Not just Australia: Poland has an egg problem

According to the European Centre for Disease Prevention and Control,  1,412 cases have been found associated with this outbreak: 532 confirmed and 166 probable cases since 1 February 2017 and 343 historical-confirmed and 367 historical-probable cases between 2012 and 31 January 2017. In addition, no dates have been reported for four outbreak-confirmed cases, so they are unclassifiable as current or historical cases (Table 1).

Table 1. Distribution of cases by case classification and country, EU/EEA, February 2012 to November 2018 (n=1 420; 4 cases missing date of onset or sampling or receipt at reference laboratory), as of 12 November 2018

 Reporting country  Confirmed cases       Probable cases          Historical-confirmed cases Probable-confirmed cases   Total number of cases

Belgium          0          46        14        127      187

Croatia           0          0          4          0          4

Czech Republic         0          6          0          3          9

Denmark       16        0          6          2          24

Finland           0          0          0          1          1

France 21        0          8          0          29

Greece            0          0          0          2          2

Hungary        0          29        0          5          34

Ireland           12        0          4          4          20

Ireland           1          0          0          0          1

Italy    0          12        1          19        32

Luxembourg 4          0          5          0          9

Netherlands  8          25        90        164      287

Norway         22        18        11        32        83

Poland            25        0          0          0          25

Slovenia         0          7          3          0          10

Sweden          11        20        12        2          45

United Kingdom      412      3          185      6          606

Total   532      166      343      367      1408

                          698                    710 

Most outbreak cases were reported during the summer months. Due to reporting delays, additional cases are expected to be reported with onset in recent months.

A total of 112 confirmed or historical-confirmed cases were reported with travel history in an EU country during the incubation period and therefore were likely infected there. Countries where infections likely took place were Poland (25 cases identified from 2016 to 2018), Bulgaria (22 cases from 2015 to 2018), Cyprus (14 cases in 2016 and 2018), Portugal (11 cases from 2015 to 2017) and Hungary (10 cases from 2016 to 2018). Additional travel-associated cases were also reported (<10 cases per country) with travel history to Austria, Belgium, Greece, Italy, the Netherlands, Romania, Slovenia and Spain.

The 2016 and 2017 European outbreak investigations identified eggs originating from Poland as the vehicle of infection in this outbreak (ECDC/EFSA rapid outbreak assessments published in March and December 2017). Outbreak-confirmed cases belong to four different WGS clusters.

4 dead 8 sick in EU outbreak of Listeria linked to salmon products beginning in 2015

A multi-country outbreak of 12 listeriosis cases caused by Listeria monocytogenes sequence type (ST) 8 has been identified through whole genome sequencing (WGS) analysis in three EU/EEA countries: Denmark (6 cases), Germany (5) and France (1).

Four of these cases have died due to or with the disease. It is likely that the extent of this outbreak has been underestimated since the outbreak was identified through sequencing and only a subset of the EU/EEA countries routinely use this advanced technique to characterise L. monocytogenes isolates.

The first case was sampled in October 2015 in Denmark and the most recent case was reported in May 2018 in Germany. In August 2017, Denmark identified the first cluster of cases, which was investigated and linked to the consumption of ready-to-eat cold-smoked salmon produced in Poland. Control measures were implemented and the Member States and competent authorities were informed.

In October 2017, France reported the identification of a matching L. monocytogenes strain in food isolates from marinated salmon originating from the same Polish processing company as identified in the Danish outbreak investigation. This supports the hypothesis that contamination may have occurred at the processing company in Poland. However, due to the lack of WGS data on the isolates found in the environmental and food samples taken at the Polish processing plant, it is not possible at present to confirm the contamination with the L. monocytogenes ST8 outbreak strain at the suspected Polish plant. Moreover, until detailed information on the Norwegian primary producers of the salmon used in the contaminated batches is reported and assessed, possible contamination at primary production level cannot be excluded either.

