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. 2024 Sep 30:152:e107.
doi: 10.1017/S0950268824001067.

Everything but the kitchen sink: The use of multiple hypothesis generation methods to investigate an outbreak of Salmonella Enteritidis associated with frozen profiteroles and eclairs

Affiliations

Everything but the kitchen sink: The use of multiple hypothesis generation methods to investigate an outbreak of Salmonella Enteritidis associated with frozen profiteroles and eclairs

Courtney R Smith et al. Epidemiol Infect. .

Abstract

In December 2018, an outbreak of Salmonella Enteritidis infections was identified in Canada by whole-genome sequencing (WGS). An investigation was initiated to identify the source of the illnesses, which proved challenging and complex. Microbiological hypothesis generation methods included comparisons of Salmonella isolate sequence data to historical domestic outbreaks and international repositories. Epidemiological hypothesis generation methods included routine case interviews, open-ended centralized re-interviewing, thematic analysis of open-ended interview data, collection of purchase records, a grocery store site visit, analytic comparison to healthy control groups, and case-case analyses. Food safety hypothesis testing methods included food sample collection and analysis, and traceback investigations. Overall, 83 cases were identified across seven provinces, with onset dates from 6 November 2018 to 7 May 2019. Case ages ranged from 1 to 88 years; 60% (50/83) were female; 39% (22/56) were hospitalized; and three deaths were reported. Brand X profiteroles and eclairs imported from Thailand were identified as the source of the outbreak, and eggs from an unregistered facility were hypothesized as the likely cause of contamination. This study aims to describe the outbreak investigation and highlight the multiple hypothesis generation methods that were employed to identify the source.

Keywords: food-borne infections; outbreaks; salmonellosis.

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Conflict of interest statement

The authors declare none.

Figures

Figure 1.
Figure 1.
Number of confirmed outbreak cases of Salmonella Enteritidis by symptom onset, specimen collection, or isolation date (n = 82). One case did not have a reported onset, specimen collection, or isolation date and is not included in this figure.
Figure 2.
Figure 2.
Timeline of hypothesis generation and testing methods employed throughout the outbreak investigation in 2019.

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