Almost 70 people became ill this past year as part of a Salmonella outbreak involving 11 countries, including the United States.

France has the most patients in the Salmonella Ball outbreak but two people from the U.S., aged 44 and 62, were ill in August 2022. They both reported travel to France.

Salmonella Ball is very rare in Europe. Between 2007 and 2021, only 52 cases were reported from 14 countries, with an average of three per year.

Information was shared in a Joint Notification Summary (JNS). These are not made public but Food Safety News has seen a copy. It is prepared by the European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC) and affected countries.

An ECDC spokesman said this week that the agency had not received any updates on the number of people or countries affected since the JNS was produced.

France hit hardest and meat link
In September 2022, France reported a cluster of Salmonella Ball cases. As of November, 38 confirmed infections including 24 women and 14 men had been recorded between July and October 2022. The median age of patients was 26 years old.

Sick people came from 10 regions in France. Three were hospitalized but no deaths were reported. Of the 20 patients interviewed, 13 reported travel in France prior to symptom onset, but no common destination was identified. Ground beef, hamburgers, and eating at restaurants or fast food outlets during the summer were commonly mentioned.

By November 2022, 69 patients, of which 54 were confirmed and 15 were possible, had been reported in nine EU countries, the UK and the United States.

The first patient was in France with an isolation date of mid-July 2022 and the last patient was in Finland in mid-October 2022. Sick people range in age from 1 to 87 years old and 43 men and 26 women fell ill.

Some patients reported traveling a week before onset of symptoms, with destinations mainly including Ibiza in Spain and France.

Confirmed and probable cases
Denmark has three confirmed cases, Norway has two while the Netherlands and Czech Republic both have one each. Germany has one confirmed and two probable patients.

Countries reporting probable cases include Greece with eight, Belgium with four and Finland has one. The outbreak in Greece in mid-October 2022 involved a kindergarten. A total of 22 children under the age of 3 and staff became ill.

Four cases in England, one in Scotland and one in Wales fell sick between August and October 2022. They are aged between 1 and 44 years old. One case was discovered in the UK in 2021.

Analysis of the outbreak and reported cases indicates frequent consumption of beef or pork products, as well as hamburgers, suggesting that meat is the main source of infection. Detection of Salmonella Ball in poultry in 2019 points to possible spread in the production chain.

EFSA and ECDC said new cases and outbreaks are likely to occur in multiple countries until the sources of infection are identified and control measures implemented. The agencies added greater efforts are needed by public health and food safety authorities to investigate outbreaks of Salmonella Ball and to identify specific sources of infection.