Although control measures were implemented following the Danish outbreak investigation in September 2017, the identification of the same strain in a salmon product in France and a new human case in Germany suggest that the source of contamination is still active and contaminated products have been distributed to other EU countries than Denmark.

Until the source of infection has been eliminated, new invasive listeriosis cases may still occur. Pregnant women, the elderly and immunocompromised individuals are at increased risk of invasive listeriosis, which is associated with severe clinical course and potentially death.

EU study reveals that most Listeria outbreaks remain undetected

More than half of the severe listeriosis cases in the European Union belong to clusters, many of which are not being picked up fast enough by the current surveillance system, suggests a new article published in Eurosurveillance.

The large-scale study looked into listeriosis epidemiology through whole genome sequencing and found that this method, when implemented at EU-level, could lead to faster detection of multi-country outbreaks, saving up to 5 months of the investigations.

The study, coordinated by the European Centre for Disease Prevention and Control (ECDC), analysed 2 726 human Listeria monocytogenes isolates from 27 countries between 2010 and 2015.

It found that slightly under 50% of the cases are isolated whereas the remaining half of cases is clustered together. Around one third of the cases that were identified as part of a cluster affected more than one country, often lasting for several years. However, only two listeriosis outbreaks were reported in the EU in 2016 and five in 2015, which suggests that many of them have gone undetected.

The authors determined that the use of whole genome sequencing to characterise listeriosis cases at EU-level could speed up the detection of clusters by up to five months, when compared to epidemiological investigation at country level. A more timely detection of clusters would potentially limit the occurrence of further cases from the same, common food source.

“This study is a milestone on the way to tackling listeriosis in Europe. With this new collaborative effort with the Member States, we have revealed the related nature of many cases of severe listeriosis. We are now strengthening routine surveillance by introducing the collection and analysis of whole genome sequencing data from all reported human listeriosis cases”, says ECDC’s Chief Scientist Mike Catchpole.

Listeriosis is a relatively rare but potentially severe food-borne disease that has been reported in increasing numbers in the EU/EEA countries since 2008. In 2016, 2 536 cases were reported, including 247 deaths. “Improving our surveillance on Listeria cases will save lives, particularly among vulnerable population groups such as the elderly and also pregnant women, who may pass on the bacteria to the fetus if they consume contaminated food”, Mike Catchpole points out.

The study also defines the most appropriate typing methods for earlier detection and investigation of dispersed cross-border clusters and outbreaks of Listeria monocytogenes.

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.

9 dead, 38 sick from Listeria linked to frozen corn in EU back to 2015

My daughters ate a lot of frozen peas and corn when they were young.

Now I’m being told by Europeans I’m stupid.

As I’ve written before, Chapman and I did a bunch of work with the processing vegetable growers in Ontario (that’s in Canada).

We didn’t do any testing, but all the plants we visited had internal Listeria testing and used test-and-hold procedures. That was over 15 years ago.

Additionally, the blanching process should have removed Listeria (but should be verified).

The UK Food Standards Agency, Food Standards Scotland, Public Health England and Health Protection Scotland – that’s a lot of admin types — are reminding people that most frozen vegetables, including sweetcorn, need to be cooked before eating. This includes if adding them to salads, smoothies or dips.

People should always follow manufacturers’ instructions when preparing their food. If the product is not labelled as “ready to eat”, the cooking instructions should always be followed before eating the food hot or cold. 

In the UK, that means piping hot mush.

Any barfbloggers in the EU wanna take a picture of those clear cooking instructions on frozen corn and send them on?

Last week, the European Food Safety Authority said that frozen corn and possibly other frozen vegetables are the likely source of an outbreak of Listeria monocytogenes that has been affecting Austria, Denmark, Finland, Sweden, and the United Kingdom since 2015.

Experts used whole genome sequencing to identify the food source, which initially was thought to be limited to frozen corn. As of 8 June 2018, 47 cases including nine deaths had been reported.

