Nineteen sick people are aged 63 to 93, including 13 men and six women. Patients have been reported from 10 different regions.

Six people with listeriosis have died. However, it is unclear what role the infection played in their death because most patients had other severe underlying diseases.

People have been sick with the same type of Listeria since autumn 2022, but 15 cases occurred from the end of May this year, said Folkhälsomyndigheten (the Public Health Agency of Sweden).

Of cases with available information, 14 reported eating vacuum-packed salmon from one of two brands before falling sick. Both these brands are produced by Leröy Seafood, and Listeria was detected in products and environmental samples in the firm’s facility.

In most cases, samples have only been analyzed qualitatively so it is unclear if Listeria was above the limit of 100 CFU/g, according to Livsmedelsverket (the Swedish Food Agency).

“For Leröy Smögen Seafood, safe and secure food is our priority, and we take this incident very seriously. We are doing everything we can to ensure this does not happen again. We have a good cooperation and dialogue with the Swedish Food Agency,” said a company statement.

Finding the source of infections
Further analysis of samples from food, the environment, and human cases found the same type of Listeria, which points to the salmon products being the likely source of infection. The company has increased sampling and is carrying out further clean-up measures at the facility.

In early August, the retailer Axfood recalled a batch of Falkenberg Seafood cold smoked salmon 200-grams after low levels of Listeria were found.

The product was available for sale in the majority of Axfood’s stores. Listeria was detected during the retailer’s internal checks.

“The production has not been stopped, but all batches are currently analyzed for the presence of Listeria before release on the market. The company must take action following its HACCP-based procedures. They must also investigate the cause of contaminated products with Listeria monocytogenes and take measures to prevent such contamination. This may involve changes to HACCP-based procedures or other measures,” said Mats Lindblad from Livsmedelsverket.

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Folkhälsomyndigheten (the Public Health Agency of Sweden) said deaths of three of the older patients were connected to their Listeria infections but it is not clear if they died with or because of listeriosis.

From the end of May to the beginning of July, 10 people contracted Listeria infections caused by the same type of the bacteria. Another four people fell ill in late 2022 from this strain.

Patients are 10 men and four women aged 63 to 93 years old. They live in eight different regions in the country.

Based on information from a questionnaire given to patients about foods they ate before becoming sick, many reported eating gravad or cold-smoked salmon but the exact product that caused the outbreak is not yet clear.

Warning for vulnerable groups
Folkhälsomyndigheten, Livsmedelsverket (the Swedish Food Agency) and regional infection control units are investigating the illnesses.

Livsmedelsverket said Listeria can cause serious illness for people in at-risk groups, such as pregnant women, the elderly and people with impaired immune systems.

“Those who belong to a risk group — or who are to offer food to someone in a risk group — can reduce the risk of infection by following the Swedish Food Agency’s advice on Listeria. Certain foods such as blue cheeses should be avoided completely, while other foods such as cold smoked and gravad salmon should be eaten within a week of the date on the packaging,” said Jonas Toljander, a microbiologist at Livsmedelsverket.

In 2022, 125 listeriosis cases were reported compared to 107 the year before. The median age was 79 and as in previous years, most were older than 80. Overall, 45 people died within one month of diagnosis.

National and local authorities took 266 samples from different types of food to test for the presence or absence of Listeria monocytogenes in 2022. The pathogen was detected eight times. Two of these were vacuum-packed salmon taken as part of work into a suspected food poisoning or complaint.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, people should monitor themselves for food poisoning symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

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In recent weeks, there has been a rise in people with Campylobacter infections. The spike in cases in late June and early July came after an increase in Campylobacter in broiler flocks. Broilers are chickens raised for their meat.

Officials from Folkhälsomyndigheten (the Public Health Agency of Sweden) said the annual summer increase seems to have started quite suddenly and a little bit earlier than usual.

Data from the National Veterinary Institute (SVA) shows it was preceded by several larger Campylobacter positive broiler flocks.

Sick people live throughout the country and infections have been recorded across age groups.

The average is about 20 reported non-travel associated cases per day and rising. This can be compared to a peak with about 25 to 30 cases per day that has usually occurred in early August in previous years.

The number of domestically infected people and cases with unknown country of infection increased from about 70 per week during most of June to 100 two weeks ago and more than 140 last week.

Fresh chicken meat suspected as main source
Previous studies have shown a connection between Campylobacter infection and consumption of fresh chicken, where about a third of those who have contracted the disease have been linked to chicken.

Campylobacter infection in humans is more common in summer, as is its presence in broiler flocks.

A total of 5,165 cases of campylobacteriosis were reported in 2022 and 57 percent of these were domestic. This is up on more than 4,000 cases in 2021. For domestic infections in 2022, the median age was 51 with a range of 0 to 101.

National and local authorities took 64 samples from different types of food in 2022 but did not find Campylobacter. Food businesses at seven abattoirs collected 1,046 pooled neck skin samples based on EU regulation. Test results at all abattoirs were satisfactory according to the legislation, and only 18 exceeded the limit of 1,000 CFU/g.

Good hygiene when handling raw chicken reduces the risk of becoming infected. Advice includes washing hands before starting to cook, and immediately after handling raw meat and chicken.

Raw chicken meat and other foods should be kept apart, especially ready-to-eat items such as salads. Cutting boards and kitchen utensils also need to be washed thoroughly after cutting meat and chicken.

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A report by the National Veterinary Institute (SVA), Folkhälsomyndigheten (the Public Health Agency of Sweden), Livsmedelsverket (the Swedish Food Agency) and Jordbruksverket (Swedish Board of Agriculture) showed a rise for Campylobacter, Salmonella, Listeria, and E. coli infections. Some of this was because of increased travel and more people being infected abroad.

A total of 5,165 cases of campylobacteriosis were reported in 2022 and 57 percent of these were domestic. This is up on more than 4,000 cases in 2021. For domestic infections in 2022, the median age was 51 with a range of 0 to 101. More men, 54 percent, than women were sick.

A correlation between human cases and Campylobacter-positive broiler batches underscores the need for further preventive measures, said the report.

Salmonella stats
In total, 1,137 cases of salmonellosis were reported, compared to 944 in 2021. Almost 450 people were considered to have been infected abroad. Among domestic cases, the median age was 44 and incidence was highest for children younger than 5 years old. Of serotyped isolates from domestic patients, the most common were Salmonella Typhimurium, Enteritidis, Agona and monophasic Salmonella Typhimurium. Another 59 different types were identified during 2022.

Six outbreaks involving 10 or more people occurred. In December, Salmonella Enteritidis was detected in laying hens at the largest egg producing facility in Sweden. Although it is the most common cause of salmonellosis in Europe, in Sweden the serovar had been detected in commercial laying hens only three times since 2003. The outbreak has caused 81 human infections, mainly during 2023.

The source in the laying flock has yet to be identified. However, isolates are genetically similar to those from other EU outbreaks caused by eggs contaminated with Salmonella Enteritidis. Belgium had a large outbreak with an almost identical strain in early 2022 linked to eggs from a domestic producer. The outbreak strain is also similar to a smaller Danish egg-linked event in summer 2022.

Fifteen people were infected with Salmonella Liverpool in frozen pre-cooked crayfish from China. Five cases were also recorded in 2021. However, the producer had only been approved for export in February 2022 and the importer had received crayfish from another firm in past years, so it was not possible to identify a connection to previous ill people.

Two Swedish producers were connected to a Salmonella typhimurium outbreak caused by rocket salad. Overall, 109 people fell sick and patients were also recorded in Finland. A Salmonella Agona outbreak affected 35 people. Cases were also recorded in Norway and the Netherlands. The suspected source was Spanish cucumbers.

E. coli and Listeria
In 2022, 857 E. coli cases were reported of which 583 were domestically acquired. As in previous years, the incidence was highest in children younger than 5. In total, 79 different serotypes were identified. The most common types were O157:H7, O26:H11, and O103:H2. A total of 653 patients were reported in 2021.

STEC-associated Hemolytic Uremic Syndrome (HUS) was reported in 19 patients of which 17 were domestically acquired. Eleven HUS patients were children under the age of 10. No single serotype caused more than two HUS cases.

Three investigations were carried out after human cases were detected with suspected connection to farm animals. Suspicions fell on drinking unpasteurized milk or direct contact with cattle. All farms were negative for STEC. A source could not be found in three outbreaks caused by O121:H19, O63:H6 and a combination of O103:H2 and O157:H7.

In total, 125 Listeriosis cases were reported compared to 107 in 2021. The median age was 79 and as in previous years, most were older than 80. Sixty-seven cases were females and 57 were males. Overall, 45 people died within one month from diagnosis.

Five patients with a rare strain of Listeria monocytogenes in Sweden were included in a larger cluster with cases from 2019 to 2022. All were notified in autumn but the source of infection was not identified.

Salmon raw material that became contaminated during processing in Norway was the source of one outbreak with four patients. Sixteen cases recorded from 2020 to 2022 were linked to products from a meat processing plant.

Listeria monocytogenes was detected in an opened pack of a washed rind cheese taken at the home of a sick person. Four other patients from 2018 through 2022 were identified. However, analysis at EU level found the source was salmon and not cheese. The five patients in Sweden were linked to 11 cases in five other countries from 2017 to 2022.

Cryptosporidium, Yersinia and Brucella
In 2022, 716 cryptosporidiosis cases were reported. The median age was 38 and 55 percent were women. A total of 550 people were infected in Sweden. The total is up from 524 cases in 2021.

