Over 100 barfing from water in Finland

More than 100 people have suffered gastrointestinal symptoms as E. coli was found in drinking water in Aanekoski, a small city in central Finland, due to a pipe fracture, Finnish new agency STT reported on Thursday.

metsagroup_aanekoski_765Residents in Aanekoski and surrounding areas were advised to boil the water that they need for preparing food. About 800 households were involved.

Sinikka Rissanen, health inspector from the Environmental Health Service of Aanekoski, estimated on Thursday that at least 100 residents have suffered gastrointestinal symptoms caused by the polluted tap water so far.

At least 200 sicken by E. coli linked to salad in Finland

Some 200 people suffered from a gastroenteritis epidemic in the Helsinki metropolitan area of Finland after eating food supplied by a catering company, media reported on Thursday.

rucola.saladEeva Ruotsalainen, deputy director of the Hospital District of Helsinki and Uusimaa (HUS), told the Finnish daily Helsingin Sanomat that most of the infections occurred in festive occasions arranged in Helsinki about two weeks ago, and some others occurred in Espoo, Vantaa and Kauniainen after the events.

Laboratory results showed that more than 80 of the patients were infected by EHEC (Enterohaemorrhagic Escherichia coli) which include Shiga-toxin producing E. coli. said Finnish National Institute for Health and Welfare.

Officials contacted patients of high-risk groups, such as children under the age of five, elderly people, pregnant women and persons who work in the food industry.

Health officials suspected that the infection originated from an Espoo-based catering company which provided food services for the events.

Finnish national broadcaster Yle reported that the source of the epidemic was traced to rucola or rocket salad sold by Kesko, a major retailer of Finland.

Matti Kalervo, vice president of Kesko, told Yle that the rucola in question was grown in Denmark and packaged in Sweden. The breakout of the epidemic was caused by a single batch of rucola exclusively for industrial kitchens. Kesko has started to perform microbiological tests on the product, said Kalervo. EHEC bacteria, a subtype of Escherichia coli, can cause human hemorrhagic colitis. The infection of EHEC can lead to hemolytic uremic syndrome, which in turn may cause permanent kidney damage or even death.

Salmonella from organic sprouts, grown in China, sickened people in Finland

Two new cases of Salmonella enteritidis are being investigated in Finland after an earlier outbreak linked to imported organic mung bean sprouts.

Bean_sproutsAccording to the European Commission’s Rapid Alert System for Food and Feed, an outbreak of Salmonella enteritidis in Finland appears to be caused by organic mung beans sprouts from China, via the Netherlands

The sprouts have been withdrawn from the market.

More details can be found in the Food Quality News article.

I’m going to serve food. Should I be pre-inspected? Finland says go back to yes

Finnish food control authorities waived pre-inspections of food premises in 2011, leaving food business operators to begin operating with no pre-operation food control. This study aims to investigate the effects of this food policy change on the preconditions for Good Hygienic Practices (GHPs) on food premises.

Traditional-Finnish-Food-fOf the 916 food premises that were included in this study, 379 were pre-approved whereas 537 merely notified their operations.

The results show that notified food service premises (restaurants) preparing food displayed significantly more non-compliance pertaining to infrastructure than did restaurants pre-approved for food preparation (11.5% and 1.8% of the premises, respectively) (p < 0.05). Significant differences also emerged in the number of premises with non-compliance pertaining to cleaning facilities and equipment, and marked differences in the adequacy of hand and other washing sites. Such instances of non-compliance weaken the preconditions for GHPs.

The results suggest that re-introducing pre-inspections of restaurants would strengthen the preconditions for GHPs and possibly provide a model for other countries with similar food control systems.

Does waiving preventive food control inspections in Finland weaken the prerequisites for safe food handling in restaurants?

Food Control; Available online 29 June 2016; doi:10.1016/j.foodcont.2016.06.044

Veera Haukijärvi, and Janne Lundén

http://www.sciencedirect.com/science/article/pii/S0956713516303589

Prerequisites for effective official food control in Finland

We studied the prerequisites for official food control and their relation to the quality of controls by using 17 Finnish municipal food control units as our sample.

finland.food.safeBased on our results, units invest in creating adequate working conditions through the provision of guidance papers, pre forma templates and possibilities for staff to collectively hold discussions. However, poor orientation, tacit knowledge and incomplete commitment among staff to quality systems remain as challenges in the units. Insufficient human resources and the inability of heads of food control units to recognize problems in the workplace setting may impair the functional capacity of units. Poor workplace atmosphere and weaknesses in organization of work may also be reflected in food businesses operators’ lesser appreciation toward official food controls.

