Family Outbreak Research Articles

A rare family outbreak of Mycobacterium abscessus infection in immunocompetent fraternal triplets

BackgroundMycobacterium abscessus (M. abscessus) infection is rare in children who were previously healthy, particularly in infants. We present the first report of a family outbreak of M. abscessus infection among immunocompetent infant triplets. MethodsWe reviewed triplets’ demographic data, laboratory tests and imaging examinations to describe their clinical features. We performed whole-exome sequencing to rule out primary immunodeficiency disorders. We used DNA sequencing for M. abscessus subspecies identification. ResultsThe fraternal triplets (triples A, B and C) presented with a 10-day history of cough. Triple A also experienced a brief episode of fever, and triple B had tachypnea. Chest CT scans showed pulmonary masses and nodules in triples A and C, and cavities in triple B. Cultures of sputum and bronchoalveolar lavage fluid from all triplets yielded M. abscessus. Further subspecies identification showed that isolates from triples A and C were M. abscessus subsp. massiliense, and isolates from triple B were M. abscessus subsp. abscessus (MAA). After eight months of combination therapy, the pulmonary lesions of the triplets improved significantly. ConclusionOur study confirms that M. abscessus pulmonary disease can occur in immunocompetent infants. We hypothesize that the simultaneous infection of the triplets may be associated with their prematurity and extensive environmental exposure. This study highlights the importance to include M. abscessus infection in the differential diagnosis of pulmonary masses and/or cavities, regardless of the age of onset or the presence of underlying pathology or susceptible genes.

SARS-CoV-2 (COVID-19) infection in patients with HTLV-1 infection in Peru - case series

Introduction: Peru has suffered a prolonged sanitary emergency and has the highest COVID – 19 mortalities per capita in the world. Some risk factors (diabetes, HIV, cardiovascular diseases, etc.) are currently considered by the CDC to develop severe COVID-19 infection. CDC considers as possible risk factors (evidence is mixed), other immunodeficiency conditions, one of them would be infection by HTLV-1 (human T-cell lymphotropic virus type 1). It is not known whether subjects with HTLV – 1 infection have a higher risk for severe COVID – 19 disease. Materials and methods: We identified 51 patients with HTLV-1 and COVID-19. The patients recruited for this article belong to the HTLV-1 cohort of the Institute of Tropical Medicine Alexander von Humboldt - Cayetano Heredia Hospital and to the study cohort: "The effect of Strongyloides Stercoralis on HTLV-1 disease progression”. Periodic telemedicine follow-up was carried out on our patients during the lockdown from April 2020 to November 2021, and information related to SARS-CoV-2 infection was recorded. Results: 51 patients from cohorts were diagnosed with COVID-19 during the pandemic between April 2020 and October 2021. The majority are female (29 patients, 56.85%). 76.47% (39 patients) underwent a molecular/PCR, antigenic or serological test; while 23.53% (12 patients) developed symptoms compatible with COVID-19 in a context of family outbreak and positive direct contact. 74.51% (38 patients) developed a mild form of the disease, 15.69% (8 patients) a moderate form and 9.80% (5 patients) were asymptomatic. The most frequent symptoms were general malaise and/or fever (82.35%), headache (80.39%) and cough (76.47%). Discussion: the course of SARS-CoV-2 in patients infected with HTLV-1 follows similar patterns in percentage and symptoms compared to the general population. 81% usually develop a mild condition, while for our data 74.51% did. 14% usually develop moderate to severe disease worldwide, in our cohort, 15.69% developed moderate disease. The patients show a clinical picture similar to what is described in the literature as a common presentation of SARS-CoV-2. American studies show that the most frequent symptoms are headache (76%) and sore throat (65%); in our cohort, 80.39% reported headache and 35.29% sore throat. Conclusion: Patients with HTLV-1 who become infected with SARS-CoV-2 develop mild or moderate disease in similar proportions to the general population. More studies are needed to elucidate the risk of developing severe SARS-CoV-2 disease in patients infected with HTLV-1 and its associated comorbidities.

Clinical manifestations of Rickettsia rickettsii in a familial outbreak in Panama.

