A Salmonella outbreak in Denmark is continuing to affect more people and has also been linked to three deaths.

The Statens Serum Institut (SSI) previously reported that 25 people were infected and 14 had needed hospital treatment with most falling ill this past month.

The agency has now revealed 33 people have the same type of Salmonella typhimurium in the country and 19 have been hospitalized.

Infection a contributing factor in deaths
Patients fell sick between mid-November 2020 and the end of March this year. Seventeen women and 16 men aged 2 to 92 years old that live across the country are affected. Hovedstaden has 12 patients, eight are sick in Syddanmark, six in Sjælland, four in Nordjylland and three in Midtjylland.

Three people positive for the Salmonella strain linked to the outbreak died within 30 days of the sample being taken but it is unknown if they died of or with the Salmonella infection. All three had underlying diseases but Salmonella infection is considered to be a contributing cause of death.

An investigation by SSI, Danish Medicines Agency, the Danish Veterinary and Food Administration (Fødevarestyrelsen) and DTU Food Institute have traced the source of infection to a brand of herbal supplements sold by Orkla Care called HUSK Psyllium in capsules.

The product was mentioned during patient interviews and testing by the Danish Veterinary and Food Administration has found Salmonella in products that two patients had at home.

A case-control study showed 13 of 15 patients had consumed the herbal medicine compared to only three of 45 in the healthy control group. All cases had the product in capsules, while the three controls had consumed it as a powder.

EU wide recalls and review started
Luise Müller, an epidemiologist at SSI, said it was the first time a herbal medicine had been identified as the cause of a Salmonella outbreak.

“Those who take this product are often people who already have stomach problems. I am therefore concerned that the Salmonella infection will not be detected because the people or their doctor believe that symptoms of the Salmonella infection stem from their existing stomach problems,” she said.

Muller added it was not yet known how Salmonella entered the product so other items may contain the pathogen.

Orkla Care has issued a recall of products in Denmark, Sweden, Finland, Iceland, Norway and Bulgaria. Norwegian authorities reported less than 3,000 packs of HUSK Gut Balance Basic capsules were sold in pharmacies throughout the country while Bulgarian officials said 162 packs were affected.

The company decided to recall the entire range of HUSK products including capsules and powder because of the suspected link and one positive test on capsules during self-controls. These supplements were discarded before being packed for the market.

Orkla Care has also started a review of processes from the raw material supply to the finished item with a hope to have products back on sale again in the summer.