Almost 3,000 people fell ill and nearly 350 were hospitalized in 30 produce-related outbreaks over a six-year period in Brazil, according to researchers.

The study published in Food Quality and Safety identified foodborne outbreaks associated with fruit and vegetable consumption in Brazil from 2008 to 2014. They resulted in 2,926 illnesses, 347 hospitalizations, and no deaths.

Salmonella was the most frequent in causing disease (nine outbreaks) followed by Staphylococcus aureus (seven), E. coli (three), Bacillus cereus (two), and thermo-tolerant coliforms (one). For eight outbreaks the pathogen responsible could not be determined.

The most common food vehicles implicated were generically named as fruits and vegetables (46.6 percent of outbreaks). The term salad was used generically and specifically like salads (two outbreaks), raw/cooked salads (four outbreaks), vegetable salad, tropical salad, Caesar salad, and a raw salad of cabbage and tomato.

Only one outbreak was related exclusively to fruit (fruit pulp), whereas others were linked to cooked carrot, lettuce, cucumber, watermelon/cabbage, and chard/beet.

In Brazil, one of the best-known education tools to help people follow a healthy diet is the Food Guide for the Brazilian Population, which recommends eating three to six servings of fruits and vegetables per day (totaling 400 g/day).

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Available annual summary data on reported foodborne outbreaks in Brazil from 2008 to 2014 from the National Sanitary Surveillance Agency (ANVISA) were examined.

The number of notified food and water-borne outbreaks in Brazil between 2008 and 2014 was 5,138. The 30 foodborne outbreaks linked to fruit and vegetables represented 0.6 percent of the total and a yearly average of 4.3 outbreaks.

This average was similar to Canada and New Zealand, which reported yearly averages of three (2001-09) and 5.5 (2002-12), respectively, for outbreaks linked to produce contamination. Corresponding values for Japan and the United States between 2002 and 2012 were higher, with yearly averages of 7.7 and 56.9, respectively (Kozak, et al., 2013; Wadamori et al., 2017).

Researchers said in the majority of foodborne outbreaks in Brazil it is not possible to identify the related food (66.4 percent the food source was ignored or inconclusive).

In 2008 and 2009, 17 outbreaks occurred compared to between 2010 and 2012 when only one in each year was registered.

On average, each outbreak consisted of 100 cases with the largest in 2009 involving 550 infections.

Job refectory (dining rooms) and restaurants/bakeries were the places where contaminated food was most often consumed (seven each). Followed by outbreaks associated with more than one place (five) and the hospital/health units and residences (three each).

The age group from 20 to 49 years old had the most patients.

“This is the age range of the more economically active population, which usually takes meals outside the home, and, perhaps, is the reason why most outbreaks also occurred outside the home,” said researchers.

Probable causes of outbreaks were mostly inadequate storage and handling. Only one was related exclusively to contaminated raw material and was caused by a salad with E. coli

Although there is no way to eliminate microbial foodborne pathogens from fresh produce, there are methods to reduce them, which include physical (brushing, rinsing), chemical (hypochlorite, acidified sodium chlorite, chlorine dioxide, trisodium phosphate, quaternary ammonium compounds, acids, hydrogen peroxide, and ozone), and biological (using microbial antagonists as a biocontrol agent).

Researchers said as the global trend is to increase consumption of fruits and vegetables, it is important to adopt control measures, such as good agricultural and manufacturing practices.

“Efforts should be made to improve the outbreak notification and investigation system and the laboratory capabilities so that biological and food samples may be collected in a timely and correct manner to identify the etiological agent. Also, quantitative data on microbiological hazards in foods are needed if risk assessment programs are to be implemented,” they added.

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