molecular epidemiology and disease surveillance of clinical salmonella...
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Molecular Epidemiology and Disease Surveillance of Clinical
Salmonella in Taiwan
Chien-Shun Chiou, PhDCenter for Research and Diagnostics
Taiwan CDC
Salmonella
2009/7/30
Popoff et al. Research in Microbiology 155 (2004) 568–570
Salmonellosis in Taiwan
� Disease burden
� Epidemiology
� Serotype distribution� Serotype distribution
� Antimicrobial resistance
�Disease surveillance and control
USA Taiwan
No. cases* 1,412,498 108,000
Disease Burden
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No. hospitalizations 15,608 1,200
No. deaths 553 42
No. isolates** 42,771 > 10,000
*Source: Mead et al. 1999. Emerg Infect Dis 5:607-25** Average of isolates, 1993-2000
Salmonella Reference LabEpidemiological investigation
1. Serotyping2. Genotyping (PFGE)3. Antimicrobial susceptibility testing (NHRI)
ServiceService1. Salmonellaidentification2. Providing isolates for research purpose
International disease surveillance1. Global Foodborne Infections Network (GFN)
former WHO Global Sal Surv (GSS)
2. PulseNet International
Paper-Bridged Method for SalmonellaPhase Reversal
脈衝電泳脈衝電泳脈衝電泳脈衝電泳脈衝電泳脈衝電泳脈衝電泳脈衝電泳(Pulsed(Pulsed--Field Gel Field Gel Electrophoresis)Electrophoresis)Electrophoresis)Electrophoresis)
Automatic CirculatorAutomatic Circulator
Lead Biotech (Lead Biotech (Lead Biotech (Lead Biotech (立圜立圜立圜立圜) ) ) ) [email protected]@[email protected]@ms62.hinet.net
Normalization by Reference MarkersNormalization by Reference Markers
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SalmonellaSalmonella DNA Fingerprint DatabaseDNA Fingerprint Database
2004200420042004 2005200520052005 2006200620062006 2007200720072007 2008200820082008 TotalTotalTotalTotal
HospitalsHospitalsHospitalsHospitals 20202020 15151515 15151515 44444444 29292929 46464646
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IsolatesIsolatesIsolatesIsolates 2,5352,5352,5352,535 2,3322,3322,3322,332 2,0982,0982,0982,098 3,7633,7633,7633,763 2,3352,3352,3352,335 13,06313,06313,06313,063
SerotypesSerotypesSerotypesSerotypes 58585858 61616161 46464646 53535353 50505050 88888888
PFGE patternsPFGE patternsPFGE patternsPFGE patterns 601601601601 557557557557 552552552552 917917917917 629629629629 2,1162,1162,1162,116
The 10 most common serotypes
SerotypeRatio (%)
2004(n = 2,535)
2005(n = 2,332)
2006(n = 2,098)
2007(n = 3,763)
2008(n = 2,335)
Total(n =
13,063)
Enteritidis 22.9 24.8 26.6 28.2 25.6 25.8
Typhimurium 22.3 24.7 20.6 20.3 21.6 21.7
Stanley 11.3 8.3 11.5 8.8 8.5 9.6
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Newport 5.6 5.9 6.4 7.5 8.4 6.9
Albany 3.4 4.7 4.9 4.0 3.8 4.1
Agona 3.2 5.1 3.9 4.1 3.8 4.0
Paratyphi B var. Java 2.4 2.6 3.4 3.5 3.8 3.2
Weltevreden 3.7 2.7 2.7 2.6 2.3 2.8
Derby 2.7 2.3 2.1 3.4 2.2 2.6
Braenderup 3.8 2.1 3.1 1.9 1.4 2.4
Choleraesuis 4.4 (5) 3.2 (8) 1.4 (14) 0.7 (18) 1.2 (16) 2.1 (13)
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Figure 2. Proportion of most common serotypes of reported human Salmonellaisolates by region, 2002. (Source: EID 2006 12:381)
26%
22%
10%7%
35%Enteritidis
Typhimurium
Stanley
Newport
Other
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Figure 2. Proportion of most common serotypes of reported human Salmonellaisolates by region, 2002. (From EID 2006 12:381)
10%
Distribution of Salmonella PFGE genotypes, 2004-2008
Enteritidis (n = 3372)
G149%
G216%
G38%
Others27%
Typhimurium (n = 2840)
G132%
G28%
G33%
Others57%
