More than 120 people are part of a multi-country Salmonella outbreak linked to Brazil nuts.
Since August 2019, the outbreak, caused by Salmonella Typhimurium and Salmonella Anatum, has affected three European Union countries, the United Kingdom and Canada. The United States was one of more than 30 countries that received Brazil nuts from Bolivia contaminated with Salmonella.
In total, 123 cases of Salmonella Typhimurium have been reported, of which 105 were in the UK, 14 in France, three in Luxembourg and one each in the Netherlands and Canada. One Salmonella Anatum patient was recorded in the UK.
A case-control study in the UK and patient interviews in the UK, France and Luxembourg indicated Brazil nuts and nut bars as likely vehicles of infections. Two batches of Brazil nuts from Bolivia tested positive for Salmonella Typhimurium and Salmonella Anatum matching the outbreak strains.
Bolivian authorities reported that both batches had been tested during “own-check” controls at the processing company and Salmonella had not been found.
Thirteen people hospitalized and one reported death
Brazil nuts were also used in other products manufactured by different companies in the UK and one in Austria. It is likely that the origin of infections is contaminated Brazil nuts, but the exact point of contamination could not be established, according to the European Centre for Disease Prevention and Control and the European Food Safety Authority.
Recalls and withdrawals of nut products started in August 2020. In the UK, they involved Holland & Barrett, Rude Health Food, Lidl GB, The Paleo Foods Co. and Hand2Mouth, which makes Eat Natural brand bars.
Thirteen people infected by Salmonella Typhimurium were hospitalized, including two children younger than five years of age. One death was reported in the UK but the role of Salmonella infection is not known.
In April, the UK reported a cluster of 38 Salmonella Typhimurium infections with sampling dates between Aug. 2, 2019, and April 4, 2020. Over 60 percent of cases were reported in March and April. Patients live in different areas of the UK and reported no travel history. Just more than half were male and the median age was 40 years with a range of 3 to 89 years old. After 14 months, the outbreak appears to be subsiding, with the latest patient reported in the UK in September.
Public Health England did 13 interviews, starting in April, that identified nuts/nut bars, chicken and salad consumption as potential vehicles of infection. A case-control study in June revealed nut and seed products as a risk factor. Patients reported consumption of several types of nut bars under two brand names produced by a British company.
Official controls and heat treatment
The first batch was imported in the UK by a British wholesaler in August 2019 in two allotments of 8,000 kilograms each. Samples were collected as part of an official control in early August 2020, with some positive for Salmonella Typhimurium.
The second batch was imported in the UK by the same British wholesaler in January 2020 in one allotment of 16,000 kilograms. Samples were collected during an official control in early August 2020 and some showed Salmonella Anatum.
Some of the nut products were heat treated but the process was only intended for organoleptic purposes. Some flapjacks and nut bars received heat treatment during the manufacturing process that was considered sufficient to eliminate Salmonella so companies producing them did not withdraw or recall their nut products.
European officials said the likelihood of new cases is low but possible, as the nut products have a long shelf life until 2021, and people may have bought them before control measures were applied.
Countries that received affected Brazil nuts from Bolivia are Austria, Bahrain, Belgium, Canada, Cyprus, Denmark, Egypt, Finland, France, Germany, Gibraltar, Greece, Hong Kong, Hungary, India, Iraq, Ireland, Italy, Jordan, Lithuania, Luxembourg, Mali, Malta, Netherlands, Norway, Philippines, Qatar, Somalia, South Africa, Spain, Switzerland, UK and the United States.
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