Next up: 200 sickened from Salmonella in tartar sauce causes outbreak in Belgian hotel school

Fresh tartar sauce is the source of the salmonella outbreak in the Bruges hotel school Spermalie in early September.

EN 24 News reports on Friday Sept. 6 and the following days, 200 pupils and teachers fell ill at the Spermalie hotel and tourism school in Bruges. Laboratory testing of stool languages ​​soon showed that Spermalie was affected by an outbreak of salmonella. The samples of the meals that were served in the school restaurant were then analyzed. An online survey of students and teachers was also launched to find out who had eaten what in which restaurant.

“All these elements together make us decide that the tartar sauce and perhaps more specifically the eggs used are at the source of this outbreak. Further research and typing of the salmonella strains will bring even more clarity on this, “says Liesbeth Van de Voorde, spokesperson for the FASFC food agency.

Student dies after eating five-day old pasta that had been left out

(Correction: This actually happened in 2008 and the paper was published in 2011. Still a good reminder of the importance of temperature control.)

Who doesn’t experiment in college?

But meddling with microbiology can be particularly risky.

A student died after eating leftover pasta that had been left on his kitchen benchtop for five days.

The 20-year-old from the Brussels in Belgium became sick after eating leftover spaghetti with tomato sauce which had been prepared five days earlier and stored at room temperature.

After becoming violently ill, he went to bed to try and sleep the sickness off, only to be found dead in bed the next morning by his devastated parents.

An autopsy later revealed he died from Bacillus cereus.

The story has been featured by Dr Bernard, a licenced practitioner who studies and shares bizarre medical cases from around the world on his YouTube channel.

Dr Bernard analysed the case, which originally featured in the US Journal of Clinical Microbiology, along with several others in a dramatised re-enactment, explaining the harmful bacteria caused AJ’s liver to shut down.

Samples of spoiled pasta and tomato sauce samples were also analysed, with the National Reference Laboratory for Food-borne Outbreak confirming the spaghetti was contaminated with “significant amounts” of the B. cereus — while it was absent in the sauce.

EU Listeria-in-frozen veg outbreak hits Australia

The Listeria-in-frozen veg outbreak in the EU that has killed nine and sickened 47 since 2015 has taken an Australian twist: the vegetables distributed by Belgium-based frozen food distributor Greenyard Frozen NV were also distributed in Australia (and who knows where else) underlying the role of bullshit and faith regarding global food safety.

Food safety is, of course, any distributor’s first priority (as Sorenne asked me today, about something completely different, “was that sarcasm?”

Nothing funny about this.

A whole bunch of frozen veg stocked by Woolworths, IGA and ALDI in Australia have been added to the recall by Food Standards Australia New Zealand (FSANZ).

FSANZ spokeswoman Lorraine Haase said there had not been any evidence of infections in Australia, but a number of people had died in the United Kingdom.

Two days later, on July 11, 2018, the Victorian Department of Health and Human Services identified a case of Listeria from earlier in 2018 that has now been linked to the strain in Europe which has led to a recall of a range of imported frozen vegetables.

The listeria is the same serotype with similar genetics.

Unfortunately, the Victorian case who was being treated for another serious illness died earlier this year.

So it is not possible to confirm whether this person actually consumed any of the frozen vegetable products.

This is not the same serotype of Listeria which killed seven in Australia and caused one miscarriage after consumption of rockmelon earlier this year.

Listeria can be anywhere, and it is up to food producers and merchants to provide rapid, reliable, relevant and repeated information about these outbreaks, which, based on conversation at a hockey tournament in New South Wales this weekend, are starting to permeate the consciousness of shoppers in Aus.

90 sick: Salmonella in Flanders

At least 90 students in the west and east of Flanders have contracted Salmonella and have become ill. According to the Agency for Care and Health, at least thirty schools have already been affected by salmonella contamination.

The Federal Food Agency FAVV has closed the company that supplies meals to 120 schools as a precaution. On Thursday, at least fourteen students were taken to the hospital.

It is not certain whether the company is responsible for the contamination. FASFC has not found a cause at the supplier for the time being. Samples were taken that are examined in a laboratory. Next week, new tests will be conducted and the agency will decide whether the caterer may reopen.

Belgian meat processing plant closed for food safety fraud

The Federal Agency for the Safety of the Food Chain (FASFC) said on Thursday it has pre-emptively closed the Verbist Group’s meat processing plant and cold store VEVIBA in Bastogne,south Belgium, following a case of fraud on meat labels.

Meanwhile, the food safety watchdog has checked all establishments of the Verbist Group in Belgium.

Investigators found a problem in a slaughterhouse in Bastogne where some labels on frozen meat were removed and replaced by others with more recent dates.

