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U.S. Department of Health and Human Services

Animal & Veterinary

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Non-Typhoid Salmonella Surveillance in China by Ran Lu, China, CDC

DR. LU: Hello. My presentation about the non-typhi Salmonella surveillance in China. This is the international corporation program, the China CDC and China FETP and China PulseNet and US CDC, WHO GFN and US FDA.

As we know Salmonella is common foodborne disease in around the world including China. In China Salmonella is top one foodborne disease outbreak. The bacteria and pathogen. And --- patient is also. 

The foodborne pathogens in food surveillance system was established as WHO GSS activities in China in 2000 year. And active laboratory-based surveillance program for Salmonellosis was established in China in 2006. The first year thee province trained program that is Shanghai, and Fujian. Until 2008, totally eight provinces joined the program. 

The goal of program was to build capacity for laboratory-base surveillance and rapid outbreak detection and responses for Salmonellosis and emerging foodborne diseases. 


The surveillance --- we collect stool samples of diarrhea ---. And sample send it to clinical laboratories or local CDC laboratories. That depends on hospital have, no have laboratory. But isolates, all Salmonella isolates send to provinces of CDC for --- isolates identification, serotyping and the antimicrobial resistance testing, and --- also. 

And the surveillance data send it to China CDC. In 2008 totally 126 sentinel hospitals from 44 administrative areas, that means the cities or the counties, in eight provinces provided isolates and the epidemiologic data to China CDC. 


This slide shows the isolation of Salmonella from diarrheal patients in eight provinces in China in 2008. And totally 23,140 stool specimens tested for Salmonella. The Salmonella positive isolates were 681 isolates. The Salmonella isolates right from person to 4.5 person. 

The three provinces --- information retested their patients so we can kind of --- specimen altering great we can see here. 


This slide shows some Salmonella cases age proportion. We can see the modern --- cases was the children, the age less than five years. 


And this slide shows the top 15 Salmonella serotypes isolates from diarrhea patients in China in 2008. We can see the top one third type was S. enteritidis. Second one is S. typhimurium, third one was S. derby. And S. Newport was fifteenth serotype. 


This slide shows the results of antimicrobial susceptibility testing for Salmonella isolates from diarrheal patients in China in 2008. Higher --- resistance was Ampicillin, Tetracycline, Nalidixic acid, Streptomycin, Sulfamethoxazole. 


This slide shows the Salmonella isolates resistance patterns. More than 60 percent of isolates were multi-drug resistant. And 14.5 person isolates resistance patterns were ACSSuT. Especially for S. typhimurium isolates, 35.4 percent of them had particular resistance patterns in ACSSuT. 

And in my country we can launch the fast typing so we just get the resistance patterns results. 


And total of 202 isolates were pan-susceptible. More than two percent of isolates were resistant to a broad spectrum cephalosporin and more than five percent were resistant to ciprofloxacin. And this results higher than those reported in industrialized countries, but similar to other places in Asia country.

Six point seven percent of nalidixic acid-resistant isolates were also resistant to ciprofloxacin and 16.3 percent showed intermediate resistance to ciprofloxacin, indicating the potential for a possible treatment failure in patients treated with fluoroquinolones. 


This --- program launched for four years, in the year 2008 we found the Salmonella imitations. First one was the Salmonella isolates were too few to detect the outbreak. Four provinces got at least in 100 isolates Salmonella per year. So the second one, the turnaround time for PFGE typing were too long to detect outbreak --- of one time, one year. So the microbiologists finished the PFGE and -- at end of year in the --- summer --- that’s not make sense for a detect outbreak. So we would like to -- quality our civilian systems. So --


Last year, I mean in 2008, we launched a Salmonella surveillance --- in Guangdong Province. So we -- we got more -- sentinel hospitals and selected to most do samples and serotyping and confirmation identification the isolates fast and ask the providence of CDC launch PFGE for months. 

And in Guangdong totally have 60 sentinel hospitals in include children hospital. So -- 


This slide shows the patterns across the --- right here. The diversity of PFGE patterns of S. typhimurium, but the one unique cluster detected. The totally cases were 36 from the May 2008 to --- now in Guangdong. 

There are cases excepted one was 78 years older, cancer patient. That means almost the cases was infant, this then one year old. 


The isolates pattern of this resistance is ACSSuT. So, as we know the antibiotic related diarrhea in people attacked, usually was C. difficile. So maybe the infant, the antimicrobial resistance --- diarrhea, the risk factors was S. typhimurium while the resistance, the drug resistance. And the information offered in domestic --- almost cases, the infant cases before diarrhea and take a antibiotics and because the other infections, for example the -- pneumonia and other diseases. 

So, we would like the --- and there is only one to trace back the source and --- because the cases were the infant, the small five days, five days, or 20 days some cases. And we test similar formula and collected from the patient’s family, but -- we don’t find Salmonella

So, and that is interesting cluster, the --- investigations is going on. 


The conclusion. The international collaboration program has been effected and promoted --- in China. My work is needed to enhance the quality and --- and time line of data.

This surveillance system has highlight important area for --- public houses patients in China including to working to increase through cultures and --- and conducting field study into animal risk of Salmonella. And we really want to promotion --- years of antimicrobial biological agents in the humans and animals. 


I would like to thank you WHO, GFN, US CDC and US FDA. And really must -- say --- partners in Guangzhou, Beijing, Guangxi, Shanghai.

And ---. All partners in public house assisting and sentinel hospitals. Thank you. 


DR. CHILLER: Thank you. We have time for a quick question or two. 

DR. CARATTOLI: If you would like to phage typed. Is it going now. Can you hear me. I did this phaged types this Salmonella ---. 

DR. LU: I really wanted to that. But in China we haven’t a phage type agent. Yes, maybe we can shift isolates to like --- laboratory or something. We tried that.

DR. CHILLER: Is there a question back there? 

DR. M’IKANATHA: Thank you for the excellent presentation. You included some of the improvement about the --- but I think your data is very timely. You showed us data from 2009 to 2010. Only two months since May of 2010 but you had drug resistance. So, very, very good job.

Question for you is because China is expanding economically and we’re having a lot of international travel to China, have you sampled your data in mind of showing cases that are recovering from international travelers and is there a continuation with other NARMPS trying to see how international travel is impacting the spread of resistant pathogens. Thank you.

DR. LU: Well, --- 

DR. CHILLER: One more question for you. What are you doing now, so you showed us human data, are you also beginning to collect or beginning to analyze food and animal isolates or is that something that China is now doing or has been doing? 

DR. LU: Yes. In food side and animal side have ---. The Minister of Agriculture established Salmonella and E. coli surveillance for chicken and pigs. And therefore 2000 year. And they have to -- foodborne pathogens in food ---. But in China and different team, different --- of information and collaborators. And we think that isolates from the published --- or something. 

DR. ZHAO: Shaohua Zhao from FDA. Tom, you know we as a civilian try very hard to push them working together, and one time I go to our sister agency in China, and --- it’s very different like --- you know, to share the isolates. So the total maybe you become the Prime Minister mandatory to share the isolates so they can do other ways, you know, because everybody looking for to support from central government. And it’s very difficult, you know, for them to working together but they are trying. 

DR. CHILLER: Thank you, Doctor Ran. Our next speaker will be a change, Antonio Vieira couldn’t make it for personal reasons, and so we’re going to bring up Doctor Danilo Lo Wong. Danilo is currently at WHO where he is leading efforts for the Global Foodborne Infectious Network, in the Office of Food Safety. And will be presenting on behalf of Doctor Vieira about Denmark.