Il Sistema ENTERNET regionale per la sorveglianza delle MTA. Mala%e a Trasmissione Alimentare Bologna, 26 Novembre 2015

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1 Il Sistema ENTERNET regionale per la sorveglianza delle MTA Mala%e a Trasmissione Alimentare Bologna, 26 Novembre 205

2 !"#!#$#%&'%%()%*!+,##!-%& Parleremo di

3 Perché?!"#!#$#%&'%%()%*!+,##!-%& Direttiva 2003/99/CE del Parlamento europeo e del Consiglio, del 7 novembre 2003, sulle misure di sorveglianza delle zoonosi e degli agenti zoonotici (a) Monitoraggio zoonosi ed agenti zoonotici; (b) Monitoraggio della resistenza agli antibiotici; (c) Indagini epidemiologiche di tutti i focolai MTA; (d) Scambio info su agenti e malattie zoonotici e MTA

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7 !"#!#$#%&'%%()%*!+,##!-%& Il sistema Enternet nazionale La rete di sorveglianza Enternet Italia è coordinata ISS È cosftuita da 20 laboratori del SSN, IsFtuF Universitari, IIZZSS, ARPA. Dal 2008 Enternet è stato incorporato nel sistema di sorveglianza europeo per le Food- and Waterborne Diseases (FWD) coordinato dall ECDC I daf raccolf awraverso Enternet Italia vengono regolarmente inviaf all ECDC awraverso il sistema TESSy (The European Surveillance System).

8 !"#!#$#%&'%%()%*!+,##!-%& Il sistema Enternet Regionale 0 laboratori medici coinvolf tra cui 2 grandi hub laboratorio di riferimento regionale (IZSLER PARMA) isolaf di Salmonella: 000/anno Finalità del sistema ENTERNET Emilia-Romagna

9 !"#!#$#%&'%%()%*!+,##!-%& Il sistema Enternet Regionale Info & daf (SeWembre 205): solo Database Bionumerics condiviso in IZSLER 2 laboratori a%vi (PR e BS) codifica condivisa isolaf nel database ~ 8000, di cui ~ 4200 umani genofpi idenfficaf ~ 600 tuwe le Typhimurium/monofasiche sono verificate PCR

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15 Presupposto!"#!#$#%&'%%()%*!+,##!-%& Ceppi epidemici: singola espansione clonale di un precursore

16 PFGE (Pulsed Field Gel Electrophoresis) PFGE Process!"#!#$#%&'%%()%*!+,##!-%& Introdo.a da Patient Specimen Collection Cell Lysis and Plug Washing Specimen US Dime coin Cells Trapped in Plug = Grow isolated colony Agarose + Cell Suspension David Schwartz nel 984 Gold Standard Restriction Electrophoresis Imaging

17 ... il risultato! l analisi dei tracciati!"#!#$#%&'%%()%*!+,##!-%& la comparison!

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20 Come interpretare crifcità!"#!#$#%&'%%()%*!+,##!-%&!"#$"%&'()" *'+,-.-,+&/0'"!" #$%&'()*"%+,("-#./" 02" 3'4&)&5("#." 67" 34889&5("-#./" :; <4%"#." CriFcita nelle indagini intra- focolaio!

21 !"#!#$#%&'%%()%*!+,##!-%& MLVA (Multi-Locus VNTR Assay) SE: AACTACC Se RIP CTTTTTGTGGGACTGCTTCAACCTTTGGGCAGATATCGGAAATGAAAAAGATAGACCAGGCAACTATTCGCTATCAGA ATATCCGGTACACC AACTACC AACTACC AACTACC AACTACC AACTACC AACAAATCATTTAGTCGATGGTC TCGTTGCCATTGGTTCATAGAGTGTTGGTCTTGGTATGGATGG Se RIP CTTTTTGTGGGACtGCTTCAACCTTTGGGCAGATATCGGAAATGAAAAAGATAGACCAGGCAACTATTCGCTATCAGA ATATCCGGTACACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACAAAT CATTTAGTCGATGGTCTCGTTGCCATTGGTTCATAGAGTGTTGGTCTTGGTATGGATGG Se 37 RIP CTTTTTGTGGGACTGCTTCAACCTTTGGGCAGATATCGGAAATGAAAAAGATAGACCAGGCAACTATTCGCTATCAGA ATATCCGGTACACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTAC CAACTACCAACTACCAACAAATCATTTAGTCGATGGTCTCGTTGCCATTGGTTCATAGAGTGTTGGTCTTGGTATGGA TGG Se 33 3 RIP CTTTTTGTGGGACTGCTTCAACCTTTGGGCAGATATCAGAAATGAAAAAGATAGACCACGCAACTATTCGCTATCAGA ATATCCGGTACACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTACCAACTAC CAACTACCAACTACCAACTACCAACTACCAACAAATCATTTAGTCGATGGTCTCGTTGCCATTGGTTCATAGAGTGTT GGTCTTGGTATGGATGG

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24 IdenFficazione Focolai!"#!#$#%&'%%()%*!+,##!-%&

25 IdenFficazione Focolai!"#!#$#%&'%%()%*!+,##!-%&

26 IdenFficazione Focolai: casi!"#!#$#%&'%%()%*!+,##!-%& SieroFpo Typhimurium Var. Monofasica - STYMXB_PR isola? in nucelo famigliare ( decesso) salame casalingo posi?vo con iden?co geno?po

27 IdenFficazione Focolai: casi!"#!#$#%&'%%()%*!+,##!-%& SieroFpo Typhimurium Var. Monofasica STYMXB casi tra luglio e agosto 204 Alimento implicato: salame 4 province coinvolte

28 IdenFficazione GenoFpi EMERGENTI!"#!#$#%&'%%()%*!+,##!-%& STYMXB_PR.42

29 IZSLER Case: Salmonella Typhimurium Monophasic (203)!"#!#$#%&'%%()%*!+,##!-%& STYMXB_PR.03 (!" '!" &!" %!"!"#$%& $!" #!"!" *+,-./0!#%#" *+,-.//*0!!#!" *+,-./230!&#)" *+,-./230!4'&" *+,-.//*0!#!%" *+,-./230!'#'" *+,-./230##&)" *+,-.//*0!!!(" *+,-./230!'44" *+,-./230#$('" *+,-./0!!5%" *+,-.//*0!$'!" *+,-./230!$!#" *+,-./230!)

