Abstract
In early September 2006, the Norwegian Institute of Public Health was alerted to an outbreak of Shigella sonnei infections (shigellosis) among 23 Norwegian passengers who had taken a bus tour from Kirkenes, Norway to Murmansk, Russia. The trip lasted from 27 to 31 August, and the group stayed in various hotels and visited several restaurants in both Kirkenes and Murmansk during this period. Stool samples from three ill passengers yielded S. sonnei; an additional 10 passengers had gastrointestinal symptoms with diarrhoea or loose stools with abdominal pain. An investigation was initiated in collaboration with the department of epidemiological surveillance in Murmansk. We sent a questionnaire to the work e-mail addresses of all passengers asking about symptoms and exposures. Two restaurants and a hotel visited by the Norwegian tourists in Murmansk were inspected and sampled. Of all the food and beverage items mentioned in the questionnaire, only cured meat consumed in restaurant A in Murmansk on 28 August was associated with the risk of developing illness. Inspections of the restaurants in Murmansk identified some hygienic shortcomings and inadequate routines. However, S. sonnei could not be isolated from food samples or the personnel. Improved routines were implemented.
Highlights
On 5 September 2006, the Norwegian Institute of Public Health .)0( WASNOTIlEDBYAMUNICIPALMEDICALOFlCEROFANOUTBREAK OFGASTROENTERITISAMONGAGROUPOFEMPLOYEESOFCOMPANY! 4HE GROUP HAD MET ON !UGUST AND TRAVELLED BY BUS FROM THE CITYOF+IRKENES INHABITANTS INNORTH.ORWAYTO-URMANSK INHABITANTS IN NORTH WEST 2USSIA A DISTANCE OF KILOMETRES4HEGROUPLEFT+IRKENESONTHEMORNINGOF!UGUST stayed for two days in Murmansk, and returned to Kirkenes on THE EVENING OF !UGUST #OMPANY ! REPORTED THAT HALF OF THE participants developed diarrhoea after their return
Stool samples were collected from the hospitalised cases at the University Hospital of North Norway and WERETESTEDFORENTERICPATHOGENS!LLS. sonnei isolates were sent to the National Laboratory for Enteric Pathogens at the NIPH for SEROGROUP VERIlCATION -ULTIPLE LOCUS VARIABLE NUMBER TANDEM REPEATANALYSIS,6! WASUSEDTOGENOTYPETHEISOLATES/N September, the NIPH contacted the department of epidemiological surveillance in Murmansk and asked about information on possible LOCALLYONGOINGOUTBREAKS"ASEDONEPIDEMIOLOGICALlNDINGS THE Centre for Hygiene and Epidemiology in Murmansk conducted an environmental inspection and took food and drinking water samples from the two restaurants and the hotel visited by the tourist group
Stool and serum samples were taken from foodhandlers, including kitchen staff, barkeepers, and waiters, and tested for ENTERICPATHOGENS4HELOCAL&OOD3AFETY!UTHORITYIN+IRKENESWAS informed about the outbreak, and they checked the records from RECENTINSPECTIONSATHOTEL8
Summary
Started an investigation in collaboration with the local public health authorities in Kirkenes and Murmansk with the aim of describing the outbreak, identifying the source and implementing control measures. WASUSEDTOGENOTYPETHEISOLATES/N September, the NIPH contacted the department of epidemiological surveillance in Murmansk and asked about information on possible LOCALLYONGOINGOUTBREAKS"ASEDONEPIDEMIOLOGICALlNDINGS THE Centre for Hygiene and Epidemiology in Murmansk conducted an environmental inspection and took food and drinking water samples from the two restaurants and the hotel visited by the tourist group.
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