The number of people getting sick, being hospitalized and dying in foodborne outbreaks in Europe increased in 2018, according to the annual report on zoonoses.

Salmonella caused almost one in three outbreaks last year with Salmonella Enteritidis behind one in five. Salmonella in egg products was the highest risk agent and food pair based on data published by the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC).

Zoonoses are infectious diseases spread between animals and humans and can be caused by microorganisms such as bacteria, viruses, fungi, and parasites.

Most outbreaks reported by France
In 2018, 5,098 foodborne outbreaks were reported with 48,365 illnesses, 4,588 hospitalizations and 40 deaths. Although fewer countries reported compared with 2017, the total increased with an additional 67 outbreaks and 5,067 cases.

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Illnesses increased mainly due to 1,981 more outbreak-related cases caused by Salmonella than in 2017, there were 1,957 more norovirus cases, 1,236 more bacterial toxins other than Clostridium botulinum reports and 890 more Campylobacter cases.

Also, the number of hospitalizations went up by 47 and seven more deaths were recorded, mainly due to an increase in listeriosis outbreaks compared to previous years. Listeria monocytogenes was responsible for 21 deaths, Salmonella for eight, bacterial toxins such as Bacillus cereus, Clostridium botulinum, Clostridium perfringens, and others for six. Three were caused by mushroom toxins or mycotoxins and two due to norovirus.

France reported almost a third of the outbreaks with 1,629, Slovakia had 804, Spain recorded 622, Poland with 522, Germany had 416, Belgium had 397 and Italy with 134. The number of cases per outbreak reported ranged between two and 1,026. Slovakia, France, Spain, and Belgium reported many more outbreaks last year than 2017 while Sweden and Croatia had much lower numbers.

For about one in four foodborne outbreaks the causative agent was unknown. Food vehicles implicated in 700 strong-evidence outbreaks were mostly of animal origins such as egg, meat or fishery products.

Also, 143 outbreaks, 2,343 cases of illness and 213 hospitalizations were recorded by Bosnia and Herzegovina, Iceland, Montenegro, Norway, Republic of North Macedonia, Serbia and Switzerland. Slovenia said there were no outbreaks in 2018, while Luxembourg and the Netherlands did not report data. In 2017, the Netherlands recorded 665 outbreaks and almost 3,000 illnesses.

Salmonella and egg risk remains
Salmonella in eggs and egg products was the highest risk agent and food pair followed by bakery products and mixed food, as in previous years. Salmonella Enteritidis outbreaks increased by 36.3 percent from 2017 mostly due to Slovakia which had 231 more than the previous year.

Salmonella in eggs remains one of the most common risks of food poisoning for EU consumers. Eggs and egg products accounted for 45.6 percent of strong-evidence salmonellosis outbreaks. In 2018, 121 egg-borne salmonellosis outbreaks were recorded involving 1,801 illnesses, 341 people hospitalized and two deaths.

Among the 1,229 Salmonella outbreaks with information on serovar, Enteritidis was top with 84.1 percent of outbreaks, followed by Typhimurium which caused 9 percent and monophasic Typhimurium, Newport and Infantis.

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In total, 1,580 foodborne and one waterborne outbreak of salmonellosis were reported by 24 EU member states in 2018. Salmonella caused almost one in three of all outbreaks, compared to a quarter of them in 2017, with 11,581 cases last year, which was an increase of 20.6 percent versus 1,241 outbreaks and 9,607 cases in 2017.

Salmonella outbreaks also caused the most illnesses with 23.9 percent of all outbreak-related infections and 50.1 percent of all outbreak-related hospitalizations. It was the leading cause of outbreaks in 14 countries. Poland, Slovakia, and Spain accounted for 67 percent or 1,581 outbreaks. Poland and Slovakia reported significantly increasing salmonellosis outbreaks from 2014 to 2018.

Of the 1,580 outbreaks, 540 with 1,872 cases were reported by Slovakia, 289 with 2,153 sick by Poland, 229 with 1,829 ill from Spain, 172 with 1,019 cases in France and 128 with 724 infections in Germany.

A large multi-country outbreak of Salmonella Enteritidis linked to contaminated eggs from Poland was confirmed in 14 countries in 2016. Poland implemented control measures and cases declined in 2017 but increased again at the end of the year. It is likely this outbreak had existed since 2012 and was ongoing during 2018. An update will be provided by EFSA and ECDC early next year.

