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Investigation of a Salmonella enterica outbreak in a nursery in Tirana, Albania: Epidemiology, implications, and control measures
aEuropean Centre for Disease Prevention and Control (ECDC), Mediterranean and Black Sea Programme for Intervention Epidemiology Training (MediPIET), Stockholm, Sweden + Local Health Care Unit, Department of Epidemiology and Environmental Health, Tirana, Albania
bAgricultural University of Tirana, Veterinary Epidemiology and Bio-statistics, Tirana, Albania
cLocal Health Care Unit, Department of Epidemiology and Environmental Health, Tirana, Albania
dInstitute of Public Health, Tirana, Albania
Keywords: Salmonella; outbreak; nursery; hygiene; control measures
Abstract
Background: Salmonella is a major cause of diarrheal diseases, transmitted through contaminated food and the faecal-oral route. We report an outbreak of Salmonella enterica in a nursery in Tirana, Albania. Methods and Objectives: On October 25, 2023, the Local Health Care Unit was informed of a confirmed case of Salmonella enterica in a hospitalized child who attended a nursery in Tirana, with 120 children aged 6-36 months and 33 staff. We conducted a cohort study, interviewing parents and staff to assess demographics, symptomatology, and risk factors. Microbiological testing of stool and environmental samples were also performed. The investigation aimed to identify the outbreak source, determine transmission methods, and identify control measures to halt spread and safeguard nursery attendees' health. We calculated attack rates and relative risks according to gender, age and nursery class. Confirmed case definition was anyone tested positive for Salmonella enterica (stool sample), and probable case definition was having symptoms consistent with Salmonella. Results: We collected data from 110 nursery attendants, 82 children and 28 staff members (72% response rate). Twenty-two cases (four confirmed and 18 probable), were identified. The overall attack rate was 20%. Males were 3.9 times (95% CI=1.74-8.75) more likely to be a case. The median age of children affected was 29 months (IQR=14-33) and those older than 24 months were less likely to be a case (RR=0.45, CI=0.22-0.93). The median duration of illness was 4.5 days. Eleven (50%) cases had visited general practitioners, and two (9.1%) were admitted to hospital. All environmental cultures, taken from the kitchen's utensils and surfaces, diaper changing tables, and hands of staff were negative for Salmonella, but positive for E.coli. Through interviews and observation, we found that nursery staff did not follow hygienic measures. Following our investigation, a mandatory two-week closure of the nursery was implemented to halt transmission and introduce corrective actions to improve conditions. Conclusions: Although environmental laboratory samples were negative for salmonella and therefore we could not prove the source, we suspect that poor hygiene practices among staff likely caused outbreak extension through faecal-oral routes. The presence of E.coli in the environmental samples supports this hypothesis.

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article language: English
document type: Conference Abstract
DOI: 10.5937/BatutPHCO24034R
published in Portal: 18/10/2024
Creative Commons License 4.0

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