Shohat T, Green M S, Merom D, Gill O N, Reisfeld A, Matas A, Blau D, Gal N, Slater P E
Israel Centre for Disease Control, Israel Ministry of Health, Schneider Children's Medical Centre of Israel, Petach Tikva, Israel.
BMJ. 1996 Nov 2;313(7065):1107-9. doi: 10.1136/bmj.313.7065.1107.
To explain an increase in the incidence of salmonellosis caused by Salmonella agona in Israel between October 1994 and January 1995 in the light of an outbreak of S agona phage type 15 infection in England and Wales caused by consumption of a ready to eat savoury snack produced in Israel.
Epidemiology of S agona in 1994-5 was analysed and two consecutive, case-control studies of 32 and 26 case-control pairs were performed. Phage typing and molecular methods were used to characterise strains of S agona isolated from cases and samples of the snack in Israel and England and Wales.
The increase in the incidence of S agona between October 1994 and January 1995 was countrywide. Cases of infection with group B salmonella increased from 60% to 80% in children under 5 years old. In both case-control studies, cases consumed more of the snack than did controls (4.25 v 2.94 packets per week in the first study (P = 0.086) and 4.04 v 2.37 packets per week in the second study (P = 0.034)). When the two studies were combined there was a significant dose-response relation for the number of packets consumed weekly. Compared with consumption of less than two packets, the odds ratio was 1.43 for between two and six packets and 3.37 for seven or more packets (chi 2 for trend = 5.27, P = 0.02) S agona phage type 15 was isolated from a packet of the snack sold in Israel, and the strain was identical with those isolated from packets and cases in Israel and England and Wales.
This outbreak of S agona was caused by the contamination of a snack produced in Israel. Even under modern operating conditions, large, widespread international outbreaks of foodborne disease can occur. The success of this investigation resulted from excellent international collaboration between public health authorities.
鉴于英格兰和威尔士因食用以色列生产的即食咸味小吃而爆发15型噬菌体阿贡纳沙门氏菌感染，解释1994年10月至1995年1月间以色列阿贡纳沙门氏菌病发病率上升的原因。
分析1994 - 1995年阿贡纳沙门氏菌的流行病学情况，并进行了两项连续的病例对照研究，分别有32对和26对病例对照。采用噬菌体分型和分子方法对从以色列、英格兰和威尔士的病例及小吃样本中分离出的阿贡纳沙门氏菌菌株进行特征分析。
1994年10月至1995年1月间阿贡纳沙门氏菌发病率的上升是全国性的。5岁以下儿童中感染B组沙门氏菌的病例从60%增至80%。在两项病例对照研究中，病例比对照食用该小吃更多（第一项研究中每周食用量为4.25包对2.94包（P = 0.086），第二项研究中每周食用量为4.04包对2.37包（P = 0.034））。两项研究合并后，每周食用量存在显著的剂量反应关系。与每周食用量少于两包相比，每周食用量在两至六包之间的比值比为1.43，七包及以上的比值比为3.37（趋势χ² = 5.27，P = 0.02）。从以色列销售的一包小吃中分离出15型噬菌体阿贡纳沙门氏菌，该菌株与从以色列、英格兰和威尔士的小吃包装及病例中分离出的菌株相同。
此次阿贡纳沙门氏菌疫情是由以色列生产的一种小吃受到污染所致。即使在现代操作条件下，也可能发生大规模、广泛传播的食源性疾病国际疫情。此次调查的成功得益于公共卫生当局之间出色的国际合作。