We report an isolated outbreak of Rickettsia rickettsii in the Ngäbe-Buglé indigenous region, located 750m (tropical wet) above sea level, in a jungle and mountainous area of Western Panama. Seven members of a family were infected simultaneously, resulting in four deaths. Family outbreaks have been previously described and are responsible for 4-8% of the cases described [1-4]. The simultaneous onset of symptoms in the affected population group is extremely unusual [1,5], but it should not dissuade the clinician from considering the possibility of Rickettsia rickettsii infection.

Retrospective Survey of Human Trichinellosis in a Romanian Infectious Diseases Hospital over a Thirty-Year Interval—The Never-Ending Story

Trichinellosis remains a food-safety risk in Romania due to cultural traditions and food behavior. The aim of the present study was to evaluate the epidemiological, clinical and therapeutical data of all human trichinellosis cases in patients admitted to an Infectious Diseases Hospital from northwestern Romania during a thirty-year interval. Between 1 January 1988 and 31 December 2018, a total of 558 patients were hospitalized with the diagnosis of trichinellosis. The number of cases/year varied between 1 and 86. The source of infection was known for 524 patients, represented by domestic pig meat (n = 484; 92.37%) and wild boar (n = 40; 7.63%). Most patients (410; 73.48%) presented were part of family or group outbreaks. Demographical and clinical data of patients will be presented. Antiparasitic therapy was prescribed in 99.46% of cases, and corticosteroids were prescribed in 77.06% of patients. In total, 48 patients (8.6%) presented complications of trichinellosis: 44 for a single complication (neurological, cardiovascular or respiratory); the others multiple complications. Pregnancy was documented in five patients. No fatalities occurred during the study period. Although the number of hospitalized patients has decreased in the last years, trichinellosis still remains an important public health problem in northwestern Romania.

A Trichinella britovi outbreak in the Northern Alps of France: investigation by a local survey network.

We describe a small family outbreak of trichinellosis caused by the consumption of raw ham from a wild boar (Sus scrofa) hunted in the northern Alps of France in February 2022. Out of the six people, aged 3-69 years, who consumed the meat, three were confirmed cases, and three were suspected cases. Eosinophilia detected in four people was the hallmark that drove the diagnosis. Three patients presented with myalgia, two with intense and prolonged chest pain, and one with elevated troponin. One patient presented with dermographism during treatment. Anti-Trichinella IgG were detected in three symptomatic individuals after about ten weeks. One patient had negative serology and no symptoms, but was on long-term corticosteroid therapy. Trichinella britovi larvae (8.3 larvae/g) were detected in the wild boar meat remnants. Trichinellosis is rare in France, but this family outbreak is reminiscent of the circulation of this pathogen in wild animals, highlighting the need to inform hunters about the risk of infection linked to the consumption of raw meat of game animals, and about the need for veterinary inspection of game meat. The consumption of raw meat outside controlled circuits is a practice not devoid of risks, which justifies raising the awareness of hunters, doctors, and medical biologists.

Trichinella infection in Serbia from 2011 to 2020: a success story in the field of One Health.

In Serbia, modern pork production systems with implemented control measures, including the detection of Trichinella larvae in meat (ISO18743), have eliminated farmed pork from pigs slaughtered at abattoirs as a source of trichinellosis. Epidemiological data from 2011 to 2020 indicate that the number of human cases and the number of infected domestic pigs has decreased significantly. Over the years, pork was the most frequent source of human infection. Cases generally occurred in small family outbreaks, and the infection was linked to consumption of raw or undercooked pork from backyard pigs. In most of the outbreaks, T. spiralis was the aetiological agent of infection, but in 2016, a large outbreak was caused by consumption of uninspected wild boar meat containing T. britovi larvae. To achieve safe pork, it is important that consumers of pork from animals raised in backyard smallholdings and of wild game meat are properly educated about the risks associated with consumption of untested meat. Laboratories conducting Trichinella testing should have a functional quality assurance system to ensure competency of analysts and that accurate and repeatable results are achieved. Regular participation in proficiency testing is needed.

Application of Metagenomic Next-Generation Sequencing in the Diagnosis of Pneumonia Caused by Chlamydia psittaci.

