AUTHOR=Li Xiaolong , Singh Nitya , Beshearse Elizabeth , Blanton Jason L. , DeMent Jamie , Havelaar Arie H. 

TITLE=Spatial Epidemiology of Salmonellosis in Florida, 2009–2018

JOURNAL=Frontiers in Public Health

VOLUME=Volume 8 - 2020

YEAR=2021

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2020.603005

DOI=10.3389/fpubh.2020.603005

ISSN=2296-2565

ABSTRACT=Non-typhoidal Salmonella enterica infections cause a high disease burden in the United States with an estimated 1.2 million illnesses annually. The state of Florida consistently has a relatively high incidence compared to other states in the United States. Nevertheless, studies regarding the epidemiology of nontyphoidal salmonellosis and its spatial and temporal patterns in Florida were rarely reported. 
We examined the spatial and temporal patterns of 62,947 salmonellosis cases reported between 2009 and 2018. Whole genome sequencing (WGS) data for 2,507 Salmonella isolates with metadata for the years 2017 and 2018 were obtained from Florida Department of Health and used to explore the dominant serotypes circulating in Florida. The representativeness of laboratory-sequenced isolates for reported cases was determined by regression modeling.
The annual incidence rate of salmonellosis decreased from 36.0 per 100,000 population in 2009 to 27.8 per 100,000 in 2016, and gradually increased in 2017 and 2018. Increased use of culture-independent testing did not fully explain this increase. The highest incidence rate was observed in children, contributing 40.9% of total reported cases during this period. A seasonal pattern was observed with the incidence peaking in September and October, later than the national average. Over these ten years, the Northeast and Northwest regions of the state had higher reported incidence rates, while reported rates in the Southeast and South were gradually increasing over time.
Serotypes were predicted based on WGS data in the EnteroBase platform. The top-five most prevalent serotypes in Florida during 2017-2018 were Enteritidis, Newport, Javiana, Sandiego and Braenderup. The highest percentage of isolates was from children under 5 years of age (41.4%), and stool (84.7%) was the major source of samples. A zero-inflated negative binomial regression model showed that the reported case number was a strong predictor for the number of lab-sequenced isolates in individual counties, and the geospatial distribution of sequenced isolates was not biased by other factors such as age group.
The spatial and temporal patterns identified in this study along with the prevalence of different serotypes will be helpful for the development of efficient prevention and control strategies for salmonellosis in Florida.