Brotes de salmonelosis y el tamaño y rol del Estado en Chile
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Date
2012
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Abstract
Durante el año 2011 dos brotes de infecciones por Salmonella afectaron la Región Metropolitana (RM) de Chile: uno de fiebre tifoidea y otro de gastroenteritis por Salmonella serotipo Enteritidis, infecciones que habían declinado en los últimos años. Se analizan las probables causas de esta reemergencia. Para el desarrollo de este trabajo se consultaron sitios web gubernamentales y de las Naciones Unidas. Las tasas de fiebre tifoidea han declinado progresivamente hasta tasas muy bajas siendo la actual cercana a un caso por 100.000 habitantes, disminución asociada a las mejorías en las condiciones de vida de la población que se expresa por el índice de desarrollo humano alcanzado. El brote del año 2011 estuvo asociado a un clon predominante que afectó al sector occidente de la RM y donde el único factor de riesgo involucrado fue el consumo de verduras adquiridas en distintas ferias libres del mismo sector, sin lograr la identificación del sitio de origen. Aunque la notificación de esta enfermedad se ha optimizado en los últimos años, al igual que la capacidad de tipificación molecular por parte del Laboratorio de Referencia (ISP), este brote se produce en forma coincidente con un bajo número de fiscalizaciones alimentarias en la RM (la más baja de Chile), explicado probablemente por el bajo número de personal en la repartición responsable en relación al tamaño de la población. En el caso de las infecciones por Salmonella serotipo Enteritidis, la tasa actual es el doble de la observada hace una década (10,7 vs 5,3 casos por 100.000 habitantes) con un incremento progresivo de los brotes alimentarios ligados a este microorganismo desde el 2005 (7 a 31 brotes anuales). La persistencia de este problema está asociada a una escasa actividad fiscalizadora del Estado de Chile hacia los planteles avícolas, a la ausencia de una cadena de frío en la distribución y venta de huevos, y a la falta de educación sobre este tema en la población. La reciente normativa de prohibir la venta de mayonesa elaborada artesanalmente, es un paso importante cuyo impacto aún debe ser evaluado. Conclusiones: La persistencia y reemergencia de ambas salmonelosis en Chile sugiere la existencia de problemas crónicos sobre el tamaño y capacidad del Estado en la seguridad alimentaria del país.
During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. Methods: Several government websites were searched looking for epidemiological data. Results: Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. Conclusions: The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.
During year 2011 two outbreaks of Salmonella infection captured media attention in the Metropolitan Area (MA) in Chile: one of typhoid fever associated to Salmonella serotype Typhi, and the other, of gastroenteritis related to Salmonella serotype Enteritidis, both with decreasing or stable rates in the previous years. The aim of this work is to analyze probable causes of their reemergence. Methods: Several government websites were searched looking for epidemiological data. Results: Typhoid fever rates have declined to current values of 1 case per 100.000 habitants, a decreased associated to improvements in the human development index. The typhoid outbreak was associated to a predominant clone within the MA. The only risk factor identified was consumption of raw vegetables acquired in open fairs, but without identifying a common source. Despite improvements in disease notification and molecular epidemiology capabilities, this outbreak is coincidental with a reduced number of food inspection visits in the MA, probably explained by the limited personnel available for this task. In the case of Salmonella Enteritidis, rates have increased twice since 1998 (5.3 to 10.7 per 100.000 habitants) with an important increase in the number of outbreaks linked to this agent (7 to 31 annual outbreaks) since year 2005. Persistence of this problem is probably associated to the low surveillance of poultry farms made by the Chilean state, to the absence of a cold chain during collection, distribution and selling of eggs, and to the lack of an educational program directed to the population. The recent regulation that bans home-made mayonnaise in restaurant or fast food stores is an important advance that requires further evaluation. Conclusions: The persistence and reemergence of different kind of Salmonellosis in Chile suggests chronic problems on the size and role of the Chilean state regarding food safety.
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Keywords
Infecciones por Salmonella, Intoxicaciones por Salmonella, Fiebre tifoidea, Brotes, Epidemiología, Contaminación de alimentos, Industria de alimentos, Salmonella infections, Salmonella food poisoning, Typhoid fever, Disease outbreaks, Epidemiology, Food contamination, Food industry