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      Salmonella enterica Serotype Enteritidis Phage Type 4b Outbreak Associated with Bean Sprouts

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          Abstract

          In November 2000 in the Netherlands, an outbreak of Salmonella enterica serotype Enteritidis phage type 4b was investigated. Eating bean sprouts was the only exposure associated with S. Enteritidis pt 4b infection (matched odds ratio 13.0, 95% confidence interval 2.0-552.5). Contaminated seeds were the most likely cause of contamination of the sprouts. The sprout grower applied a concentration of hypochlorite solution that was too low for seed disinfection.

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          Gastroenteritis in sentinel general practices,The Netherlands.

          From 1996 to 1999, the incidence of gastroenteritis in general practices and the role of a broad range of pathogens in the Netherlands were studied. All patients with gastroenteritis who had visited a general practitioner were reported. All patients who had visited a general practitioner for gastroenteritis (cases) and an equal number of patients visiting for nongastrointestinal symptoms (controls) were invited to participate in a case-control study. The incidence of gastroenteritis was 79.7 per 10,000 person years. Campylobacter was detected most frequently (10% of cases), followed by Giardia lamblia (5%), rotavirus (5%), Norwalk-like viruses (5%) and Salmonella (4%). Our study found that in the Netherlands (population 15.6 million), an estimated 128,000 persons each year consult their general practitioner for gastroenteritis, slightly less than in a comparable study in 1992 to 1993. A pathogen could be detected in almost 40% of patients (bacteria 16%, viruses 15%, parasites 8%).
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            Infections associated with eating seed sprouts: an international concern.

            Recent outbreaks of Salmonella and Escherichia coli O157:H7 infections associated with raw seed sprouts have occurred in several countries. Subjective evaluations indicate that pathogens can exceed 107 per gram of sprouts produced from inoculated seeds during sprout production without adversely affecting appearance. Treating seeds and sprouts with chlorinated water or other disinfectants fails to eliminate the pathogens. A comprehensive approach based on good manufacturing practices and principles of hazard analysis and critical control points can reduce the risk of sprout-associated disease. Until effective measures to prevent sprout-associated illness are identified, persons who wish to reduce their risk of foodborne illness from raw sprouts are advised not to eat them; in particular, persons at high risk for severe complications of infections with Salmonella or E. coli O157:H7, such as the elderly, children, and those with compromised immune systems, should not eat raw sprouts.
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              An international outbreak of Salmonella infections caused by alfalfa sprouts grown from contaminated seeds.

              An outbreak of Salmonella serotype stanley infections occurred in the United States and Finland in 1995. The outbreak was investigated through case-control studies in Arizona, Michigan, and Finland; by isolate subtyping; and by tracing and culturing of the implicated food. Alfalfa sprout consumption was the only exposure associated with S. stanley infections in Arizona (matched odds ratio [MOR] = 11.1; 95% confidence interval [CI], 1.4-513), Michigan (MOR = 5.5; CI, 1.6-23), and Finland (MOR undefined; CI, 4.9-infinity). US and Finnish patient isolates were a unique outbreak strain distinct from S. stanley isolates not linked to the outbreak. Alfalfa sprouts eaten by patients in 6 US states and Finland were traced to seed shipped by a Dutch shipper. Thus, it was concluded that alfalfa sprouts grown from contaminated seed caused an international outbreak of > or =242 S. stanley infections in > or =17 US states and Finland. This outbreak illustrates a new mechanism through which contamination of fresh produce can cause large, widely dispersed outbreaks.
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                Author and article information

                Journal
                Emerg Infect Dis
                EID
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                1080-6040
                1080-6059
                April 2002
                : 8
                : 4
                : 440-443
                Affiliations
                [* ]National Institute of Public Health and the Environment, Bilthoven, the Netherlands
                []Inspectorate for Health Protection and Veterinary Public Health, the Hague, the Netherlands
                []Inspectorate for Health Protection and Veterinary Public Health, Region East, Zutphen, the Netherlands
                Author notes
                Address for correspondence: Yvonne THP van Duynhoven, National Institute of Public Health and the Environment, Department for Infectious Diseases Epidemiology, P.O. Box 1, 3720 BA Bilthoven, the Netherlands; fax: 31 30 2744409; e-mail: y.van.duynhoven@ 123456rivm.nl
                Article
                01-0213
                10.3201/eid0804.010213
                2730240
                11971783
                8a6d432a-50cd-4b19-82e8-e587aef1d467
                History
                Categories
                Dispatch

                Infectious disease & Microbiology
                salmonella,enter-net,outbreak investigation,bean sprouts
                Infectious disease & Microbiology
                salmonella, enter-net, outbreak investigation, bean sprouts

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