Germany recorded more than 400 foodborne outbreaks in 2019 with almost 2,000 illnesses and five deaths, according to recently released statistics.

In 2019, there were 402 foodborne disease outbreaks  reported to the Robert Koch-Institut (RKI) or the Federal Office of Consumer Protection and Food Safety (BVL). At least 1,970 illnesses, 385 hospitalizations and five deaths were linked to the outbreaks.

As in previous years, the most common causes were Campylobacter and Salmonella. The pathogen or agent remained unknown in 35 outbreaks. Other pathogens that caused five or more outbreaks were norovirus, hepatitis A virus, Shiga toxin-producing E. coli (STEC), Shigella, Giardia lamblia and Clostridium perfringens.

The full RKI report on infections for 2019 shows 902 potential foodborne outbreaks — excluding norovirus gastroenteritis — were reported to the agency with 2,632 patients compared to 886 outbreaks in 2018.  Campylobacter was behind 387 outbreaks and Salmonella was responsible for 277 in 2019.

Of the 902 outbreaks, 333 were listed as food-related and affecting 1,213 patients. This included 163 outbreaks from Campylobacter with 391 patients and 126 from Salmonella with 676 cases. Two deaths were caused by listeriosis.

Germany has a system for collecting data on foods involved in outbreaks called BELA. In 2019, 82 BELA reports were sent to the BVL and 59 were defined as a foodborne outbreak. The most common causative pathogens in these reports were Salmonella 17 times, Campylobacter on seven occasions and six for norovirus. In 15 outbreaks, the pathogen was unknown.

Examples of outbreaks
A total of 343 foodborne outbreaks were transmitted to the RKI, of which 11 were foodborne norovirus outbreaks and 332 were caused by other notifiable pathogens.

The most common cause of outbreaks was Campylobacter on 163 occasions and Salmonella 126 times. Ninety percent involved fewer than five cases but larger incidents were mostly due to Salmonella.

The largest outbreak was caused by Clostridium perfringens with 75 people sick. Bacillus cereus was also detected. Food was delivered by a caterer for a buffet at a Christmas party. It included roast beef with gravy and spaetzle, a German dumpling or noodle.

The second largest incident included 64 patients, 19 of whom had to be hospitalized. It was caused by Salmonella Enteritidis infection from eating eggs. It was the second wave of an outbreak that involved illnesses in 2017 and 2018.

Norovirus caused an outbreak with 53 cases linked to a frozen seaweed salad from China. More than 100 people also fell sick in Norway. A cross-state hepatitis A outbreak with 35 cases and 26 hospitalizations was associated with frozen strawberries and products that contained them.

Strong evidence outbreaks
In total, 33 of the 402 outbreaks were classed as having strong evidence according to European Food Safety Authority (EFSA) criteria. These resulted in 684 illnesses and 137 hospitalizations.

Thirteen of the 33 outbreaks with 262 people sick were caused by Salmonella compared to eight of 38 in 2018. Six outbreaks in 2019 were from Salmonella Enteritidis and three by Salmonella Typhimurium. Salmonella Infantis was reported four times and Salmonella agona and Salmonella group D were each reported once.

Four each were due to Campylobacter, histamine and norovirus, with 38, 59 and 139 people sick respectively. Two each because of Bacillus cereus, Clostridium perfringens and Staphylococcus aureus with 29, 87 and 33 people sick. Listeria monocytogenes and Hepatitis A both caused one with two and 35 related infections.

Most strong evidence outbreaks were caused by eggs and egg products or composite and prepared foods. Milk and pork and pork products were linked to four outbreaks each while meat products and fish products caused three each.

Decline in milk-related outbreaks
While nine of 38 outbreaks were caused by raw milk in 2018 it was only three of 33 in 2019. All three were caused by Campylobacter with two due to Campylobacter jejuni.

In 2019, Salmonella Enteritidis and egg products was the most commonly reported pathogen and food combination. Other pairs that occurred several times were histamine and tuna and Salmonella Typhimurium and raw sausage.

The food causing the outbreak was consumed in private households for nine of the 33 strong evidence outbreaks. Six outbreaks each took place in the catering sector or at various locations with four linked to canteens and three to takeaways.

Factors that contributed to outbreaks included cross-contamination, inadequate heat treatment or cooling and an infected employee. Failure to comply with storage conditions such as temperature and time was also mentioned.

Campylobacter caused 162 of the 369 low evidence outbreaks while Salmonella was behind with 114. The pathogen could not be identified in 35 outbreaks.

These outbreaks affected at least 1,286 people, of whom 248 were hospitalized and five died. Four deaths were due to Listeriosis. Shigella, STEC, Yersinia enterocolitica and hepatitis E caused a few of these outbreaks.