Sweden has noted an increase in foodborne outbreaks and illnesses in 2021 but levels were still below pre-COVID-19 pandemic figures.

The number of outbreaks reported to the Swedish Food Agency (Livsmedelsverket) in 2020 and 2021 was affected by measures taken during the pandemic.

There were 251 reports of suspected or confirmed food poisoning outbreaks with 1,467 illnesses. Both the number of reports and the number of cases increased compared to 160 outbreaks and 1,314 cases in 2020 but are still lower than the historical average.

When several Coronavirus-related restrictions were lifted in the autumn of 2021, the number of cases increased. Sixteen major outbreaks occurred during this season.

Eleven people have been hospitalized in seven outbreaks and one person died during a Campylobacter epidemic which infected eight people.

Outbreak causes

For 213 reports and 843 cases, the cause was unknown. Bacteria were blamed for 26 outbreaks and 343 cases, followed by viruses in 12 events with 194 cases, and other agents such as histamine or lectins in seven reports with 52 cases.

Norovirus caused the most with 11 outbreaks and 189 cases, followed by Salmonella with eight outbreaks and 179 cases. Norovirus declined in 2021 but Salmonella rose.

Listeria was behind five outbreaks with 14 infections and Campylobacter caused five with 23 cases. Four outbreaks with 78 infections were due to Shiga toxin-producing E. coli (STEC). Cryptosporidium affected 23 people and one Yersinia enterocolitica outbreak sickened 16.

Four other outbreaks that also had cases in previous years were reported. In a Listeria monocytogenes outbreak, 17 people have been affected since 2019 with the source unknown. Tahini and halva have sickened 41 people since 2019.

Food categories with the most reported illnesses were vegetables with 210 cases and seafood such as oysters, mussels, and fish products with 151 patients.

Three histamine outbreaks were linked to tuna from Southeast Asia and frozen raspberries from Bosnia were behind one incident. A Salmonella outbreak was traced to alfalfa sprouts wher seeds came from Italy and an outbreak caused by Yersinia enterocolitica was linked to iceberg lettuce from Spain. The Cryptosporidium outbreak was due to kale produced in Sweden.

In 55 percent of reports, and for 41 percent of the cases, the source of infection was food contaminated in facilities such as restaurants, cafes, or cooking kitchens in schools.

The top contributing factor was “infection/poor hygiene among staff”, which was started in 18 of 52 reports. This means people who handled food were carriers of infection or did not follow hygiene practices. The second most common factor was “wrong storage with respect to time and temperature”, which was listed in 15 reports.

Inspection results

Another report has found food controls are largely back to normal after a decline due to the peak of the COVID-19 pandemic.

Controls of food and food businesses involve several different authorities including the Swedish Food Agency, County Administrative Boards, and municipal control authorities.

The number of inspections in manufacturing, distribution, and sales have increased after the sharp dro during the pandemic in 2020. A larger percentage of high-risk facilities have also been inspected.

However, there are areas for improvement. For example, in primary production, local authorities did not reach the goal of 1,000 checks. In 2021, only 72 percent of such controls were carried out, down from 78 percent in the previous year.

There are still large differences in how often checks are undertaken and how detected deficiencies at food companies, producers, and distributors are handled by authorities. There are also agencies that finance food control in the wrong way, found the report.