The date of the first illness in a Salmonella outbreak linked to Ferrero chocolate doesn’t match with when contamination was detected, according to two EU agencies.

Ferrero has recalled numerous Kinder products, including products labeled for Easter, worldwide.

A total of 156 Monophasic Salmonella Typhimurium cases have been reported in 10 EU countries and the UK, said the European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA). The vast majority of those sick are younger than 10 years old and many have been hospitalized.

Time from manufacture to retail is between 55 and 60 days. The supplier of raw materials for Kinder branded products is batch-dependent but there have been no changes in the past year.

EU officials said the first case in the UK in December cannot be explained by contamination found in the processing plant in the same month. This suggests that if the factory in Belgium was the sole source of infection, contamination in the production line occurred earlier.

There are gaps in information that need to be investigated to understand the root cause, timing and factors behind the contamination, including the possible wider use of contaminated raw material in other processing plants, according to EFSA and ECDC.

Confirmed and probable infections
The first patient was in the UK on Jan. 7, 2022, with a sampling date of Dec. 21, 2021. In mid-February, the UK reported a cluster of 18 cases to an EU system. The latest sampling date is from the UK on March 28, 2022.

The UK has 65 confirmed cases, France has 25, Ireland has 15, Germany has six, Sweden has four, Netherlands has two and one patient each has been reported in Luxembourg and Norway. Belgium has 26 probable cases, Germany has four and Spain has one. In Austria, six people, including five children aged 3 to 6, were infected with the outbreak strain between January and March.

Overall, 88 of 101 interviewed sick people in 10 countries reported consumption of various Ferrero chocolate products, mainly milk chocolate eggs with a small toy inside or small oval shaped, bite-sized chocolate pralines.

Belgian authorities have withdrawn approval for the production site as the company was not able to provide guarantees concerning management of the contamination or safety of its products. A criminal investigation has also been opened, according to media reports.

Ferrero acknowledged there were “internal inefficiencies,” creating delays in getting and sharing information, which impacted the speed and effectiveness of investigations.

Positives in December and January
Monophasic Salmonella Typhimurium matching the outbreak strain was identified at the factory in Arlon in mid-December 2021 by internal analysis. Production was stopped, the affected semi-finished product was destroyed and deep cleaning of lines was carried out. Some finished products made from Dec. 10 to 15 were blocked and later released to market after an internal investigation.

A processing step involving buttermilk was the possible contamination point. The origin of contamination was a filter at the outlet of two raw material tanks, which was removed, cleaned and reconnected after negative testing. Chocolate products were distributed across Europe and globally after negative Salmonella testing.

In January, samples on semi-finished and finished products and surfaces were positive for Salmonella. The last Salmonella-positive was recorded on Jan. 11, 2022, from two buttermilk tanks.

The Arlon plant makes about 7 percent of the total Kinder products manufactured globally on a yearly basis. Distribution includes more than 60 countries ranging from most of Europe, the United States, Argentina, Australia, Canada, New Zealand, Singapore, Hong Kong and Mexico.

about Salmonella infections
Food contaminated with Salmonella bacteria does not usually look, smell, or taste spoiled. Anyone can become sick with a Salmonella infection. Infants, children, seniors, and people with weakened immune systems are at higher risk of serious illness because their immune systems are fragile, according to the CDC.

Anyone who has eaten any recalled products and developed symptoms of Salmonella infection should seek medical attention. Sick people should tell their doctors about the possible exposure to Salmonella bacteria because special tests are necessary to diagnose salmonellosis. Salmonella infection symptoms can mimic other illnesses, frequently leading to misdiagnosis.

Symptoms of Salmonella infection can include diarrhea, abdominal cramps, and fever within 12 to 72 hours after eating contaminated food. Otherwise, healthy adults are usually sick for four to seven days. In some cases, however, diarrhea may be so severe that patients require hospitalization.

Older adults, children, pregnant women, and people with weakened immune systems, such as cancer patients, are more likely to develop a severe illness and serious, sometimes life-threatening conditions.

Some people get infected without getting sick or showing any symptoms. However, they may still spread the infections to others.