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The use of sequential studies in a salmonellosis outbreak linked to continental custard cakes

Published online by Cambridge University Press:  09 October 2002

B. WARD
Affiliation:
Victorian Public Health Training Scheme, Melbourne Health
R. ANDREWS
Affiliation:
Communicable Diseases Section, Department of Human Services, Victoria
J. GREGORY
Affiliation:
Communicable Diseases Section, Department of Human Services, Victoria
D. LIGHTFOOT
Affiliation:
Microbiological Diagnostic Unit, University of Melbourne
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Abstract

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We investigated an outbreak of 54 cases of Salmonella Typhimurium phage type 9 (STM9) with a specific antibiotic resistance pattern. We used sequential analytic studies: two retrospective cohort studies, a case-control study, and a modified case-control study. An outbreak of salmonellosis due to Salmonella Typhimurium PT9 SSu (resistant to streptomycin and sulphafurazole) was identified. Fifty-four cases had illness onset from November 1998 to March 1999. Notifications commenced following a restaurant birthday party in December 1998. An initial cohort and case control study found no association with consumption of custard cake. However, case follow-up identified another cohort of people who had attended a birthday party in February at which 8/27 people who consumed a continental custard cake were ill compared to 0/10 who did not (P = 0.07). A revised case control study found illness was strongly associated with consumption of a particular continental custard cake (Mantel–Haenszel matched OR ∞, P = 0.00004). This report highlights the epidemiological value of using sequential study types, and persisting with the investigation of apparently sporadic food-borne outbreaks.

Type
Research Article
Copyright
© 2002 Cambridge University Press