GBSI would be glad to start a web page on foodborne outbreaks in case that would be a helpful alert to people elsewhere.

Thank you for the fascinating presentation on the epidemiology of the foodborne outbreak in SE Asia. Your study brings to mind that further research as to possible acquired GI colonization through food is much needed.

Yes - GBS seems to be very versatile. It's found in lots of animals besides humans. The potential for zoonotic transmission is known from the cow strains and now fish, and may be more common than was previously appreciated, unfortunately...

This is a One Health topic. It has been fascinating to be involved in learning about the interaction of animal and human health that has resulted in ST283 causing disease in both arenas. We have toured fish farms in the region and witnessed the concern that mass fish die-offs cause to the farmers, and learnt a lot from our aquaculture collaborators. Like so many other food borne infections, human disease depends on the alignment of several events; fish contaminated with ST283, perhaps warmer weather to increase the inoculum in the fish to a level high enough to infect humans, and finally a human who enjoys eating undercooked fish! There is still a lot unanswered. We hope to resolve the question of the ultimate source of ST283, including the routes of transmission, which may involve other animals/food items: we would like to be able to explain how it has spread so far across SE Asia whilst being absent elsewhere. Is it in the fish-food?, or perhaps the water? or are the hatchling nurseries infected? We found a few early onset neonatal cases of ST283 sepsis, presumably reflecting vaginal carriage in the mothers; this prompts us to ask what the vaginal & gastrointestinal carriage rate is, in these countries. We have also had a few anecdotal adult cases who deny exposure to raw fish; if this is true then perhaps they acquired it sexually from a carrier, or perhaps from food infected by a colonised 'chef'! So much to do!