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Outbreaks down but illnesses up, finds EFSA and ECDC

By Joe Whitworth+

19-Dec-2016
Last updated on 19-Dec-2016 at 13:58 GMT2016-12-19T13:58:44Z

France reported the largest number of outbreaks. Picture: iStock
France reported the largest number of outbreaks. Picture: iStock

More than 4,300 foodborne outbreaks were reported in 2015, according to the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC).

The EU summary report on trends and sources of zoonoses, zoonotic agents and foodborne outbreaks reported 4,362 outbreaks last year, a 17% decrease from 2014.

They caused 45,874 illnesses (209 more than 2014), 3,892 hospitalisations (2,546 less) and 17 deaths (10 less).

Norway and Switzerland (non-MS) reported 50 outbreaks involving 1,853 cases and seven hospitalisations.

What caused the outbreaks?

Most were caused by bacterial agents (33.7% of all outbreaks), in particular Salmonella (21.8%) and Campylobacter (8.9%), even though reporting involving these has been declining in recent years.

Bacterial toxins ranked second and were reported in 19.5% while viruses, which were the agents most frequently reported in 2014, accounted for 9.2% in 2015.

Parasites and other causative agents, in particular histamine, were reported in less than 3% of outbreaks, according to member state (MS) data.

EFSA and ECDC said estimates should be carefully interpreted at EU level.

“It is important to note that the vast majority of outbreaks caused by bacterial toxins and other causative agents were reported from a single MS (France), and therefore, the respective findings are to be interpreted with caution, as they cannot be considered representative of the EU,” they said.

“It is important to highlight that they may not only reflect true epidemiological differences among the MS in the rate of occurrence of outbreaks as well as in the causative agents and food vehicles involved but also the different systems, components (e.g. case definition, diagnostic procedures), and sensitivity of surveillance programmes for foodborne outbreaks in place in the various EU countries.”

For a third (34%) of them the causative agent remained unknown.

France reported the largest number (1,429) of reported outbreaks followed by Slovakia (425).

In Switzerland, 1,194 cases were reported in a single outbreak. In the Czech Republic, three outbreaks of norovirus caused 5,344 cases of illness.

Those caused by C. botulinum and hepatitis A had the highest proportion of cases hospitalised (71.7% and 62.8%) and Listeria and Hepatitis A resulted in the highest proportion of fatal cases.

C. perfringens and B. cereus

Bacterial toxins other than C. botulinum (mainly C. perfringens and B. cereus then staphylococcal enterotoxins) in ‘other foods’ was third most common combination of strong-evidence outbreaks, while from 2010-2014 it was 14th.

Twenty MS reported 849 outbreaks caused by bacterial toxins which caused 8,847 illnesses, 497 hospitalisations and three deaths.

Behind the outbreak

Contamination of the implicated food vehicle by unprocessed contaminated ingredients and cross-contamination was reported in 84 (42.2% of strong-evidence outbreaks with information available) and 20 outbreaks, respectively.

For 65 outbreaks, storage/time temperature abuse as well as inadequate heat treatment or chilling were reported.

Manipulation of the implicated vehicle by an infected food handler was reported in 36 outbreaks and in three failure in the treatment of water or use of untreated water was reported.

This includes those associated with toxins produced by Bacillus, Clostridium and Staphylococcus.

Findings are similar to 2014, when 840 outbreaks were reported by 18 MS.

In 2015, 291 outbreaks caused by Bacillus cereus toxins were reported by nine MS, 277 of them by France, and involved 3,131 cases, of which 101 were hospitalised. Norway reported four outbreaks, which affected 17 human cases.

In the 24 strong-evidence ones caused by B. cereus toxins, ‘mixed food’ was most commonly implicated (eight outbreaks), followed by ‘cereal products including rice and seeds/pulses (nuts, almonds) (two).

Last year, 24 outbreaks caused by C. botulinum toxins with 60 cases, of which 43 hospitalised, were reported by 10 MS compared to nine outbreaks in 2014.

Fifteen were supported by strong evidence, associated with eating different foods, including ‘pig meat and product’ (four outbreaks, two associated with smoked ham), unspecified ‘meat and meat products’ (three including smoked meat) and ‘canned food products’ (three including mushrooms in oil).

For two of them, contamination of food (smoked sausage and chickpea spread) with C. botulinum was at processing plants. Botulinum toxin B was specified for five outbreaks.

A total of 96 outbreaks caused by C. perfringens toxins were reported last year by seven MS but 66 came from France.

In France, two patients died in such an outbreak associated with broiler meat that involved 38 people in a residential institution.

