Outbreaks increased across Europe in 2022, figures show

Foodborne outbreaks and related deaths in Europe increased in 2022, according to EFSA and ECDC.

The One Health Zoonoses Report 2022, published by the European Food Safety Authority (EFSA) and the European Center for Disease Prevention and Control (ECDC), revealed that the number of outbreaks and cases, hospitalizations and deaths caused by food, is higher than in 2021. Deaths from outbreaks are the most in the EU in the last 10 years, with 28 caused by Listeria monocytogenes.

In 2022, the 27 member states of the European Union and Northern Ireland reported 5,763 outbreaks, 48,605 illnesses, 2,783 hospitalizations and 64 deaths. A total of 108 outbreaks, 2,166 cases, 186 hospitalizations and one death were recorded in Bosnia and Herzegovina, Iceland, Montenegro, Norway, North Macedonia, Serbia and Switzerland.

Outbreaks in the EU increased by 43.9 percent from 4,005 in 2021. Cases and hospitalizations also increased by 49.4 percent and 11.5 percent. Deaths jumped 106.5 percent compared to 31 in 2021.

Belgium, France, the Netherlands and Spain account for three-quarters of the outbreaks. France has 1,861, followed by the Netherlands with 1,162, Belgium with 830 and Spain with 591.

In 2022, the highest number of outbreaks with unknown agents was reported to EFSA. Most of them were notified by Belgium and the Netherlands. Nine incidents have more than 100 cases.

Salmonella and Campylobacter

The causative agent was identified in 3104 outbreaks. Salmonella remains the most common. Norovirus (and other caliciviruses) are associated with most of the more than 7,300 cases.

Salmonella was responsible for 1,014 outbreaks with 6,632 cases. Despite outbreaks jumping from 773 in 2021, the number of people sickened by them fell from 6,755.

The most are France, Spain, Poland and Slovakia, while Bulgaria and Latvia report none. Belgium, France, Slovenia and Sweden had large outbreaks with more than 100 cases. Salmonella Enteritidis is the main serovar reported, followed by Typhimurium and monophasic Salmonella Typhimurium.

In Spain, 34 salmonella outbreaks were linked to egg products, while in Poland there were 26. One incident in Spain sickened 265 people.

Campylobacter caused 255 outbreaks and 1,097 cases – both a slight increase from 2021. In Germany and Malta, it was the leading agent in the outbreaks.

Listeria and E. coli

Listeriosis outbreaks increased from 23 to 35 and patients increased from 104 to 296. Italy had the two largest listeriosis outbreaks. The first included 97 cases, all hospitalized and five people died. The second is with 43 hospitalized cases with one death. The vehicles involved are broiler meat products and pork products, respectively. Finland reported two outbreaks in vegetables. The first included eight cases with six hospitalizations and three deaths. The second lasted from 2021 and was related to pre-cut vegetables. In 2022, there were seven cases and two deaths.

STEC outbreaks jumped from 31 to 71 and the number of cases from 275 to 408. It was the most common cause in Ireland and Northern Ireland, but there were 37 outbreaks in France.

E. coli O157 was associated with seven outbreaks, with others caused by O26, O104, O111, O113, O145 and O178. Poland reported an outbreak of STEC O104 involving 16 cases, five hospitalizations and one death. This is the first time this serogroup has been linked to an outbreak in Europe since 2011, when a large multi-country incident caused more than 3,000 cases, 50 deaths and 800 cases of hemolytic uremic syndrome. The outbreak occurred at a school or daycare center, but the food involved has not been identified.

Toxins, viruses and parasites

An outbreak of Streptococcus equi subspecies zooepidemicus was reported to EFSA for the first time from Italy. Causes 37 cases with 23 hospitalizations and five deaths. Cheese made from unpasteurized milk has been identified as the source.

A total of 27 Shigella and 14 Yersinia outbreaks were registered. Other bacterial agents include Aeromonas caviae, Enterococcus spp., nontoxigenic Vibrio cholerae, and Vibrio parahaemolyticus.

With 1,020, France contributed to almost 90 percent of all outbreaks caused by bacterial toxins in the EU. Bacillus cereus toxins are at the forefront and have been the cause of five outbreaks with more than 100 cases reported from Spain and France. The largest is with 383 patients.

The largest outbreak caused by Clostridium perfringens had 950 cases and was in Portugal. It was linked to prepared RTE meat in temporary mass catering establishments.

A dozen norovirus outbreaks in seven member states involved more than 100 patients each, totaling 1,606 cases. Slovakia has reported three outbreaks of tick-borne viral encephalitis from raw sheep’s milk and cheese made from sheep’s milk.

The two largest outbreaks of Cryptosporidium occurred in Sweden and had 107 and 75 cases associated with RTE salad and buffet meals. Seven outbreaks of trichinella were reported from Croatia, France, Italy, Romania and Spain with 68 patients.

France had 55 outbreaks of histamine and scombrotoxin in 2022, while Spain had 19. Ciguatoxin was identified in 11 outbreaks and mushroom toxins in seven outbreaks. Denmark reported two lectin outbreaks involving 99 cases.

For the first time since data collection began, the number of outbreaks with strong evidence in restaurants, pubs, street vendors and takeaways exceeded those in the home environment.

In terms of contributing factors, an unprocessed contaminated ingredient was reported in 41 outbreaks. Other problems include inadequate refrigeration or heat treatment, storage over time or temperature abuse, cross-contamination, and infected food handlers.

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