ABSTRACTPsittacosis is an uncommon disease which mainly presents as community-acquired pneumonia (CAP). We aim to apply metagenomic next-generation sequencing (mNGS) as a promising tool in the diagnosis of psittacosis pneumonia and to describe its clinical spectrum to provide physicians with a better understanding and recognition of this disease. Thirteen cases of psittacosis pneumonia were diagnosed by using mNGS. A retrospective analysis of the data on clinical manifestations, laboratory data, computed tomography (CT) images, new diagnosis tools, treatments, and outcomes was summarized. These patients had common symptoms of fever and weakness; some had poor appetite, cough, myalgia, and headache. Ten patients developed acute respiratory distress syndrome (ARDS), among which six patients were severe pneumonia cases and needed ventilator therapy. Most patients got psittacosis pneumonia during the cold season. Ten cases were sporadic, but three were family clustering. All of the 13 patients were traced to an exposure history to birds, cat, or poultry, among which 2 only touched the innards of killed poultry before cooking, which may be an atypical exposure history not been reported before, to our knowledge. Most patients had various degrees of liver dysfunction. Air-space consolidations, along with ground-glass opacities and reticular shadows, were detected on chest CT scan. mNGS takes 48 to 72 h to provide results and helps to diagnose psittacosis. After being diagnosed by mNGS, with effective medicines, all patients finally had complete recoveries. The use of mNGS can improve the diagnostic rate of psittacosis pneumonia and shorten the course of disease control. IMPORTANCE Psittacosis pneumonia is easily underdiagnosed and misdiagnosed. In this study, we use mNGS in the diagnosis of psittacosis pneumonia. We found this disease is prone in the cold season, and touching the innards of killed poultry during cooking may be an atypical exposure history which has not been reported before to our knowledge. There are sporadic cases and family outbreak cases as well. Except for typical symptoms of fever and weakness, headache may be the main and only symptom in some patients. The rate of severe pneumonia is high among inpatients with psittacosis pneumonia, and the incidence of hepatic involvements is also high. Psittacosis pneumonia can be cured if the diagnosis is accurate and in time, even if it is severe pneumonia on admission. Some problems worthy of our attention about psittacosis pneumonia were put forward, such as its sick season, special exposure history, the rate of severe disease, and the high cure rate. mNGS can quickly and objectively detect more rare pathogenic microorganisms in clinical specimens without the need for specific amplification and has an advantage in the diagnosis of rare pathogenic bacteria in difficult cases such as psittacosis pneumonia. The use of mNGS can improve the accuracy and reduce the delay in the diagnosis of psittacosis, which shortens the course of disease control.

A Family Outbreak of Type E Botulism Caused by Contaminated Vacuum-Packed Ambient-Stored Chili Chicken Feet in Zhangjiakou, China.

The epidemiological investigation and laboratory-based confirmation were performed on samples from a family botulism outbreak in Zhangjiakou, Hebei province, China. Forty-four samples, including 14 samples (leftover food, and swabs taken of both food packaging bags and dishes, and serum and vomitus of the victims) related to outbreak and 30 causative food products after outbreak, were collected and analyzed. Isolation, bacterial identification, toxin detection, and whole-genome sequencing of Clostridium spp. cultured from the latter samples and animal assays were performed. Mice injected with the cultures of the leftover chili chicken feet, together with the inner layer of its packaging bag, the plate for serving it, and supernatant of two patients' serum that demonstrated the typical signs of botulism. The polyvalent anti-botulinum neurotoxin (BoNT) and the monovalent anti-BoNT/E exhibited protective effects when administered to mice. Three Clostridium botulinum cultures were obtained and verified to be positive for BoNT/E. The whole genome analysis of the isolates revealed that the classic bont/e gene orfX cluster was found to be located on the chromosomes of all three isolates. Single nucleotide polymorphism analysis suggested that these might be from the same source. Our findings indicated that this botulism outbreak occurred following the ingestion of vacuum-packed chili chicken feet contaminated with BoNT/E produced by C. botulinum.

Family outbreak of Microsporum canis infection.

Family outbreak of Microsporum canis infection.

Two trichinellosis outbreaks in Serbia - challenging diagnosis due to a potential co-infection with Toxocara spp.