“This can potentially be a risk, especially for people who consume raw meat, although for well-cooked meat the risk is lower,” Philippe Houdart, former spokesperson of FASFC, was quoted by local media as saying in a press release.

Two products have been identified as potentially risky for consumers: minced meat as well as cow tails sold to other companies.

About those assumptions: The problem with models

This is the stuff that friend-of-the-barfblog Don Schaffner gets excited about: Modelling.

Belgian researchers attempted to predict future rates of specific foodborne illnesses to guide policy efforts and came up with this:

Salmonellosis, campylobacteriosis and listeriosis are foodborne diseases. We estimated and forecasted the number of cases of these three diseases in Belgium from 2012 to 2020, and calculated the corresponding number of disability-adjusted life years (DALYs). The salmonellosis time series was fitted with a Bai and Perron two-breakpoint model, while a dynamic linear model was used for campylobacteriosis and a Poisson autoregressive model for listeriosis.

The average monthly number of cases of salmonellosis was 264 (standard deviation (SD): 86) in 2012 and predicted to be 212 (SD: 87) in 2020; campylobacteriosis case numbers were 633 (SD: 81) and 1,081 (SD: 311); listeriosis case numbers were 5 (SD: 2) in 2012 and 6 (SD: 3) in 2014.

After applying correction factors, the estimated DALYs for salmonellosis were 102 (95% uncertainty interval (UI): 8–376) in 2012 and predicted to be 82 (95% UI: 6–310) in 2020; campylobacteriosis DALYs were 1,019 (95% UI: 137–3,181) and 1,736 (95% UI: 178–5,874); listeriosis DALYs were 208 (95% UI: 192–226) in 2012 and 252 (95% UI: 200–307) in 2014.

New actions are needed to reduce the risk of foodborne infection with Campylobacter spp. because campylobacteriosis incidence may almost double through 2020.

Burden of salmonellosis, campylobacteriosis, and listeriosis: a time series analysis



Maertens de Noordhout et al.

16 sickened with trichinellosis in Belgium from imported wild boar meat

Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses.

wild-boar-recipes-and-uses_homemediumIn November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients’ muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative.

The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.

Outbreak of Trichinellosis related to eating imported wild boar meat, Belgium, 2014

Eurosurveillance, Volume 21, Issue 37, 15 September 2016, DOI:

P Messiaen, A Forier, S Vanderschueren, C Theunissen, J Nijs, M Van Esbroeck, E Bottieau, K De Schrijver, IC Gyssens, R Cartuyvels, P Dorny, J van der Hilst, D Blockmans

Cross-contamination happens in labs too

This paper describes a case of Salmonella cross-contamination in a food laboratory.

belgian.chocolateIn 2012, chocolate bars shipped from Belgium to the USA were prevented from entering the USA because a Salmonella Rissen strain had been isolated from one of the chocolate bars in a Belgian food laboratory. However, a retrospective study of the Salmonella isolates sent from the laboratory to the Belgian National Reference Laboratory for Salmonella revealed that 7 weeks prior, a Salmonella Rissen strain had been isolated from fish meal in the same food laboratory.

The chocolate bars were not expected to be contaminated with Salmonella because the ingredients all tested negative during the production process. Furthermore, because Salmonella Rissen is only rarely isolated from food, it was hypothesized that the two Salmonella Rissen isolates belonged to the same strain and that the second isolation event in this laboratory was caused by cross-contamination.

To confirm this hypothesis, both Salmonella Rissen isolates were fingerprinted using different molecular techniques. To evaluate the discriminatory power of the techniques used, 11 other Salmonella Rissen isolates from different origins were included in the comparison. Pulsed-field gel electrophoresis, repetitive element palindromic PCR and three random amplified polymorphic DNA PCR assays were used.

Repetitive element palindromic PCR and random amplified polymorphic DNA PCR assays were insufficiently discriminatory, whereas pulsed-field gel electrophoresis using the combination of two restriction enzymes showed sufficient discrimination to confirm the hypothesis.

Although cross-contamination in food laboratories are rarely reported, cross-contamination can always occur. Laboratories should therefore always be aware of the possibility of cross-contamination, especially when enrichment is used in the microbiological analysis. Furthermore, it is advised that results showing isolates of the same serotype isolated in a short time frame from unrelated food products should be interpreted carefully and should be confirmed with additional strain typing.

