Strawberry fields forever: At least 20 sickened with hepatitis A linked to frozen berries from Poland

Hepatitis A virus is an important cause of food-borne diseases and has been associated with several European outbreaks linked to berries [14]. Here, we describe an ongoing outbreak of hepatitis A virus (HAV) in Sweden and Austria and the confirmation of frozen strawberries imported from Poland as the source of infection. The aims are to highlight the importance of sequencing in outbreak investigations and, due to the long shelf-life of the food vehicle, to increase awareness and warnings towards HAV infections related to frozen strawberries in Europe.

According to a report by the scientific journal Eurosurveillance, 20 cases of hepatitis A were reported in six districts of Sweden between June and September 2018, of which 17 were confirmed and three were likely. “In combined epidemiological and microbiological studies, imported frozen strawberries produced in Poland were identified as the source of the outbreak,” the journal said. Also in Austria hepatitis A diseases have been associated with strawberries from the same manufacturer.
Swedish and Austrian researchers have identified strawberries as a source of infection for many hepatitis A diseases in their countries. “Examinations and interviews with kitchen staff showed that the strawberries had never been sufficiently heated before serving. Strawberries were the only food that was common to all cases, “says the Swedish experts.

The best protection against hepatitis A is vaccination, which is available for children 12 months and older.

Hepatitis A outbreak linked to imported frozen strawberries by sequencing, Sweden and Austria, June to September 2018

Eurosurveillance 2018;23(41)

Theresa Enkirch1,2Ronnie Eriksson3Sofia Persson3Daniela Schmid4Stephan W. Aberle5,Emma Löf1,6Bengt Wittesjö7Birgitta Holmgren8Charlotte Johnzon9Eva X. Gustafsson8,Lena M. Svensson10Lisa Labbé Sandelin11Lukas Richter4Mats Lindblad3Mia Brytting1,Sabine Maritschnik4Tatjana Tallo1Therese Malm12Lena Sundqvist1Josefine Lundberg Ederth1

 https://doi.org/10.2807/1560-7917.ES.2018.23.41.1800528

https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2018.23.41.1800528

We let our kids explore the world, they get raw milk and barf

Following a school ski-trip to Austria from 10-18/02/2017, nine of 25 participants of the group from Lower Saxony (Germany) developed gastroenteritis. The students and teachers (17-41 years) shared meals in a hotel. Active case finding revealed further cases among German school groups from North Rhine-Westphalia and Schleswig-Holstein, staying at the same hotel in February 2017.

We conducted two retrospective cohort studies using self-administered questionnaires on clinical symptoms and food consumption. We defined a case as a trip participant in February 2017, staying at the aforementioned hotel and developing diarrhoea, vomiting or abdominal pain during or within ten days after the trip and/or who had a stool sample tested positive for STEC within four weeks after the trip. During the outbreak investigation, Austrian authorities detected that unlabeled raw cow milk delivered by a dairy farm had been offered at the hotel for breakfast during January and February 2017. Stool samples of participants, samples of milk served in the hotel and fecal samples of various animals kept at the milk-delivering farm were examined by culture and polymerase chain reaction. STEC isolates were typed using Pulsed-field Gel Electrophoresis (PFGE) and Whole-Genome Sequencing (WGS).

All 25 participants from Lower Saxony completed the questionnaire on symptoms and milk consumption; 14 were cases (56%). Thirteen of 20 participants who had consumed cold milk fell ill (risk ratio (RR): 3.25; 95%-confidence interval (CI): 0.55-19.32). Of 159 trip participants from North Rhine-Westphalia, 81 completed the questionnaire (51%), 25 were cases (31%); RR for cold milk was 2.11 (CI: 0.89-5.03). The combined RR for cold milk in both groups was 2.49 (CI: 1.16-5.35). Shiga toxin 1a-gene and eaeA-gene positive STEC O103:H2 were detected in nine of 32 patients’ stool samples and in two of 18 dairy farm cattle. Nine isolates from human stool samples and two isolates from cattle fecal samples yielded the same strain with an almost identical PFGE-pattern and WGS-profile.

Microbiological and epidemiological evidence identified raw cow milk as the vehicle. Results may have been compromised by misclassification of cases due to a recall bias and mild symptoms. As a result of this outbreak investigation, the Austrian authorities enforced Austrian law in the hotel, to provide milk only when pasteurized. We recommend re-emphasizing the risk of raw milk consumption to providers.

