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

2009/7/30

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)

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Normalization by Reference MarkersNormalization by Reference Markers

2009/7/30

SalmonellaSalmonella DNA Fingerprint DatabaseDNA Fingerprint Database

2004200420042004 2005200520052005 2006200620062006 2007200720072007 2008200820082008 TotalTotalTotalTotal

HospitalsHospitalsHospitalsHospitals 20202020 15151515 15151515 44444444 29292929 46464646

2009/7/30

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)

2009/7/30

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

2009/7/30

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

2009/7/30

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

2009/7/30

2004

200520062007

Distribution of S. Agona Outbreak Strain, 2004-2007

2009/7/30

Foodborne Disease

Surveillance and ControlSurveillance and Control

Table

USDA CDC

FDA

2009/7/30

FarmFlash

USDA

From farm to table (fork)From farm to flash

2009/7/30

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

2009/7/30

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!!