European Food Safety Authority: Update on Salmonella agona outbreak

The withdrawal and/or recall of infant formula produced by a single French processing company will significantly reduce the risk of more infants being infected by Salmonella Agona, say EFSA and ECDC as a result of a rapid outbreak assessment.

An outbreak of S. Agona linked to the consumption of infant formula has been ongoing in France since August 2017. So far the outbreak has affected 37 children under one year of age in France. Whole genome sequencing (WGS) analysis confirmed that a Spanish case is closely related to the outbreak in France. A probable case has been identified in Greece. The last case was notified on 2 December 2017.

EFSA and ECDC recommend that competent authorities in affected Member States keep sharing information on the epidemiological, microbiological and environmental investigations and issue relevant notifications in the Rapid Alert System for Food and Feed (RASFF) and the Early Warning Response System (EWRS).

To prevent infections using infant formulas, both in infants and caregivers, Member States should consider providing advice to the public regarding:

Not to use any of the infant formulas involved in this outbreak;

Hand washing before and after the preparation of the bottle;

Bottles should not be prepared in advance and the contents should be discarded if not consumed within two hours.

What is a rapid outbreak assessment?

In case of multi-country foodborne outbreaks coordination at EU level is important. A Rapid Outbreak Assessment is jointly prepared by EFSA and ECDC in close cooperation with affected countries. The ROA gives an overview of the situation in terms of public health and identifies the contaminated food vehicle that caused the infections. It also includes trace-back and trace-forward investigations to identify the origin of the outbreak and where contaminated products have been distributed. This is crucial to identify the relevant control measures in order to prevent further spread of the outbreak.

An outbreak of Salmonella Agona linked to the consumption of infant formula (powdered milk) has been ongoing in France since August 2017. As of 11 January 2018, the outbreak had affected 39 infants (children <1 year of age): 37 in France, one in Spain confirmed by whole genome sequencing (WGS) and one in Greece, considered to be associated with this event based on the presence of a rare biochemical characteristic of the isolate.

The date of symptom onset for the most recent case was 2 December 2017. Available evidence from epidemiological investigations in humans and traceability investigations in food identified seven different brands of infant formula from a single processing company in France as the vehicles of infection.

After receiving the first notification on 2 December 2017 of an unusual number of S. Agona cases in France, the French authorities carried out investigations at the implicated factory. On 4 December 2017, they notified the Rapid Alert System for Food and Feed (RASFF) after confirming that some of the affected products were exported to other countries. Following investigations at the processing company, all products manufactured since 15 February 2017, including products other than infant formula, have been recalled and/or withdrawn, as a precautionary measure. The French competent authorities are verifying that the measures taken by the processing company in response to this event have been sufficient and appropriate. As of 15 January 2018, recalled products had been distributed to 13 European Union (EU) countries (Belgium, Bulgaria, Cyprus, the Czech Republic, France, Greece, Ireland, the Netherlands, Romania, Slovenia, Slovakia, Spain and the United Kingdom) and to 54 third countries. Most of the batches involved in the investigation have not yet passed their expiry date. However, broad withdrawal and/or recall measures, export bans and a suspension of market distribution of these batches, implemented since the beginning of December 2017 by the French competent authority and processing company A, are likely to significantly reduce the risk of human infection. The possibility remains, however, that new cases may be detected. Third countries, where the recalled products had been distributed, have been notified by RASFF through INFOSAN. ECDC offers WGS services to EU/EEA countries that do not have the capacity for a timely sequencing and analysis as part of this investigation. A multi-country WGS analysis is under way at the Pasteur Institute.