Between late September and mid-October, 107 cases with Cryptosporidium parvum were detected in 15 different regions. The median age was 40 and more females than males were infected. Epidemiological investigations pointed toward contaminated frisée lettuce in ready-to-eat green leaf mixes as the probable cause.

A total of 238 Yersinia cases were reported, down from 313 in 2021. Like previous years, the incidence was highest among children younger than 5. Yersinia is not part of the national microbial surveillance program in Sweden but no outbreaks were detected.

In 2022, 10 cases of brucellosis were reported. They ranged in age from 25 to 71 including five men and five women. Three people were infected in Sweden by a goat cheese from Iraq. Six acquired their infections in Iraq and for one person the country of infection was unknown. For seven cases, unpasteurized dairy products were the probable source of infection.

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European regulation lists 14 allergens that are subject to labeling and information requirements.

Inspections by the Netherlands Food and Consumer Product Safety Authority (NVWA) showed that 60 percent of nearly 13,000 companies in retail, hospitality, and catering did not properly inform customers about which allergens are used in food. Information can be provided orally or in writing.

Results from checks in 2022 found that 6 in 10 firms did not inform customers completely or correctly about allergens in unpackaged foods. Sometimes labels were not kept or details of ingredients were not recorded.

Despite more inspections, there was hardly any improvement from 2021, said NVWA. The agency added it would continue monitoring the situation and try to help the sector improve.

Companies in the hospitality industry such as restaurants, hotels, and cafeterias, performed slightly better than in 2021 but the situation was worse in the retail sector. Enforcement action, in the form of written warnings or fines, was taken at sites that did not meet the requirements.

Written allergen information is often incomplete and sometimes incorrect. It is also not always visible to consumers, said NVWA. Employees can usually say which allergen is in a product, but the information is not available elsewhere in writing or electronically, so the inspector cannot check if it is correct.

Danish findings
In Denmark, the Danish Veterinary and Food Administration (Fødevarestyrelsen) verified companies’ labeling of pre-packed food, including for allergens.

Requirements state that allergens must be highlighted in a way that distinguishes them from other ingredients on the list, for example by the font, style, or background color.

Random checks at 773 companies from June to December 2022 found serious errors in the labeling of allergens at 1.4 percent of businesses, who were fined.

The campaign shows that controls should continue to focus on the labeling of pre-packaged foods, especially with allergenic ingredients, as it is a big challenge for companies and could have severe consequences for allergic consumers, said authorities.

“Results show that companies generally have a good grasp of the rules, but we expect companies to do better – not least because the rules on allergen labeling are so important for allergy sufferers,” said Henrik Dammand Nielsen, of the Danish Veterinary and Food Administration.

Swedish results
In a national control project in Sweden in 2022, the allergen information provided for 4,344 products at 2,172 restaurants, cafes, and other large outlets was reviewed. Incorrect information was provided for 17 percent of products and 25 percent of the businesses.

Mustard and celery were the allergens that caused businesses the most trouble. Incorrect information regarding milk, eggs, and gluten was given in more than 100 cases each. The problem was not as bad for peanuts and nuts.

The project showed that how the information is available – written or provided verbally – had no bearing on how likely it was to be correct.

“The fact that an allergy sufferer so often risks getting wrong information in restaurants is very serious as it can lead to allergic reactions. Restaurants and similar businesses have an obligation to inform about allergenic ingredients in the food they serve,” said Maria Svensson, unit manager for food inspection in the city of Malmö.

Anyone who has received incorrect information about allergens at a restaurant or other outlet should report it to their local municipality, said the Swedish Food Agency (Livsmedelsverket).

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At least 170 people have fallen ill in Helsinki, Finland, after eating oysters in various restaurants in February and March. Cases have also been reported in other Finnish cities.

Norovirus has been found in nine different oyster batches with two from the Netherlands, six from France, and one from Ireland. Importers have withdrawn affected batches from the market.

Officials have tested food from restaurants and taken patient samples, finding norovirus. Some of those sick reported eating oysters.

A report on the outbreak is being prepared for the Finnish Food Authority (Ruokavirasto) and the Finnish Institute for Health and Welfare (THL).

Norovirus is the most commonly identified cause of foodborne outbreaks in Finland. Between 2017 and 2021, oysters caused 11 norovirus outbreaks in which more than 110 people fell ill.

Finland has published four Rapid Alert System for Food and Feed (RASFF) alerts on food poisoning due to norovirus in oysters since late February.

Cases in other countries
Sweden had three notifications in March. Norovirus in mussels from Sweden sickened seven people. Norovirus in oysters from France affected three and norovirus in oysters from the Netherlands is suspected to be behind 15 illnesses.

RASFF alerts have also been issued by Spain and Italy concerning norovirus in oysters from France.

Harvesting areas have been closed and outbreaks reported in France, although it is unclear how many people were sick.

Twenty people were ill in Belgium in February from norovirus in oysters from France. Another outbreak was linked to oysters from the Netherlands but authorities did not say how many were sick.

Two outbreaks in Denmark from late 2022 to early 2023 were caused by oysters. The first with 19 people sick involved oysters from France but originating in Ireland. The second with 73 cases were linked to oysters from Norway.

Authorities in Hong Kong have reported several outbreaks linked to raw oysters including one from products from Ireland that caused at least 16 illnesses earlier this year.

The Health Protection Surveillance Centre said there had been an increase in the number of norovirus cases and outbreaks reported in Ireland in the past few weeks, with the residential care sector particularly affected.

Norovirus cases have also significantly increased in England, according to data from the UK Health Security Agency (UKHSA).

Laboratory reports of norovirus are 77 percent higher than the 5-season average for the same period prior to the Coronavirus pandemic. The rise is across all age groups but mostly in those aged 65 and over and those under 5 years old.

The incubation period for illness caused by norovirus is 12 to 48 hours. Symptoms include sudden onset of cramping, abdominal pain, and nausea, followed by vomiting. Most people also have diarrhea. They usually last 12 to 72 hours.

Handwashing with soap and water is one key to fighting the virus. Affected staff in the food industry should stay away from work for at least two days after symptoms have stopped to avoid spreading the infection. Norovirus can be transmitted directly from one person to another and through contaminated surfaces, food, and beverages.

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The Public Health Agency of Sweden (Folkhälsomyndigheten) said new findings of Salmonella at the site of the same company were made in mid-February. This prompted another wave of recalls in February and March.

In late December 2022, Salmonella Enteritidis was identified at CA Cedergren, a major producer, in one of the egg-laying stables during a routine environmental sampling check. Eggs were then recalled by Coop, Axfood, ICA, Lidl, and Kronägg. 

Investigations found Salmonella from the production environment in December was identical to isolates from sick people.

No cases linked to second recall
In an update this past week, Folkhälsomyndigheten said 79 people were sick in the outbreak, which is up three cases since mid-February.

The latest date of illness onset among reported cases is early February. So far, nothing indicates that anyone has been infected in connection with the detection of Salmonella made in February during enhanced sampling, said health officials.

Patients from 16 different regions are sick with the outbreak strain of Salmonella Enteritidis.

Cases include 36 women and 43 men. They fell ill between Dec. 6, 2022, and Feb. 4, 2023, and are between 1 to 91 years old with a median age of 35.

After Salmonella was found at the farm in Småland in December, local media reported that the Swedish Agency for Agriculture said that 165,000 laying hens must be killed. The latest finding means 160,000 hens will be killed.

National control program data shows it is unusual to find Salmonella in Swedish meat or eggs and most people who get sick are usually affected abroad or by imported food.

The outbreak is being investigated by the Swedish Agency for Agriculture, the Swedish Food Agency (Livsmedelsverket), the Public Health Agency of Sweden as well as regional and local authorities.

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile.

Anyone who has eaten or handled any of the implicated eggs and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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The Public Health Agency of Sweden (Folkhälsomyndigheten) said 76 people were sick, which is up from 48 in a previous update.

Patients from 16 different regions have been confirmed as infected with the outbreak strain of Salmonella Enteritidis.

Sick people include 36 women and 40 men who fell ill between early December 2022 and the end of January 2023. They are one to 91 years old with a median age of 35.

In late December 2022, Salmonella Enteritidis was identified at CA Cedergren, a major Swedish producer in one of the egg-laying stables during a routine environmental sampling check.

After Salmonella was found at the farm in Småland, the Swedish Agency for Agriculture said that 165,000 laying hens must be killed. Similar strains have previously been found in several other countries.

National control program data shows it is unusual to find Salmonella in Swedish meat or eggs and most people who get sick are affected abroad or by imported food.

The outbreak has been linked to eggs, which were recalled by Coop, Axfood, ICA, Lidl, and Kronägg and are now past their shelf life dates.

Recent cases appear to involve people who have carried the infection for a while before being tested and getting sampling results or instances of secondary infections from other patients.

The outbreak was investigated by the Swedish Agency for Agriculture, the Swedish Food Agency (Livsmedelsverket), the Public Health Agency of Sweden as well as regional and local authorities.

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile.

Anyone who has eaten any of the implicated eggs and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illnesses and serious, sometimes life-threatening conditions. Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

(To sign up for a free subscription to Food Safety News, click here.)

