Surveillance of acute infectious gastroenteritis (1992-2009) and food-borne disease outbreaks (1996-2009) in Italy, with a focus on the Piedmont and Lombardy regions.

We describe trends in the occurrence of acute infectious gastroenteritis (1992 to 2009) and food-borne disease outbreaks (1996 to 2009) in Italy. In 2002, the Piedmont region implemented a surveillance system for early detection and control of food-borne disease outbreaks; in 2004, the Lombardy region implemented a system for surveillance of all notifiable human infectious diseases. Both systems are internet based. We compared the regional figures with the national mean using official notification data provided by the National Infectious Diseases Notification System (SIMI) and the National Institute of Statistics (ISTAT), in order to provide additional information about the epidemiology of these diseases in Italy. When compared with the national mean, data from the two regional systems showed a significant increase in notification rates of non-typhoid salmonellosis and infectious diarrhea other than non-typhoid salmonellosis, but for foodborne disease outbreaks, the increase was not statistically significant. Although the two regional systems have different objectives and structures, they showed improved sensitivity regarding notification of cases of acute infectious gastroenteritis and, to a lesser extent, food-borne disease outbreaks, and thus provide a more complete picture of the epidemiology of these diseases in Italy.

Staphylococcal poisoning foodborne outbreak: epidemiological investigation and strain genotyping.

In June 2011, an outbreak of Staphylococcus aureus enterotoxin food poisoning gastroenteritis occurred in Turin, Italy, following a catered dinner party at a private home. Within a few hours, 26 of the 47 guests experienced gastrointestinal illness, and 9 were hospitalized. A retrospective cohort study using a standardized questionnaire was carried out, and the risk ratios for each food item were calculated. The analysis indicated consumption of seafood salad as the most probable cause of the outbreak (risk ratio = 11.72; 95 % confidence interval, 1.75 to 78.54). Biological samples were collected from four of the hospitalized guests (stool and vomit), nasal mucosa swabs from three food handlers employed with the caterer, and available food residuals. All stool and vomit samples tested positive for enterotoxigenic S. aureus. As residues of the seafood salad were no longer available for sampling, suspected contamination could not be verified. However, no other food was found contaminated by S. aureus or its enterotoxins. All isolates from the biological samples were characterized at the genomic level by means of two multiplex PCR protocols to determine the presence of genes encoding staphylococcal enterotoxins, pulsed-field gel electrophoresis and staphylococcal protein A gene (spa) typing to describe their genetic profiles. All the isolates presented genes encoding SEA and SEI; the pulsed-field gel electrophoresis genetic profiles revealed the same pulsotype in the microorganism isolated from the hospitalized guests as in one of the isolates from a food handler's nasal mucosa, and the spa typing analysis reported two closely related spa types (t701 and t267), implicating the food handler as the most likely outbreak source.

Serological evidence of Cryptosporidium infections in southern Europe.

Although cryptosporidiosis outbreaks have been frequently reported in the United States, Canada and the United Kingdom, few outbreaks have been reported on the European continent. The reasons for this are unclear. To ascertain whether a European population has been previously exposed to Cryptosporidium, we conducted a survey of 100 resident blood donors in a northern Italian city for IgG serological response to two oocyst antigen groups. A serological response to the 15/17-kDa antigen group was detected in 83% of blood donors and response to the 27-kDa antigen group in 62%. Donors who traveled outside of Italy during the prior 12 months were less likely to have had a response to the 15/17-kDa antigen group (p < 0.04) and to have a less intense response (p < 0.05). Older age was predictive of a more intense response to each antigen group (p < 0.01). The fraction of Italian blood donors with a serological response to either antigen group was higher than in four United States blood donor populations, with differences more pronounced for response to the 15/17-kDa antigen group (p < 0.01). A lower fraction of Italian donors had a serological response to either antigen group than persons tested at the time of a cryptosporidiosis outbreak in the United States or blood donors tested six months after that outbreak (p < 0.05). Since the presence of serological responses to these antigen groups predicts a reduced risk of cryptosporidiosis, the high prevalence of serological responses in these Italian blood donors may explain the infrequent occurrences of clinically detectable cryptosporidiosis in this city.