The Norwegian Institute of Public Health has, according to Outbreak News Today, in collaboration with the Norwegian Veterinary Institute, detected Salmonella enteritidis with the outbreak profile in a batch of beef imported from Germany.
The imported batch of beef is used for, among other things, chop dough. This product has been withdrawn from the market. Some of the imported batch of beef has also been sold to other companies and the Norwegian Food Safety Authority is still working to trace this.
This agrees well with the information we have from the cases that have so far been interviewed, where several state that they have tasted raw chop dough, says doctor Hilde Marie Lund.
I would also like to remind you of the importance of frying chop dough and minced meat as an important preventive piece of advice, adds doctor Hilde Marie Lund.
Of the total of 22 cases, 19 have so far been detected in the Salmonella enteritidis outbreak strain. For 3 of the cases, we are awaiting a final confirmation, but preliminary analyzes indicate that these belong to the outbreak. In addition, we are awaiting analysis of one case.
Outbreak News Today reports the Norwegian Institute of Public Health (NIPH) is reporting a Salmonella outbreak which is geographically spread over large parts of country.
Twenty cases have been reported–12 confirmed and 8 suspected cases. The same genetic profile have been detected in all 12 confirmed cases. Preliminary analyzes of samples from the 8 suspected cases indicate that these also carry the outbreak strain.
Those affected are aged from 11 to 91 years, median age is 59 years. 60% are women.
“The infected live in many different counties. Therefore, we believe that they are infected through a food that is widely distributed”, says doctor Hilde Marie Lund at the department of infection control and emergency preparedness.
“Investigation work can be complicated and time consuming, and in many cases it will not be possible to find the source of the infection or to clarify whether it is a common source. It is too early to say whether this is a limited outbreak or whether it will increase in scope. We follow the situation closely”, says doctor Hilde Marie Lund.
Listeria monocytogenes may persist in food production environments and cause listeriosis. In Norway, a product of concern is the traditional and popular fermented fish product “rakfisk”, which is made from freshwater salmonid fish by mild-salting and brine maturation at low temperatures for several months. It is eaten without any heat treatment, and L. monocytogenes, therefore, poses a potential hazard.
We investigated the effect of salt and temperature on the growth of L. monocytogenes in rakfisk during the 91 days of maturation. The amounts of organic acids produced during fermentation were too low to inhibit growth of L. monocytogenes.
Temperature was clearly the most important parameter for controlling L. monocytogenes. At 7 °C, approximately 2 log growth was observed during the first 14 days of fermentation, and the level of L. monocytogenes thereafter remained constant. At 4 °C, only a little growth potential of the pathogen was recorded. We also investigated the effect of the anti-Listeria bacteriophage P100 on rakfisk with added L. monocytogenes. The phage was introduced to the L. monocytogenes-inoculated fish before fermentation, and an average of 0.9 log reduction was observed throughout the fermentation period.
This is the first study of L. monocytogenes behavior in rakfisk and points to possible measures for increasing the product safety.
Growth behavior of listeria monocytogenes in a traditional Norwegian fermented fish product (rakfisk), and its inhibition through bacteriophage addition
Lars Axelsson, Guro Alette Bjerke, Anette McLeod, Ingunn Berget and Askild L. Holck
Two abstracts attempt to provide guidance to these important questions to reduce the toll of STEC.
FAO and WHO conclude shiga toxin-producing Escherichia coli (STEC) infections are a substantial public health issue worldwide, causing more than 1 million illnesses, 128 deaths and nearly 13 000 Disability-Adjusted Life Years (DALYs) annually.
To appropriately target interventions to prevent STEC infections transmitted through food, it is important to determine the specific types of foods leading to these illnesses.
An analysis of data from STEC foodborne outbreak investigations reported globally, and a systematic review and meta-analysis of case-control studies of sporadic STEC infections published for all dates and locations, were conducted. A total of 957 STEC outbreaks from 27 different countries were included in the analysis.
