Farm-to-fork food safety in Denmark: Campylobacter is prominent

Burden of disease metrics is increasingly established to prioritize food safety interventions. We estimated the burden of disease caused by seven foodborne pathogens in Denmark in 2017: Campylobacter, Salmonella, Shiga toxin–producing Escherichia coli, norovirus, Yersinia enterocolitica, Listeria monocytogenes, and Toxoplasma gondii.

We used public health surveillance data and scientific literature to estimate incidence, mortality, and total disability-adjusted life year (DALY) of each, and linked results with estimates of the proportion of disease burden that is attributable to foods.

Our estimates showed that Campylobacter caused the highest burden of disease, leading to a total burden of 1709 DALYs (95% uncertainty interval [UI] 1665–1755), more than threefold higher than the second highest ranked pathogen (Salmonella: 492 DALYs; 95% UI 481–504). Campylobacter still led the ranking when excluding DALYs attributable to nonfoodborne routes of exposure. The total estimated incidence was highest for norovirus, but this agent ranked sixth when focusing on foodborne burden. Salmonella ranked second in terms of foodborne burden of disease, followed by Listeria and Yersinia. Foodborne congenital toxoplasmosis was estimated to cause the loss of ∼100 years of healthy life, a burden that was borne by a low number of cases in the population. The ranking of foodborne pathogens varied substantially when based on reported cases, estimated incidence, and burden of disease estimates.

Our results reinforce the need to continue food safety efforts throughout the food chain in Denmark, with a particular focus on reducing the incidence of Campylobacter infections.

Burden of disease estimates of seven pathogens commonly transmitted through foods in Denmark, 2017

Foodborne Pathogens and Disease

Sara Monteiro PiresLea Sletting JakobsenJohanne Ellis-IversenJoana Pessoa, and Steen Ethelberg

https://doi.org/10.1089/fpd.2019.2705

https://www.liebertpub.com/doi/abs/10.1089/fpd.2019.2705

Two children die from E. coli complications in Denmark

The Local reports that Danish Patient Safety Authority (Styrelsen for Patientsikkerhed, DPSA) has confirmed that two children have died as a result of complications related to E. coli poisoning. The two cases are not connected.

Two children – one on the island of Funen and another in the Copenhagen area – died due to a rare complication related to VTEC, a strain of the E. Coli bacteria.

Both children died of kidney failure, but the two tragic cases are not connected. A third child also contracted kidney failure but survived, DPSA said.

A consultant doctor and head of department at Copenhagen infectious disease research institute SSI stressed that the cases were not evidence of an outbreak and that the number of cases was not improbable.

In Denmark food companies caught selling fake organic products escape prosecution

Bullshit.

The systematic kind.

Dutch News reports government and organic food label inspectors identified 68 companies which have been selling or trading products labeled as organic which broke the rules, RTL Nieuws.

 In some cases the companies earned tens of thousands of euros selling non-organic coffee, meat, chocolate and vegetables as organic even though they did not meet the proper standards, RTL said. The broadcaster bases its claim on an analysis of reports made to the two watchdogs covering the sector between 2015 and 2018. In total, 58 cases involved ‘misleading’ the public and the remaining 10 were more serious fraud offences, RTL said.

‘These are not incidents,’ VU University criminologist Wim Huisman told the broadcaster. ‘This shows that there is a substantial problem and that it is happening systematically.’

“People who buy organic food pay a higher price for produce which is animal and environment friendly” (more bullshit) food scientist Gertjan Schaafsma said. ‘If there is fraud, these people are being ripped off.’

A spokesman for the NVWA told RTL that the agency does not have enough staff to tackle all the fraud involving organic food. Priority, therefore, is given to cases which have implications for food safety.

Salmonella cases double in Denmark

Ben Hamilton of CPH Post reports there were twice as many salmonella outbreaks in Denmark in 2017 than in the previous year.

In total, there were 25 outbreaks, and 1,067 people became ill as a result.

The increase is partly blamed on improved ways of detecting outbreaks. ‘Whole genome sequencing’, for example, makes it easier to detect the same source of infection.

“We hope it can lead to a decline in salmonella cases in the long term,” noted Luise Müller, an epidemiologist at Statens Serum Institut.

“It should enable us to become better at deducing why some foods are more likely to make people sicker than others.”

Danish-produced pork was the biggest culprit, while there were no cases sourced to chicken.

Foodborne outbreaks in general are increasing. In 2017, there were 63, up from 49 in the previous year.

The biggest culprit is campylobacter, a bacterium that made 4,257 people ill in 2017.

Jigsaw puzzle: Salmonella cases double in Denmark

Ben Hamilton of CPH Post reports there were twice as many salmonella outbreaks in Denmark in 2017 than in the previous year.

