case was defined as any resident developing one or more acute loose stool episodes between the evenings of 23 July and 27 July. RESULTS: Fifty-two residents (41%) had been ill with diarrhea, and eight residents had fecal samples positive for C. perfringens enterotoxin. LTCF staff failed to perform routine temperature checks on hot foods before the outbreak. A sweet-and-sour pork lunch served on 23 July was implicated in causing residents' illness, but no residual food remained for microbiological testing. Independent associations with illness were demonstrated among residents living in two wings of the facility that received a standard level of service, whereas an inverse association with illness was shown among residents living in an "extra service" wing. Male residents were also more likely to become ill. Illness was mild with case patients reporting a median of two loose stools (range 1-12). CONCLUSIONS: C. perfringens is an important cause of both foodborne and nonfoodborne gastroenteritis outbreaks in LTCF, but may be missed due to the often mild nature of illness. This investigation highlights the potential burden of C. perfringens disease among vulnerable LTCF populations. To prevent C. perfringens outbreaks, facilities must adhere to food safety plans and ensure high standards of infection control practice.

Campylobacter jejuni gastroenteritis at an Australian boarding school: consistency between epidemiology, flaA typing, and multilocus sequence typing.

In this study, an outbreak of Campylobacter jejuni gastroenteritis occurring at a boarding school was investigated using a retrospective cohort study and environmental health investigation. Thirty-five cases of gastroenteritis were recorded among 58 questionnaire respondents, with 14 of 18 persons submitting fecal samples having confirmed C. jejuni infections. Attendance at one evening meal was statistically associated with illness (ratio of proportions of 3.09; 95% confidence intervals: 1.21, 14.09; p = 0.02). There was no statistically significant association between any single food provided at the implicated evening meal and illness, suggesting that the potential cause of the outbreak was a cross-contamination event. Among the human isolates, two distinct restriction fragment length polymorphism-flaA subtypes were found. Results from subsequent multilocus sequence typing data were consistent with the flaA typing results. The study highlights the potential of cross-contamination as a cause of epidemic campylobacteriosis. The application of molecular techniques to aid epidemiological investigation of recognized C. jejuni outbreaks is illustrated.

Treating and preventing influenza in aged care facilities: a cluster randomised controlled trial.

BACKGROUND: Influenza is an important cause of morbidity and mortality for frail older people. Whilst the antiviral drug oseltamivir (a neuraminidase inhibitor) is approved for treatment and prophylaxis of influenza during outbreaks, there have been no trials comparing treatment only (T) versus treatment and prophylaxis (T&P) in Aged Care Facilities (ACFs). Our objective was to compare a policy of T versus T&P for influenza outbreaks in ACFs. METHODS AND FINDINGS: We performed a cluster randomised controlled trial in 16 ACFs, that followed a policy of either "T"-oseltamivir treatment (75 mg twice a day for 5 days)-or "T&P"-treatment and prophylaxis (75 mg once a day for 10 days) for influenza outbreaks over three years, in addition to enhanced surveillance. The primary outcome measure was the attack rate of influenza. Secondary outcomes measures were deaths, hospitalisation, pneumonia and adverse events. Laboratory testing was performed to identify the viral cause of influenza-like illness (ILI) outbreaks. The study period 30 June 2006 to 23 December 2008 included three southern hemisphere winters. During that time, influenza was confirmed as the cause of nine of the 23 ILI outbreaks that occurred amongst the 16 ACFs. The policy of T&P resulted in a significant reduction in the influenza attack rate amongst residents: 93/255 (36%) in residents in T facilities versus 91/397 (23%) in T&P facilities (p=0.002). We observed a non-significant reduction in staff: 46/216 (21%) in T facilities versus 47/350 (13%) in T&P facilities (p=0.5). There was a significant reduction in mean duration of outbreaks (T=24 days, T&P=11 days, p=0.04). Deaths, hospitalisations and pneumonia were non-significantly reduced in the T&P allocated facilities. Drug adverse events were common but tolerated. CONCLUSION: Our trial lacked power but these results provide some support for a policy of "treatment and prophylaxis" with oseltamivir in controlling influenza outbreaks in ACFs. TRIAL REGISTRATION: [corrected] Australian Clinical Trials Registry ACTRN12606000278538.

Incompletely matched influenza vaccine still provides protection in frail elderly.

A cluster-randomised controlled trial of antiviral treatment to control influenza outbreaks in aged-care facilities (ACFs) provided an opportunity to assess VE in the frail, institutionalised elderly. Data were pooled from five influenza outbreaks in 2007. Rapid testing methods for influenza were used to confirm outbreaks and/or identify further cases. Vaccination coverage among ACF residents ranged from 59% to 100%, whereas it was consistently low in staff (11-33%). The attack rates for laboratory-confirmed influenza in residents ranged from 9% to 24%, with the predominate strain determined to be influenza A. Sequencing of the hemagglutinin gene from a sub-sample demonstrated an incomplete match with the 2007 southern hemisphere influenza vaccine. Influenza VE was estimated to be 61% (95%CI 6%, 84%) against laboratory-confirmed influenza, 51% (95%CI -16%, 79%) against influenza-like illness, 82% (95%CI 27%, 96%) against pneumonia-related and influenza-related hospitalisations and 71% (95%CI -28%, 95%) against death from all causes. This supports the continued policy of targeted vaccination of the institutionalised, frail elderly. There is also reassurance that influenza vaccine can be effective against disease and severe outcomes, despite an incomplete vaccine match. This benefit is additional to protection from antivirals.