Case report of Salmonella cross-contamination in a food laboratory


BMC Research Notes, Volume 9, Number 156, March 2016, Pages 1-4

Rasschaert G, De Reu K, Heyndrickx M, and Herman L

20 toddlers sickened: An emetic Bacillus cereus outbreak in a kindergarten

 Bacillus cereus is a ubiquitous spore-forming, potential foodborne pathogen that may cause two types of gastrointestinal illnesses: diarrhea and emesis. emetic syndrome results from the presence of a heat-resistant toxin, called cereulide, produced by B. cereus in food products. Although both syndromes are usually mild, with patients recovering after about 24 h, an intoxication can be fatal for vulnerable individuals such as children or elderly people

In Belgium, from 2007 until 2012, two to eight foodborne outbreaks were reported on a yearly basis in which B. cereus was identified as the causative agent. During this period 8 of 26 B. cereus  outbreaks were caused by emetic B. cereus  representing 147 cases and 1 death.

In this report, we describe a foodborne outbreak affecting 20 toddlers aged between 10 and 18 months caused by the consumption of a homemade mashed rice–cucumber–chicory meal contaminated with critical levels of the B. cereus emetic toxin.

This outbreak highlights the importance of respecting good hygienic practices and strict storage conditions. An ill staff member had been involved in the preparation of the implicated food and may have contaminated the food. Unfortunately, no fecal sample from the staff member could be analyzed and thus her role could not be confirmed. It is recommended to withdraw any ill person from food preparation activities, as stated by the Codex Alimentarius.

Moreover, the temperature in the refrigerator where the food was stored had never been registered by the director of the kindergarten. The refrigerator at the kindergarten did not meet the Belgian recommendation on refrigeration temperatures, which are recommended to be between 0 and 4_ C, although it was in accordance ( <  7_ C) with the Belgian and European Legislation. Storage of foods below 10_ C prevents the growth of strains that produce emetic toxin, while refrigeration below 4_ C is necessary to prevent growth of all types of B. cereus , including psychrotrophic strains. In this case, high levels of B. cereus were present and cereulide was detected in the leftovers. It is known that cooked rice supports cereulide production at temperatures from 15_ C to 37_ C.

gastro.daycare.sep.12Therefore, inappropriate and slow cooling probably allowed the development of B. cereus  and subsequent cereulide production in the rice. After cooking, the temperature of the food should be allowed to drop to 10_ C as quickly as possible and should ideally reach 4_ C to avoid any growth of B. cereus.

Portioning the rice for storage would also have helped to achieve a more rapid drop in temperature below 10_ C in the center of the bowl in which the rice was stored.

Subsequent to this outbreak, a plan for cleaning was established at the kindergarten, and measures for temperature control of the refrigerators were taken.

Given that hazardous levels of cereulide can be reached quickly as demonstrated in this investigation, it is important to remain vigilant during food preparation and food storage to prevent illness and outbreaks caused by B. cereus .

An emetic Bacillus cereus outbreak in a kindergarten: detection and quantification of critical levels of cereulide toxin

Foodborne Pathogens and Disease. January 2015, 12(1): 84-87

Delbrassinne Laurence, Botteldoorn Nadine, Andjelkovic Mirjana, Dierick Katelijne, and Denayer Sarah

Lessons learned from a textbook outbreak: EHEC-O157:H7 infections associated with the consumption of raw meat products, June 2012, Limburg, Belgium

On 5 June 2012 several enterohemorrhagic Escherichia coli, EHEC, O157:H7 infections were reported to the public health authorities of Limburg.


We performed a case-control study, a trace back/forward investigation and compared strains isolated from human cases and food samples. A case was defined as anyone with a laboratory-confirmed E. coli O157:H7-infection in North-East Limburg from May 30 2012 till July 15 2012. Family members with bloody diarrhea were also included as cases. E. coli O157 was isolated by culture and the presence of the virulence genes was verified using (q)PCR. Isolates were genotyped and compared by Pulsed Field Gel Electrophoresis (PFGE) and insertion sequence 629-printing (IS629-printing).


The outbreak involved 24 cases, of which 17 were laboratory-confirmed. Five cases developed Hemolytic Uremic Syndrome (HUS) and fifteen were hospitalized. Cases reported a significantly higher consumption of “steak tartare”, a raw meat product (OR 48.12; 95% CI; 5.62- 416.01). Cases were also more likely to buy meat-products at certain butcheries (OR 11.67; 95% CI; 1.41 – 96.49). PFGE and IS629-printing demonstrated that the vtx1a vtx2a eae ehxA positive EHEC O157:H7 strains isolated from three meat products and all seventeen human stool samples were identical. In a slaughterhouse, identified by the trace-back investigation, a carcass infected with a different EHEC strain was found and confiscated.


We present a well described and effectively investigated foodborne outbreak associated with meat products. Our main recommendations are the facilitation and acceleration of the outbreak detection and the development of a communication plan to reaches all persons at risk. 

Archives of Public Health, 2014, 72:44

Abstract (provisional)