HPR volume 16 issue 4: news (22 April 2022)
Updated 30 December 2022
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European collaboration on control of food-borne salmonella infections
Following the identification in early February 2022 of a cluster of monophasic Salmonella Typhimurium infections – reported mainly in children – the UK Health Security Agency (UKHSA), together with Public Health Scotland (PHS), Public Health Wales (PHW), Public Health Agency for Northern Ireland (PHANI) and UK food safety authorities, initiated an outbreak investigation and began considering potential sources of the outbreak.
The outbreak strain demonstrated an unusual antimicrobial resistance pattern not commonly seen in either livestock, food or human disease cases in the UK; nor was the cluster closely related to any other S. Typhimurium strains previously seen in the UK. Exploratory, open-ended interviews were undertaken with the parents or guardians of the first cases in the UK, followed by administration of a more targeted questionnaire, to test the hypothesis that the cases might be associated with consumption of chocolate products.
Following the initial investigations, the UK notified European surveillance networks of the UK outbreak and shared representative sequence data for comparison by other countries. This led to identification of cases in Germany, Sweden, France and the Netherlands and subsequently in 5 other mainland Europe countries.
A European Centre for Disease Prevention and Control (ECDC) Early Warning and Response System (EWRS) alert was issued on 25 March. An EU case definition was agreed and investigations carried out in the affected countries.
As at 10 April 2022, a total of 150 confirmed and probable cases had been identified across 10 European countries with case sampling dates ranging from 21 December 2021 (the first UK case) to 28 March 2022, including confirmed or probable cases in Luxembourg, Norway, Ireland, Belgium and Spain. Descriptive epidemiological investigations demonstrated cases ranging in age from 8 months to 56 years, but were predominately under the age of 10 years (n = 134; 89%) and disproportionately female (n = 99; 66%). The hospitalisation rate was 42% of cases for whom information was available (116 cases with 49 hospitalised) – higher than that usually reported in salmonellosis outbreaks.
Multi-country collaboration through teleconferences and sharing of information between public health agencies and reference laboratories indicated that cases in affected countries commonly reported consumption of a specific brand of chocolate products. As of 10 April, 101 case interviews had been carried out across the 10 affected countries, with 88 cases (87%) confirming consumption of chocolate from a specific company. The most commonly consumed products were marketed primarily for children in the age group 3 to 10 years, but multiple other product types were also reported.
Strong descriptive epidemiological evidence implicating chocolate products, identification of food chain links and evidence of contamination at one production facility in Belgium, led to risk management actions being taken in all affected countries, including withdrawal of all product lines produced at the implicated production facility. News alerts and advice for consumers were initiated from 2 April in the UK and Ireland and extended to other countries shortly after. Extensive product recalls followed across Europe, constituting one of the largest chocolate product withdrawals and recalls in European commercial history.
Belgian authorities stopped production at the Belgium facility on 8 April and, following the European Rapid Alert System Food and Feed (RASFF) alert notifications, the World Health Organization and the Food and Agriculture Organization International Food Safety Authorities Network (INFOSAN) also issued a global alert on 10 April notifying 77 countries and territories to which distribution of the implicated products had been established to initiate a global recall.
ECDC published a rapid outbreak assessment on 12 April and a rapid communication in Eurosurveillance was published on 14 April.
The UK food standards bodies have reiterated the advice that the recalled products should not be consumed, irrespective of sell-by date.
The UK case numbers are being regularly reported, with consumer advice, on GOV.UK.
Infection reports in this issue
Group A streptococcal infections: report on seasonal activity in England, 2021 to 2022.
Acquired carbapenemase-producing Gram-negative bacteria in England: October 2020 to December 2021.