In Serbia, in most cases, small family outbreaks of trichinellosis occur due to the consumption of untested infected meat from domestic pigs that are raised and slaughtered in the backyards of small individual farms. The aim of this study is to present data regarding 24 patients involved in two outbreaks that occurred in two neighbouring districts in Serbia during a closely related period of time in August 2014. The source of infection in the first outbreak was undercooked pork, while raw pork sausages caused the second outbreak. Meat samples and sausages were Trichinella spp. positive by artificial digestion. With the aim to obtain a second opinion and validate the serological findings discovered at the Public Health Institute Nis, all samples were sent to the National Reference Laboratory for Trichinellosis, INEP. Serodiagnosis showed that 21 persons were positive (87.5%) and three (12.5%) were negative for anti-Trichinella antibodies, while 15 patients fulfilled the trichinellosis case definition. Western blot analysis (using an epitope unique for the muscle larvae stage of the Trichinella genus) confirmed the diagnosis of trichinellosis in five patients. Six patients also had specific antibodies against Toxocara canis (T. canis). Due to the fact that in endemic foci in Serbia there is the presence of Trichinella spiralis and T. canis and that these two infections could be asymptomatic, we consider that trichinellosis cases were irrefutably proven. The dilemma about the existence of co-infection with T. canis remained open due to the lack of clinical findings.

Epidemiological features of COVID-19 family outbreaks in children

Nicolae Testemitanu State University of Medicine and Pharmacy, Municipal Clinical Hospital of Contagious Diseases in Children

SARS-CoV-2 infection in a child with Fanconi anemia and determined immunosuppressed status

Introduction. SARS-CoV-2 virus infection affects all age groups. In children, the infection mainly causes asymptomatic or mildly symptomatic forms of the disease, regardless of their immune status. Case presentation. We describe the case of a 7-year-old male child, known to have Fanconi anemia, scheduled for bone marrow transplantation. The patient comes from a family outbreak of COVID-19, which is why he was tested for SARS-CoV-2 infection. He is asymptomatic at the time of admission to our clinic. The clinical examination performed at the time of admission shows a patient in good general condition, afebrile, with pale skin and mucous membranes, without respiratory changes. Paraclinically, severe neutropenia, severe normochromic normocytic anemia and severe thrombocytopenia are detected, for which transfusions of erythrocyte mass and platelet mass are performed. Due to the immunocompromised status, antibiotic therapy is instituted. If necessary, symptomatic treatment is administered. The evolution is favorable, and the SARS-CoV-2 RT-PCR control test is negative on the eighth day of hospitalization. Conclusions. Immunocompromised status is not a major risk factor for severe COVID-19 in children.

Metagenomic next-generation sequencing in the family outbreak of psittacosis: the first reported family outbreak of psittacosis in China under COVID-19

ABSTRACT Chlamydia psittaci infection in humans, also known as psittacosis, is usually believed to be an uncommon disease which mainly presents as community-acquired pneumonia (CAP). It is usually sporadic, but outbreaks of infection may occasionally occur. In outbreaks, diagnosis and investigations were usually hampered by the non-specificity of laboratory testing methods to identify C. psittaci. In this study, we use metagenomic next-generation sequencing (mNGS) in the diagnosis of a family outbreak of psittacosis under COVID-19. Three members of an extended family of 6 persons developed psittacosis with pneumonia and hepatic involvement with common symptoms of fever and weakness. Two newly purchased pet parrots, which had died successively, were probably the primary source of infection. Imagings show lung consolidations and infiltrates, which are difficult to be differentiated from CAP caused by other common pathogens. mNGS rapidly identified the infecting agent as C. psittaci within 48 h. The results of this work suggest that there are not characteristic clinical manifestations and imagings of psittacosis pneumonia which can differentiate from CAP caused by other pathogens. The use of mNGS can improve accuracy and reduce the delay in the diagnosis of psittacosis especially during the outbreak, which can shorten the course of the disease control. Family outbreak under COVID-19 may be related to the familial aggregation due to the epidemic. To our knowledge, this is the first reported family outbreak of psittacosis in China, and the first reported psittacosis outbreak identified by the method of mNGS in the world.

Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study.