The same strains of L. monocytogenes have been detected in frozen vegetables produced by the same Hungarian company in 2016, 2017 and 2018. This suggests that the strains have persisted in the processing plant despite the cleaning and disinfection procedures that were carried out.

The available information confirms the contamination at the Hungarian plant. However, further investigations, including thorough sampling and testing, are needed to identify the exact points of environmental contamination at the Hungarian plant. The same recommendation applies to other companies belonging to the same commercial group if environmental contamination is detected.

On 29 June 2018, the Hungarian Food Chain Safety Office banned the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected plant between August 2016 and June 2018, and ordered their immediate withdrawal and recall. This last measure is likely to significantly reduce the risk of human infections and contain the outbreak. All freezing activity at the plant has been stopped.

New cases could still emerge due to the long incubation period of listeriosis (up to 70 days); the long shelf-life of frozen corn products; and the consumption of frozen corn bought before the recalls and eaten without being cooked properly.

To reduce the risk of infection, consumers should thoroughly cook non ready-to-eat frozen vegetables, even though these products are commonly consumed without cooking (e.g. in salads and smoothies). This applies especially to consumers at highest risk of contracting listeriosis – such as the elderly, pregnant women, new-borns and adults with weakened immune systems.

Frozen fruit and veg: That’s what my 2-decade hockey buddy, who also has four Canadian kids about the same age as mine, said when I asked, how do you go about managing the food for all these kids (along with the pets and horses).

But like Hepatitis A in frozen fruit, I now cook the shit out of them.

Food fraud: Over 3600 tonnes of dangerous food removed from EU market

Trafficking in fake and substandard food is big business, and efforts to stop this global phenomenon are ongoing

Rotten meat, chemically coloured tuna and fake baby milk powder – these are just a small sampling of the products seized as part of the latest OPSON investigation into the presence of counterfeit and substandard food and beverage products on the market in Europe and beyond.

Run over the course of 4 months (December 2017 – March 2018) across 67 countries*, OPSON VII resulted in the total seizure of more than 3 620 tonnes and 9.7 million litres of either counterfeit or substandard food and beverages as a results of more than 41 000 checks carried out at shops, markets, airports, seaports and industrial estates. In total some 749 people were arrested or detained with investigations continuing in many countries.

“The results of OPSON demonstrate what can be achieved to protect consumers worldwide when law enforcement agencies join their efforts and perform coordinated actions”, said Jari Liukku, Head of Europol’s European Serious and Organised Crime Centre, “It is a threat which requires such cooperation across borders, taking into account the increased integration and globalisation of supply chains. All countries face this threat and it is the duty of law enforcement agencies to make sure what consumers get in their plate is genuine and safe”.

“The dismantling of nearly 50 criminal networks involved in the production of fake food and drink is an important result in stemming the flow of potentially lethal products into the marketplace,” said Daoming Zhang, Head of INTERPOL’s Illicit Markets unit. “The volume of counterfeit and substandard products seized is a reminder to the public that they need to remain careful about what they buy and from where.”

The annual operation coordinated by Europol and INTERPOL is supported by customs, police and national food regulatory bodies in addition to partners from the private sector. Since its first edition in 2011, the number of countries taking part in OPSON has grown every year, reflecting the growing commitment to tackle this issue.

In Europe the close cooperation established between Europol and the EU Commission coordinating the EU Food Fraud Network led to the implementation of a specific project targeting the fraudulent trade of tuna. A comprehensive approach involving all stakeholders allowed the phenomenon to be tackled in an innovative and more effective manner via the simultaneous use of administrative and criminal enforcement tools. Europol will continue to support this multiagency approach in the upcoming editions of OPSON.