30 US Dime coin IZSLER Case: Salmonella Typhimurium Monophasic (203)!"#!#$#%&'%%()%*!+,##!-%& OUTBRAK INVESTIGATION PFGE Process Patient Specimen Collection Specimen Grow isolated colony G*!"#$%&'# Cell Lysis and Plug Washing Cells Trapped in Plug Restriction Electrophoresis Imaging = + Agarose Cell Suspension!"#$%&'()* * +##,*!!"#()*+# +&%-*.#*/#%0* %#,23"%4562''78"%4* 92.C%"&0*=DEF3E#F* 69:;<=*>?=@A>+><BA>9@*

31 IZSLER Case: Salmonella Typhimurium Monophasic OUTBRAK INVESTIGATION 5 human cases + SUSPECTS Producer SecFoning Plant Farm

32 IZSLER Case: Salmonella Typhimurium Monophasic OUTBRAK INVESTIGATION 5 human cases? + SUSPECTS Producer SecFoning Plant Farm PFGE: STYMXB NA- 2; NA- 2; NA- 2; NA- 2; NA- 2; NA- 2; NA- 2 PFGE: STYMXB.03, STYMXB NA- 2; NA- 2; NA- 2; NA- 2; NA- 2

33 !"#!#$#%&'%%()%*!+,##!-%& IZSLER Case: Salmonella Typhimurium Monophasic!"#$%&'"()*&+,$-)./)02) 3/4)56$&"#7+8) 3/4)9:"87;#"7+8) /"8+<&+=) H",)3"$") E6EFG)

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40 Lineage I Lineage II , ST_ ,89 ST_9 ST_2 9 ST_8 59 ST_ ST_0 ST_ , , , , LM47 AS57 AP07 ENV Q LM28 AS57 AP04 ENV O LM29 AS57 AP04 ENV O LM27 AS57 AP05 ENV N! LM26 AS57 AP42 ENV N! LM48 AS44 AP9 ENV R LM49 AS44 AP9 ENV R LM33 AS44 AP6 ENV D LM4 AS44 AP6 ENV D LM40 AS44 AP6 ENV D LM36 AS45 AP6 ENV D LM73 AS44 AP6 ENV S LM72 AS44 AP6 ENV S LM50 AS44 AP6 HAM S LM5 AS43 AP06 ENV S LM5 AS45 AP ENV D LM7 AS05 AP7 ENV Z LM70 AS05 AP7 ENV Z LM66 AS05 AP7 ENV Z LM69 AS05 AP7 ENV V LM68 AS05 AP7 ENV V LM67 AS05 AP7 ENV V LM6 AS09 AP5 ENV T " LM60 AS09 AP5 ENV T " LM59 AS09 AP5 ENV T " LM53 AS09 AP5 ENV T " LM43 AS09 AP5 ENV Q LM44 AS09 AP5 ENV Q LM45 AS09 AP5 ENV Q LM46 AS09 AP5 ENV Q LM2 AS09 AP5 ENV L LM22 AS09 AP5 ENV L LM6 AS09 AP5 ENV J LM3 AS09 AP5 ENV H LM35 AS09 AP5 ENV D LM42 AS09 AP5 ENV D LM38 AS09 AP5 ENV D LM8 AS09 AP5 ENV G LM9 AS09 AP5 ENV G LM6 AS09 AP5 ENV E LM7 AS09 AP5 ENV F LM5 AS09 AP5 ENV I LM4 AS09 AP50 ENV I LM0 AS09 AP5 ENV F LM3 AS09 AP5 ENV B LM2 AS09 AP5 ENV B LM74 AS3 AP4 ENV S LM56 AS3 AP4 ENV T # LM58 AS3 AP4 ENV T # LM AS28 AP3 ENV F LM AS28 AP3 ENV A LM2 AS28 AP3 ENV F LM63 AS28 AP3 ENV U LM9 AS23 AP09 ENV K LM8 AS23 AP09 ENV K LM7 AS23 AP09 ENV K LM20 AS74 AP09 ENV K! LM3 AS23 AP0 ENV P LM30 AS23 AP0 ENV P LM64 AS25 AP08 ENV U LM65 AS25 AP08 ENV U LM25 AS23 AP09 ENV N LM23 AS23 AP09 ENV M LM24 AS23 AP02 ENV M! LM32 AS23 AP0 ENV D LM34 AS23 AP0 ENV D! LM39 AS23 AP0 ENV D LM37 AS23 AP0 ENV D LM4 AS25 AP5 ENV C O N R D S Z V Q L D2 G B K P M D3!"#!#$#%&'%%()%*!+,##!-%&

41 !"#!#$#%&'%%()%*!+,##!-%& RingraziamenF Servizio di Sanità Pubblica Emilia- Romagna Servizio Veterinario Emilia- Romagna Rete AO e ASL regionali ER IZSLER Marina Morgan? Paola Bello^ Erika Scaltri? Luca Bolzoni Stefano Pongolini