Epidemiology and Infection



Risk factors for Salmonella Enteritidis and Typhimurium (DT104 and non-DT104) infections in The Netherlands: predominant roles for raw eggs in Enteritidis and sandboxes in Typhimurium infections


Y. DOORDUYN a1c1, W. E. VAN DEN BRANDHOF a1, Y. T. H. P. VAN DUYNHOVEN a1, W. J. B. WANNET a2 and W. VAN PELT a1
a1 Centre for Infectious Diseases Epidemiology, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
a2 Diagnostic Laboratory for Infectious Diseases Diagnosis and Perinatal Screening, National Institute of Public Health and the Environment, Bilthoven, The Netherlands

Article author query
doorduyn y   [PubMed][Google Scholar] 
van den brandhof we   [PubMed][Google Scholar] 
van duynhoven yt   [PubMed][Google Scholar] 
wannet wj   [PubMed][Google Scholar] 
van pelt w   [PubMed][Google Scholar] 

Abstract

Since 1996 Salmonella Typhimurium DT104 salmonellosis has increased in The Netherlands. This prompted a case-control study of risk factors for salmonellosis to inform transmission routes for this phage type. Cases were laboratory-confirmed patients with a Salmonella infection and controls were selected from population registries by frequency matching for age, sex, degree of urbanization and season. Cases and controls received a questionnaire on risk factors. Of the 1171 cases, 573 (49%) responded: 245 S. Enteritidis and 232 S. Typhimurium cases (both DT104 and non-DT104), of which 58 were DT104. Of the 10250 controls, 3409 (33%) responded. Use of H2 antagonists [odds ratio (OR) 4·4, 95% CI 1·6–12·2] and proton pump inhibitors (OR 4·2, 95% CI 2·2–7·9), consumption of raw eggs (OR 3·1, 95% CI 1·3–7·4) and products containing raw eggs (OR 1·8, 95% CI 1·1–3·0) were associated with endemic S. Enteritidis infection. Risk factors for endemic S. Typhimurium infection were use of proton pump inhibitors (OR 8·3, 95% CI 4·3–15·9), occupational exposure to raw meat (OR 3·0, 95% CI 1·1–7·9), playing in a sandbox (for children aged 4–12 years) (OR 2·4, 95% CI 1·6–3·7), consumption of undercooked meat (OR 2·2, 95% CI 1·1–4·1) and use of antibiotics (OR 1·9, 95% CI 1·0–3·4). Use of proton pump inhibitors (OR 11·2, 95% CI 3·9–31·9) and playing in a sandbox (OR 4·4, 95% CI 1·8–10·7) were the only risk factors for S. Typhimurium DT104 salmonellosis. This study confirms known risk factors for salmonellosis. However, playing in a sandbox was a predominant new risk factor for S. Typhimurium salmonellosis in children [population attributable risk (PAR) 14%], and especially for S. Typhimurium DT104 (PAR 32%).

(Published Online November 21 2005)
(Accepted August 26 2005)
(November 21 2005)


Correspondence:
c1 Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands. (Email: yvonne.doorduyn@rivm.nl)


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