OBJECTIVE. The increasing number of cases of confirmed coronavirus disease (COVID-19) in China is striking. The purpose of this study was to investigate the relation between chest CT findings and the clinical conditions of COVID-19 pneumonia. MATERIALS AND METHODS. Data on 101 cases of COVID-19 pneumonia were retrospectively collected from four institutions in Hunan, China. Basic clinical characteristics and detailed imaging features were evaluated and compared between two groups on the basis of clinical status: nonemergency (mild or common disease) and emergency (severe or fatal disease). RESULTS. Patients 21-50 years old accounted for most (70.2%) of the cohort, and five (5.0%) patients had disease associated with a family outbreak. Most patients (78.2%) had fever as the onset symptom. Most patients with COVID-19 pneumonia had typical imaging features, such as ground-glass opacities (GGO) (87 [86.1%]) or mixed GGO and consolidation (65 [64.4%]), vascular enlargement in the lesion (72 [71.3%]), and traction bronchiectasis (53 [52.5%]). Lesions present on CT images were more likely to have a peripheral distribution (88 [87.1%]) and bilateral involvement (83 [82.2%]) and be lower lung predominant (55 [54.5%]) and multifocal (55 [54.5%]). Patients in the emergency group were older than those in the non-emergency group. Architectural distortion, traction bronchiectasis, and CT involvement score aided in evaluation of the severity and extent of the disease. CONCLUSION. Patients with confirmed COVID-19 pneumonia have typical imaging features that can be helpful in early screening of highly suspected cases and in evaluation of the severity and extent of disease. Most patients with COVID-19 pneumonia have GGO or mixed GGO and consolidation and vascular enlargement in the lesion. Lesions are more likely to have peripheral distribution and bilateral involvement and be lower lung predominant and multifocal. CT involvement score can help in evaluation of the severity and extent of the disease.

Mumps: MMR vaccination and genetic diversity of mumps virus, 2007\u20132011 in Catalonia, Spain

BackgroundMumps is a vaccine-preventable disease but outbreaks have been reported in persons vaccinated with two doses of MMR vaccine.The objective was to describe the demographic features, vaccination effectiveness and genetic mumps virus diversity among laboratory-confirmed cases between 2007 and 2011 in Catalonia.MethodsCases and outbreaks of mumps notified to the notifiable diseases system of Catalonia between 2007 and 2011 retrospectively registered were included. Public health care centres provided written immunization records to regional public health staff to determine the vaccination history.Saliva and serum specimens were collected from suspected cases for laboratory-confirmation using real-time reverse-transcriptase PCR (rtRT-PCR) or serological testing.Phylogenetic analysis of the complete SH gene (316 nucleotides) and complete coding HN protein (1749 nucleotides) sequences was made.Categorical variables were compared using the Chi-square or Fisher’s tests and continuous variables using the Student test. Vaccination effectiveness by number of MMR doses was estimated using the screening method.ResultsDuring the study period, 581 confirmed cases of mumps were notified (incidence rate 1.6 cases/100,000 persons-year), of which 60% were male. Three hundred sixty-four laboratory-confirmed cases were reported, of which 44% were confirmed by rtRT-PCR. Of the 289 laboratory-confirmed cases belonging to vaccination cohorts, 33.5% (97) had received one dose of MMR vaccine and 50% (145) two doses.Based on phylogenetic analyses of 316-nucleotide and 174-nucleotide SH sequences, the viruses belonging to viral genotypes were: genotype G (126), genotype D (23), genotype H (2), genotype F (2), genotype J (1), while one remained uncharacterized.Amino acid differences were detected between circulating strains and the Jeryl Lynn vaccine strains, although the majority of amino acid substitutions were genotype-specific.Fifty-one outbreaks were notified that included 324 confirmed mumps cases. Genotype G was the most frequent genotype detected. The family (35%), secondary schools (25%) and community outbreaks (18%) were the most frequent settings.ConclusionsOur study shows that genotype G viruses are the most prevalent in Catalonia. Most cases occurred in people who had received two doses of MMR, suggesting inadequate effectiveness of the Jeryl Lynn vaccine strain. The possible factors related are discussed.

Food-borne botulism in Apulia region, Italy: an expert witness testimony.

We report the epidemiology of food-borne botulism in Puglia, Italy, between 1977-2017, using surveillance data and Experts' personal observations. As the disease is rare, the diagnosis is often missed or delayed, and cases are initially misdiagnosed. This was the case of a family outbreak of botulism in the 1970s.

