Published Date: 1999-09-04 23:50:00
Subject: PRO/EDR> Salmonella paratyphi B - Europe ex Turkey
Archive Number: 19990904.1553

SALMONELLA PARATYPHI B - EUROPE EX TURKEY
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A ProMED post
<http://www.healthnet.org/programs/promed.html>
Date: Sat, 4 Sep 1999
From: Chan Yow Cheong mailto:chanyowcheong@pacific.net.sg
ProMED-mail Regional Moderator for Asia
Source: Eurosurveillance Weekly, 2 Sep 1999
<http://www.eurosurv.org/jhp/>

A European Union action team has been formed to investigate the continuing
outbreak of _Salmonella paratyphi_ B infection associated with travel to
south west Turkey that began in early July 1999 (1,2). By 1 September 105
cases had been recognised in several European countries, including 44 in
Norway, 36 in Denmark, 25 in Sweden, 19 in Finland, eight in England and
Wales, and six in Germany. Over half of the cases have required admission
to hospital and most have had fever and septicaemia; relatively few have
had diarrhoeal illness alone. _S. paratyphi_ B has been isolated from many
blood cultures, but from stool specimens only in some cases. At least 26
clinical isolates have been identified as phage type Taunton.
The earliest date of onset in the outbreak was 13 July. Cases arose at a
constant rate during the four weeks from 19 July to 15 August. Given the
rate at which new cases are being recognised and reported, it is probable
that transmission has continued more recently.
Practically all the new cases stayed in the town of Alanya in the Antalya
region of Turkey, where they used many different hotels, apartments, and
restaurants. They travelled to Turkey with various tour operators. Most of
the cases are young adults aged between 15 and 29 years, but the range is
from 7 to 69 years.
The outbreak's source(s) is not yet known. A possibility is faecally
contaminated water and food contaminated from such water. People who choose
to go to Alanya area of Turkey should practise good kitchen hygiene and
always wash their hands before preparing food and after visiting the toilet.
Other preventive measures are:
eat meat, fish, and shellfish only if they have been thoroughly roasted,
grilled, or cooked eat fruit and vegetables only if peeled by yourself
avoid mayonnaises, stews, salads, raw vegetables, ice cream, and
unpasteurised milk products use bottled water or boil the water before use.
The incubation period is one to ten days. Doctors should consider the
diagnosis of paratyphoid fever and arrange for microbiological examination
of specimens from all patients who present with diarrhoea, septicaemia, or
high fever after returning from Turkey. To assist the investigation by
public health authorities in Turkey, information about the detailed
exposures of cases in Alanya is being compiled. The Public Health
Laboratory Service Communicable Disease Surveillance Centre in London and
the Statens Serum Institut in Copenhagen are coordinating the investigation.
References:
1. Lassen J, Hasselvedt V, Kuusi M, Kapperud G. Paratyphoidfeber etter
opphoid I Tyrkia. MSIS-rapport 1999; 27(32).
<http://www.doktoronline.no/medweb/artikler/msis9932.html>
2. Hasseltvedt V. Salmonella paratyphi B phage type Taunton in travellers to
southwest Turkey. Eurosurveillance Weekly 1999; 3: 990826.
<http://wwweurosurv.org/update/news.html>
3. Jørgen Lassen, Viggo Hasseltvedt, Markku Kuusi, Georg Kapperud.
Paratyphoidfeber etter opphoid I Tyrkia - status per 30.08.99. MSIS-rapport
1999; 27(32).
<http://www.doktoronline.no/medweb/artikler/msis9934.html>
Reported by Alfons Lieftucht (alieftucht@phls.nhs.uk), PHLS Communicable
Disease Surveillance Centre, London, England and Kare Molbak (krm@ssi.dk),
Statens Serum Institut, Copenhagen, Denmark, on behalf of the action team.
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