In total, there were 25 outbreaks, and 1,067 people became ill as a result.

The increase is partly blamed on improved ways of detecting outbreaks. ‘Whole genome sequencing’, for example, makes it easier to detect the same source of infection.

“We hope it can lead to a decline in salmonella cases in the long term,”  noted Luise Müller, an epidemiologist at Statens Serum Institut.

“It should enable us to become better at deducing why some foods are more likely to make people sicker than others.”

Danish-produced pork was the biggest culprit, while there were no cases sourced to chicken.

 Foodborne outbreaks in general are increasing. In 2017, there were 63, up from 49 in the previous year.

The biggest culprit is campylobacter, a bacterium that made 4,257 people ill in 2017.

Thank you, WGS: Listeria linked to smoked salmon in Denmark and France

In Denmark, on 23 August 2017, Statens Serum Institut (SSI) identified a genetic cluster of four human Listeria monocytogenes sequence type (ST) 8 isolates by core genome multilocus sequence typing (cgMLST) [1]. The allele calling was performed in BioNumerics (v7.6.2, Applied Maths, Belgium). We initiated an epidemiological investigation and notified the Danish Central Outbreak Management Group (collaboration between the Danish Veterinary and Food Administration (DVFA), the National Food Institute at the Technical University of Denmark (DTU) and SSI). On 25 August, two additional human isolates were found to belong to the same genetic cluster.

A confirmed case was defined as a person clinically diagnosed with listeriosis after 1 January 2017 with laboratory-confirmed L. monocytogenes ST8 clustering using cgMLST (≤ 5 allelic distance, single linkage). Cases diagnosed before 1 January 2017 with an isolate belonging to this cluster were defined as probable cases.

As of 25 August 2017, the genetic cluster comprised six cases; five confirmed and one probable. The age of the cases ranged from 59 to 96 years (median 80 years) and four were women. All patients had underlying illness and no travel history. One patient died within 30 days of diagnosis. Epidemiological investigations including a standard questionnaire on exposures showed that all five confirmed cases had consumed cold-smoked and/or cured salmon in the 30 days before disease onset. Four cases had bought the salmon in retail chain X. No other food-item was reported as consumed in high frequencies among cases. Epidemiological follow-up for the probable case did not include information on fish consumption.

On 29 August 2017, a comparison between the human outbreak isolates and 16 L. monocytogenes ST8 food- and environmental isolates identified in Denmark from 2014 to August 2017 showed that the human isolates clustered with a food isolate from cold-smoked salmon, cut and packaged at company Y in Poland (zero to two allelic differences using cgMLST). L. monocytogenes had been detected on 31 July 2017 at levels of 110 CFU/g (threshold: 100 CFU/g) at the end of shelf life. The product was widely sold in Denmark and had been sampled by the DVFA in retail chain X, as part of a consumer exposure survey (i.e. analyses project on retail packages). Because the L. monocytogenes concentration had been just above the accepted limit and found at the end of the product shelf life a recall of this batch was not conducted. However, due to the positive finding, follow-up sampling had been performed on the 9 and 10 August 2017 from the central storage unit of retail chain X. L. monocytogenes had been isolated from two batches analysed before end of shelf life. In one sample from the same batches, which was also analysed at the end of the shelf life, on 28 August 2017 a L. monocytogenes level of 240 CFU/g was found. Isolates from the follow-up samples had zero to four allelic differences to the human outbreak isolates using cgMLST.

The human outbreak sequences were also compared to all L. monocytogenes ST8 genomes derived from clinical samples in Denmark from 2012 onwards. Although ST8 genomes from Danish patients in the period 2012–2017 showed high diversity, the outbreak isolates clearly formed a distinct cgMLST cluster with 16 allelic differences to the nearest isolates outside the genetic outbreak cluster and a maximum of nine allelic differences within the cluster (Figure 2a). We investigated the relatedness of outbreak isolates further by single-nucleotide polymorphisms (SNP) analysis performed by both SSI and DTU using two analysis pipelines: Northern Arizona SNP Pipeline (NASP) [2] and CSI Phylogeny version 1.4 from Center for Genomics Epidemiology (CGE), DTU [3] leading to the same conclusion.

On 30 August 2017, DVFA advised retail chain X to recall all cold-smoked salmon produced at company Y. This advice was based on the elevated number of L. monocytogenes (240 CFU/g) found in the product at the end of shelf-life and the link to the outbreak. Retail chain X voluntarily recalled both cold-smoked and cured salmon produced at company Y. As part of the recall procedure, retail chain X informed company Y on the situation. Information from company Y, provided by the Polish food authorities via the European Union Rapid Alert System for Food and Feed (RASFF), showed that the implicated batches were exclusively sold via retail chain X and only in Denmark.