Milk outbreaks of tick-borne encephalitis in Slovakia, 2012-2016.

Tick-borne encephalitis virus (TBEV) is most commonly transmitted to humans via the bite of an infected tick. Alimentary infection through the consumption of TBEV-contaminated dairy products is also well-documented and is responsible for some diseases in endemic areas. The aim of the study was to emphasize the risk of contracting tick-borne encephalitis (TBE) by consuming raw milk and dairy products and to describe TBE epidemics in Slovakia for the period 2012-2016. The data on epidemics were obtained from the Annual Reports for the period 2012-2016 available on the website of the Public Health Authority of the Slovak Republic. Medical records of patients hospitalized during epidemics were provided by the Department of Infectology and Travel Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, and the Louis Pasteur University Hospital in Košice. During the period 2012-2016, 13 smaller or larger TBE epidemic outbreaks were recorded in the Slovak Republic. The two outbreaks of TBE reported in 2012 were associated with the consumption of raw goat's milk and dairy products. The first case was an outbreak involving 12 infected people in the Lučenec District. The second case was a family outbreak in the Žilina District, where 3 persons out of 4 family members were infected. In 2013, one epidemic was reported involving 5 persons following the consumption of sheep's cheese from a farm in the Prešov District. One outbreak with 11 cases was reported in 2014. The investigation confirmed its association with the consumption of sheep's cheese in a restaurant located in the Ružomberok District. In 2015, 4 epidemics were described related to the consumption of goat's/sheep's milk and cheese (Žilina District, Krupina District, Kysucké Nové Mesto District, Trenčín District). In 2016, there were 5 TBE epidemics related to the consumption of milk and dairy products. The largest TBE epidemic outbreak in the last 5 years occurred in the Košice District. In this outbreak approximately 500 people were exposed, and 44 contracted the disease. Infected persons confirmed consumption of sheep's cheese from a farm. Consumption of milk and dairy products made only from pasteurized milk, as well as the immunization of humans and animals are the most effective preventive measures against TBE.

Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities

In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.

A Large Family outbreak of Keratoconjunctivitis in General Practice: Specific Epidemiological Implications in Family Medicine

A Large Family outbreak of Keratoconjunctivitis in General Practice: Specific Epidemiological Implications in Family Medicine

Foodborne Salmonellosis in Italy: Characterization of Salmonella enterica Serovar Typhimurium and Monophasic Variant 4,[5],12:i− Isolated from Salami and Human Patients

Salmonella enterica serovar Typhimurium (STm) and its monophasic variant 4,[5],12:i:- (VMSTm) have been responsible for an increased number of foodborne infections in humans in Europe in recent years. The aim of this study was to investigate the origin of three foodborne salmonellosis outbreaks that occurred in Pavia Province (Lombardy region, northern Italy) in 2010. Phenotypic and genetic characteristics of the STm and VMSTm isolates from patients and from food that were recovered in the framework of the three outbreaks were evaluated through serotyping, phage typing, antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), and multiple-locus variable-number tandem repeat analysis (MLVA). Salami from three artisan producers, which had all purchased meat from the same slaughterhouse, was the food source of infection in outbreak I. STm isolates were recovered from salami and patients with symptoms of gastroenteritis. These isolates had the same PFGE type and the same rare MLVA profile (3-18-9-NA-211). The same molecular profiles were found in an STm isolate from a salami, which likely was the source of another family outbreak (II). A VMSTm strain with common phenotypic and molecular profiles was isolated from three hospitalized patients and identified as the cause of another putative outbreak (III). During the following 3 years (2011 through 2013), 360 salami produced in Pavia Province were monitored for the presence of S. enterica . In 2011, no STm and VMSTm isolates were recovered from 159 salami tested. During 2012 and 2013, 13.9% of 201 tested salami harbored S. enterica , and half of the isolates were VMSTm, mainly in salami from those artisan producers involved in the previous outbreaks. These isolates were genetically variable, especially in terms of MLVA profiles. The data collected suggest that from 2012, VMSTm has replaced STm in the environments of the salami producers monitored in this study, and these data confirm the dominance of this emergent serovar along the pork supply chain.