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Biological Health Hazard – Salmonella Outbreak: Multi-state outbreak of multi-drug-resistant Salmonella [enterica_ serotype] Heidelberg infections


Published Date: 2017-08-03 17:11:53
Subject: PRO/AH/EDR> Salmonellosis, st Heidelberg – USA: MDR, cattle contact
Archive Number: 20170803.5225307

Date: Wed 2 Aug 2017
Source: Centers for Disease Control and Prevention (CDC) [edited]

Multistate outbreak of multidrug-resistant _Salmonella_ Heidelberg infections linked to contact with dairy bull calves
CDC, several states, and the Department of Agriculture’s Animal and Plant Health Inspection Service (USDA-APHIS) are reopening the investigation of a multistate outbreak of multidrug-resistant _Salmonella [enterica_ serotype] Heidelberg infections. A total of 10 more people infected with the outbreak strains of _S._ Heidelberg have been reported since 20 Mar 2017, when CDC closed the outbreak investigation.

Whole genome sequencing on clinical samples from ill people showed a close genetic relationship between the bacteria that sickened people after 20 Mar 2017, and the bacteria that sickened people before that time. This means that people in both groups were more likely to share a common source of infection and that this outbreak is ongoing.

A total of 46 people infected with the outbreak strains of _Salmonella_ Heidelberg have been reported from 14 states.
States / Ill People
California / 1
Iowa / 2
Idaho / 1
Indiana / 2
Kentucky / 3
Minnesota / 5
Missouri / 7
North Dakota / 1
New Jersey / 1
Ohio / 1
Oklahoma / 1
South Dakota / 5
Texas / 1
Wisconsin / 15

As many as 14 (30 per cent) people have been hospitalized. No deaths have been reported. Illnesses started on dates ranging from [27 Jan 2015] to [11 Jul 2017].
15 (33 per cent) people in this outbreak are children under the age of 5.

Epidemiologic and laboratory investigations linked ill people in this outbreak to contact with calves, including dairy bull calves. Dairy bull calves are young, male cattle that may be raised for meat. In interviews, ill people answered questions about contact with animals and foods eaten in the week before becoming ill. Of the 44 people interviewed, 29 (66 per cent) reported contact with dairy bull calves or other cattle. Some of the ill people interviewed reported that they became sick after their dairy bull calves became sick or died.

Ongoing surveillance in veterinary diagnostic laboratories showed that calves in several states continued to get sick with the outbreak strain of multidrug resistant _S._ Heidelberg after reports of illnesses in people had stopped. ‎Information collected earlier in the outbreak indicated that most of the calves came from Wisconsin. Regulatory officials in several states are now tracing the origin of the calves that are linked to the newer illnesses.

Antibacterial-resistance testing conducted by CDC on clinical isolates from ill people shows that the isolates were resistant to multiple types of antimicrobials. Antimicrobial resistance may be associated with increased risk of hospitalization, development of a bloodstream infection, or treatment failure in patients.

Whole genome sequencing has identified multiple antimicrobial resistance genes in outbreak-associated isolates from 33 ill people, 65 cattle, and 11 from animal environments. This correlates with results from standard resistance testing methods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory on clinical isolates from 8 ill people in this outbreak. The 8 isolates tested were susceptible to gentamicin, azithromycin, and meropenem. All 8 were resistant to amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, streptomycin, sulfisoxazole, and tetracycline, and had reduced susceptibility to ciprofloxacin. A total of 7 isolates were also resistant to trimethoprim-sulfamethoxazole; 5 were also resistant to nalidixic acid; and 3 were also resistant to chloramphenicol.

Follow these steps to prevent illness when working with any livestock:
– Always wash your hands thoroughly with soap and water right after touching livestock, equipment, or anything in the area where animals live and roam. Use dedicated clothes, shoes, and work gloves when working with livestock. Keep and store these items outside of your home.
– It is especially important to follow these steps if there are children under age 5 in your household. Young children are more likely to get a salmonellosis because their immune systems are still developing.
– Work with your veterinarian to keep your animals healthy and prevent diseases.

This investigation is ongoing and we will provide updates as more information becomes available. Livestock owners should continue to watch for increased sicknesses in dairy calves and consult their veterinarian if needed.

communicated by:

[This continued outbreak is, at this point, related to contact with dairy bull calves, but if the infected cattle are used for meat, undercooked beef may also be relevant. It is important to note that in most individuals who have salmonellosis, the enteritis has resolved before the diagnosis is made and no antimicrobial intervention is needed. In invasive salmonellosis, however, multidrug resistant isolates limit the choices for treatment.

Among the 3 antimicrobials (azithromycin, gentamicin, and meropenem) to which the outbreak strain of _S._ Heidelberg is susceptible, azithromycin is the only one that can be given orally. None of the 3 is considered 1st line treatment for salmonellosis. – Mod.LL

A HealthMap/ProMED-mail map can be accessed at:]

See Also

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Salmonellosis – USA (12): (WA) pork, st I 4,[5, 12:i:- 20160726.4371010
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Salmonellosis, st. Enteritidis – USA: (MN, VA) packaged kale salad, alert, recall 20160517.4226922
Salmonellosis – USA (09): (MI) live poultry, multiple serotypes 20160505.4203696
Salmonellosis – USA (08): FDA, contaminated raw retail meat & poultry, resistance 20160501.4195399

A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases

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