Overall, outbreak data identified that 16% (95% UI, 2-17%) of outbreaks were attributed to beef, 15% (95% UI, 2-15%) to produce (fruits and vegetables) and 6% (95% UI, 1-6%) to dairy products. The food sources involved in 57% of all outbreaks could not be identified. The attribution proportions were calculated by WHO region and the attribution of specific food commodities varied between geographic regions.
In the European and American sub-regions of the WHO, the primary sources of outbreaks were beef and produce (fruits and vegetables). In contrast, produce (fruits and vegetables) and dairy were identified as the primary sources of STEC outbreaks in the WHO Western Pacific sub-region.
The systematic search of the literature identified useable data from 21 publications of case-control studies of sporadic STEC infections. The results of the meta-analysis identified, overall, beef and meat-unspecified as significant risk factors for STEC infection. Geographic region contributed to significant sources of heterogeneity. Generally, empirical data were particularly sparse for certain regions.
Care must be taken in extrapolating data from these regions to other regions for which there are no data. Nevertheless, results from both approaches are complementary, and support the conclusion of beef products being an important source of STEC infections. Prioritizing interventions for control on beef supply chains may provide the largest return on investment when implementing strategies for STEC control.
Second up, in 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC.
We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results.
All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens.
Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.
Mapping of control measures to prevent secondary transmission of STEC infections in Europe during 2016 and revision of the national guidelines in Norway
The Norwegian Food Safety Authority warns pregnant women and women planning to become pregnant to avoid ginger supplements and ginger-containing shots.
Will Chu of Nutra reports the warning comes after the Danish Technical University (DTU) and the Danish Veterinary and Food Administration carried out a new risk assessment that found a higher abortion risk in animal studies.
In the report, the DTU said the results did not exclude the possibility that large ginger quantities could also increase this risk in humans.
“The DTU Food Institute concludes that in many cases ginger root ingestion from a single ginger shot will be larger (up to 20-23 grams (g) per day) than the fresh or dried amount typically eaten in the diet.
“Experiments in rats indicate that ginger can affect the normal foetal development,” says the report, dated 21 December 2018.
“The studies conducted so far in humans did not investigate whether ginger can have a harmful effect early in pregnancy. Animal studies suggest that it may be a particularly sensitive period.
“There is a small safety margin between the daily dose linked to harmful effects during pregnancy in rats and the amount of ginger that can be consumed with one ginger shot,” the report continues.
Along with the Norwegian Food Safety Authority, the Norwegian Institute of Public Health assessed the Danish report, supporting its conclusions and issuing the warning against taking ginger shots and supplements with ginger.
MRT reports that a patient from a southern Norway island with contaminated water has died after being hospitalized with gastrointestinal symptoms, authorities said Thursday.
Erik Vigander of the regional hospital entity in southern Norway said the bacteria Campylobacter was found in the patient’s system. That’s the same bacteria identified in other people sickened since E. coli was found in a reservoir that supplied drinking water for the island of Askoey.
Vigander says the patient who died Wednesday also had “a very serious underlying” health disorder and an autopsy will be performed to determine “the ultimate cause of death.”
A 1-year-old child from the island died last week of an infection in the digestive tract, but it was not clear whether the death was linked to the water contamination.
About 2,000 people have fallen sick. Since June 6, 64 have been hospitalized.
Hospital tests have shown that Campylobacter was found in at least three dozen cases.
Local newspaper Askoeyvaeringen reported that there had been been safety issues with the waterworks in the Askoey municipality, and feces was recently found near a reservoir that supplied part of the area’s drinking water.
All those infected had drunk from the same container of self-pressed apple juice. Incubation period (1 week) and clinical signs were similar among those infected, although some experienced a more prolonged duration of symptoms (up to 2–3 weeks) than others.
The infections resulted after consumption from only one of 40 containers of juice and not from any of the other containers. It seems that although Cryptosporidium oocysts were detected in a sample from another container, the contamination did not affect the whole batch. This is perhaps indicative of a restricted contamination event, either from contaminated ground in the orchard, or during collection of the fruit, or during processing.
