The number of people getting sick and dying in foodborne outbreaks in Europe went up in 2019, based on figures from the annual report on zoonoses.

Salmonella was behind the majority of outbreaks followed by norovirus, according to data published by the European Food Safety Authority (EFSA) and European Centre for Disease Prevention and Control (ECDC).

During 2019, 27 member states reported 5,175 foodborne outbreaks involving 49,463 illnesses, 3,859 hospitalizations and 60 deaths. Slovakia did not send in data. It had 522 outbreaks, 2,454 cases and 531 hospitalizations annually, on average in the five previous years. Another 117 outbreaks, 3,760 illnesses and 158 hospitalizations were recorded by Iceland, Montenegro, Norway, Republic of North Macedonia, Serbia and Switzerland.

Totals are up from 2018, excluding delayed data from the Netherlands, when there were 5,098 foodborne outbreaks with 48,365 illnesses, and 40 deaths. In 2019, a germ was identified in 60 percent of foodborne outbreaks with almost 36,000 cases, 3,300 hospitalizations and 54 deaths.

Focus on vulnerable people and children
Outbreaks reported by Belgium, France, Netherlands, Poland and Spain accounted for three-quarters of the total with more than 4,000 and two-thirds of cases at almost 33,000. France had the most with 1,785 outbreaks, followed by Netherlands with 735, Belgium with 571, Spain with 506, Poland with 445 and Germany with 402.

France and the United Kingdom both reported 15 deaths among outbreak cases. In France, 10 were in outbreaks that occurred in a residential institution. For the UK, seven deaths were from an outbreak in hospitals. Spain also had a high number of deaths with nine. Three were linked to a large outbreak of Listeria monocytogenes from chilled roasted pork meat sold by Magrudis.

Most deaths were in settings such as residential institutions such as  nursing home, prison or boarding school, and hospitals. This calls for attention to the increased risk of vulnerable people, including children, elderly and chronically ill patients to foodborne hazards, said EFSA and ECDC.

Another critical aspect is outbreaks in schools and kindergartens. A large Salmonella outbreak in Hungary affected almost 600 people and 11 countries recorded school and kindergarten outbreaks. EFSA and ECDC said there is a need to strengthen the standard of hygiene and procedures for food manufacturing and preparation, plus the HACCP plans for such sites.

More than 40 percent of outbreaks took place in a domestic setting which reinforces the importance of continued recommendations to consumers about the correct mode of preparation, storage and consumption, according to the report.

Listeria, Salmonella, STEC and Campylobacter
Listeria monocytogenes was responsible for 349 illnesses and more than half of all outbreak associated deaths at 31, which is 10 more than 2018. Twenty deaths were because of meat and meat products. The number of outbreaks was 21, which is up from 14 in 2018. Outbreaks, patients and hospitalizations associated with Listeria infections have continuously gone up during the past four years.

Salmonella remained the most frequently detected agent and caused 926 outbreaks, accounting for almost a fifth of the total. It also caused the most hospitalizations with half of the total and seven deaths. Salmonella was the main cause of outbreaks in Croatia, Czech Republic, Estonia, Greece, Hungary, Latvia, Lithuania, Poland, Romania, Slovenia and Iceland.

Among 606 outbreaks with information on the Salmonella serovar involved, Enteritidis was top with 439 outbreaks followed by Typhimurium with 85, monophasic Typhimurium with 12 and Infantis with 10. The outbreaks caused by Salmonella Enteritidis was 596 fewer than 2018. Missing data from Slovakia contributed to this drop., according to the report

Shiga toxin-producing E. coli (STEC) was the third most frequent bacterial agent detected in the EU, with 42 outbreaks, 273 cases, 50 hospitalizations and one death. STEC O157, O26 and O145 were identified in nine, seven and one outbreak, respectively.

Campylobacter caused 319 outbreaks, 1,254 illnesses and 125 hospitalizations. It was the leading outbreak agent in Austria and Germany. Outbreaks were mostly small with less than 10 cases. However, larger events including up to 91 cases were reported by Denmark, France, Germany, Spain, Sweden and the UK. A waterborne outbreak in Norway affected 2,000 people.