All outbreaks involved 2,014 cases, of which 25 were hospitalised and three died. One additional strong-evidence outbreak due to bovine meat that involved 18 cases was reported by Norway.

Twelve of the 24 strong-evidence outbreaks were associated with different types of meat and such products.

Sixteen MS reported 434 outbreaks caused by staphylococcal toxins, as in 2014, France reported the vast majority (91.7%) of these.

For 39 strong-evidence outbreaks, ‘cheese’ was the most commonly implicated food vehicle (13).

In 95 outbreaks (six strong-evidence and 89 weak-evidence) an ‘infected food handler’ was reported as a contributory factor.

Histamine and marine biotoxins

© iStock/goce#

Nine MS reported 127 outbreaks due to other causative agents involving 648 cases, of which 64 were hospitalised. France reported the highest number (103).

Other causative agents’ includes chemicals, histamine, marine biotoxins, mushroom toxins and scrombotoxin.

Two strong-evidence outbreaks with 24 cases were reported by Switzerland, both caused by histamine.

The majority (63%) were caused by histamine (23 strong- and 57 weak-evidence outbreaks), which accounted for 67.4% of cases and 67.2% of hospitalisations.

Histamine was the causative agent in 20 out of 21 strong-evidence outbreaks caused by ‘other causative agents’ in fish and fishery products but this combination was slightly down compared with previous years.

Forty-four of 127 outbreaks were caused by marine biotoxins, while chemical agents, mushroom toxins and scrombotoxins were associated with one outbreak each.

Most of the strong-evidence outbreaks were associated with ‘fish and fishery products’ (21 out of 25 strong-evidence outbreaks), mostly containing tuna.

Also, ‘cheese’ was the food vehicle in two strong-evidence outbreaks, while ‘mixed food’ (plain yogurt with banana) was associated with one strong-evidence incident.

Calicivirus including norovirus

Overall, 16 MS reported 396 outbreaks caused by viruses representing a decrease compared with 2014, when 1,070 were reported.

They implicated 13,453 cases, 526 hospitalisations and five deaths while Norway reported 13 weak-evidence outbreaks implicating 320 cases.

15 MS reported 285 outbreaks (36 strong evidence and 249 weak evidence) caused by calicivirus including norovirus implicating 12,591 cases, 349 hospitalisations and one death.

One death was connected with a strong-evidence outbreak caused by calicivirus in broiler meat and products that involved nine patients in a residential institution in Croatia.

France reported the highest number 22.4%, followed by Poland (14.7%) and Latvia (13%).

In the 36 strong-evidence outbreaks caused by norovirus, ‘crustaceans, shellfish, molluscs and products’ was the most commonly implicated food vehicle.

The two most often contributory factors for the strong-evidence outbreaks were ‘infected food handler’, ‘cross-contamination’ in 11 outbreaks and ‘unprocessed contaminated ingredient’ in nine of the 22 strong-evidence outbreaks.

A total of 13 outbreaks (two strong-evidence outbreak and 11 weak-evidence) with 78 cases, 49 hospitalisations and one death were reported from Finland, Germany, Greece, Hungary and Poland.

Four of the five strong-evidence outbreaks involving viruses other than calicivirus and hepatitis A were caused by flavivirus and associated with milk (raw goat milk in three outbreaks).

One death in two different household outbreaks caused by flavivirus (in one case it was specified as tick-borne encephalitis virus) in raw goat milk was reported by Slovakia and Lithuania. In both, inadequate heat treatment of milk was reported as the critical contributory factor.

These were characterised by the high severity of clinical illness with 13 hospitalisations and two deaths among the 14 cases.

For Hepatitis A, 13 outbreaks with 78 cases, 49 hospitalisations and one death were reported from Finland, Germany, Greece, Hungary and Poland. 

Trichinella, Shigella and E. coli

Twelve MS reported 45 outbreaks caused by parasites, an increase compared with 2014 with 33 outbreaks.

There were 15 Trichinella outbreaks reported by eight MS with 119 people involved, 34 of which were hospitalised.

Twelve were strong-evidence outbreaks: five were associated with ‘pig meat and products’, five with ‘other or mixed red meat and products’ (including four outbreaks involving wild boar meat) and two with ‘meat and meat products’.

Last year, 22 outbreaks caused by Shigella were reported by 11 MS and affected 134 people, of which 20 were hospitalised, similar to 2014 statistics.

One strong evidence outbreak was associated with coriander.

Another strong-evidence outbreak caused by ‘pathogenic E. coli other than STEC’ and involving 43 cases was reported by Luxembourg and linked to ‘fish and fishery products’.

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