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Abstract

In May 2014, a cluster of (YE) O9 infections was reported from a military base in northern Norway. Concurrently, an increase in YE infections in civilians was observed in the Norwegian Surveillance System for Communicable Diseases. We investigated to ascertain the extent of the outbreak and identify the source in order to implement control measures. A case was defined as a person with laboratory-confirmed YE O9 infection with the outbreak multilocus variable-number tandem repeat analysis (MLVA)-profile (5-6-9-8-9-9). We conducted a case–control study in the military setting and calculated odds ratios (OR) using logistic regression. Traceback investigations were conducted to identify common suppliers and products in commercial kitchens frequented by cases. By 28 May, we identified 133 cases, of which 117 were linked to four military bases and 16 were civilians from geographically dispersed counties. Among foods consumed by cases, multivariable analysis pointed to mixed salad as a potential source of illness (OR 10.26; 95% confidence interval (CI): 0.85–123.57). The four military bases and cafeterias visited by 14/16 civilian cases received iceberg lettuce or radicchio rosso from the same supplier. Secondary transmission cannot be eliminated as a source of infection in the military camps. The most likely source of the outbreak was salad mix containing imported radicchio rosso, due to its long shelf life. This outbreak is a reminder that fresh produce should not be discounted as a vehicle in prolonged outbreaks and that improvements are still required in the production and processing of fresh salad products.

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2016-08-25
2024-11-22
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2016.21.34.30321
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National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Emily+MacDonald&option1=author&noRedirect=true" class="nonDisambigAuthorLink">MacDonald Emily</a>, <a href="/search?value1=Margot+Ein%C3%B6der-Moreno&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Einöder-Moreno Margot</a>, <a href="/search?value1=Katrine+Borgen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Borgen Katrine</a>, <a href="/search?value1=Lin++Thorstensen+Brandal&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Thorstensen Brandal Lin </a>, <a href="/search?value1=Lore+Diab&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Diab Lore</a>, <a href="/search?value1=%C3%98ivind+Fossli&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fossli Øivind</a>, <a href="/search?value1=Bernardo++Guzman+Herrador&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Guzman Herrador Bernardo </a>, <a href="/search?value1=Ammar+Ali+Hassan&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hassan Ammar Ali</a>, <a href="/search?value1=Gro+S+Johannessen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Johannessen Gro S</a>, <a href="/search?value1=Eva+Jeanette+Johansen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Johansen Eva Jeanette</a>, <a href="/search?value1=Roger++J%C3%B8rgensen+Kimo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jørgensen Kimo Roger </a>, <a href="/search?value1=Tore+Lier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lier Tore</a>, <a href="/search?value1=Bj%C3%B8rn+Leif+Paulsen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Paulsen Bjørn Leif</a>, <a href="/search?value1=Rodica+Popescu&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Popescu Rodica</a>, <a href="/search?value1=Charlotte++Tokle+Schytte&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Tokle Schytte Charlotte </a>, <a href="/search?value1=Kristin++S%C3%A6b%C3%B8+Pettersen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Sæbø Pettersen Kristin </a>, <a href="/search?value1=Line+Vold&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Vold Line</a>, <a href="/search?value1=%C3%98yvind+%C3%98rmen&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ørmen Øyvind</a>, <a href="/search?value1=Astrid+Louise+Wester&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wester Astrid Louise</a>, <a href="/search?value1=Marit+Wiklund&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wiklund Marit</a>, <a href="/search?value1=Karin+Nyg%C3%A5rd&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nygård Karin</a></span>. National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014. <a href="/content/ecdc">Euro Surveill.</a> 2016;21(34):pii=30321. <a href="https://doi.org/10.2807/1560-7917.ES.2016.21.34.30321" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2016.21.34.30321</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 06 Jul 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 20 Jul 2016 </span> </p>
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