The French National Reference Centre (NRC) for Listeria (Institut Pasteur, Paris), compared the sequences of the Danish human isolates against its database, using cgMLST as previously described [1,4]. A human isolate from a French resident belonged to the same cluster (L2-SL8-ST8-CT771) as the Danish isolates. This French probable case, a female patient in her mid-80s, was diagnosed in June 2016. Epidemiological investigations carried out by Santé Publique France were inconclusive, since food consumption history was not available at the time of diagnosis nor could information on travel to Denmark be retrieved, as the person had since died.

On 6 September 2017, an official control by the Ministry of Economy was carried out at a French retailer where a kosher chilled cured salmon was sampled for analysis. The sample was contaminated with L. monocytogenes at the level of 460 CFU/g and the salmon producer was company Y. An isolate was sent to the French NRC for typing and showed to belong to the same cgMLST type as the Danish outbreak. Further investigations on the food product confirmed that it had not been further processed after production in Poland. The product was recalled and no human cases were linked to its consumption as of beginning of December 2017.

The other nine countries that replied to the EPIS-FWD UI-426 notification (Austria, Finland, Germany, Luxembourg, the Netherlands, Norway, Slovenia, Sweden, United Kingdom) did not report any human or food isolates linked to the Danish outbreak. However, after submission of this report, at the end of November, we were informed through EPIS about three genetically linked human isolates in Germany.

Discussion

Here we report on a listeriosis outbreak and highlight the value of rapidly comparing the genomes of human and food/environmental isolates at the national and international levels.

The fact that the contaminated salmon products identified in Denmark and France were from different batches suggests environmental contamination possibly at the production facility at company Y. It is too early to assess whether any measures taken at company Y have been effective in controlling the outbreak. However, experiences from previous investigations suggest that once L. monocytogenes is detected in one product, the whole production site should be subject to a thorough inspection, and sampling with special attention to all the possible contamination/cross contamination issues before implementing corrective measures [5,6]. Moreover, the risk for L. monocytogenes persistent strains in the production environment requires the close monitoring for several years to ensure the elimination of these [7,8].

Since WGS was introduced for routine surveillance in Denmark, a number of listeriosis outbreaks have been detected and solved, including outbreaks involving cold-smoked ready-to-eat sliced fish products [5]. The present investigation further reinforces the suspicion that ready-to-eat fish products are important sources of L. monocytogenes infections in Denmark, as well as in other countries.

Though only involving a low number of isolates, WGS L. monocytogenes surveillance and communication between countries allowed us to detect and rapidly solve this salmon-associated outbreak, leading to food product recall in two European countries. Compared with previous typing methods, WGS has a higher discriminatory power and the ability to determine genetic distance between isolates. The introduction of WGS for surveillance of food-borne infections has shown that it improves outbreak detection and facilitates outbreak investigations and likely helps reduce the number of infections [4,9-16]. The EPIS-FWD communication platforms allowed for the communication to link cases across borders. However, currently cross-border outbreaks are only detected when case numbers in at least one country exceed normal levels and are notified internationally. Therefore, a possible future system for easy exchange of and comparison of WGS data, e.g. by the use of an agreed cgMLST nomenclature, across borders will enable the identification of more dispersed outbreaks as well as cross-border links between food samples and human infections. This report highlights that by the application of cross-disciplinary and real-time cross-border comparison of WGS data, L. monocytogenes infections can be prevented and thereby providing safer food for at-risk groups such as the elderly, immunodeficient individuals and pregnant women.

Cross-border outbreak of listeriosis caused by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017

Schjørring Susanne, Gillesberg Lassen Sofie , Jensen Tenna, Moura Alexandra, Kjeldgaard Jette S, Müller Luise, Thielke Stine, Leclercq Alexandre, Maury Mylene M, Tourdjman Mathieu, Donguy Marie-Pierre, Lecuit Marc, Ethelberg Steen, Nielsen Eva M. Cross-border outbreak of listeriosis caused by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017. Euro Surveill. 2017;22(50):pii=17-00762. https://doi.org/10.2807/1560-7917.ES.2017.22.50.17-00762

https://eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.50.17-00762

17 sick from hepA in Denmark linked to dates

Since the end of January, the State Serum Institute has investigated a disease outbreak of contagious hepatitis caused by hepatitis A virus infections. This indicates that the source of infection may be dates, and the case is further investigated in collaboration with the Danish Veterinary and Food Administration and the DTU Food Institute. The outbreak is the second national food-borne outbreak of hepatitis A in Denmark.

