Norway has reported two cases that are part of a botulism outbreak in Spain, bringing the number of people affected to 11.

There is a link between patients and different packaged brands of Spanish omelet (tortilla de patata), which is made with potatoes and eggs, purchased in various supermarkets in different regions.

The Norwegian cases stayed in Barcelona between July 10 and 23.

The first case, a 38-year-old man, was confirmed with onset of symptoms on July 23. He consumed the suspected product between July 17 and 23. The man required hospitalization on August 10, admission to the ICU on August 12, and treatment with botulinum antitoxin.

The second is a probable case; a 38-year-old woman, with onset of botulism symptoms on July 22. She reported eating the implicated product between July 14 and 20 but did not need hospitalization or specific treatment.

Eleven people sick

Five confirmed and four probable cases of botulism had previously been reported from June 21 to July 22. Sick people ranged from 23 to 63 years old with a median age of 49. Four confirmed patients required medical attention in intensive care units but no deaths have been reported.

Italy recorded two cases of botulism linked to omelets eaten in Spain. The patients are a 23-year-old woman and her 61-year-old father who returned home from Valladolid on July 1, having consumed the suspected item on June 30.

The other three confirmed patients live in Madrid, Galicia and Asturias and are aged 43, 49 and 50. Four probable patients are from Valencia, Andalusia and Madrid and are aged 49, 27, 63 and 48.

According to information from the Spanish Agency for Food Safety and Nutrition (AESAN), all brands of Spanish omelets consumed by the cases were made by a single company. Items were also distributed to Andorra, France, and Portugal.

All items with a batch number equal to or greater than 10001 and an expiration date later than September 2 are safe to eat. Spanish omelets with lot numbers between 5426 and 5563 should not be consumed.

Restart of operations

Earlier this month, the firm linked to the outbreak restarted production after being given the all-clear.

Grupo Empresarial Palacios Alimentación said the production line at the Mudrián factory had been reopened after approval from authorities. Production was stopped and products were removed from sale in July.

All official and internal analyses carried out on the products and manufacturing processes were negative for Clostridium botulinum and botulinum toxin, according to the company.

Palacios Alimentación said it was important to always follow the recommendations for use and conservation instructions on the labeling of such products, which should have been kept refrigerated.

Botulinum poisoning is a rare but life-threatening condition, caused by toxins produced by Clostridium botulinum bacteria. In foodborne botulism, symptoms generally begin 18 to 36 hours after eating contaminated food. However, they can occur as soon as six hours or up to 10 days later. Symptoms may include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing or breathing, paralysis, a thick-feeling tongue, dry mouth, and muscle weakness.

Anyone who has eaten suspect products and developed symptoms should immediately seek medical attention.