Public Health England Briefing Note 2019/038
Public Health England (PHE), Public Health Wales and the Food
Standards Agency (FSA) are investigating a 5-single nucleotide
polymorphism (SNP) cluster of _Salmonella enterica_ 4,[5],12:b:- (SNP
address: identified through the analysis of
whole genome sequencing (WGS) data. To date, 54 cases have been
reported, with sample dates ranging from 23 Apr 2019 to 7 Jul 2019.
Investigation is warranted due to the large number of cases and high
reporting rate, with 6 cases reported in May, 23 in June and 25 in
July [2019].

The age of cases ranges from 14 months to 80 years, with half of the
cases 20 to 40 years of age (27 of 54 cases). Sex distribution is
similar with 26 females and 28 males. A total of 12 cases have been
reported from Wales and 42 from England distributed across 6 PHE
centers. An EU-wide query (EPIS) was posted, but there is no
indication that this outbreak is affecting other countries. The
isolates are fully sensitive to all antimicrobials tested, apart from
one strain that is ampicillin resistant.

No common food product has been identified to date; however, several
cases reported eating at various Indian restaurants throughout England
and Wales in the week prior to their onset: 2 Indian restaurants in
London have been identified where multiple confirmed cases reported
eating prior to onset. These restaurant outbreaks are being
investigated by the relevant HPTs, supported by the Field Service.

To identify the source of the outbreak and allow the FSA to follow up
restaurant supply chain information, the OCT has agreed to administer
a hypothesis-generating questionnaire developed for this outbreak to
prospective cases. Cases will be identified by TARGET (GI infections)
and notified to the relevant Field Service team for coordination of
questionnaire completion.