Health authorities are working to control a deadly outbreak of a rare strain of salmonella across Illawarra aged care facilities after a fresh case took the number of infected patients to 26 on Tuesday.
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Two people have died after contracting the salmonella bovismorbificans and the fresh case dashed hopes the rate of infections was on the decline.
Health Minister Jillian Skinner said yesterday: "It's always a concern to me when there are deaths that are attributed to salmonella or any other cause like this.
"I believe investigations are under way right across the system and I'm very pleased to know that because we take it as very serious."
Illawarra Shoalhaven Local Health District public health director Curtis Gregory said there were 26 confirmed cases across 10 aged care facilities. The most recent case had an onset date of February 3.
Until Tuesday there had been six days' reprieve since the last notification and while authorities remained cautious they had hoped for no new infections.
Staff from the public health unit have been visiting the facilities and interviewing patients, carers and staff and analysing the information collected such as cases and food histories.
"We have been providing advice and information around the incident, the pathogen involved and any likely risks," Mr Gregory said.
"The analysis has not identified a likely source as yet."
Cases have been confirmed in the Illawarra, Shoalhaven, ACT and south-eastern Sydney regions.
Mr Gregory said the investigation was made difficult because it was spread over a longer period of time than usual for a food-borne outbreak, involved numerous facilities spread over some distance and the menu was large - "all of which makes it harder to collect as accurate data around the cases".
IRT have confirmed 23 cases at seven of their aged care facilities and there is one case each reported at three other facilities.
"From a health perspective one key element is to define the symptoms associated with the illness so we can determine whether patients are part of an outbreak or not," Mr Gregory said.
"This is based off the illness and risk factors that may affect transmission.
"With salmonella it's mainly a food-borne transmission so the person-to-person transmission isn't really a factor and people who have had contact with confirmed cases aren't at increased risk."
Mr Gregory said that once the public health unit staff developed a list of people who may be ill, they confirm date of onset and what they had eaten in the days prior to becoming ill.
"We can then map or analyse the information and find out more useful data like the incidence of the disease, the scope of its spread and whether the cases may be linked.
"Confirmed cases for this incident are ill patients that have a positive result for salmonella at a laboratory.
"Once we have a confirmed case we then have it serotyped and if the infected cases return results of the same serotype it can be used as evidence that the source of the infection is from the one type of pathogen and links the cases."
IRT said on Tuesday it was continuing to work with the NSW Food Authority, NSW Health and ACT Health to determine the source of the infection.
"The NSW Food Authority has conducted rigorous scientific testing at the affected care centre and at IRT Catering over the past two weeks," a spokesman said.
"The authority has confirmed to us in writing that there was no evidence of salmonella at any of our sites and that adequate controls are in place to ensure the safety of our residents."
IRT has temporarily withdrawn potentially at-risk foods from service.
Families or residents with any concerns should contact their area manager or call 1800132202.