The report covers the safety of seaweed used as food, with a focus on chemical and microbiological hazards. The main hazards for seaweed harvested in Nordic countries are iodine, cadmium, and inorganic arsenic. Other issues are nickel, lead, and mercury, Bacillus in heat-treated products, kainic acid in dulse seaweed, and allergens.

Experts said levels of heavy metals and iodine vary greatly between and within species and can be affected by age, growing conditions, and processing methods. Data on iodine, cadmium, inorganic arsenic, lead, and mercury in seaweed from different Nordic nations have confirmed the variations.

In 2020, a project funded by the Nordic Council of Ministers started involving food agencies in Denmark, Iceland, the Faroe Islands, Sweden, and Norway and a report has recently been published.

Need for seaweed-specific rules
The authors of the report called for a common Nordic approach because of differences in tradition, food culture, production methods, seawater quality, and types of seaweed species used. They recommended developing food safety legislation for seaweed, in which it should be classed as a specific group of foodstuffs, with subgroups for different species.

Europe lacks specific rules on food safety for the products. In the EU, there is limited experience in using seaweed, and little is known about the potential risks and benefits to human health when it is consumed. There are also no international standards on seaweed safety, such as Codex guidelines.

The European Food Safety Authority (EFSA) has published findings on dietary exposure to metals and iodine in seaweed. The highest mean occurrence levels were reported for iodine. For heavy metals, the biggest mean levels were for arsenic, in particular total arsenic but also in a few samples for inorganic arsenic and cadmium. Mean concentrations of mercury in seaweeds were the lowest. The highest levels were reported for brown seaweeds, followed by red and green seaweeds.

In 2022, the UN Food and Agriculture Organization (FAO) and World Health Organization (WHO) issued a report looking at microbiological, chemical, and physical hazards linked to eating seaweed and aquatic plants.

Guidance is needed for producers and public agencies to ensure food safety, facilitate uniform control and trade, and support innovation and growth, according to the Nordic report.

Nordic species are used as ingredients in foodstuffs such as spices, bread, pesto, fish cakes, beverages, and food supplements and as a main ingredient in snacks, crisps, soups, salads, pasta, and smoothies. Imported species nori, kombu, and wakame are used in sushi and other Asian dishes.

Potential hazards identified
Seaweed can be produced by aquaculture or harvested from wild stocks in the sea. It is sold fresh or after processing, such as drying, rinsing, blanching, freezing, and fermentation. Processing methods may alter the risk as it is possible to reduce iodine content. However, some products may still contain high levels after this step.

In general, brown algae have the most iodine content, with the highest levels found in the species sugar kelp, winged kelp, oarweed, and tangle. Red and green algae species have lower levels of iodine, except for the red algae wrack siphon weed. Oarweed can have very high levels of inorganic arsenic, while cadmium is highest in several brown and red algae.

One outbreak in 2019 was caused by Norovirus in frozen wakame seaweed salad from China. The salad was suspected of being the cause of more than 100 cases from at least 11 eateries in different areas of Norway. Microbial contamination may occur when seaweed is harvested from polluted water or after harvest due to factors such as poor handling.

Other issues may include physical hazards such as sand and stones or allergens from seaweed or traces of crustaceans, mollusks, or fish.

Hazards in seaweed in Nordic countries may change in the future, with new data from research, and conditions may be affected by climate change, such as increased sea temperature. New seaweed species may also be introduced to Nordic waters.

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The Public Health Agency of Sweden (Folkhälsomyndigheten) also warned this figure is expected to increase again.

There are 48 people from 13 regions confirmed to have been infected with the outbreak strain of Salmonella Enteritidis, this is up from 22 people in 11 regions.

Illnesses occurred between early December and mid-January. Of those sick, 22 are women and 26 are men. The age range is 1 to 90 years old with a median age of 34.

The outbreak has been linked to eggs, which have been recalled. Analysis has revealed Salmonella found during environment sampling at an egg producer is identical to isolates from sick people.

Typing of Salmonella isolates from people that reported having food containing eggs from recalled batches is ongoing, which is why the Public Health Agency of Sweden believes the number of people affected will go up.

Recall and public warning
No contaminated eggs from recalled lots should be left in shops or restaurants but it is possible people still have them in their homes.

Alerts have been made by Coop, Axfood, ICA, Lidl, and Kronägg involving different pack sizes of eggs. Some have a best-before date up to Jan. 28, 2023.

These firms said they were taking the incident seriously and were investigating, with the supplier, how contamination could have occurred. This included trying to make sure that something similar does not happen again.

In late December 2022, Salmonella Enteritidis was identified at CA Cedergren, a major Swedish producer in one of the egg-laying stables during a routine check.

After Salmonella was found at the farm in Småland, the Swedish Agency for Agriculture said that 165,000 laying hens must be killed.

The outbreak is being investigated by the Swedish Agency for Agriculture, the Swedish Food Agency (Livsmedelsverket), the Public Health Agency of Sweden as well as regional and local authorities.

National control program data shows it is very unusual to find Salmonella in Swedish meat or eggs and most people who get sick are affected abroad or by imported food.

Swedish Salmonella control covers feed, animals, and food which means that positive findings are handled along the entire food chain. Authorities and industry try to prevent and combat Salmonella through statutory and voluntary control programs. There is mandatory monitoring of all commercial poultry flocks, where regular sampling takes place on the farm.

In the event of an outbreak where the Swedish Board of Agriculture is involved and decides on various measures, restrictions, and requirements, animal owners may be entitled to compensation.

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile.

Anyone who has eaten any of the implicated eggs and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illnesses and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

(To sign up for a free subscription to Food Safety News, click here.)

The Salmonella Enteritidis outbreak involves 22 people from 11 different regions. Patients are aged between 7 and 90 years old. A dozen of the patients are women and illnesses occurred between early December and the start of January.

In late December 2022, Salmonella Enteritidis was identified at CA Cedergren, a major Swedish producer in one of the egg-laying stables during a routine check, which led to several recalls.

Some sick people ate meals containing eggs from the now-recalled batches, so there is a likely connection to the Salmonella finding at the egg producer, said the Public Health Agency of Sweden (Folkhälsomyndigheten).

In recent days, a larger number of Salmonella infections have been reported than was expected. These isolates have not yet been typed to determine the strain. However, several ill people mentioned the consumption of products with eggs from suspected contaminated batches so there is a good chance the number of people in the outbreak will increase.

Dent to Sweden’s good Salmonella record
Because of the recalls, there should be no contaminated eggs left in stores or restaurants but it is possible that consumers still have them at home.

The outbreak is being investigated by the Swedish Agency for Agriculture, the Swedish Food Agency (Livsmedelsverket), the Public Health Agency of Sweden as well as regional and local authorities.

When the prevalence of Salmonella in certain animals or food is very low and strict national control programs apply, the European Commission may grant special guarantees to an EU country. This includes extended monitoring showing the absence of Salmonella before sending shipments to those countries. Such guarantees are in place for Sweden, Finland, Denmark, and Norway.

National control program data shows it is very unusual to find Salmonella in Swedish meat or eggs and most people who get sick are affected abroad or by imported food. However, since the detection of Salmonella in Swedish eggs in December a number of recalls have been issued.

Alerts have been made by Coop, Axfood, ICA, Lidl, and Kronägg involving different pack sizes of eggs. Some have a best-before date up to Jan. 28, 2023.

These firms said they are taking the incident seriously, and were investigating, with the supplier, how contamination could have occurred. This included trying to make sure that something similar does not happen again.

Salmonella was found at the farm in Småland in late December and the Swedish Agency for Agriculture has decided that 165,000 laying hens must be killed.

About Salmonella
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any recalled products and developed symptoms of Salmonella food poisoning should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illnesses and serious, sometimes life-threatening conditions. Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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Shigella patients have also been found in the Netherlands, Denmark, France, Germany, Portugal, and the United Kingdom. From November 2021 to October 2022, 55 shigellosis cases were recorded.

From mid-November, an increase in Shigella infections with travel to Cape Verde was reported, said the Public Health Agency of Sweden (Folkhälsomyndigheten).

So far, 30 cases have been identified. Analysis of 11 bacterial isolates found nine are Shigella sonnei and two are Shigella boydii. Infections with other pathogens, such as E. coli, Campylobacter, Cryptosporidium, and Giardia, have also been noted.

Infection with Shigella linked to trips to Cape Verde has been a recurring problem, according to Folkhälsomyndigheten. Combined with the presence of various Shigella species and other pathogens, this suggests contamination via food or water.

The European Centre for Disease Prevention and Control (ECDC) and World Health Organization (WHO) are monitoring the situation.

Sick people in the UK want answers
Holiday Claims Bureau and Hudgell Solicitors in the UK have seen complaints of illness and poor hygiene standards from holidaymakers. 

Holiday Claims Bureau is representing a number of people with confirmed Shigella infection from hotels in Cape Verde. The firm also has clients who tested positive for Salmonella and E. coli following stays at the same hotels.

One of these is Jake Slater, from Leeds, who went away in December 2021. Slater started to suffer stomach cramps, diarrhea, and nausea while on holiday and these symptoms continued on his return home. Tests confirmed Slater had contracted Shigella and he was given antibiotics. Another client went on holiday to the same hotel in October 2022 and contracted Shigella.

More than 500 people have asked lawyers at Irwin Mitchell to investigate illnesses linked to trips to Cape Verde.

