Approaches to the detection of very small, common, and easily missed outbreaks that together contribute substantially to human Cryptosporidium infection.

Water supply-associated cryptosporidiosis outbreaks have decreased in England since the application of risk reduction measures to public water supplies. We hypothesized that smaller outbreaks were occurring which could be better detected by enhanced surveillance. Rolling analysis of detailed questionnaire data was applied prospectively in a population of 2·2 million in the south of England in 2009 and 2010. Detection of spatiotemporal clusters using SaTScan was later undertaken retrospectively. Together these approaches identified eight outbreaks, compared to an expectation of less than one based on national surveillance data. These outbreaks were small and associated with swimming pool use or, less commonly, direct (e.g. petting-farm) contact with animals. These findings suggest that frequent small-scale transmission in swimming pools is an important contributor to disease burden. Identification of swimming pool-level risk factors may inform preventative measures. These findings and the approaches described may be applicable to many other populations and to some other diseases.

Large outbreak of verocytotoxin-producing Escherichia coli O157 infection in visitors to a petting farm in South East England, 2009.

In the summer of 2009, an outbreak of verocytotoxigenic Escherichia coli O157 (VTEC O157) was identified in visitors to a large petting farm in South East England. The peak attack rate was 6/1000 visitors, and highest in those aged <2 years (16/1000). We conducted a case-control study with associated microbiological investigations, on human, animal and environmental samples. We identified 93 cases; 65 primary, 13 secondary and 15 asymptomatic. Cases were more likely to have visited a specific barn, stayed for prolonged periods and be infrequent farm visitors. The causative organism was identified as VTEC O157 PT21/28 with the same VNTR profile as that isolated in faecal specimens from farm animals and the physical environment, mostly in the same barn. Contact with farm livestock, especially ruminants, should be urgently reviewed at the earliest suspicion of a farm-related VTEC O157 outbreak and appropriate risk management procedures implemented without delay.

A Salmonella Typhimurium phage type (PT) U320 outbreak in England, 2008: continuation of a trend involving ready-to-eat products.

In March 2008, the Health Protection Agency in England conducted a retrospective case-control study to investigate the cause of 179 cases of the newly recognized, fully antimicrobial-sensitive Salmonella Typhimurium PT U320. Forty-three symptomatic laboratory-confirmed case-patients and 84 asymptomatic location-matched controls were interviewed by telephone about exposures in the 3 days prior to illness or interview. Multivariate logistic analysis indicated consumption of pre-packaged egg sandwiches (odds ratio 3·29, 95% confidence interval 1·19-9·09) was independently associated with illness. Eight of the 15 case-patients who consumed egg sandwiches did so from retail chain A (53·3%) whereas none of the eight controls consumed similar sandwiches (χ2=7·20, P≤0·01). A review of the pre-packaged egg sandwich ingredients suggested this outbreak was probably caused by exposure to an ingredient common to pre-packaged sandwiches and prepared salads but we established a definitive epidemiological link with only the former. Short shelf-life, product diversity and investigation lag hinder epidemiological investigations of such popular products, providing continued challenges for food safety enforcement of freshly prepared produce.

Some potential sources for transmission of Campylobacter jejuni to broiler chickens.

AIMS: The aim of the study was to determine Campylobacter jejuni contamination and prevalence on fomites moving between broiler farms and the processing plant in the period after cleaning and before departure to harvest chickens. In addition, changes in the proportion of contaminated fomites in the course of a day were assessed. METHODS AND RESULTS: Pooled swab samples were obtained from pallets, crates, wheels of trucks, tractors and forklifts, truck beds, and from drivers' and catchers' boots. After enrichment in Bolton's broth Campylobacter were recovered on modified blood-free Campylobacter selective agar (mCCDA). Isolates were identified using tests for phenotypic and biochemical characteristics. Of the 209 samples collected, 53% were positive for C. jejuni, with all fomites positive except tractor wheels. Pallets had the highest contamination rate at 75%. More than 50% of catchers' boots, drivers' boots, crates and truck wheels were positive. Forty-seven per cent and 31% of truck beds and forklift wheels, respectively, were contaminated. The proportion of contaminated fomites did not change significantly during the day. CONCLUSIONS: This study has identified trucks, forklifts, pallets, crates, drivers' and catchers' boots as potential sources of C. jejuni for broilers. SIGNIFICANCE AND IMPACT OF THE STUDY: Campylobacter jejuni contamination of broiler processing plant fomites was found to be extensive ranging from 31% for truck beds to 75% for pallets. The proportion of contaminated fomites was observed to be similar throughout the day. The impact of contaminated fomites as sources of colonization of broilers with C. jejuni is discussed.

Free available chlorine in commercial broiler chicken drinking water in New Zealand.

Free available chlorine (FAC) concentrations in drinking water supplied to broiler chickens grown commercially in New Zealand were monitored for 11 farms in two companies. Different sites within a growout house were examined at different times of the day to determine spatial and temporal differences in FAC concentrations. Taps provided water with significantly higher FAC concentrations than did drinkers. There were no significant differences between the concentrations of FAC taken from various drinkers around the growout house. There were differences in the variations of measurements taken from the same drinker within a growout house at different times of the day, with variations increasing in the afternoon. No growout houses provided an average FAC content of 2 ppm, the suggested standard in one company. Three growout houses consistently met the chlorine concentration of 0.2 ppm suggested by the New Zealand Drinking Water Standards.