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Food Illness

Food-borne illness outbreaks in Germany decreased in 2013, according to data collated by Germany’s Federal Institute for Risk Assessment, Bundesinstitut Risikobewertung (BfR), down to 73 outbreaks, from 84 in 2012. Despite this reduction, food handling, preparation and cooking remain serious issues for consumer health.

German authorities define a food-borne disease outbreak as when two, or more, people contract a disease from the same food. Utilising the country’s standardised federal system for recording data on foods implicated in disease outbreaks, BELA, the BfR has been able, on the basis of good evidence, to identify a specific food product in 33 of the 73 outbreaks. In addition, the BfR’s data analysis has identified the pathogens present, the food vehicles and the location of outbreaks.

Insufficient hygiene and inappropriate temperature management caused many of the food-borne illness outbreaks reported to the BfR in 2013. This demonstrates that improved education for consumers on food hygiene and cooking methods, as well as regular training of personnel in restaurants and communal facilities on correct food handling can all help to prevent outbreaks.

Food Vehicles

Based on the evidence submitted via BELA, and investigated by the BfR, the same two categories topped the grocery vehicles involved in 2013’s food-borne disease outbreaks as in previous years; meat, meat products and sausages, and ready meals and prepared foods. This reflects the trend of the last two years, which also saw these two categories identified as the most prevalent food vehicles.

Food Vehicle Outbreaks in 2013
Meat, meat products and sausages         7
Ready meals and prepared food        6
Fish, fish cuts and fishery products
       6
Breads, biscuits and pastries
       5
Mayonnaise, emulsified sauces, cold ready-made sauces and salads
       3
Milk        2
Ice cream and cream products        2
Puddings, desserts and sweet sauces
       1
Vegetable products/preparation
       1 

Reported foodborne outbreaks from 2013 with high evidence on food type

Meat, meat products and sausages

Of the seven outbreaks identified, six were triggered by the Salmonella pathogen. Two S. Agona outbreaks were traced back to chicken kebab meat and an outbreak of S. Muenchen related to the consumption of raw minced meat sold through a chain of butcher’s shops. On a wider scale, an S. Derby outbreak was traced to a sausage spread served in hospitals and nursing homes, impacting some of the most vulnerable consumers. Sausages and minced meat preparations were the source of a S. Typhimurium outbreak, while Wild Boar snacks were determined as the source of a Trichinella spriralis outbreak.

Ready meals and prepared foods

Increasingly popular in today’s time poor society and the era of mass catering, ready meals and prepared food were identified as the source of six food-borne disease outbreaks. Poor food handling and preparation resulted in two outbreaks caused by Bacillus cereus. A caterer supplying several day care centres was the common link in an outbreak caused by a noodle dish, with cheese sauce that had been cooked one day then re-heated and served the next. Within a few hours those affected began violent vomiting. Testing on two spice samples used to prepare the pasta contained 103 colony forming unit per gram (cfu/g) of Bacillus cereus. The uncooled remains of the dish, tested the next day, showed very high concentrations of up to 4.9 x 106cfu/g.

In the second outbreak, at a country house, the heating and cooling of rice used in a soup was determined to be the decisive factor. Analysis of soup residues confirmed Bacillus cereus levels of 360cfu/g.

An outbreak of S. Typhirium DT 193 was traced to consumption of smoked pork, roasted and with sauerkraut.

Fish, fish cuts and fishery products

In a year when most figures have been decreasing, the frequency of outbreaks involving fish and fish products has increased. Smoked mackerel and tuna were the foods principally identified as the source of six outbreaks in this category. Research suggests that the contamination was introduced during the smoking process as, although high histamine levels were found (varying from 700 mg/kg to almost 10,000 mg/kg), the bacterial load was low.

Breads, biscuits and pastries

S. enteritidis was identified as the cause of all five outbreaks in this category. In the evidence supplied to BELA all the dished implicated in this category used raw eggs, these included a Tiramisu and several fine bakery products. In addition to the outbreak’s trigger pathogen, further testing also identified high levels of Bacillus Cereus.