Holidaymakers stayed at seven hotels in the country. People have tested positive for bacterial pathogens including Salmonella, Campylobacter, Shigella, and E. coli. All had been on holidays booked through tour operator TUI.

Jatinder Paul, the senior associate solicitor at Irwin Mitchell, said if the causes are identified, then lessons must be learned to ensure no other holidaymakers suffer illness.

“That so many should have been affected at these hotels, in the same region under the same tour operator, has left the people we are representing with a lot of questions over what happened to them this summer and we’re determined to help them find the answers,” he said.

“Bacterial illnesses such as Salmonella, Campylobacter, Shigella, and E. coli are serious and should never be underestimated. They can cause long-term health issues for the most vulnerable, and even death. The fact some still remain ill several months after their return is very concerning.”

Shigella bacteria cause an infection called shigellosis. Most infected people have diarrhea, fever, and stomach cramps. Symptoms usually begin a couple of days after infection and last a week. Travelers may be exposed to the bacteria through contaminated food, water, or surfaces. Those with a Shigella infection can spread it to others for several weeks. People should wash their hands with soap and water before preparing and eating food to help control the pathogen.

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The Norwegian Institute of Public Health (FHI) said 72 people are sick in the Salmonella Agona outbreak and 24 have been hospitalized.

People across the country fell sick from the end of October to the start of December. Patients are aged 1 to 88, with a median of 36 years old, and 37 of them are women.

In Sweden, 31 people have been affected, according to the Public Health Agency of Sweden (Folkhälsomyndigheten).

The Netherlands has six confirmed and two probable cases. They are four men and two women with an age range of 5 to 75. All of them have been hospitalized. Epidemiological investigations are ongoing so the link to cucumbers from Spain has not been established.

Only one Spanish supplier involved
Investigations by FHI, local officials, the Norwegian Food Safety Authority (Mattilsynet), and the Veterinary Institute show no new cases have been reported recently which indicates the contaminated product is no longer being sold.

Officials believe the outbreak is over and cucumbers from one Spanish supplier are the likely source. Sick people could have bought the affected product in shops or been served it while eating out.

The Norwegian Institute of Public Health has analyzed 50 patient interviews and purchase information. The agency also carried out a case-control study comparing what patients ate with what a random selection of other people have eaten.

Nearly 90 percent of those infected reported having eaten cucumber in the week before they became ill, but cucumber is commonly eaten in Norway. The case-control study helped to rule out other potential foods as a source of infection in the outbreak.

“Results of the outbreak investigation show that certain batches of cucumber from a Spanish supplier stand out as a likely source of infection. These batches are no longer on the market, and we have not been able to test the product for the outbreak strain,” said Heidi Lange, from FHI.

Wider outbreak
Norwegian importers of cucumbers from the Spanish supplier have intensified sampling as an additional safety measure but Salmonella has not been found.

The Norwegian Food Safety Authority has notified Spanish authorities and other EU countries about the findings from the investigation.

In Sweden, 31 people have fallen ill since the start of November. Patients range in age from 3 to 86 years old and are from 12 different regions in the country. Twenty cases are women and 11 are men.

A trawling questionnaire about food intake in the week before falling ill from 14 cases indicated cucumber as the single most consumed food item. However, statistical evidence is lacking because it is such a commonly eaten product.

Whole genome sequencing has shown patients have the same type of Salmonella Agona, so are suspected of having been infected by a common source.

About Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop severe illnesses and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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The Norwegian Institute of Public Health (FHI) said 58 people are sick in the Salmonella Agona outbreak and 23 had been hospitalized. This is up from 31 sick and 13 hospitalizations.

In Sweden, 26 people have been affected, according to the Public Health Agency of Sweden (Folkhälsomyndigheten).

Norwegian situation

In Norway, people in 10 regions were diagnosed with infections from Nov. 7 to 29 with a peak in the middle of the month. Salmonella Agona is a rare type of Salmonella in Norway and Europe.

Those sick are aged 1 to 88 years old and 27 of them are women. Bacteria with the same genetic profile, meaning they were likely infected by the same source, have been detected in 37 of 58 patients. For the other 21, sequencing results from laboratory tests are pending.

The majority of sick people live in Viken, followed by Vestland and Vestfold og Telemark. Single-figure patient numbers have been recorded in Innlandet, Trøndelag, Troms og Finnmark, Møre og Romsdal, Oslo, Rogaland, and Nordland.

Source of the outbreak not yet known
An investigation to find the source is ongoing with FHI, local officials, the Norwegian Food Safety Authority (Mattilsynet), and the Veterinary Institute. The cause is believed to be an imported food product distributed across the country and also in Sweden.

Heidi Lange, from FHI, said patients are being interviewed to see if there is a common source of infection.

“In addition, we also collect information from purchase receipts in cooperation with the Norwegian Food Safety Authority and the grocery industry. We do this because it can be challenging to remember everything that was eaten before illness,” she said.

“FHI plans to carry out a case-control study. This involves comparing what patients have eaten with what a random selection of other people have eaten within the same time period. In this way, we can test out various clues about the source of the outbreak, and whether there is an increased risk of disease linked to certain foods.”

In Sweden, 26 people have fallen ill since the start of November. Patients range in age from 3 to 86 years old and are from 12 different regions in the country. Fifteen cases are women.

Whole genome sequencing has shown they have the same type of Salmonella Agona, so are suspected of having been infected by a common source.

Folkhälsomyndigheten, local infection control units, and the Swedish Food Agency (Livsmedelsverket) are helping Norwegian authorities to search for the source of the outbreak.

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Presentations at the European Scientific Conference on Applied Infectious Disease Epidemiology (ESCAIDE) covered Salmonella, Listeria, Clostridium Perfringens, and botulism outbreaks.

ESCAIDE was held in November in Stockholm, Sweden, and remotely. It was organized by the European Centre for Disease Prevention and Control (ECDC).

In October 2021, the Public Health Agency of Sweden (Folkhälsomyndigheten) detected a nationwide outbreak of people infected with identical monophasic Salmonella Typhimurium strains.

Forty illnesses with onset during October were reported from eight regions with an age range of 5 to 70 years old. More women than men were sick. One region reported a cluster of nine cases linked to a preschool.

In a case-case study, researchers compared exposures of 24 outbreak patients to 47 other salmonellosis patients, reported during mid-September-November 2019 to 2021. Compared to other cases, outbreak patients were more likely to report grocery shopping at one supermarket and consumption of tomatoes and ground beef.

Fresh small tomatoes from one supermarket chain were the most likely source. They were the only item found in all five of the patients’ receipts from this retailer. Almost all outbreak cases reported eating tomatoes. Pre-school shopping receipts included tomatoes but not ground beef.

The outbreak stopped before control measures were taken, supporting the theory that the vehicle of infection had a short shelf life. Traceback by the Swedish Food Agency (Livsmedelsverket) identified suppliers of fresh small tomatoes in Italy and Spain but samples were not available for analysis.

German Listeria outbreak
Another presentation covered a Listeria monocytogenes outbreak caused by shredded vegetables in Hesse, Germany, from 2021 to 2022.

In November 2021, two cases of listeriosis were reported with hospital stays during their suspected exposure periods. Four patients belonged to the cluster from October 2021 to January 2022. The median age was 76 and a half years old.

In February 2022, the outbreak strain was isolated from a retained salad sample in one hospital. Traceback identified a manufacturer who processed vegetables for raw consumption and supplied several hospitals in Hesse. Infections in three patients could be epidemiologically linked to their stay in two hospitals supplied by the company.

The manufacturing site had hygiene deficiencies and the outbreak strain was detected in sliced vegetables such as Chinese cabbage, onions, parsley, cucumber, and leek, and environmental samples like kitchen utensils and from the floor.

Scientists recommended removing industrially pre-cut vegetables for raw consumption from the menu of vulnerable people such as hospitalized patients and more inspections in the supply chain.

Two English incidents
A separate poster detailed an outbreak of Clostridium perfringens associated with roast beef in a restaurant in South West England in January this year.

Contact details were available for 40 of 85 attendees; 31 provided information on food consumption and symptoms, and 15 were defined as cases. The median age was 47 and more men than women were sick.

The incubation period for all cases ranged between 14 and 26 hours. Symptom duration ranged from less than 6 hours to 4 days, with most being sick for 3 days.

Clinical stool and beef samples contained Clostridium perfringens. However, only one stool sample was positive for enterotoxigenic Clostridium perfringens, which is capable of causing gastrointestinal illness. Stool samples were collected between 4 and 9 days after symptom onset which reduces the chances of positive results. One sample had low levels of norovirus. Beef consumption was able to explain three-quarters of cases.

Findings were used to give food safety recommendations to the restaurant, primarily about temperature control when cooking, cooling, and storing beef.

In October 2021, researchers investigated an outbreak of Salmonella Poona in North West England. The outbreak had 13 cases between 2016 and 2021 and was discovered through routine Salmonella surveillance whole genome sequencing (WGS).

Eleven sick people were under the age of 3 and two were adults. The earliest patient in 2016 had attended one nursery while the other 10 child cases from December 2018 to September 2021 had been at another nursery at the time of infection. No other common exposures were identified. Six of 12 children were hospitalized.

Staff sampling at the second nursery identified an asymptomatic staff member who had been employed since 2018 and who tested positive for the outbreak strain. This person had also worked at the first nursery in 2016 when the first case was reported.