Belgium – sale of rotten meat unfit for consumption

Belgium closed a major meat processing plant in the country, and supermarkets have taken meat products off their shelves in a scandal over rotten meat. The incriminated company saw its licence revoked by the federal government, after spot checks revealed a potential health risk in two products: minced beef and oxtail. Officials found traces of so-called meat waste, pieces of the carcass, intended for animal feed which are prohibited for human consumption.

Spain – fake baby milk powder

Four people have been arrested and a factory that packaged counterfeit baby milk mostly destined for China dismantled in Spain. Eight tonnes of the forged product were seized. The powder bought in bulk in Poland for one euro per kilo and delivered to Barcelona was not harmful but it lacked the nutrients needed by infants. It was also made in an environment that did not comply with food health and safety standards.

European wide-action – fraudulent practices in the tuna fish industry

During OPSON VII, an EU coordinated action was run with the support of the EU Food Fraud Network across 11 European countries** in order to detected fraudulent practices pertaining to tuna fish. This was the first time that such an action was carried out on a specific product. The illicit practises included species substitution and fraudulently selling tuna intended for canning as fresh. In this case, the tuna intended for canning was illegally treated with chemical substances that altered its colour to give the misleading impression of its freshness. In total, more than 51 tonnes of tuna were seized and more than 380 samples were taken.

France- smuggling of perishable goods

In a joint operation, The French Gendarmerie, Customs, Police and Ministry of Agriculture seized in its overseas territories over 9.5 tonnes of smuggled perishable goods and 60 litres of fuel and raw material intended for illegal gold mining.

Training in the detection of food fraud

Throughout the year, representatives from a variety of agencies and sectors – police and customs officers, prosecutors, investigative experts – attend training courses and workshops in advance of the operational activity. These hands-on workshops equip participants with the knowledge they need for the raids and follow-up investigations, in particular, enabling them to better distinguish fake products from genuine ones. In Hungary, the National Tax and Customs Administration in cooperation with the National Food Chain Safety Office and the National Board Against Counterfeiting produced a short video to explain the operation to law enforcement officers and a general audience.

A final and detailed report on the results of the operation OPSON VII will be published in the upcoming months.

Does Europe have an egg problem? Salmonella cases no longer falling in the EU

The declining trend of salmonellosis cases in the EU has levelled off according to the annual report on zoonotic diseases published today.

The European Centre for Disease Prevention and Control reports that cases of Salmonella Enteritiis acquired in the EU have increased in humans by 3% since 2014. In laying hens, the prevalence increased from 0.7% to 1.21% over the same period. 

“The increase shown by our surveillance data is worrying and a reminder that we have to stay vigilant,” said Mike Catchpole, ECDC’s Chief Scientist. “Even in a state of high awareness and with national control programmes for S. Enteritidis in place, there is a need for continuing risk management actions at the Member State and EU level,” he added. 

Marta Hugas, EFSA’s Chief Scientist, said: “The decrease of Salmonella has been a success story in the EU food safety system in the last 10 years. Recent S. Enteritidis outbreaks contributed to a change in this trend in humans and poultry. Further investigations by competent authorities in the field of public health and food safety will be crucial to understand the reasons behind the increase.” 

There were 94 530 human cases of salmonellosis reported in the EU in 2016. S. Enteritidis – the most widespread type of Salmonella, accounted for 59% of all salmonellosis cases originating in the EU and is mostly associated with the consumption of eggs, egg products and poultry meat. 

Campylobacter and Listeria

Campylobacter, the most reported food-borne pathogen in humans, was detected in 246 307 people, an increase of 6.1% compared with 2015. Despite the high number of cases, fatalities were low (0.03%). Levels of Campylobacter are high in chicken meat.

Listeria infections, which are generally more severe, led to hospitalisation in 97% of reported cases. In 2016, listeriosis continued to rise, with 2 536 cases (a 9.3% increase) and 247 deaths reported. Most deaths occur in people aged over 64 (fatality rate of 18.9%). People over 84 are particularly at risk (fatality rate of 26.1%). Listeria seldom exceeded legal safety limits in ready-to-eat foods.