Shigella was detected in 22 outbreaks, involving 106 cases and 19 hospitalizations. Norway and Serbia reported three outbreaks with 38 cases and four hospitalizations.

Fifteen outbreaks, 14 hospitalizations and 149 illnesses from Yersinia were reported by seven member states. Vibrio was identified in four small outbreaks in France and Italy.

Arcobacter butzleri was detected in an outbreak in Belgium involving 40 people. Francisella tularensis was reported in two outbreaks in Norway and Serbia, causing 24 illnesses and six hospitalizations.

Latvia, Spain and Sweden had four outbreaks caused by enterotoxigenic E. coli (ETEC) which involved 199 patients and seven hospitalizations. The largest in Sweden led to 130 cases. Another outbreak by enteropathogenic E. coli (EPEC) with 38 cases was reported by Sweden. Latvia and Norway recorded one outbreak each caused by EPEC.

Toxins, viruses and parasites
Toxins produced by Bacillus cereus caused 155 outbreaks, 1,636 illnesses and 44 hospitalizations. Those produced by Clostridium perfringens were responsible for 75 outbreaks, 2,426 illnesses and 27 hospitalizations and S. aureus for 74 outbreaks, 1,400 illnesses and 141 hospitalizations. Two large outbreaks of the latter agent caused 380 illnesses in Hungary and 300 including one hospitalization in France.

Fatalities also increased due to Bacillus cereus to seven, which is six more than 2018. This was because of an outbreak in France in a residential setting, with five deaths. Six deaths were caused by Clostridium perfringens and other bacterial toxins. Clostridium botulinum led to seven outbreaks, 17 illnesses, 15 hospitalizations and one death.

Norovirus, and other Calicivirus, was the second most frequent causative agent in foodborne outbreaks, according to the report. In Denmark, Finland, Lithuania, UK and Norway it was the leading cause. Norovirus was associated with 457 outbreaks and 11,125 related illnesses. Two large outbreaks in Greece and France involved 638 and 593 illnesses, respectively.

In total, 22 hepatitis A outbreaks involving 135 illnesses were reported. The Republic of North Macedonia and Norway also had three and one outbreak, respectively.

Giardia caused the most outbreaks that involved parasites with 14. An outbreak caused by Giardia intestinalis in Italy resulted in 199 illnesses. Trichinella was named in five outbreaks. Cryptosporidium led to 11 outbreaks and 468 cases.

In 2019, 96 outbreaks caused by histamine were recorded and 48 because of marine biotoxins. France reported 19 incidents caused by Ciguatoxin. The UK had an outbreak with 13 illnesses involving okadaic acid, a heat stable toxin found in various species of shellfish.

Food and pathogen pairings
Eating food of animal origin was associated with most, 469, strong-evidence foodborne outbreaks and 5,709 illnesses. It was mainly implicated in incidents caused by Salmonella, norovirus, histamine, Clostridium perfringens and Campylobacter.

Noroviruses in fish and fishery products caused the highest number, 145, of outbreaks that had strong evidence implicating a food source, mainly driven by a rise in France.

Eggs and egg products, the next most frequently reported foodstuff, were implicated in 108 strong-evidence outbreaks. There was one large outbreak with more than 100 patients. Salmonella in this food group was the second top pathogen and food vehicle pairing with 98 outbreaks and the most hospitalizations followed by Salmonella in meat products with 72 outbreaks.

The number of strong-evidence outbreaks associated with cheese fell to four, which is the lowest since the beginning of data collection in the EU.

Fifty-one outbreaks were associated with foods of non-animal origin (FNAO). Vegetables and juice were the most frequently reported vehicle of this group with 30 outbreaks.

In Hungary, consumption of various types of mixed food was associated with five outbreaks that involved 946 illnesses. The largest ,with 575 illnesses, was associated with types of contaminated mixed food, also involving cross-contamination, by Salmonella Enteritidis. This was the largest outbreak by mixed food registered since the start of EU surveillance. Seven other large outbreaks with more than 100 patients were reported by Belgium, Denmark, Hungary, Poland and Romania.

In Germany, frozen Wakame algae was responsible for an outbreak with 53 cases. In Sweden, salad dressing basil oil contaminated with EPEC caused 38 illnesses.