Although outbreaks of foodborne cryptosporidiosis have previously been associated with consumption of contaminated apple juice, most of the more recent outbreaks of foodborne cryptosporidiosis have been associated with salad vegetables or herbs. This outbreak, the first outside U.S. reported to be associated with apple juice, is a timely reminder that such juice is a suitable transmission vehicle for Cryptosporidium oocysts, and that appropriate hygienic measures are essential in the production of such juice, including artisanal (non-commercial) production.
Robertson, L. J., Temesgen, T. T., Tysnes, K. R., & Eikås, J. E. (2019). An apple a day: An outbreak of cryptosporidiosis in Norway associated with self-pressed apple juice. Epidemiology and Infection, 147. doi:10.1017/s0950268819000232
During summer 2016, Norway observed an increase in Salmonella enterica subsp. enterica serovar Chester cases among travellers to Greece.
Our aim was to investigate genetic relatedness of S. Chester for surveillance and outbreak detection by core genome multilocus sequence typing (cgMLST) and compare the results to genome mapping.
We included S. Chester isolates from 51 cases of salmonellosis between 2000 and 2016. Paired-end sequencing (2 × 250 bp) was performed on Illumina MiSeq. Genetic relatedness by cgMLST for Salmonellaenterica subsp. enterica, including 3,002 genes and seven housekeeping genes, was compared by reference genome mapping with CSI Phylogeny version 1.4 and conventional MLST.
Confirmed travel history was available for 80% of included cases, to Europe (n = 13), Asia (n = 12) and Africa (n = 16). Isolates were distributed into four phylogenetic clusters corresponding to geographical regions. Sequence type (ST) ST411 and a single-locus variant ST5260 (n = 17) were primarily acquired in southern Europe, ST1954 (n = 15) in Africa, ST343 (n = 11) and ST2063 (n = 8) primarily in Asia. Part of the European cluster was further divided into a Greek (n = 10) and a Cypriot (n = 4) cluster. All isolates in the African cluster displayed resistance to ≥ 1 class of antimicrobials, while resistance was rare in the other clusters.
Whole genome sequencing of S. Chester in Norway showed four geographically distinct clusters, with a possible outbreak occurring during summer 2016 related to Greece. We recommend public health institutes to implement cgMLST-based real-time Salmonella enterica surveillance for early and accurate detection of future outbreaks and further development of cluster cut-offs.
Whole genome sequencing of Salmonella Chester reveals geographically distinct clusters, Norway, 2000 to 2016
Siira Lotta, Naseer Umaer, Alfsnes Kristian, Hermansen Nils Olav, Lange Heidi, Brandal Lin T. Whole genome sequencing of Salmonella Chester reveals geographically distinct clusters, Norway, 2000 to 2016. Euro Surveill. 2019;24(4):pii=1800186. https://doi.org/10.2807/1560-7917.ES.2019.24.4.1800186
News Beezer reports that shortly before Christmas, the Norwegian Institute of Public Health announced that there had been six reports of a new outbreak of Listeriosis. Today it was known that this number has increased significantly and that the affected area is also larger than previously known
Typically, 1-2 patients with listeriosis are reported monthly. Four of the six patients reported in December come from Hedmark and Oppland. Now the infection has spread further and is increasing more and more.
A total of thirteen people have been reported with listeriosis. Most are located in the above circles, and Buskerud is now included in the list. It is common that they are older than 70 years and affect their general condition. The Norwegian Food Safety Authority works with the Norwegian Institute of Public Health, the Municipal Health Service and the Norwegian Veterinary Institute to determine if patients can share a common source of infection. So far, five patients have detected bacteria with a similar DNA profile.
Four of the six patients reported in December are from Hedmark and Oppland.
Health officials are working to identify if their is a common food source linked to the increase in cases.
Listeria is usually transmitted through food, especially long-life foods that are refrigerated and eaten without further heat treatment. Many of these food products are popular as Christmas foods and can be found on many Christmas parties.