The scale of a Salmonella outbreak in France linked to raw milk cheese has jumped to more than 80 possible cases.

Santé publique France, the national public health agency, said 83 people had been identified so far in the Salmonella Enteritidis outbreak, which is up from 14 in the initial announcement. The cheese was also distributed to Austria, Belgium, Germany and Italy. Belgium and Germany have issued recall notices.

Sixty-five patients in France have been interviewed about their symptoms and food consumption history.  Of them, 80 percent reported eating reblochon made with raw milk before the onset of symptoms. The French Ministry of Agriculture and Food previously said the outbreak had been traced to reblochon – a type of cheese – made by Fromagerie De La Tournette.

In late November, the company recalled whole 450-gram packs and half cheeses under a variety of brand names with sanitary mark FR 74.128.050 CE and use-by dates between Nov. 17 and Dec 16, 2018.

Epidemiological, environmental and traceability investigations are continuing to find the origin of contamination. As of early December, there had not been positive sampling of the cheese with Salmonella but the connection was made from consumption history of patients. Santé publique France is investigating with the National Salmonella Reference Center at the Institut Pasteur and Auvergne-Rhône-Alpes Regional Health Agency (ARS).

Symptom onset dates range from Sept. 16 to Nov. 19, with a peak from Oct. 1 to 7. Fifteen people were hospitalized for salmonellosis. They have now been discharged and are well with no deaths reported.

The National Salmonella Reference Center identified 71 strains sharing the same results via whole genome sequencing. The strains correspond to sick people living mainly in Rhône-Alpes (n=53) with 18 others being spread across 10 regions in the country. There are 47 men and 24 women, with a mean age of 40. only two children under the age of five are concerned.

Twelve additional strains of Salmonella Enteritidis isolated from people living in Rhône-Alpes received by the National Salmonella Reference Center are being sequenced to see if they share the same characteristics and belong to the same cluster.