There was a substantial increase in Salmonella Coeln infections in the EU in the last two years. Austria, Croatia, Czech Republic, Germany, and Slovakia had a rise in 2018 compared with previous years. Investigations of a possible multi-country outbreak are ongoing.

In total, 522 foodborne and two waterborne campylobacteriosis outbreaks with 2,335 cases were reported compared to 395 outbreaks with 3,608 infections in 2017.

Of the 524 outbreaks, Slovakia reported 202 with 448 people sick, Germany 170 with 449 cases and France 52 with 383 people ill.

Campylobacter was identified in 29 strong-evidence and 495 weak-evidence outbreaks with 135 hospitalized and no deaths. Of strong-evidence outbreaks, 10 originated from milk and 10 from broiler meat, meaning these categories remain the most frequently reported food causing campylobacteriosis.

Campylobacter jejuni was reported for 273 outbreaks and Campylobacter coli for 18. Campylobacter was the top cause of outbreaks in Austria and Germany with numbers slightly increasing in 2018. Large outbreaks of more than 100 illnesses were reported in Hungary, France, and Sweden.

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Listeria and STEC outbreaks
In 2018, 14 listeriosis outbreaks causing 158 cases were reported compared to 10 outbreaks with 39 cases in 2017 and six outbreaks with 27 cases in 2016.

Germany recorded four outbreaks with 40 illnesses, Denmark had three with 14 ill, the U.K. had two with 17 sick and Austria and Finland both had one with 30 cases.

Denmark, Finland, and the U.K. reported 46 cases including five deaths related to the multi-country outbreak from 2015 to 2018 of Listeria monocytogenes ST6 linked to frozen vegetables.

The category ‘vegetables and juices and other products thereof’ caused the most outbreaks with two being strong evidence in 2018.

In total, 43 foodborne and five waterborne STEC outbreaks with 381 cases were reported in 2018. The number of outbreaks was the same as in 2017 but only 260 fell ill in that year.

Nine were associated with STEC O157, eight with STEC O26, two each with STEC O103 and O145 and one with STEC O111.

Denmark had two outbreaks with 46 people sick, France had 15 with 55 cases, Germany nine with 48 illnesses, Sweden had four with 139 cases and the U.K. had two with 55 infections.

Two strong-evidence outbreaks were caused by cheese while milk, other or mixed red meat and products thereof and vegetables and juices and other such products all caused one.

Trichinella, norovirus, and others
Trichinella caused 10 outbreaks with 114 cases including 76 hospitalizations in two countries compared to 11 with 199 cases in 2017.

Six were reported by Romania and four from Bulgaria. Five in Romania involved 60 people who needed hospitalization due to Trichinella spiralis. A sixth in Romania was caused by Trichinella britovi and all four ill people were hospitalized after eating wild boar meat.

Twelve of the 50 illnesses reported by Bulgaria were hospitalized. Trichinellosis outbreaks were mostly caused by pig meat and products thereof, as in previous years.

Norovirus was the virus most frequently identified in foodborne and waterborne outbreaks and caused the second-highest number of illnesses. Outbreaks increased with 178 more notified to EFSA than in 2017.

Sixteen countries had 376 foodborne and 13 waterborne outbreaks due to norovirus, compared to 211 in 2017. Twelve caused more than 100 cases. Norovirus was the top cause of outbreaks in four countries.

Hepatitis A and norovirus ranked second and third with 6.8 percent and 4.8 percent of all outbreak-related hospitalizations in 2018.

No foodborne brucellosis outbreak was reported for 2018. During 2005 to 2017, there were 16 outbreaks in the EU, of which four were due to cheeses and 12 due to an unknown food. Shigella was detected in 33 outbreaks with 17 caused by Shigella sonnei and five by Shigella flexneri resulting in 472 illnesses.

Yersinia enterocolitica caused 12 outbreaks with 58 cases and Vibrio parahaemolyticus 10 outbreaks with 31 infections. Bacillus cereus was behind 98 outbreaks and 1,539 cases, Clostridium botulinum 15 outbreaks and 48 cases, Clostridium perfringens 71 outbreaks and 1,783 infections and Staphylococcus 114 outbreaks and 1,124 illnesses. Histamine and scombotoxin caused 80 outbreaks with 488 cases.

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