Shiga toxin-producing Escherichia coli O103:H2 outbreak in Germany after school trip to Austria due to raw cow milk, 2017-The important role of international collaboration for outbreak investigations, 29 May 2018

International Journal of Medical Microbiology

Maren Myliusabc, , Johannes Dreesmana, Matthias PulzaGerhard Pallaschd, Konrad Beyrera, Katja ClaußenaFranz AllerbergereAngelika FruthfChristina LangfRita PragerfAntje FliegerfSabine SchlagereDaniela KalhöfergElke Mertensa

https://doi.org/10.1016/j.ijmm.2018.05.005

https://www.sciencedirect.com/science/article/pii/S1438422118301905

Gorgonzola recalled over Listeria contamination in Austria

According to The Local, Gorgonzola cheese produced by Italian manufacturer CasArrigoni has been recalled from sale after it was found to be infected with Listeria.

gorgonzola-recall-sideThe infected cheese was reportedly recalled immediately from points of sale across Austria and nobody is reported to have been sickened yet, but eight people in Austria died in 2009 because of exposure to Listeria bacteria in cheese, and this summer at least 12 people are reported to have died in Denmark after eating lunch meat contaminated with the bacteria.

8 dead, 26 sickened in Listeria outbreak linked to Quargel cheese in Austria; genomic sequencing

A large listeriosis outbreak occurred in Austria, Germany and the Czech Republic in 2009 and 2010. The outbreak was traced back to a traditional Austrian curd cheese called Quargel which was contaminated with two distinct serovar 1/2a Listeria monocytogenes strains (QOC1 and QOC2).

Quargel_cheeseQuargel is an acid curd cheese with a red smear made from skimmed pasteurized milk. Some recalled Quargel lots were highly contaminated with up to 106–108 colony forming units (CFU) of L. monocytogenes per gram of cheese.

From June 2009 to January 2010 Quargel outbreak clone 1 (hereafter: QOC1) was the cause of 14 cases, including 5 with a fatal outcome, while between December 2009 and February 2010, clone 2 (hereafter: QOC2) accounted for 20 cases, which resulted in 3 fatalities. No maternal or neonatal case had been reported. The median age of the cases was 72 years (range 57 to 89) and 76% of the patients were male. Of the 34 patients, 25 were Austrian, 8 were German and one was from the Czech Republic.

Rychli et al. report we sequenced and analysed the genomes of both outbreak strains in order to investigate the extent of genetic diversity between the two strains belonging to MLST sequence types 398 (QOC2) and 403 (QOC1). Both genomes are highly similar, but also display distinct properties: The QOC1 genome is approximately 74 kbp larger than the QOC2 genome. In addition, the strains harbour 93 (QOC1) and 45 (QOC2) genes encoding strain-specific proteins. A 21 kbp region showing highest similarity to plasmid pLMIV encoding three putative internalins is integrated in the QOC1 genome. In contrast to QOC1, strain QOC2 harbours a vip homologue, which encodes a LPXTG surface protein involved in cell invasion. In accordance, in vitro virulence assays revealed distinct differences in invasion efficiency and intracellular proliferation within different cell types. The higher virulence potential of QOC1 in non-phagocytic cells may be explained by the presence of additional internalins in the pLMIV-like region, whereas the higher invasion capability of QOC2 into phagocytic cells may be due to the presence of a vip homologue. In addition, both strains show differences in stress-related gene content. Strain QOC1 encodes a so-called stress survival islet 1, whereas strain QOC2 harbours a homologue of the uncharacterized LMOf2365_0481 gene. Consistently, QOC1 shows higher resistance to acidic, alkaline and gastric stress. In conclusion, our results show that strain QOC1 and QOC2 are distinct and did not recently evolve from a common ancestor.

Going public: listeriosis in Austria: report of the National Reference Centre for 2013

In 2013, 33 invasive human listeriosis disease were registered in Austria, including two pregnancies. The 28-day mortality was 24% in 2013 (8 of 33). This high lethality and occasional serious permanent damage, require efforts listeriafor earliest possible detection of any food-borne outbreaks.

The example of an outbreak with a serovar 1/2b-Klon (2 cases in 2012 and 2 in the first half of 2013) shows that increased awareness as part of an outbreak investigation, when the causative source of infection can not be definitely proven, leads to increased preventative measures (something may be lost in translation).

Campylobacter in the kitchen: observational trial of safe food handling behavior during food preparation

Austrian researchers report on an observational trial of safe food handling behavior during food preparation using the example of Campylobacter spp.

chicken.thermJournal of Food Protection®, Number 3, March 2013, pp. 376-551 , pp. 482-489(8)

Hoelzl, C.; Mayerhofer, U.; Steininger, M.; Brüller, W.; Hofstädter, D.; Aldrian, U.

