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Running Head: SALMONELLA INFECTIONS

Order ID: FPUK-0714-61536364


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