Mayonnaise, emulsified sauces, cold ready-made sauces and salads

Prepared salads, from delicatessens, were the root cause of three outbreaks, triggered by staphylococcal enterotoxins, rotavirus and norovirus pathogens.

Milk

Campylobacter was again associated with raw milk outbreaks in 2013. In the first incident, a kindergarten group visiting a farm were given the opportunity to taste raw milk which had been drawn from its storage an hour in advance of the visit. Campylobacter jejuni was subsequently detected at the site. Elsewhere, a kindergarten’s heated milk was identified as the vehicle for Staphylococcus aureus with the ability to form enterotoxin A. Analysis detected Staphylococcus aureus at a high concentration (1.3 x 108 cfu/g).

These outbreaks prompted the BfR to issue a media statement to the effect that children, pregnant women, the elderly and sick people in particular should refrain from consuming raw milk and raw milk products, even those visiting farms.

Ice cream and cream products

Ice cream contaminated with Staphylococcus aureus resulted in two food-borne disease outbreaks. On investigation of the samples, high concentrations of Staphylococcus aureus and enterotoxin, about 106 cfu/g, were detected.

Puddings, desserts and sweet sauces

Eating out and a sweet tooth made several diners sick as a result of a Bacillus cereus outbreak triggered by eating a starchy dessert. Inadequate cooling was determined as a contributing factor. Analysis of a sample from the same batch showed Bacillus cereus present at levels from 105 cfu/g. In addition, in two of five isolates tested, a toxin-forming ability for Diarrhoetoxin of Bacillus cereus was detected.

Bela Reporting of Contributing Factors

In order to help identify the root cause of food-borne disease outbreaks, the BELA reporting system asks those making a submission to nominate, where possible, factors that may have contributed to an outbreak. To make this as easy as possible, BELA offers users a predefined list, from which multiple factors can be selected, as well as the opportunity to add free text comments. Despite this, 6 out of the 33 food-borne outbreaks with high evidence did not include any contributory factors.

Influencing factor Number of entries
Handling by infected persons        7
Cross contamination
       6
Use of a contaminated ingredient without further heating
       5
Processing of shell eggs
       5
Inadequate hygiene plan
       5
Inadequate cleaning equipment
       5
Inadequate separation of pure/impure area
       3
Pathogen detection in primary production
       1

Factors Influencing Food-borne Outbreaks with High Evidence from the Year 2013, Which May Have Contributed to the Contamination of the Food

Resulting in outbreaks of Salmonella and rotavirus, poor food handling, either by an infected person, or through cross-contamination is the highest risk factor. Raw eggs resulted in five outbreaks of S. Enteriditis and the use of a contaminated ingredient without further heating contributed to three Salmonella outbreaks, one of Listeria monocytogenes and one of Trichinella spriralis.

BELA also explores factors that may have contributed to the survival or multiplication of pathogens in foods. The majority of these involved temperature management. Insufficient cold storage or uncontrolled cooling was given as a factor in four outbreaks from histamine, two of Bacillus cereus and one of S. Enteriditis. Insufficient heating of food was named as a major factor in two Salmonella outbreaks, and an outbreak each of Campylobacter jejuni and staphylococcal enterotoxin. In the catering sector, two submissions cited an inadequate HACCP concept.

Continuous Improvement and Education

Based on 12 months’ data, Germany’s BELA reporting system offers a detailed snapshot of the issues facing the food industry and its consumers. Poor food handling is the biggest cause of food borne disease outbreaks, whether in the food supply chain, or domestically. Education is key to combating these problems. Within the food industry this means improved HACCP plans, staff training and effective implementation of food safety management systems. Plus, stakeholders across the food supply chain must ensure that safety systems and training plans aim for continuous improvement. This will ensure that businesses maintain a focus on brand protection as well as product and consumer safety.

For further information on SGS please visit SGS Food page or contact:

Jim Cook
Consumer Testing Services
Food Safety Technologist
SGS North America, Inc.
t: +1 973 461-1493