Coverage of the national surveillance system for human Salmonella infections, Belgium, 2016-2020

Abstract

Introduction: The surveillance of human salmonellosis in Belgium is dependent on the referral of human Salmonella isolates to the National Reference Center (NRC). Knowledge of current diagnostic practices and the coverage of the national Salmonella surveillance system are important to correctly interpret surveillance data and trends over time, to estimate the true burden of salmonellosis in Belgium, and to evaluate the appropriateness of implementing whole-genome sequencing (WGS) at this central level.

Methods: The coverage of the NRC was defined as the proportion of all diagnosed human Salmonella cases in Belgium reported to the NRC and was assessed for 2019 via a survey among all licensed Belgian medical laboratories in 2019, and for 2016-2020 via a capture-recapture study using the Sentinel Network of Laboratories (SNL) as the external source. In addition, the survey was used to assess the impact of the implementation of culture-independent diagnostic tests (CIDTs) at the level of peripheral laboratory sites, as a potential threat to national public health surveillance programs.

Results: The coverage of the NRC surveillance system was estimated to be 83% and 85%, based on the results of the survey and on the two-source capture-recapture study, respectively. Further, the results of the survey indicated a limited use of CIDTs by peripheral laboratories in 2019.

Conclusion: Given the high coverage and the limited impact of CIDTs on the referral of isolates, we may conclude that the NRC can confidently monitor the epidemiological situation and identify outbreaks throughout the country. These findings may guide the decision to implement WGS at the level of the NRC and may improve estimates of the true burden of salmonellosis in Belgium.

Fig 1. Number of Salmonella cases per 100 000 inhabitants reported by the National Reference Center (NRC) per region, Belgium, 2016–2020.

Panel A: Salmonella ser. Typhimurium; Panel B: Salmonella ser. Enteritidis; Panel C: other Salmonella serotypes (panel C).

Fig 2. Number of Salmonella cases in the National Reference Center (NRC) database (solid line) and the Sentinel Network of Laboratories (SNL) database (dotted line), Belgium, 2016–2020.

Fig 3. Linking peripheral laboratory sites that sent isolates to the National Reference Center (NRC) with licensed medical laboratories that were invited to the survey to estimate the coverage of the NRC surveillance system, Belgium, 2019.

Fig 4. Coverage of the NRC surveillance system per licensed laboratory, per region, Belgium, 2019.

Fig 5. Coverage of the NRC surveillance system as estimated through a capture-recapture study, 2016–2020, Belgium.