“This outbreak highlights the possibility of persistent carriage and shedding of Salmonella Poona and the implications of this where individuals work with vulnerable groups, necessitating consideration of more enhanced risk management measures such as the exclusion of the individual or changing their duties until the clearance is achieved,” said researchers.

Finally, nine people were hospitalized in a botulism outbreak in Tajikistan in 2020. In 2019, there were 19 cases and three deaths in the country. Botulism is a rare but life-threatening condition caused by toxins produced by Clostridium botulinum bacteria.

The age of patients in the 2020 outbreak ranged from 6 to 44 years old and six were male.

Interviews revealed patients were from the same village in the Dangara region and all reported eating a homemade canned salad at dinner. Investigators retrieved the salad and destroyed it. Consumption of improperly preserved foods was the source of the outbreak, said, investigators.

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The number of outbreaks reported to the Swedish Food Agency (Livsmedelsverket) in 2020 and 2021 was affected by measures taken during the pandemic.

There were 251 reports of suspected or confirmed food poisoning outbreaks with 1,467 illnesses. Both the number of reports and the number of cases increased compared to 160 outbreaks and 1,314 cases in 2020 but are still lower than the historical average.

When several Coronavirus-related restrictions were lifted in the autumn of 2021, the number of cases increased. Sixteen major outbreaks occurred during this season.

Eleven people have been hospitalized in seven outbreaks and one person died during a Campylobacter epidemic which infected eight people.

Outbreak causes

For 213 reports and 843 cases, the cause was unknown. Bacteria were blamed for 26 outbreaks and 343 cases, followed by viruses in 12 events with 194 cases, and other agents such as histamine or lectins in seven reports with 52 cases.

Norovirus caused the most with 11 outbreaks and 189 cases, followed by Salmonella with eight outbreaks and 179 cases. Norovirus declined in 2021 but Salmonella rose.

Listeria was behind five outbreaks with 14 infections and Campylobacter caused five with 23 cases. Four outbreaks with 78 infections were due to Shiga toxin-producing E. coli (STEC). Cryptosporidium affected 23 people and one Yersinia enterocolitica outbreak sickened 16.

Four other outbreaks that also had cases in previous years were reported. In a Listeria monocytogenes outbreak, 17 people have been affected since 2019 with the source unknown. Tahini and halva have sickened 41 people since 2019.

Food categories with the most reported illnesses were vegetables with 210 cases and seafood such as oysters, mussels, and fish products with 151 patients.

Three histamine outbreaks were linked to tuna from Southeast Asia and frozen raspberries from Bosnia were behind one incident. A Salmonella outbreak was traced to alfalfa sprouts where seeds came from Italy and an outbreak caused by Yersinia enterocolitica was linked to iceberg lettuce from Spain. The Cryptosporidium outbreak was due to kale produced in Sweden.

In 55 percent of reports, and for 41 percent of the cases, the source of infection was food contaminated in facilities such as restaurants, cafes, or cooking kitchens in schools.

The top contributing factor was “infection/poor hygiene among staff”, which was started in 18 of 52 reports. This means people who handled food were carriers of infection or did not follow hygiene practices. The second most common factor was “wrong storage with respect to time and temperature”, which was listed in 15 reports.

Inspection results

Another report has found food controls are largely back to normal after a decline due to the peak of the COVID-19 pandemic.

Controls of food and food businesses involve several different authorities including the Swedish Food Agency, County Administrative Boards, and municipal control authorities.

The number of inspections in manufacturing, distribution, and sales have increased after the sharp drop during the pandemic in 2020. A larger percentage of high-risk facilities have also been inspected.

However, there are areas for improvement. For example, in primary production, local authorities did not reach the goal of 1,000 checks. In 2021, only 72 percent of such controls were carried out, down from 78 percent in the previous year.

There are still large differences in how often checks are undertaken and how detected deficiencies at food companies, producers, and distributors are handled by authorities. There are also agencies that finance food control in the wrong way, found the report.

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The Public Health Agency of Sweden (Folkhälsomyndigheten) said 101 cases of a certain type of Cryptosporidium parvum had been confirmed in 13 regions of the country.

Patients fell ill from Sept. 25 to Oct. 15 this year and women were more affected than men. Cases range from 4 to 86 years old with an average age of 42. 

Link to salad
The agency added there are another 99 potential cases being investigated. The type of Cryptosporidium parvum involved is common so there could be several possible sources. 

Local infection control units, the Swedish Food Agency (Livsmedelsverket) and Folkhälsomyndigheten investigated the increase in infections to find a source.

Analysis of information from patients on what they had eaten before becoming ill shows they ate mixed or bagged salad more often than a control group.

Salad has a short shelf life so health officials don’t think it is still available for sale but no products have been sampled.

Livsmedelsverket has looked into possible producers and growers but has been unable to find the likely source of infection.

As reported cases of Cryptosporidium have decreased and are at similar levels to previous years, officials believe the outbreak is over.

Salad was also linked to a national Salmonella Typhimurium outbreak that affected 102 people in September and October. Arugula, also known as rocket or rucola, and bagged salad mixes that included arugula were the likely source of infection.

Cryptosporidium in Finland
In October, health authorities in Finland also warned about a Cryptosporidium outbreak that was first noticed in Helsinki.

The Finnish Institute for Health and Welfare (THL) said those sick took part in an organized event at the end of September and since then there had been around 30 cases across the country.

Investigation work includes patient surveys, laboratory sampling, and food tracing. THL does not monitor the occurrence of cryptosporidiosis regularly so local health professionals play a key role in detecting and controlling outbreaks.

Cryptosporidium is a parasite that, if ingested, can cause cryptosporidiosis. Transmission occurs mainly through contact with contaminated water but can be via food or exposure to infected animals or water contaminated by the feces of infected animals. The risk of infection can be reduced by good hand hygiene.

The main symptom is watery diarrhea, which can range from mild to severe. It is often accompanied by stomach pain, nausea or vomiting, fever, and sometimes dehydration. Symptoms usually appear two to 10 days after infection and last one to two weeks.

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In 2018, a project was funded to examine the threats from criminal activity in the Nordic food production chain. Participating countries were Norway, Denmark, Iceland, and Sweden. Key topics were raw materials of animal origin, fish and seafood, declaration of Nordic origin, and of organic production.

In 2019, Denmark, Norway, and Sweden carried out national threat assessments. In Denmark, there has been a dedicated unit to manage suspected food fraud for years. In Sweden, the National Food Agency (Livsmedelsverket) has been working on an assessment at the central government level. Norway has few dedicated resources but has more inspectors partly specialized in the management of food fraud cases. Iceland has a relatively small market and few government resources.

An overall assessment of the threat uses reputation, financial loss, food safety, and consumer confidence on a scale of very low to very high.

Meat and seafood examples
Several different types of meat fraud have been discovered in Norway, including unlawful importation, theft, re-labeling of products, camouflaging poor quality and black market sales, and unlawful production. The food safety risk of meat fraud was judged to be moderate to high.

Denmark found home slaughter decreased considerably after a mobile unit focused on detection, destruction, recall, publication, and fines for participants. Sweden and Norway are particularly vulnerable to vehicle and ferry traffic from Eastern European and Baltic countries.

Two case studies were presented. One was an illegal abattoir found after tips from the public about sales of home-slaughtered pork before Christmas. Another involved meat sales at a car dealership. Empty packaging of chicken fillets from Brazil, beef from the Netherlands and Ireland, and lamb from New Zealand were found. Four freezers were hidden behind stacks of car tires, plastic tarpaulins, and car mats. A total of 230 kilograms of meat was seized.

For fish and seafood, the most common forms of fraud are species substitution, labeling related to geographical origin, undeclared additives, illegal additives to increase weight, forgery of documents, and the use of fake businesses and identities. The food safety risk was estimated as low to moderate.

There have been instances in Norway of online fraud. Websites claim to be Norwegian seafood producers and offer goods at favorable prices. They provide documentation that includes copied websites from real producers and stolen identities of people working in Norwegian seafood production, as well as falsified health certificates and customs documents. They request partial payment in advance before goods are shipped, the seller then vanishes and no goods are supplied.

Another case involved a company producing forged analysis certificates showing salmon were clear of Listeria when this was not the case. Authorization numbers assigned to a different company were used. The case led to the business going bankrupt. There have also been several cases relating to tuna in the EU. Tuna is colored red using additives such as nitrites, antioxidants, and carbon monoxide to make it appear fresh. If fish is stored at incorrect temperatures for too long it could pose a risk of histamine poisoning.

Product origin and organic authenticity
Fraud related to the origin of food is another area. Products labeled as coming from a Nordic nation are normally considered to have special characteristics. The motive may be a discrepancy between supply and demand or higher profits.

One company in Sweden sold foreign meat as Swedish and had inadequate Salmonella guarantees. An anonymous tip led to a firm in Denmark being fined for selling Brazilian beef as Danish. Another incident involved Canadian prawns sold as coming from Iceland. However, the case was dismissed due to procedural errors.

Nordic food authorities consider it easy to carry out fraud relating to organic foodstuffs. Just as with origin labeling, the tools needed are easy to obtain. Counterfeiting of traceability documents and certificates from supervisory bodies can be easy and the supply chain is complex. The large price difference between conventional and organic food may encourage fraud.

Swedish authorities discovered that one company had supplied organic fruit baskets containing conventional fruit to a number of large customers, including government agencies. It also had several branches that were not registered as food companies. The company was banned from selling organic food and was fined.

