It was the hemp seed flour from the Dutch; dietary supplement sickens 15 with Salmonella Montevideo in Germany, 2010

"There are only two things I can’t stand in this world. People who are intolerant of other people’s cultures and the Dutch."

Michael Caine in Austin Powers, Goldmember

The freaky dekey Dutch got some salmonella in their groovy hemp seed flour and it made a bunch of Germans sick.

In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany.

Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1–90 years) were mainly affected.

An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case–control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1–infinity, p-value=0.002). Restricting the case–control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8–infinity, p-value=0.001).

Trace-back of the supplement’s main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak.

The authors note in the discussion that, “while investigations of the food safety authorities were thorough, without delay, and strictly following regulations, it is worth noting that the process from the beginning of the analysis of the first positive sample from an opened package to the recall took more than five weeks. In potential outbreak situations, strength of evidence for a suspected food product ought to be weighed against the potential harm to the consumers posed by the suspected food.

"Interestingly, in the end there was no international aspect to this outbreak (as the Dutch label on the product did not correspond to sales in the Netherlands). … In Germany, unfortunately, currently there is no general requirement to communicate non-international food contamination events to the public health authorities."