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Euro Surveill. 2019 Jan;24(3). doi: 10.2807/1560-7917.ES.2019.24.3.1700703.

Disentangling a complex nationwide Salmonella Dublin outbreak associated with raw-milk cheese consumption, France, 2015 to 2016.

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These authors contributed equally to this article and share first authorship.
European Programme for Intervention Epidemiology Training (EPIET), European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden.
Santé publique France (SpFrance), the French national public health agency, Saint-Maurice, France.
Institut Pasteur, Enteric Bacterial Pathogens Unit, National Reference Center (NRC) for E. coli, Shigella and Salmonella, Paris, France.
European Programme for Public Health Microbiology Training (EUPHEM), European Centre of Disease Prevention and Control (ECDC), Stockholm, Sweden.
Sorbonne Université, UPMC, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, Paris, France.
French Directorate General for Food (DGAL), Ministry of Agriculture and Food, Paris, France.
Université Paris-Est, French Agency for Food, Environmental and Occupational Health and Safety (ANSES), Laboratory for Food Safety, Maisons-Alfort, France.
These authors contributed equally to this article and share last authorship.


On 18 January 2016, the French National Reference Centre for Salmonella reported to Santé publique France an excess of Salmonella enterica serotype Dublin (S. Dublin) infections. We investigated to identify the source of infection and implement control measures. Whole genome sequencing (WGS) and multilocus variable-number tandem repeat analysis (MLVA) were performed to identify microbiological clusters and links among cases, animal and food sources. Clusters were defined as isolates with less than 15 single nucleotide polymorphisms determined by WGS and/or with identical MLVA pattern. We compared different clusters of cases with other cases (case-case study) and controls recruited from a web-based cohort (case-control study) in terms of food consumption. We interviewed 63/83 (76%) cases; 2,914 controls completed a questionnaire. Both studies' findings indicated that successive S. Dublin outbreaks from different sources had occurred between November 2015 and March 2016. In the case-control study, cases of distinct WGS clusters were more likely to have consumed Morbier (adjusted odds ratio (aOR): 14; 95% confidence interval (CI): 4.8-42) or Vacherin Mont d'Or (aOR: 27; 95% CI: 6.8-105), two bovine raw-milk cheeses. Based on these results, the Ministry of Agriculture launched a reinforced control plan for processing plants of raw-milk cheeses in the production region, to prevent future outbreaks.


France; Salmonella Dublin; WGS; cheese; outbreaks; raw-milk

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