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In total, 102 people fell sick in the national Salmonella Typhimurium outbreak from Sept. 17 to Oct. 19.

Arugula, also known as rocket or rucola, and bagged salad mixes that included arugula were the likely source of infection, according to the Public Health Agency of Sweden (Folkhälsomyndigheten), but no specific brand or company was named.

Twenty of 21 Swedish regions were affected. Most cases were reported in Västra Götaland, Skåne, Värmland, Jönköping, and Halland.

Patients were aged 4 to 87 with an average of 48 years old and 64 were women. Most people fell ill in the second half of September.

Tracing the source
Regional infection control units and the Swedish Food Agency (Livsmedelsverket) helped Folkhälsomyndigheten try and find the source of infection.

This involved collecting information from confirmed outbreak patients about what they ate before falling ill using interviews, surveys and purchase receipts.

A case-control study was also conducted based on questions about suspect foods to find out to what extent the outbreak cases ate these in the week before they became ill compared to healthy control subjects.

Results showed that those who became ill in the outbreak had eaten arugula or a mixed salad that possibly included arugula more than the control group. These products have also been found on a number of purchase receipts held by patients from around mid-September.

However, the source has not been able to be confirmed via microbiological analysis of products.

Such products have a limited shelf life and the number of new reported illnesses has decreased since the start of October, so officials believe contaminated salad is no longer on the market.

The incident doesn’t appear to be connected to a recent Salmonella Typhimurium outbreak in Denmark. Officials believe the outbreak in Sweden was caused by a different source because the strains don’t cluster.

In Denmark, 15 cases were recorded between Aug. 15 and Sept 27. Patients were eight men and seven women aged between 4 and 84 years old, with a median age of 61. The source was not identified.

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A total of 61 people have been confirmed as being infected by the same certain type of Cryptosporidium parvum. These people fell ill from Sept. 25 to Oct. 10 and live in 10 different regions of the country.

Of confirmed cases, 41 are women and 20 are men. They are aged between 11 and 86 years old with an average age of 44.

There are another 98 possible infections that have been reported within the same period and some of these may also belong to the outbreak.

The Public Health Agency of Sweden (Folkhälsomyndigheten) said the increase is under investigation but could be caused by food with wide distribution in the country.

Local infection control units, the Swedish Food Agency (Livsmedelsverket) and Folkhälsomyndigheten are investigating the outbreak to identify the source of infection.

Cryptosporidium is a parasite that, if ingested, can cause cryptosporidiosis. Transmission occurs mainly through contact with contaminated water but can be via food or exposure to infected animals or water contaminated by the feces of infected animals.

The main symptom is watery diarrhea, which can range from mild to severe. It is often accompanied by stomach pain, nausea or vomiting, fever, and sometimes dehydration and weight loss. Symptoms usually appear two to 10 days after infection and last one to two weeks.

Salmonella outbreak looks to be ending
Meanwhile, a Salmonella Typhimurium outbreak has grown again with 84 people now affected, up from the 54 cases in mid-October.

The ill people fell sick between Sept. 17 and Oct. 6. They live in 20 of the country’s 21 regions.

Patients are between the ages of 4 to 87 with an average age of 48 years old. The majority are women with 52 cases.

Cases have been connected by whole genome sequencing of patient samples. This means they are suspected of having been infected by a common source.

Officials reported that the number of suspected and confirmed infections has decreased in recent days, indicating the outbreak is coming to an end. This, as well as the rapid start of the incident and wide geographic distribution of cases, means fresh food with a limited shelf life is suspected of having been the cause.

Work to identify a specific source is ongoing between regional infection control units, the Swedish Food Agency, and the Public Health Agency of Sweden.

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A total of 54 confirmed cases of Salmonella Typhimurium have been reported from 20 different regions in the country from Sept. 17 to Oct. 5.

Patients are aged between 8 and 86 years old; 31 of them are women.

Cases have been connected by whole genome sequencing of patient samples. This means they are suspected of having been infected by a common source, according to the Public Health Agency of Sweden (Folkhälsomyndigheten).

Local infection control units, the Swedish Food Agency (Livsmedelsverket) and Folkhälsomyndigheten are investigating the outbreak to identify the source of infection, which is suspected to be a food with wide distribution in Sweden.

Patient interviews to compile information about what those sick have eaten before falling ill are ongoing. Answers will be used to form a hypotheses about the source and compared to what people in a control group that are not part of the outbreak have eaten.

The incident doesn’t appear to be connected to a Salmonella Typhimurium outbreak that is ongoing in Denmark. Officials believe the outbreak in Sweden is caused by a different source because the strains don’t cluster.

In Denmark, 14 cases have been recorded between Aug. 15 and Sept 16. Patients are seven men and seven women aged between 4 and 84 years old, with a median age of 61. 

The Statens Serum Institut (SSI), Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food Institute are investigating to find the source of the outbreak.

About Salmonella
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the U.S. Centers for Disease Control and Prevention.

Anyone who has developed symptoms of Salmonella food poisoning should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions. Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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There are 12 hepatitis A infections from eating frozen berries in New Zealand. Eight have been linked by genetic sequencing, meaning they were likely exposed to the same source of the virus. Seven people have been hospitalized. The virus attacks the liver. The Ministry for Primary Industries (MPI) was informed by the Ministry of Health of three Hepatitis A cases in September.

Foodstuffs Own Brands has recalled various Pams brand frozen berry products because of a possible link to the hepatitis A cases. Products are being removed from New World, Pak’n Save and Four Square shops nationwide, and from Trents and Raeward Fresh stores in the South Island.

All batches and dates of Pams brand Mixed Berries 500-gram, Two Berry Mix 1-kilogram and 750-gram, Smoothie Berry Mix 500-gram, and raspberries 500-gram and 350-gram are involved.

Vincent Arbuckle, New Zealand Food Safety deputy director-general, said the agency was asking people to look in their freezers for the recalled product.

“People who have these products at home should not eat them raw. Bringing them to the boil will make them safe, or they can be returned to the place of purchase for a full refund. It is important to note the situation is still evolving and the picture could change. Our advice to all consumers in the meantime is to continue to exercise care and take extra precautions at home by heat treating frozen berries to kill the virus,” he said.

Hepatitis A is relatively rare in New Zealand with the 12 cases so far accounting for half of the reported infections in the country this year. New Zealand is heading toward the summer months when more frozen berries are likely to be consumed.

Suspicion falls on frozen berries from Serbia
The virus in New Zealand is a genetic match to one which caused illness in Sweden in 2020 and 2021.

“That illness had a possible link to frozen berries from Serbia. The recalled products contain berries from Serbia and were reported as eaten by most of the people who have become sick. We were able to identify the recalled products by matching the onset of the illness with the food history reported by the cases,” said Arbuckle.

“Tracing the illness back to specific products in the case of frozen berries from imported sources is widely accepted to be a very challenging process. The 12 cases report eating a range of berries. In addition, hepatitis A has a long incubation period — up to 50 days between consumption of the product and symptoms appearing.”

Product testing by the Institute of Environmental Science and Research (ESR) has not yet identified any hepatitis A virus.

Other frozen berry importers have placed on hold products that can be traced back to Serbia while the investigation continues.

“These products have a weaker link to the cases and contain fewer berries from Serbia. We support the importers’ voluntary decision to place them on hold from sale while our work to identify the source of infection continues. It is an imposition for them, but like us, they have prioritized the safety of consumers,” said Arbuckle.

Hepatitis A virus is inactivated by heating to above 85 degrees C (185 degrees F) for one minute. Washing frozen berries will not destroy the virus. 

The virus is spread when someone ingests the virus through close contact with an infected person or by having contaminated food or drinks. Symptoms include inflammation of the liver, fever, low appetite, nausea, vomiting, diarrhea, muscle aches, and yellowing in the whites of the eyes and the skin (jaundice).

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An opinion article in Svenska Dagbladet said unpasteurized, raw milk is almost impossible to buy in Sweden and the regulations are an example of when state control has good intentions but negative consequences.

Ann-Helene Meyer von Bremen and Martin Ragnar said the rules place too much emphasis on the risks and not enough attention is given to the benefits.

In Sweden, unpasteurized milk cannot be bought in shops but it can be sold or given away from farms directly to the consumer. Farms that want to sell unpasteurized milk must register with their local authority.

Once registered, they can sell up to 70 liters of unpasteurized milk per week to the public. Written information must be provided to consumers saying milk is unpasteurized and that it may contain harmful bacteria. The recommendation is that milk should be boiled or used in dishes that are heat treated before consumption. Children and people with weakened immune systems should not drink the milk without prior heat treatment.

Authority’s view
In reply to the article, Mats Lindblad, from Livsmedelsverket, said it is not true that there is a low risk from drinking unpasteurized milk, as it can contain several different types of bacteria that can make people sick.

E. coli, a bacteria sometimes found in cows, was given as an example. It can have very serious consequences as infection can damage the kidneys of young children and lead to death in severe cases.

One of the main aims of Livsmedelsverket is to ensure that consumers do not get sick from food. Sale of unpasteurized milk is regulated and this is cited as a likely explanation for so few related illnesses in recent years.

The agency said it had looked at both the benefits and risks of drinking unpasteurized milk, acknowledging studies on vitamin content of milk before and after pasteurization and a reduction in allergies in children who grew up on farms. Overall, the assessment is that the risks of unpasteurized milk outweigh any benefits.