Stanley (n = 1252)
G164%
G213%
G35%
Others18%
3%
Newport (n = 895)
G123%
G211%
G36%
Others60%
Albany (n = 539)
G29%
G35%
Others74%
G112%
Agona (n = 524)
G216%
G310%
Others50%
G124%
MLVA Subtyping of MLVA Subtyping of S.S. TyphimuriumTyphimurium
PFGE type No. isolatesNo. MLVA
type*No. MLVA
type**
JPX.0001 40 33 31
JPX.0010 10 9 9
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JPX.0010 10 9 9
JPX.0013 23 16 16
JPX.0049 17 15 14
JPX.0077 8 8 8
Total 98 81 78* by all (16) VNTR loci** by 5 VNTR loci (STTR3, STTR5, STTR6, STTR9, STTR10)
Distribution of S. Enteritidis TWJEGX01.0003 Strain in 2004
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2004
200520062007
Distribution of S. Agona Outbreak Strain, 2004-2007
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Foodborne Disease
Surveillance and ControlSurveillance and Control
Table
USDA CDC
FDA
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FarmFlash
USDA
From farm to table (fork)From farm to flash
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The 1993 Western States E. coli O157 Outbreak
60
70
Actual cases in 1993 =726
meat recall
2009/7/30 1 8 15 22 29 36 43 50 57 64 710
10
20
30
40
50
Day of Outbreak
Num
ber of Cases
outbreak detected
If the Western States outbreak If the Western States outbreak had occurred in 1999, and the had occurred in 1999, and the number of cases required to number of cases required to detect the outbreak had been detect the outbreak had been detect the outbreak had been detect the outbreak had been 1/3 the actual number in 1993 1/3 the actual number in 1993 (60 instead of 180)(60 instead of 180)
Predicted curve had the outbreak occurred in 1999
50
60
70
50
60
70
Num
ber of Cases
predicted number of cases in 1999 = 235
predicted date of meat recall
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1 8 15 22 29 36 43 50 57 64 710
10
20
30
40
50
Day of Outbreak1 8 15 22 29 36 43 50 57 64 71
0
10
20
30
40
50
Day of Outbreak
Num
ber of Cases
predicted date of outbreak detection
2002 Colorado E. coli O157 Outbreak
0
10
20
30
40
50
60
70
1 8 15 22 29 36 43 50 57 64 71
Day of Outbreak
Num
ber
of Cas
es
outbreak detected 1993
Meat recall
1993 Western States E. coli O157 Outbreak
726 cases4 deaths
39 d
2002 Colorado E. coli O157 Outbreak
0
10
20
30
40
50
60
70
1 8 15 22 29 36 43 50 57 64 71
Day of Outbreak
Num
ber of
Cas
es
outbreak detected 2002
18 d
CL PHL: 0-7 d
PHL: 4-7 d
Slide courtesy to Bala Swaminathan, CDC, Atlanta, GA
16 cases
Initial recall of 354,200pounds of ground beefExpanded to 18.6 million pounds38 cases from 11 states, 17 hospitalizations, one death
Public health impact of PulseNetPublic health impact of PulseNet
�Prior to PulseNet, the average number of cases in E. coli O157:H7 outbreaks reported to CDC was 27
�By 1998, average number of cases was 9– Smaller outbreaks detected– Outbreaks detected earlier, preventing
additional cases
PulseNet USAPulseNet USA� Celebrating 10th anniversary� Began building PulseNet in 1996� Inaugurated by the Vice-President of
the United States at the White House in 1998
�in 1998
� Recognized as one of 10 most innovative government programs in 1998 and as one of 15 most innovative government programs in 15 years
� PulseNet is now recognized as a critical component of foodborne disease outbreak detection and investigation in the USA
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Foodborne disease surveillance
by PulseNet USAby PulseNet USA
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Thank you!!Thank you!!Thank you!!Thank you!!