An outbreak of gastroenteritis due to Salmonella Typhimurium phage type 170 associated with consumption of a dessert containing raw egg.

Eggs are frequently implicated as a source of foodborne salmonellosis. In February 2009 an investigation was commenced following reports of gastrointestinal illness among diners at a Canberra restaurant. The investigation sought to confirm the existence of an outbreak, identify a source and implement public health measures to prevent more cases. Menus and booking lists were obtained from the restaurant and a case-control study was commenced. A suspected case was defined as a person who ate at the restaurant on 13 or 14 February 2009 and subsequently developed diarrhoea and/or vomiting. Twenty cases and 31 controls were enrolled in the study. Eating a tiramisu dessert containing raw egg had a highly statistically significant association with illness (crude odds ratio 130.50, 95% confidence interval 13.54-1605.28). Among the 20 cases, nine of 12 stool samples were positive for Salmonella Typhimurium phage type 170 (STm 170). No microbiological evidence of STm 170 was obtained from the restaurant or during the egg trace-back investigation. This report highlights the risk associated with consumption of foods containing raw or undercooked shell egg.

Outbreak of Salmonella Typhimurium 44 related to egg consumption.

ACT Health investigated an outbreak of gastroenteritis associated with a local restaurant in December 2008. The infecting agent was Salmonella serotype Typhimurium phage type 44. A case control study was conducted to identify the source of infection. A total of 22 cases and 9 controls were recruited to take part in the study. Both poached eggs (odds ratio [OR] 42.00) and hollandaise sauce (OR 19.00) had elevated odds ratios that were statistically significant. The major limitation of the study was the small sample size and small number of controls. Despite this, a strong association with illness and consumption of eggs and hollandaise sauce was detected and this was further supported by environmental evidence. The investigation concluded that the cause of the outbreak was putatively contaminated eggs, either on their own or as an ingredient used in hollandaise sauce. The investigation and control measures led to an improvement in hygiene practices at the restaurant and contributed to the voluntary recall of the contaminated batch of eggs from the Australian Capital Territory. The results of the study also build upon other evidence that egg-related salmonellosis is now common in Australia and attention to commercial practices at production and processing is overdue.

Diagnostic accuracy in skin cancer clinics: the Australian experience.

BACKGROUND: Australia, with the world's highest incidence of skin cancer, has witnessed the emergence of "open access" skin cancer clinics during the past decade. These clinics are becoming increasingly popular destinations for the diagnosis and treatment of skin cancers, yet little is known about the diagnostic performance of practitioners in this setting. We sought to measure the accuracy of clinical diagnosis in this setting. METHODS: Clinical and histological data were obtained from 199 consecutive patients undergoing biopsy or excision for 287 skin lesions. We measured the sensitivity, specificity and predictive value of the clinical diagnoses compared with histological diagnoses. RESULTS: Of 287 biopsied or excised lesions, the most common were benign nevi (24%) and basal cell carcinomas (22%), followed by actinic keratoses (11%), dysplastic nevi (11%) and squamous cell carcinomas (7%). Sensitivity was highest for diagnosing BCC (0.89, 95%CI 0.78-0.95) and dysplastic nevi (0.80, 95%CI 0.61-0.93), and lowest for actinic keratoses and the group of benign lesions. Specificity was greater than 0.93 for all diagnoses except BCC (0.76, 95%CI 0.70-0.81). Treating clinicians perceived moderate to strong pressure to excise 49% of lesions overall, but in particular for benign nevi (73%). CONCLUSIONS: Australian family practitioners in open access skin cancer clinics diagnose a wide range of skin lesions with high specificity and moderate to high sensitivity. Benign nevi are accurately diagnosed and often excised because of patient pressure.

An outbreak of Salmonella Typhimurium phage type 64 gastroenteritis linked to catered luncheons in Adelaide, South Australia, June 2005.

Salmonella sp. are important causes of foodborne illness, with restaurants and catered functions being commonly reported settings for outbreaks. In June 2005 an investigation commenced following reports of gastrointestinal illness in attendees at luncheons catered by an Adelaide café, as well as persons eating at the café itself. The investigation sought to determine the existence of an outbreak, identify a source and method of transmission and implement public health measures to prevent further cases. Lists of luncheon attendees were obtained from function organisers. A retrospective cohort study was commenced using a structured questionnaire developed from the café's menu listings. A suspected case was defined as a person developing two or more gastrointestinal symptoms after attending a luncheon catered by the café. A case series investigation was used for café diners. Of the 102 respondents, 61 (60%) met the case definition with 32 subsequently confirmed as Salmonella Typhimurium phage type 64 (STM 64) infections. Of the 61 cases, 59 (96%) reported eating a bread roll. STM 64 was detected in raw defrosted chicken recovered from the café's kitchen. This suggested cross-contamination from the chicken to one or more ingredients common to the bread rolls was the route of infection. To prevent further cases, perishable goods were discarded, the café was closed, the premises cleaned, then restrictions were placed on the types of foods served. This investigation's findings highlight the importance of safe food handling and hand hygiene in commercial food preparation.