More sick people and Salmonella types are part of an outbreak in Europe linked to tahini and halva from Syria.

More than 120 people have now been affected since 2019 in Germany, Sweden, Norway, Denmark, and the Netherlands with at least five types of Salmonella linked to the outbreak. Officials have provided Food Safety News with an update several months on from the outbreak being revealed.

The European Food Safety Authority (EFSA) and European Centre for Disease Prevention and Control (ECDC) also plan to publish an assessment on the multi-country outbreak of multiple Salmonella serotypes soon.

Investigations in Germany and Sweden
based on epidemiological information and WGS analyses, experts from the Robert Koch Institut (RKI) in Germany believe patients with the Salmonella serovars Mbandaka, Havana, Orion, Amsterdam, and Senftenberg to be part of the outbreak.

There are 72 patients in Germany as of late September. A dozen are Salmonella Mbandaka, 36 are Salmonella Havana, 12 are Salmonella Orion, five are Salmonella Amsterdam; one patient is co-infected with Mbandaka and Amsterdam and six have infections from Salmonella Senftenberg sequence type 14.

The age of patients ranges from less than 1 to 69 years old and 51 percent are male. Reported illness onset dates began in January 2019 and also affected people in 2020.

RKI initially noted an increase in Salmonella Havana in 2019 but were unable to identify the source of infection. Those patients have been retrospectively linked to the current outbreak based on results from whole genome sequencing.

Since July 2019, 36 people have fallen ill with several different types of Salmonella in Sweden after eating sesame-based products from Syria.

The most recent illness was in September. The sick people live in 12 regions. Patients are aged 0 to 88 years old with a median age of 30. Thirteen are children younger than 5. Twenty men and 16 women have been sickened. Whole genome sequencing has been used to link cases with each other and with isolates of Salmonella identified in food.

A dozen people have been infected with both Salmonella Havana and Salmonella Mbandaka. Seven with Salmonella Kintambo, four had Salmonella Orion and one with Salmonella Senftenberg.

Testing on tahini and halva purchased in Sweden has found Salmonella Havana, Salmonella Mbandaka and Salmonella Orion, which can be linked to infections. Additional Salmonella types have also been detected. Officials believe products were sold in smaller specialty stores in Sweden.

Patients with Salmonella Kintambo and Salmonella Senftenberg can be linked to findings in products of tahini and halva sampled in Germany and Norway.

Recall in Norway

Recalled products in Norway

Norway has two patients with Salmonella Mbandaka who reported eating sesame seed products. They are 5 and 45 years old, both are female but are from different regions of the country. Sampling dates of the isolates were March 2020 and June 2021.

There are also now two patients with Salmonella Orion and one with Salmonella Havana infections associated with the outbreak.

In July, sesame seed-based products Al Burj Tahina and Al Burj Halwa were recalled in Norway. Four RASFF alerts have been posted for Salmonella in sesame products from Syria since June.

Denmark has logged nine cases from February 2019 to July 2021. Three females and six males aged 0 to 86 years old were sick. The serotypes include three each for Salmonella Mbandaka and Salmonella Havana and one each for Salmonella Kintambo, Salmonella Orion and Salmonella Amsterdam.

The Netherlands has identified one matching Salmonella Mbandaka case and one Salmonella Orion patient based on whole genome sequencing. One of those sick was a young child with the sample taken in March this year.