Increased Salmonella activity in Toronto

As of February 28, Toronto Public Health (TPH) has received reports of 114 cases of salmonellosis in 2012 (as compared to the previous 10-year average of 70 cases for the same period). This increased activity is affecting individuals across the city and related to several potential sources.

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The known clusters of recent Salmonella infection include:
1) a large catered event in York Region on February 11 that resulted in transmission of S. typhimurium to numerous attendees who continue to report illness since that time;
2) an outbreak of a less common species of Salmonella (S. heidelberg) across the GTA. This is under investigation by Public Health Ontario;
3) an increase of S. enteriditis (the most common strain of Salmonella reported in Toronto) linked to recent travel to Cuba

In addition, with a general increase in circulating Salmonella infection there is higher chance of person-to-person transmission.
TPH Recommends the Following
• Consider salmonellosis in the differential diagnosis of patients presenting with signs and symptoms of gastroenteritis.
o Symptoms usually occur within 6 to 72 hours after exposure and may last 2 to 5 days.
o Symptoms include diarrhea, nausea, vomiting, abdominal cramps and fever.
• Infants, elderly and immunocompromised individuals are at higher risk of bacteremia. Extraintestinal focal infections (e.g., arthritis, meningitis, pneumonia) can occur in those with bacteremia.
• Remind ill patients of the potential for transmission to others.
• Emphasize the importance of proper hand hygiene and safe food handling practices.
• Public Health requires individuals infected with Salmonella who work in or attend high risk environments such as food premises and child care facilities to be excluded from these settings until symptom-free for 24 hours (or until cleared with two negative stool specimens if asymptomatic with poor hygiene practices).

Testing for Salmonella
Salmonella infection is confirmed by culture.
• Stool specimens should be collected in the appropriate stool transport media.
• If bacteremia is suspected, two sets of blood cultures should be collected.
• Specimens should be sent to a local laboratory for testing.

Reporting Salmonella infection
Salmonellosis is reportable to the local Medical Officer of Health. Please fax reports of confirmed cases of salmonellosis to Toronto Public Health’s surveillance unit at 416-392-0047 at any time (24-hour fax line)


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