Food Control, Volume 61, March 2016, Pages 172–179

Tiina Läikkö-Rotoa, Janne Lundén, Jaakko Heikkilä, Mari Nevas

http://www.sciencedirect.com/science/article/pii/S0956713515302218

43 sickened: Yersinia in raw milk in Finland

In March 2014, a Yersinia pseudotuberculosis (YP) outbreak was detected by a municipal authority in southern Finland.

napoleon.raw.milkWe conducted epidemiological, microbiological and traceback investigations to identify the source. We defined a case as a person with YP infection notified to the National Infectious Disease Registry between February and April 2014, or their household member, with abdominal pain and fever ≥ 38 °C or erythema nodosum. Healthy household members were used as household-matched controls. We identified 43 cases and 50 controls. The illness was strongly associated with the consumption of raw milk from a single producer. The odds ratio of illness increased with the amount of raw milk consumed. Also previously healthy adults became infected by consuming raw milk. Identical YP strains were identified from cases’ stool samples, raw milk sampled from a case’s refrigerator and from the milk filter at the producer’s farm. The producer fulfilled the legal requirements for raw milk production and voluntarily recalled the raw milk and stopped its production.

We advised consumers to heat the raw milk to 72 °C for 15 s. Current legislation for raw milk producers should be reviewed and public awareness of health risks linked to raw milk consumption should be increased.

 Outbreak of Yersinia Pseudotuberculosis O:1 Infection Associated With Raw Milk Consumption, Finland, Spring 2014

Eurosurveillance, Volume 20, Issue 40, 08 October 2015

T Pärn, S Hallanvuo, S Salmenlinna, A Pihlajasaari, S Heikkinen, H Telkki-Nykänen, M Hakkinen,  J Ollgren, S Huusko, R Rimhanen-Finne

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21268

Finland marketing: Please don’t go to the toilet in the water

And you thought Canadians were polite (we’re not, we swear a lot, fornicate and play hockey, what else to do in cold weather; sorta like Finland).

la-et-mn-russell-crowe-career-in-pictures-2015-045Finland’s health authorities have been issuing advice in an attempt to prevent the spread of Norovirus among swimmers this summer, following last year’s outbreak when hundreds of beachgoers caught the contagious vomiting bug.

Authorities are now keen to avoid a repeat of last year’s numerous beach closures.

Senior inspector Jaana Kilponen, from the health and safety executive Valvira, said that changing rooms and toilet facilities at bathing spots were also responsible for the spread.

“When you’ve got ideal swimming conditions, such as warm water and lots of people, then it’s important that authorities make sure the facilities are cleaned more frequently, and kept well stocked with soap and hand towels,” she told Yle.

Kilponen also implored swimmers to avoid being sick or going to the toilet in the water – and not to drink it. Anyone with Norovirus should wait two weeks before going swimming. Kilponen admits that in theory it’s possible that a single infected swimmer could contaminate the water.

214 sickened at teen hockey tournament in Finland

Chapman and I get sorta excited when food safety intersects with hockey.

ben.family.feb.15So after watching Anaheim take a 2-1 lead after two periods over Chicago, and several OMG e-mails, I can note that in Finland last month, about 30 teens got sick with Salmonella at the Riga Cup.

And then the numbers went to over 200.

But the authors, writing in Eurosurveillance, do a much better job describing the outbreak, so I’ll go back to figuring out my practice plan for this weekend.

On 14 April 2015, a general practitioner in a municipal public health authority in Finland notified the National Registry for Food and Waterborne Outbreaks (RYMY) [1] about a cluster of 30 cases of gastrointestinal disease. All had attended the Riga Cup on the 3 to 6 April weekend 2015 and six had laboratory-confirmed Salmonella serogroup D infection.

The Riga Cup is an annual international youth ice-hockey competition where mainly male teams, with occasional female players, participate. Players in the event are officially categorised in five age groups comprising individuals between 10 and 18 years-old. In 2015, the competition consisted of five tournaments lasting three to four days each, which took place over five consecutive weekends from 27 March to 26 April. The competition attracted 197 teams from Europe, including Belarus, Russia and Ukraine as well as 16 European Union and European Free Trade Association (EU/EFTA) countries. Finland contributed 50 teams. The total number of international and national participants was around 5,000. Tournaments were played according to age groups in four hockey arenas, which were used in parallel, with arena A being the main arena. A fifth arena was added on the last weekend of the tournament. Lunches and dinners for the teams were included in the competition package. The teams, including their male and female coaches and officials, were scheduled to have their meals at the arenas where they were playing. Breakfasts were taken at the hotels where the teams stayed.