Meanwhile, Livsmedelsverket has revealed it closed a company earlier this month due to poor hygiene conditions.

Al Hana Mejeri AB has also been banned from selling food. All food manufactured or sold by the company must be removed from stores and disposed of. People who have any affected items at home were told not to consume them. Items are labeled as Al Hana Mejeri.

The company primarily manufactures dairy products such as yogurt and cheese but also offered items including olive oil. Most products were sold to stores in Skåne, but they may also have been passed on to other companies.

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An investigation into the incident in Gammelstad on Aug. 5 revealed people fell ill after eating spaghetti bolognese from a restaurant in the city of Luleå.

An investigation by officials from Luleå Municipality to determine the cause included studying the symptoms of those affected, interviewing patients, visiting the food company and sampling leftovers.

Food had been prepared at a restaurant the day before the event and stored in a refrigerator. On Aug. 5, it had been reheated for transporting to and serving at the tournament.

Bacillus cereus and Staphylococcus aureus
Testing of the bolognese left at the restaurant was found to be satisfactory. Samples were also taken in Gammelstad where serving took place. High levels of bacteria were detected in the pasta, plus the presence of toxins that can cause food poisoning. Food had been left at room temperature for some time after serving, which provided an opportunity for bacterial growth.

Bacillus cereus and Staphylococcus aureus were found in the pasta meal. Symptoms experienced by those sick matched what would be expected with such contamination.

Staphylococcal food poisoning is caused by eating foods contaminated with toxins produced by the Staphylococcus aureus bacteria. If this bacteria ends up in food that is stored at the wrong temperature for too long, it can multiply and form a heat-resistant toxin that can make people sick.

Based on the short period from when food was delivered to people eating it, officials said it was likely that bacteria were present before delivery. However, from information provided by the restaurant it was not possible to pin down how such bacterial and toxin growth occurred.

To increase knowledge about such outbreaks, follow-up analyses will be carried out at Livsmedelsverket (the Swedish Food Agency) and further controls of the business will be done by authorities.

Histamine in fish again
Meanwhile, 20 people fell sick recently in Sweden due to histamine levels in fish. The foodborne outbreak was linked to tuna from Vietnam.

In April 2021, 19 people were affected by histamine poisoning in Stockholm after eating tuna loins from Vietnam at three different restaurants.

In 2020, there were three outbreaks of histamine poisoning in tuna from Vietnam in three months. These incidents affected about 60 people but contaminated tuna came from different batches. Patients were from different areas in southern and central Sweden.

Onset of histamine food poisoning symptoms can range from minutes to several hours following ingestion of the toxin. Typically, the average incubation period before illness is one hour.

The most common symptoms of histamine, also known as scombroid fish poisoning, are tingling or burning sensation in the mouth, facial swelling, rash, hives and itchy skin, nausea, vomiting or diarrhea. They usually resolve within several hours without medical intervention.

Production of histamine is related to mishandling of food because of storage at incorrect temperatures. Once produced, histamine cannot be eliminated by normal cooking or freezing temperatures.

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This suggests that the broiler prevalence two weeks earlier can partly explain domestic Campylobacter infections with transmission via handling and consumption of fresh chicken meat. 

However, there is no simple relationship between prevalence in chickens bred for meat and patients. Additional factors also need to be evaluated to understand the transmission routes and epidemiology of campylobacteriosis, said the study published in the International Journal of Food Microbiology.

The research explored the relationship between the proportion of Campylobacter positive broiler batches and the number of reported domestic human cases in Sweden.

Scientists applied two approaches for analyzing time series data using weekly, bi-weekly or monthly data of human campylobacteriosis cases and prevalence of Campylobacter in broiler slaughter batches in Sweden between 2009 and 2019. Both data sets revealed a clear seasonality and a variation between years.

One model showed a close overlap in seasonal patterns in terms of timing and the proportional change of peaks from normal yearly levels.

Swedish situation
In Sweden, slaughter of broilers is concentrated to a few slaughterhouses and the four largest cover 97.2 percent of all birds slaughtered. Increased demand has led to changes in production such as the introduction of thinning, shorter empty periods between rounds of broiler batches in primary production, and slaughtering during several shifts at the slaughterhouse.

The annual prevalence of Campylobacter in sampled slaughter batches has ranged between 2009 and 2019 from 5 to 15 percent, but there is seasonal variation with the highest rates in late summer and lowest during the winter months. There is also a wide variation in prevalence in batches from different producers, from virtually never to up to 30 percent of flocks.

An analysis was also done for a subset of the data not covering 2014 to 2018, when several national outbreaks occurred. 

The inability of either model to capture and predict the extended period with a high number of cases during 2016–2017 indicates that increased broiler prevalence alone cannot explain the rise in human cases. These findings highlight the need for data of Campylobacter in broiler meat, and genomic comparisons between isolates from humans and broilers, said researchers.

It is reasonable to expect a lag between broiler prevalence at slaughter and identification of human cases given the time between sampling of slaughter batches, the time meat is on display at retail, the shelf life of fresh broiler meat, the incubation period for Campylobacter infections and the time between onset of illness and visiting a physician.

The sampling date of broilers is in most cases the same day as slaughter, poultry products reach the retail market three to four days later, and the shelf life of fresh meat is about 10 to 11 days after slaughter.

Assuming fresh broiler meat is consumed on average seven days after slaughter, that the incubation period range is 1 to 10 days with a median of three days and the median time between onset of disease and testing is four days, this would result in a median two week lag between sampling of broiler batches and human cases, which is in agreement with the study’s results.

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In late September 2019, the Public Health Agency of Sweden (Folkhälsomyndigheten) identified a cluster of nine patients with Salmonella Newport infections. By the end of October, there were 25 cases with onset of disease from mid-August to mid-October.

At the start of the investigation, several patients said they had eaten crayfish. This was, however, not unexpected since crayfish feasts are a traditional celebration in Sweden in August and September. They are typically served cold, and frozen pre-cooked crayfish are ready to eat after thawing, without reheating.

Positive product sampling
A case–case study was done based on notified salmonellosis cases and a Salmonella trawling questionnaire, comparing 20 outbreak and 139 control cases. Outbreak patients were more likely to have consumed crayfish, according to the study published in the journal Eurosurveillance.

Based on additional work and the open-ended questions in the trawling questionnaire, one brand of frozen, pre-cooked whole crayfish in dill brine imported from China was identified as the source.

Results of the epidemiological investigation were communicated to ICA, the retail company selling the specific brand of crayfish in dill brine on Nov. 8. The retailer recalled all remaining packs. From these, with production dates from Nov. 30 to Dec. 4, 2018, they analyzed 84 samples from different batches. 

Salmonella Newport was detected in six samples from batches with best-before dates Dec. 1 and 2, 2021, respectively. It was also found in the same brand of crayfish in dill brine in follow-up sampling at a border control post with a best-before date of Dec. 12, 2021. Isolates from food samples clustered with the human outbreak strain by WGS.

It is not known how the product was contaminated. Salmonella has been detected in wild crayfish and it is possible that they were undercooked. However, since Salmonella was found in two batches, indicating a persistent contamination, it is more likely that product was contaminated after cooking, by adding contaminated dill or by environmental contamination during preparation, according to the study.

Two cases after recall
In total, 33 cases were confirmed, with onset of symptoms between July 31 and Nov. 2, 2019. They were distributed among 12 of the 21 counties in Sweden, with between one and eight cases in each region. Sick people ranged in age from 1 to 82 years old and 20 were female.

Two other sick people with the outbreak strain were identified in 2020 and 2021. The case in 2020 had eaten crayfish from one of the recalled batches in 2019, but the ill person in 2021 claimed not to have eaten crayfish before disease onset.

“This demonstrates the difficulty of completely removing the risk associated with contaminated foods with long best-before dates, as the chance of connecting a food in the freezer with a recall, or news of an outbreak, decreases over time,” said researchers.

No other European countries reported an increase in Salmonella Newport.

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The report by the National Veterinary Institute (SVA), Folkhälsomyndigheten (the Public Health Agency of Sweden), Livsmedelsverket (the Swedish Food Agency) and Jordbruksverket (Swedish Board of Agriculture) showed a rise for Campylobacter, Salmonella, Listeria, E. coli and Yersinia infections.

Disease surveillance relies on patients seeking care and fewer people have done this during the pandemic. This is believed to be related to patients with symptoms choosing to not seek care and a true reduction in disease incidence because of changes in general hygiene such as increased handwashing, physical distancing and reduced travel because of COVID-19-related recommendations, according to the agencies.

Rise in Campylobacter cases and Salmonella outbreaks
A total of 4,059 cases of campylobacteriosis were reported in 2021 and 3,025 were domestic compared to 3,434 cases overall in 2020.  

Incidence of domestic cases in 2021 increased by 23 percent from the year before. The rate of travel-related cases was at a record low, which makes the overall incidence the second lowest since the reporting system was introduced in 1997.

A large increase in people infected with Campylobacter was noticed in June with a peak in July-August. Also, in the surveillance program for chickens, a higher prevalence was noted from July through October. Most cases have been considered sporadic, but recent work has found many are part of outbreaks, which are often linked to poultry meat.

A total of 946 cases of salmonellosis were reported, compared to 826 in 2020 and 1,993 in 2019. Domestic cases increased from 422 in 2020 to 722 in 2021.

