Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
N Engl J Med. 2012 May 31;366(22):2065-73. doi: 10.1056/NEJMoa1111818.
Outbreaks of human salmonella infections are increasingly associated with contact with live poultry, but effective control measures are elusive. In 2005, a cluster of human salmonella Montevideo infections with a rare pattern on pulsed-field gel electrophoresis (the outbreak strain) was identified by PulseNet, a national subtyping network.
In cooperation with public health and animal health agencies, we conducted multistate investigations involving patient interviews, trace-back investigations, and environmental testing at a mail-order hatchery linked to the outbreak in order to identify the source of infections and prevent additional illnesses. A case was defined as an infection with the outbreak strain between 2004 and 2011.
From 2004 through 2011, we identified 316 cases in 43 states. The median age of the patient was 4 years. Interviews were completed with 156 patients (or their caretakers) (49%), and 36 of these patients (23%) were hospitalized. Among the 145 patients for whom information was available, 80 (55%) had bloody diarrhea. Information on contact with live young poultry was available for 159 patients, and 122 of these patients (77%) reported having such contact. A mail-order hatchery in the western United States was identified in 81% of the trace-back investigations, and the outbreak strain was isolated from samples collected at the hatchery. After interventions at the hatchery, the number of human infections declined, but transmission continued.
We identified a prolonged multistate outbreak of salmonellosis, predominantly affecting young children and associated with contact with live young poultry from a mail-order hatchery. Interventions performed at the hatchery reduced, but did not eliminate, associated human infections, demonstrating the difficulty of eliminating salmonella transmission from live poultry.
人类沙门氏菌感染的爆发越来越与接触活禽有关，但有效的控制措施却难以捉摸。2005 年，通过国家亚型网络脉冲场凝胶电泳（暴发菌株），鉴定出一组人沙门氏菌蒙得维的亚感染的集群，其模式非常罕见。
我们与公共卫生和动物卫生机构合作，进行了多州调查，涉及与暴发相关的邮购孵化场的病人访谈、追溯调查和环境测试，以确定感染源并防止更多疾病发生。病例定义为在 2004 年至 2011 年间感染暴发菌株。
从 2004 年到 2011 年，我们在 43 个州鉴定出 316 例病例。患者的中位年龄为 4 岁。对 156 名患者（或其照顾者）（49%）进行了访谈，其中 36 名患者（23%）住院。在可获得信息的 145 名患者中，80 名（55%）有血性腹泻。在 159 名有接触活幼禽信息的患者中，有 122 名（77%）报告有此类接触。81%的追溯调查确定了一家位于美国西部的邮购孵化场，从孵化场采集的样本中分离出了暴发菌株。在孵化场采取干预措施后，人类感染的数量有所下降，但传播仍在继续。
我们发现了一起长期的多州沙门氏菌病暴发，主要影响儿童，并与来自邮购孵化场的活幼禽接触有关。在孵化场采取的干预措施减少了，但没有消除与人类感染相关的传播，这表明从活禽中消除沙门氏菌传播的难度。
