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Risk factors for Salmonella Enteritidis and Typhimurium (DT104 and non-DT104) infections in The Netherlands: predominant roles for raw eggs in Enteritidis and sandboxes in Typhimurium infections

  • Y. DOORDUYN (a1), W. E. VAN DEN BRANDHOF (a1), Y. T. H. P. VAN DUYNHOVEN (a1), W. J. B. WANNET (a2) and W. VAN PELT (a1)...

Since 1996 Salmonella Typhimurium DT104 salmonellosis has increased in The Netherlands. This prompted a case-control study of risk factors for salmonellosis to inform transmission routes for this phage type. Cases were laboratory-confirmed patients with a Salmonella infection and controls were selected from population registries by frequency matching for age, sex, degree of urbanization and season. Cases and controls received a questionnaire on risk factors. Of the 1171 cases, 573 (49%) responded: 245 S. Enteritidis and 232 S. Typhimurium cases (both DT104 and non-DT104), of which 58 were DT104. Of the 10250 controls, 3409 (33%) responded. Use of H2 antagonists [odds ratio (OR) 4·4, 95% CI 1·6–12·2] and proton pump inhibitors (OR 4·2, 95% CI 2·2–7·9), consumption of raw eggs (OR 3·1, 95% CI 1·3–7·4) and products containing raw eggs (OR 1·8, 95% CI 1·1–3·0) were associated with endemic S. Enteritidis infection. Risk factors for endemic S. Typhimurium infection were use of proton pump inhibitors (OR 8·3, 95% CI 4·3–15·9), occupational exposure to raw meat (OR 3·0, 95% CI 1·1–7·9), playing in a sandbox (for children aged 4–12 years) (OR 2·4, 95% CI 1·6–3·7), consumption of undercooked meat (OR 2·2, 95% CI 1·1–4·1) and use of antibiotics (OR 1·9, 95% CI 1·0–3·4). Use of proton pump inhibitors (OR 11·2, 95% CI 3·9–31·9) and playing in a sandbox (OR 4·4, 95% CI 1·8–10·7) were the only risk factors for S. Typhimurium DT104 salmonellosis. This study confirms known risk factors for salmonellosis. However, playing in a sandbox was a predominant new risk factor for S. Typhimurium salmonellosis in children [population attributable risk (PAR) 14%], and especially for S. Typhimurium DT104 (PAR 32%).

Corresponding author
Centre for Infectious Disease Epidemiology, National Institute of Public Health and the Environment, PO Box 1, 3720 BA, Bilthoven, The Netherlands. (Email:
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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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