6 December 2013
Next update: 13 December 2013
Salmonella Goldcoast outbreak (England, June-October 2013) investigation report
A report on PHE-coordinated epidemiological, environmental and microbiological investigations carried out in September 2013 following the identification of a high number of cases of Salmonella enterica (serotype Goldcoast) infection in England has been published in Eurosurveillance .
The investigation involved collaboration between several PHE area teams and scientists, the Food Standards Agency (which oversaw a recall of contaminated whelks that were identified as a source of the infection) and environmental health officers in the region most affected, East Anglia.
The exceedance was first recorded in September  and investigations began on 12 September to establish the source of the outbreak and propose control measures to prevent further cases. A total of 38 cases (with symptom onset dates between 21 June and 6 October) were covered by the investigation, of whom 10 were hospitalised and four admitted to intensive care.
Initial investigations suggested that consumption of whelks might have been the source of infection. This hypothesis was tested, and confirmed, by means of an unmatched case-control study involving telephone interviews, by trained investigators, with cases and controls.
A seafood factory was visited by environmental health officers and a product recall initiated on 20 September, the effectiveness of which was monitored by the FSA  and affected local authorities.
Salmonella Goldcoast outbreaks have in the past been associated with various foodstuffs (including watercress  and cheese ) but this was the first reported outbreak linked to seafood.
1. “Outbreak of S. enterica serotype goldcoast infection associated with whelk consumption, England, June to October 2013”, Eur Surveill. 18(49), 5 December 2013.
3. Food Standards Agency. “FSA statement on Salmonella Goldcoast incident”, 27 September 2013.
4. CDR (1990). “A national outbreak of Salmonella goldcoast”, Communicable Disease Report (CDR) 90/04.
5. CDR (1997). “Goldcoast and cheddar cheese: update” CDR 7(11), 93/96.
A new British Paediatric Surveillance Unit (BPSU) study on acute symptomatic infectious hepatitis will be launched in January 2014 by Public Health England in collaboration with St. George's University of London .
Hepatitis remains a key public health priority in most industrialised countries, yet little is known about the epidemiology, causative agents, clinical features, risk factors, management or outcome of children diagnosed with acute infectious hepatitis. Acute hepatitis is characterised by an acute onset of discrete symptoms including fever, jaundice, abdominal pain, nausea and vomiting. Occasionally, the condition may progress to fulminant hepatic failure and the need for liver transplantation. Most childhood cases of acute hepatitis are infection-related, with hepatitis A (HAV) and B (HBV) being the commonest causes. Although effective vaccination against both HAV and HBV are available, they are not routinely used in the UK because these infections are considered to be rare.
Clinicians who look after children aged one month up to 14 years with raised levels of the liver enzyme, alanine transaminase (ALT), with or without jaundice, and any suspicion of an infective cause (with or without an identified causative agent), will report the case through the BPSU orange card.
The BPSU surveillance methodology provides a unique opportunity to collect vital clinical and epidemiological information on hospitalised cases of acute symptomatic infectious hepatitis, irrespective of the causative agent(s). In the past, this has not been possible because national surveillance systems are not set up to reliably identify all acute hepatitis cases. The BPSU study will not only allow assessment of the contribution of vaccine-preventable causes in context with the total burden of disease, but provide invaluable data on other potential causes of acute infectious hepatitis and enable comparison of disease characteristics cause by different pathogens. Collection of clinical data through the BPSU would also help determine where and how children with acute hepatitis are investigated and managed and identify factors that contribute to referral of cases to intensive care and/or tertiary hepatology centres. Understanding the contribution of different agents causing acute infectious hepatitis in childhood and possible risk factors will be important for informing the investigation, prevention and management of this condition.
Although the BPSU study asks paediatricians to report cases of acute infectious hepatitis, any healthcare professional can report a case directly to the surveillance team at PHE. It is also vitally important that all laboratory-confirmed strains causing hepatitis are submitted to the Blood Borne Virus Unit within the Virus Reference Department at PHE Colindale for confirmation and molecular typing .
Further information: Dr Shamez Ladhani, firstname.lastname@example.org.
1. BPSU Bulletin 28(3), November/December 2013.
Although Public Health Wales has an Anaerobe Reference Unit, which grew out of PHLS, Public Health England has no dedicated anaerobic laboratory for this specialised branch of clinical microbiology. In NHS laboratories, anaerobic infections have been considered low priority as it was thought that metronidazole was active against all such infections and resistance was not an issue. However, a recent Society for Anaerobic Microbiology (SAM) meeting held at CIDSC (Colindale)  reported a significant rise in resistance to metronidazole, and enhanced multidrug resistance across a broad range of pathogens, highlighting the need for continuing diagnostic work in this area.
Clostridium difficile and Bacteroides fragilis have dominated recent SAM meetings and a review of C. difficile was presented at the Colindale meeting. However, this event was overshadowed by investigations on Propionibacterium acnes. Four papers documented the growing awareness of this species as a potential pathogen – in chronic back pain, prostate cancer and various systemic infections – although normally it is considered a commensal of the skin and regarded as a skin contaminant in clinical samples. Its presence in platelets prior to blood transfusion is disturbing and was discussed.
Genetically, the species may be subtyped into three broad genotypes based on multiple house-keeping genes with types 1 and 2 (and their subtypes) being associated more commonly with disease. Type 3 appears to be more typical of the classical skin commensal and not pathogenic. The stability of these three groups were reinforced through analysis of their proteome by the PHE proteomics team who also demonstrated increased expression of several virulence factors as the organism switched metabolism from aerobic to anaerobic growth; the latter likely to be the mode of metabolism in systemic infections.
The SAM meeting demonstrated the impact that “MALDI-TOF” mass spectrometry is having in clinical microbiology, not least through its success in identifying poorly characterised species. A resurgence of interest in anaerobic microbiology reflects both awareness of increasing drug resistance in anaerobes and the impact that the technology is having in the field.
1. “Diagnosis and clinical impact on anaerobic infections”, PHE/CIDSC, 2 December 2013.