Almost 400 foodborne outbreaks occurred in Germany last year, according to a report. Most outbreaks with high evidence were caused by raw milk.

A total of 389 outbreaks involved at least 2,277 illnesses, 412 hospitalizations and four deaths. Salmonella was implicated in two deaths and Verotoxin-producing E. coli (VTEC) and Hepatitis A virus in one each.

Almost three-quarters of the outbreaks were caused by Campylobacter spp. and Salmonella.

The number of outbreaks is down slightly from 397 in 2016, while illnesses fell from 2,508 but hospitalizations rose from 256. The amount of associated deaths stayed the same.

Data on foodborne outbreaks in Germany are collected by local health and food safety authorities and transmitted to the Robert Koch Institute (RKI) or the Federal Office of Consumer Protection and Food Safety (BVL). The nationwide system for collecting data on foodstuffs involved in disease outbreaks is called BELA.

Campylobacter accounted for the largest proportion of outbreaks with 38 percent. They were most commonly caused by the consumption of untreated raw milk. As in the previous year, Campylobacter and raw milk were the most frequently reported combination of pathogen and causative food.

Other causes of outbreaks were Salmonella with 34 percent, Norovirus with 5 percent, VTEC at 3 percent, Hepatitis A and Hepatitis E virus both with 2 percent, Giardia Lamblia at 2 percent and Staphylococcus aureus and Bacillus cereus both with 1 percent.

Outbreaks were also caused by Clostridium perfringens, Ciguatoxin and histamine. In 7 percent of them the pathogen or agent remained unknown.

A total of 49 of the 389 outbreaks were classified as high-evidence according to European Food Safety Authority (EFSA) criteria. These outbreaks considered a causal relationship between a food and the cases to be likely.

A high level of evidence was found in 27 outbreaks from detection of the pathogen or virus in the food or its ingredients. In 21 outbreaks, the descriptive epidemiological evidence was considered enough without detection of a pathogen in the food and in two outbreaks, the association between disease and a suspected food could also be established through an analytical epidemiological study.

In addition to raw milk, foods linked to outbreaks included pork, meat, fish, bakery products, egg products and cereals. Re-occurring pathogen and food combinations included Salmonella in tiramisu, Clostridium perfringens in goulash and histamine in tuna.

Foods causing the high level evidence outbreaks were consumed mostly at home, followed by catering such as restaurants and hotels and at farm level.

The outbreak with the most cases, 126, was caused by norovirus. Patients had consumed bread and rolls from a bakery. While it was not possible to detect it in samples, the descriptive epidemiological evidence suggested that transmission could have occurred from an infected bakery employee via delivered food.

The second largest, with 102 cases, occurred in two restaurants supplied by a hotel kitchen. The outbreak was caused by Clostridium perfringens which was detected in samples of goulash.

The third largest with 72 infections was caused by Salmonella Typhimurium. A survey of sick people pointed to raw sausage products and Thüringer Mett (minced pork eaten raw) traced back to a slaughterhouse. The pathogen was detected in food, the environment and patients.

A country wide outbreak of VTEC O157, which led to 15 cases and one death, was linked to mixed minced beef (beef and pork). Two nationwide salmonellosis outbreaks were caused by Salmonella Kottbus. In one, a strong link was found between infection and consumption of smoked ham. In the other, quail eggs were identified as the probable cause.

Produce testing
Meanwhile, in summer this year, the BVL warned about microbial contamination of fruits and salads if they are not kept in the refrigerator and stored correctly. As part of a risk-oriented nationwide surveillance plan 745 samples of prepackaged sliced fruit were tested for various microorganisms in 2016.

Mold was most frequently detected in 135 out of 737 samples at levels above recommendations of the German Society for Hygiene and Microbiology. Warning values for enterobacteria were exceeded in some samples indicating good hygiene practices were not followed. E. coli was detected in five of 745 samples, two of which exceeded the society’s guidelines.

In two out of 700 samples the guideline values for coagulase-positive staphylococci were exceeded but Salmonella was not found in any of the 632 fruit samples analyzed.

BVL said there is a risk of contamination from cultivation to packaging with salads and fruit as they are eaten raw and do not undergo any production step capable of killing microorganisms. It advised consumers to look out for curved packaging, color loss or brown spots, keep produce in the fridge and stick to the expiry date, eat quickly once opened and dispose of items left uncooled for a long period of time.

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