Salmonella food-borne outbreaks increasing 

The 4 786 food-borne disease outbreaks reported in 2016 represent a slight increase in comparison with 2015 (4 362 outbreaks), but the figure is similar to the average number of outbreaks in the EU during 2010–2016. 

Outbreaks due to Salmonella are on the rise, with S. Enteritidis causing one in six food-borne disease outbreaks in 2016. Salmonella bacteria were the most common cause of food-borne outbreaks (22.3%), an increase of 11.5% compared to 2015. They caused the highest burden in terms of numbers of hospitalisations (1,766; 45.6% of all hospitalised cases) and of deaths (10; 50% of all deaths among outbreak cases).

Salmonella in eggs caused the highest number of outbreak cases (1 882).

If it’s not chickens, it’s eggs

In a risk communication fiasco reminiscent of the 1999 dioxin-in-chicken-feed scandal in the EU, millions of eggs have been pulled from supermarket shelves across Europe after contamination with a banned insecticide.

On July 19, 2017, the government of Belgium said that fipronil had been found in eggs produced there, one month after the fipronil was actually detected. The contamination is thought to have been caused by the mixing of the insecticide with a cleaning agent used at chicken farms to control blood lice.

Dutch health authorities admitted that they had received a tip about fipronil being used in barns against blood lice as early as November 2016.

After initially poo-pooing the threat, things picked up in early Aug. as more countries found eggs with fipronil, and more supermarkets pulled eggs.

Dutch police arrested two individuals they say could be accountable for allowing the insecticide Fipronil to be used inside Dutch poultry farms.

A joint Dutch-Belgian task force conducted raids at eight poultry farms in the Netherlands, according to the Dutch prosecution service.

The investigation “focused on the Dutch company that allegedly used Fipronil, a Belgian supplier as well as a Dutch company that colluded with the Belgian supplier,” according to the prosecutor.

Heather Hancock, chairman of the UK Food Standards Agency said: “Our advice remains clear – there’s no need to change how you buy or consume eggs. We are responding very quickly to any new information, to ensure that any products left that contain egg from the affected farms is withdrawn immediately. We’re doing this because Fipronil is not authorised for use in food producing animals, not because we are concerned about any risk to health.”

No risk messages are risky.

So is commercial exploitation.

Robert Chapman, who packs four million eggs a week under the Farmlay label from his West Cockmuir farm at Strichen, Aberdeenshire, urged buyers to learn a lesson from the incident, adding, “Price is obviously a major factor why so many imported eggs come into Britain, but the fact that so many have been found to be contaminated is a major issue. Surely processors and retailers will take this on board and source more eggs from UK producers whose standards are second to none.”

British Free Range Egg Producers Association chief executive Robert Gooch said, “British egg producers follow stringent production standards to ensure that what they produce is perfectly safe and nutritious for consumers to eat.”

Until it isn’t.

Toxo: You don’t want it

Toxoplasmosis is a foodborne zoonosis transmitted by Toxoplasma gondii, a cosmopolitan protozoan that infects humans through exposure to different parasite stages, in particular by ingestion of tissue cysts or tachyzoites contained in meat, primary offal (viscera), and meat-derived products or ingestion of environmental sporulated oocysts in contaminated food or water.

The pig is an important species for infection: raw or undercooked pork consumption not subject to treatment able to inactivate the parasite represents a risk to consumers’ health. Broadening knowledge of transmission ways and prevalence concerning this important pathogen in swine, together with a thorough acquaintance with hazard management are key elements to avoid T. gondii spreading within the swine production chain.

This review aims to illustrate why toxoplasmosis should be regarded as a veterinary public health issue through a careful description of the parasite, routes of infection, and inactivation treatments, highlighting the main prevention lines from pig breeding to pork consumption.