The most common types in domestic patients were Salmonella Enteritidis, monophasic Salmonella Typhimurium and Salmonella Typhimurium. Another 60 different serovars were identified in 2021.

Eleven outbreaks involving 10 or more cases were recorded, up from 2020 when only two such outbreaks occurred. These outbreaks accounted for 293 of the 722 domestic infections.

An outbreak of Salmonella Enteritidis linked to chocolate wafers was investigated where 19 of 34 cases were younger than 10 years old. The outbreak strain was identified in two of 22 analyzed samples of products from cases’ homes. Neither the company that made the wafers nor the control authority could find any Salmonella in the production line or the product.

Salmonella Coeln affected 53 people with sprouts as the suspected source and Salmonella Dublin has sickened 22 people between September 2019 and the end of 2021.

Sweden had 48 cases in the multi-country Salmonella Braenderup outbreak linked to melons from Honduras and 42 cases linked to six serotypes and eight different strains of Salmonella in the outbreak from tahini and halva produced in Syria.

More E. coli and Listeria cases recorded
In 2021, 653 cases of E. coli were reported and 530 were domestically acquired, compared to 491 overall cases in 2020.

STEC-associated Hemolytic Uremic Syndrome (HUS) was reported in 24 cases of which 23 were domestic infections in 2021. 16 HUS cases were children younger than 10.

In total, 80 different serotypes were identified. The most common types were O157:H7, O103:H2 and O26:H11.

Three outbreaks had cases spread across the country where the source was suspected to be food, but no source could be identified. Two were O157 and one was O103.

In total, 107 Listeria infections were reported compared to 88 in 2020. The median age was 78 and as in previous years, most cases were in the over 80’s age group. A total of 21 people died within one month of diagnosis.

In 2021, five cases of Listeria monocytogenes were linked to a cluster of 14 cases in Belgium. They were reported between 2014 and 2021 and the outbreak strain was detected in salmon from Norway. For Swedish cases, salted non-heat-treated salmon was the suspected source of infection.

The source of an outbreak with two cases was traced to a meat plant. One person had eaten a locally produced sausage. The outbreak strain was found in samples from equipment and processing areas. One cluster included 10 cases from 2021 and eight from 2019 but a source was not found.

Another case was linked to a local cheese. A sample of washed rind cheese from the refrigerator of the patient was positive for the outbreak strain. Cheese was made from pasteurized milk, but analysis of cheese and environmental samples from the dairy showed the premises was contaminated by the outbreak strain and it was isolated from a washed rind and a semi-hard cheese.

Yersinia, Cryptosporidium and Brucella
During 2021, 313 Yersinia infections were reported with the majority falling sick in Sweden versus 220 cases in 2020.

Sixteen people were ill after eating iceberg lettuce at a restaurant chain in early 2021.

A total of 524 cryptosporidiosis cases were recorded. Most people were infected in Sweden but 83 fell sick abroad. A total of 42 domestic cases were reported in January because of an outbreak that had vegetables as the suspected source.

In January, several illnesses were detected in a retirement home followed by cases in March among students and staff at two different schools in Jönköping county. Fourteen cases were positive for Cryptosporidium parvum. Kale and cabbage were suspected as the probable cause of infection. Kale was positive for Cryptosporidium parvum. Fecal matter from rodents and deer at the farm was sampled, but the source of contamination of vegetables was not established.

In 2021, 10 cases of brucellosis were reported. Patients had an age range of 25 to 78 years old and four were female. Two people acquired the infection in Iraq, two in Somalia, one in Afghanistan and one in Ethiopia and for three country of infection was unknown. For five cases, unpasteurized dairy products were the likely source of infection.

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A summary of the epidemiological annual report for 2021 shows that foodborne diseases, such as Campylobacter and Salmonella, increased slightly compared with 2020 but the number of cases was still down on levels before the pandemic in 2019.

Figures for several infectious diseases continued to be at low levels during 2021 but the role of Coronavirus measures were not as clear as in 2020.

In 2021, fewer cases of notifiable infectious diseases were reported than before the pandemic, but the difference was not as large as it was in 2020.

Impact on foodborne diseases
Yersinia, E. coli and Hepatitis A increased compared to 2020, while Shigella cases were unchanged.

The decrease was largely due to the continued low number of people infected abroad, according to the report. For Cryptosporidium, infections decreased for the second year in a row, while the situation was stable for Listeria.

Detailed annual reports on each disease will be published later this year.

There were more than 4,000 Campylobacter infections in 2021, compared to almost 3,500 in 2020 and 6,700 in 2019. Almost 950 Salmonella infections were reported in 2021 versus 826 in 2020 and nearly 2,000 in 2019.

The number of E. coli infections went up to 653 in 2021 from 491 in 2020 but decreased from 755 in 2019. A total of 313 Yersinia cases were recorded in 2021, 221 in 2020 and 393 in 2019. In 2021, 107 Listeria infections were noted compared to 88 in 2020 and 113 in 2019.

“There is probably an effect of infection control measures against COVID-19 and changed behaviors, but the connections are complex. We will see an increase in infectious diseases when people meet more and more people travel abroad,” said state epidemiologist Anders Lindblom.

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Nearly 100 people are thought to be affected in the United Kingdom, Ireland, France, Germany, Sweden and the Netherlands. Italy is also checking if some of its analytical results are connected to the monophasic Salmonella Typhimurium outbreak.

The UK has the most infections with 57. Those sick have sample dates between December 2021 and March 2022, with the majority confirmed between February and March.

All cases are 18 years old or under, with around 60 percent under the age of 5. There are more females than males sick. At least nine patients linked to the outbreak were hospitalized but no deaths have been reported.

Link to Ferrero product
Dr. Lesley Larkin, surveillance lead, gastrointestinal pathogens and food safety (One Health) at the UK Health Security Agency, said: “We are investigating a number of cases of Salmonella that have occurred across the UK alongside the Food Standards Agency and Food Standards Scotland and in conjunction with Public Health Scotland, Public Health Wales and Public Health Agency Northern Ireland. Information gathered from those affected and microbiological data from whole genome sequencing has identified that the cases are linked.”

The Food Standards Agency and Food Standards Scotland are advising consumers not to eat certain Kinder products with best before dates between July, 11 and Oct. 7, 2022. Selected batches of Kinder Surprise 20-gram and 20-gram x 3 pack are implicated and were manufactured in Belgium.

Investigations have found a link between cases of Salmonella across the UK and a product made by Ferrero.

Tina Potter, FSA head of incidents, said it was important that consumers follow the agency’s advice to avoid the risk of being ill due to Salmonella.

“We know that these particular products are popular with young children, especially as Easter approaches, so we would urge parents and guardians of children to check if any products already in their home are affected by this recall. The food business involved has voluntarily carried out this product withdrawal and recall and we are working closely with them and their competent authorities to identify the precise cause of this outbreak,” she said.

Wider EU situation
Initially, a Rapid Alert System for Food and Feed (RASFF) notification was published by the European Commission but this was later removed from public view while member states investigated the incident. It revealed France had 17 patients, Germany had six, Sweden had four, and the Netherlands had two.

Information from the European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA) had suggested a multi-country foodborne outbreak was caused by chocolate products.

The Food Safety Authority of Ireland (FSAI) and Health Protection Surveillance Centre of the Health Service Executive (HSE) are investigating the ongoing food poisoning outbreak. Ireland has recorded 10 cases with the same strain of Salmonella responsible for the UK outbreak. A number of these involved young children, whom have recovered.

Before the link was made to Ferrero, an ECDC spokesperson told Food Safety News that the majority of cases were below 18 years old and some of them had been hospitalized. Chocolate was suspected due to findings from patient interviews.

A spokesman for INFOSAN told Food Safety News that it was part of the incident as it involved a non-EU country, which was the UK, and Salmonella in a ready-to-eat food.

“We have been informed of the Salmonella outbreak in the UK on March 27 via WHO internal channels and surveillance partners. The INFOSAN Secretariat is in the process of gathering more information on further international distribution and the source of the outbreak,” he said.

Ferrero has issued a product withdrawal and recall whilst investigations continue.

In a statement, the company said none of its Kinder products released to market have tested positive for Salmonella, and no consumer complaints have been received.

“We are working with retailers to ensure that these products are no longer available for purchase. If you have one of these products, you are advised not to consume it. We take food safety extremely seriously and we sincerely apologize for this matter.”

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An outbreak with 15 cases of salmonellosis after a lunch at a hotel restaurant was investigated by the local food safety authority and the regional public health agency in Jämtland Härjedalen.

The Salmonella Enteritidis outbreak occurred among students and teachers from the Fjällgymnasiet high school during a ski competition in northern Sweden.

Based on information from 11 patients, the first date of illness onset was Jan. 28 and the last was Feb. 4. The age range was 17 to 57 years old with a median age of 19. Ten of those sick were male and one was female, all of them were from northern Sweden.

All sick people had a common meal where ground (minced) meat burgers were consumed. Some of those who ate the lunch reported that the burgers were clearly undercooked.

After finding Salmonella in samples of ground meat, further tracing of the implicated batch of frozen beef and pork meat was performed by local authorities, which revealed it came from Poland.

Salmonella was found in three of six meat samples but there is no ongoing risk of people getting sick as the implicated batch was only distributed to restaurants and has now been withdrawn.

About Salmonella
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has developed symptoms of Salmonella food poisoning should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions. Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.

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