The outbreak thus includes 17 patients, nine women and eight men aged 17 years. Patients have become ill from December 2017 onwards. Patients are resident throughout the country and 16 have been hospitalized. Virus from seven of the patients has been type-approved for type 3A, and for the time being, genetic studies have shown that four of these are identical, which supports the suspicion of a common source of infection. It is still expected that more patients will come, as about four weeks from eating the contaminated dates until you get sick with hepatitis A.

To investigate the source of infection for the outbreak, the State Serum Institute has conducted extensive interviews with patients and made a so-called case-control study. During the initial interviews, dates, as several of the patients indicated to have eaten, were suspected. The correlation between dates and disease risk was then investigated in the case-control study. Here you compare how often patients have eaten a number of specific foods with similar information from a comparable group of healthy Danes. 

The results have shown that the source of infection was most likely to have been dates since patients had far more eaten this food than the comparable group of healthy Danes. The dates are described by most patients as soft dark stones with stones purchased in Rema1000. The results were handed over to the Danish Veterinary and Food Administration, The importer and Rema1000 chose to withdraw the dates on 6 February .

The likelihood of infectious hepatitis infection caused by infection with Hepatitis A virus by eating dates from Rema1000 is considered very small. Therefore, there is no need to consult a doctor if you have no symptoms of hepatitis A infection.

If you have eaten Rema1000 dadels after 1 December 2017 and develop symptoms of hepatitis such as nausea, madness, abdominal pain, vomiting, diarrhea or fever without any other obvious causes or yellowing of the skin and the whites of the eyes, light colored dye and / or dark , porter-colored urine, consult your own doctor. 

1 dead, 5 sick from Listeria in cold-smoked salmon, 2017, Denmark

In Denmark, on 23 August 2017, Statens Serum Institut (SSI) identified a genetic cluster of four human Listeria monocytogenes sequence type (ST) 8 isolates by core genome multilocus sequence typing (cgMLST) [1]. The allele calling was performed in BioNumerics (v7.6.2, Applied Maths, Belgium). We initiated an epidemiological investigation and notified the Danish Central Outbreak Management Group (collaboration between the Danish Veterinary and Food Administration (DVFA), the National Food Institute at the Technical University of Denmark (DTU) and SSI). On 25 August, two additional human isolates were found to belong to the same genetic cluster.

Lox 014

A confirmed case was defined as a person clinically diagnosed with listeriosis after 1 January 2017 with laboratory-confirmed L. monocytogenes ST8 clustering using cgMLST (≤ 5 allelic distance, single linkage). Cases diagnosed before 1 January 2017 with an isolate belonging to this cluster were defined as probable cases.

As of 25 August 2017, the genetic cluster comprised six cases; five confirmed and one probable. Laboratory sample dates ranged from 25 October 2015 to 21 August 2017. The age of the cases ranged from 59 to 96 years (median 80 years) and four were women. All patients had underlying illness and no travel history. One patient died within 30 days of diagnosis. Epidemiological investigations including a standard questionnaire on exposures showed that all five confirmed cases had consumed cold-smoked and/or cured salmon in the 30 days before disease onset. Four cases had bought the salmon in retail chain X. No other food-item was reported as consumed in high frequencies among cases. Epidemiological follow-up for the probable case did not include information on fish consumption.

Cross-border outbreak of listeriosis cause by cold-smoked salmon, revealed by integrated surveillance and whole genome sequencing (WGS), Denmark and France, 2015 to 2017

Eurosurveillance, 2017, Susanne SchjørringSofie Gillesberg LassenTenna JensenAlexandra MouraJette S Kjeldgaard, Luise MüllerStine ThielkeAlexandre LeclercqMylene M MauryMathieu Tourdjman ,Marie-Pierre DonguyMarc LecuitSteen EthelbergEva M Nielsen, https://doi.org/10.2807/1560-7917.ES.2017.22.50.17-00762

http://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2017.22.50.17-00762

Raw is risky: Norovirus in raw oysters sickens 10 in Denmark

Joseph James Whitworth of Food Quality News writes 10 people have been sickened by norovirus after eating raw oysters at Danish restaurants.

Fødevarestyrelsen (Danish Veterinary and Food Administration) said oysters are from Lemvig.

The agency has closed the area in Lemvig for commercial harvest of mussels and oysters and is monitoring it.

Illnesses can be avoided if oysters are cooked to an internal temperature of 90° Celsius/194° Fahrenheit for a minimum of 90 seconds.

Denmark: 1 dead, 4 sick from Listeria in salmon

Joe Whitworth of Food Quality News reports that four people have been sickened and one has died from Listeria in salmon processed in Poland and sold in Denmark.

Dansk Supermarked Group issued a recall after Fødevarestyrelsen (Danish Veterinary and Food Administration) detected Listeria monocytogenes in two packs of cold-smoked salmon.

L. monocytogenes was identified at 240 CFU/g in chilled cold smoked salmon.