Toxoplasma gongii, a foodborne pathogen in the swine production chain form a European perspective

Foodborne Pathogens and Disease, ahead of print, July 2017,  De Berardinis Alberto, Paludi Domenico, Pennisi Luca, and Vergara Alberto, https://doi.org/10.1089/fpd.2017.2305

http://online.liebertpub.com/doi/abs/10.1089/fpd.2017.2305

Going public fail 2-in-1 day: Tainted eggs were known about for months

I hate the phrase, food scare.

Hate is a strong word, but when it comes to food poisoning outbreaks that kill little kids and others, it’s not a scare, it’s real.

A scare implies former scream-queen Jamie-Lee Curtis flogging yoghurt that makes people poop.

That’s a food scare.

See how many times the N.Y. Times can use the word scare in its opening paragraphs:

The European Union on Monday notified the food safety authorities in Britain, France, Sweden and Switzerland to be on the lookout for contamination in eggs after a food scare in Belgium, Germany and the Netherlands.

Anna-Kaisa Itkonen, a European Commission spokeswoman, said, “We do not know if the eggs are contaminated or not, but because of these notifications, it’s now up to the national authorities to check.”

The scare over contaminated eggs, which began in Belgium, has led supermarkets there and in Germany and the Netherlands to clear shelves of the product as the crisis entered its third week.

The removal of eggs from shops was prompted by the discovery of the insecticide fipronil in some shipments. The contamination is thought to have been caused by the mixing of the insecticide with a cleaning agent used at chicken farms. The scare began July 19 when the government of Belgium said that fipronil had been found in eggs produced there.

Major supermarket chains in Belgium, including Delhaize and Colruyt, have stopped selling eggs from affected farms. In the Netherlands, one poultry producer declared bankruptcy on Friday as a result of the insecticide scare, according to an industry group.

 The Dutch consumer safety authority has published a guide on identifying the tainted eggs through a 10-digit serial number stamped on the shells. The country’s biggest supermarket chain, Albert Heijn, stopped selling many eggs last week, but the company said that eggs were back on sale as normal on Monday. In the Netherlands, an estimated nine million chickens from about 180 farms have been affected.

In Germany, the supermarket chain Aldi withdrew all eggs from sale after the authorities said that about three million eggs imported from the Netherlands had been affected. Since then, fipronil contamination has been found at four farms in the German state of Lower Saxony.

Fipronil is toxic in large quantities and can damage kidneys, liver and lymph glands. The Belgian and Dutch authorities are investigating how the contamination happened.

The Dutch poultry association said that farmers had no idea that cleaners were using the substance. Aalt den Herder, the group’s secretary, said the risk had been overstated.

“It was never an issue of human health, it was an issue of consumer confidence,” he said.

Yeah, except, as explained by the Irish Examiner:

Belgian authorities have now admitted they began investigating pesticide contamination in eggs in early June – several weeks before the public was made aware of a food safety scare affecting several European countries.

Kathy Brison, of the Belgian food safety agency, said on Sunday that a Belgian farm alerted authorities to a possible contamination in June, and they began investigating and alerted Belgian prosecutors.

German authorities are frustrated by the apparent delay in informing European neighbours.

German Agriculture Minister Christian Schmidt plans to speak to his Belgian counterpart about the issue on Monday.

And where would a risk communication failure be without the UK Food Standards Agency, who today reported, “We have no evidence that eggs laid in the UK are contaminated or that Fipronil has been used inappropriately in the UK. 85% of the eggs we consume in the UK are laid here.

“The number of eggs involved represents about 0.0001% of the eggs imported into the UK each year. Our risk assessment, based on all the information available, indicates that as part of a normal healthy diet this low level of potential exposure is unlikely to be a risk to public health and there is no need for consumers to be concerned. Our advice is that there is no need for people to change the way they consume or cook eggs or products containing eggs.”

Sounds good if they’re all getting “laid here.”

Once again:

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public.

Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough.

Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions.

There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.