Abstract:

Campylobacter infections are one of the most prominent worldwide food-related diseases. The primary cause of these infections is reported to be improper food handling, in particular cross-contamination during domestic preparation of raw chicken products. In the present study, food handling behaviors in Austria were surveyed and monitored, with special emphasis on Campylobacter cross-contamination. Forty participants (25 mothers or fathers with at least one child ≤10 years of age and 15 elderly persons ≥60 years of age) were observed during the preparation of a chicken salad (chicken slices plus lettuce, tomato, and cucumber) using a direct structured observational scoring system. The raw chicken carcasses and the vegetable part of the salad were analyzed for Campylobacter. A questionnaire concerning knowledge, attitudes, and interests related to food safety issues was filled out by the participants. Only 57% of formerly identified important hygiene measures were used by the participants. Deficits were found in effective hand washing after contact with raw chicken meat, but proper changing and cleaning of the cutting board was noted. Campylobacter was present in 80% of raw chicken carcasses, albeit the contamination rate was generally lower than the limit of quantification (10 CFU/g). In the vegetable part of the prepared product, no Campylobacter was found. This finding could be due to the rather low Campylobacter icarly.chicken.cell.handscontamination rate in the raw materials and the participants’ use of some important food handling behaviors to prevent cross-contamination. However, if the initial contamination had been higher, the monitored deficits in safe food handling could lead to quantifiable risks, as indicated in other published studies. The results of the observational trial and the questionnaire indicated knowledge gaps in the food safety sector, suggesting that further education of the population is needed to prevent the onset of foodborne diseases.

Beetles brought deadly listeria to Prolactal cheese?

Maybe I’m losing something in translation.

On Sunday, Prolactal of Austria said in a statement that its Quargel cheese, which has killed 8 or 10 people depending on the source, and has sickened dozens, was contaminated with listeria from using cultures “that do not give enough protection," whatever that means.

Today, the Styrian weekly newspaper Woche claimed the company said “a scarab or type of beetle (Dungkäfer or aphodius fimetarius) had been the carrier of the disease. Beetles had climbed through a window left open and contaminated machines used to make the cheese.”

So if making cheese, don’t leave the windows open.

Listeria-laden cheese from Austria kills 8, human error suspected

Austria’s Linz-based company Prolactal said Sunday contamination of its cheese which caused eight people to die from listeriosis was due to human error during the manufacturing process.

In November 2009, preservatives supposed to prevent the development of listeria in cheese were accidentally replaced twice "by cultures that do not give enough protection", the company said in a statement.

The cheese was recalled on January 23. Eight have died in Austria and Germany from eating the contaminated dairy product.

Prolactal cheese with listeria kills seven, sickens dozens in Austria

Twelve people have been hospitalised with listeria infections, nine of them having become ill after eating deadly Quargel cheese produced by Styrian firm Prolactal GmbH.

The Austrian Agency for Health and Food Safety (AGES) also reported today that a 57-year-old man became the seventh person to die from eating the tainted cheese. The previously known deaths — four Austrians and two Germans –occurred in 2009.

AGES said that all infections occurred before Prolactal’s tainted cheese was taken off supermarket shelves on January 23.

Health authorities have struggled to link the listeriosis deaths to Prolactal’s cheese, because the cases occurred only sporadically and the disease has a long incubation period.

A Prolactal spokesman said,

"A comprehensive investigation that will determine the cause of the contamination is our highest priority."

The firm said it had received more than 500 calls as of Wednesday last week on the hotline it set up for concerned consumers on 0800-201080.

The relatives of the six people who died are planning to sue Prolactal.

According to a Eurosurveillance report earlier in Feb., approximately 16 tons of Quargel per week are produced by the Austrian manufacturer. Fifty-three per cent of the product is exported to the German market and small amounts to the Czech Republic, Poland and Slovakia. This cheese is made of curdled milk, which ripens after addition of starter cultures for one day at 28°C, and after being sprayed with Brevibacterium linens for another two days at 14°C. The shelf life after packing and marketing is two months.

Listeria in cheese from Austria killed six last year

Austria’s health ministry says contaminated cheese has killed six people.

The ministry said the deaths – four in Austria and two in Germany – occurred last year and were caused by listeria, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people and others with weakened immune systems.

The ministry said the four Austrians who died were senior citizens.

The contaminated cheese was made in the southern province of Styria by Prolactal.

It issued a recall last month and said it had halted production until the case is cleared up.

In 2009, Austria recorded 45 listeria infections that led to a total of 11 deaths.