Following the notification of the first cluster of cases in mid-April, the Finnish National Institute for Health and Welfare (THL) monitored notifications reported to the National Infectious Disease Registry (NIDR) in order to capture Salmonella infections with a travel history to Latvia. Names were cross-checked against a list of the Finnish players in the Riga Cup obtained from the tournament website. Other cases of Salmonella sp. in NIDR with travel history to Latvia were contacted to determine whether they had participated in the tournament as an accompanying family member or official. Cases were identified according to the outbreak case definition.

doug.sorenne.hockey.apr.14Since this led to the finding of other possible clusters in different parts of Finland, THL invited on 21 April, the Finnish clubs participating in the Riga Cup 2015 to an online survey in order to describe and determine the magnitude of the outbreak. This survey asked about demographics, dates of participation in the competition and place of accommodation. Further, the respondents were requested to specify the tournament venues where they had eaten and on which dates, along with a description of what had been consumed. It was also enquired whether any foods and beverages had been taken outside the venues. Date of onset of diarrhea with three or more loose stools a day, fever (≥38°C), headache, nausea, vomiting, or stomach ache were questioned as were any possible hospitalisations.

As of 8 May, 65 persons with Salmonella sp. infection, who had participated as players or officials in the Riga Cup 2015 between 27 March and 26 April 2015 and had onset of symptoms on or after 27 March were identified by the NIDR in Finland. By the same date, 315 persons had also responded to the online survey. Of these, 31 respondents were classified as confirmed, and were among the 65 confirmed cases identified by the NIDR. The survey additionally identified 57 suspected cases.

Of the 88 cases identified in the survey (Figure), 78 (87%) were male, the median age was 13 years (range: 8–66 years), 7 (8%) had been hospitalised, 86/87 (99%) had been playing at arena A and 39/88 (44%) participated during the tournament taking place over the second weekend of the competition.

Nine patient isolates were microbiologically characterised [2-4] at THL. The isolates were selected so that they represented clusters identified in different participating teams from different parts of Finland (Figure). All nine cases had been infected by S. Enteritidis phage type 1 (PT1) with multilocus variable-number tandem repeat analysis (MLVA) profile 3–10–6-4–1 (SENTR7-SENTR5-SENTR6-SENTR4-SE3). The isolates were susceptible to the standard panel of antibiotics tested (ampicillin, cefotaxime, chloramphenicol, gentamicin, mecillinam, meropenem, nalidixic acid, perfloxacin, streptomycin, sulfonamide, tetracycline, and trimethoprim). S. Enteritidis PT1 is rare in Finland as well as in Norway and Sweden (Lin Thorstensen Brandahl and Cecilia Jernberg, personal communications, May 2015), but common in Baltic countries, Russia and Korea [5,6].

On 16 April, THL launched an urgent inquiry through the Epidemic Intelligence Information System for Food and Waterborne Diseases (EPIS-FWD) [7] to identify cases in other countries. Potentially affected non-EU countries were informed of the outbreak via the World Health Organization and were given access to EPIS-FWD.

On 24 April, a Rapid Risk Assessment of the outbreak by the European Centre for Disease Control and Prevention (ECDC) [8] was distributed through the Early Warning and Response System (EWRS). On the request from Latvia, ECDC deployed a fellow from the European Programme for Intervention Epidemiology Training (EPIET) from Finland to support the investigation in Riga on 26 April 2015.

On 29 April, the Latvian Centre for Disease Prevention and Control (LCDC) contacted the leaders of all teams participating in the Riga Cup, except the Finnish and Norwegian teams, which had already been contacted by their national public health authorities, by email and asked if they were aware of cases of gastroenteritis with onset during or after the tournament.

2004HockeyTournanment 051An ECDC expert on food and waterborne disease outbreaks joined the investigating team in Riga on 4 May 2015. As of 8 May, seven countries (Estonia, Finland, Hungary, Lithuania, Norway, Sweden, and the United Kingdom (UK)) have reported a total of 214 cases with gastrointestinal symptoms. Identical MLVA profiles to the Finnish cases were confirmed in one Norwegian and three Swedish patient isolates. The MLVAs were performed at the Department of Food-borne Infections at the Norwegian Institute of Public Health, and Public Health Agency of Sweden, respectively. The results were communicated through EPIS and at telephone conferences concerning the outbreak (Lin Thorstensen Brandahl and Cecilia Jernberg, personal communications, May 2015).

Food and environmental investigations in Latvia

Based on the information gained from the first detected cluster in Finland, the cafeteria at arena A was suspected as the source of outbreak [8]. On 16 April, the THL and the Finnish Food Safety Authority, Evira, alerted their respective counterparts in Latvia through the EWRS [9] and the Rapid Alert System for Food and Feed [10]. On the same day, the LCDC in collaboration with the Latvian Food and Veterinary services inspected the kitchen at arena A, interviewed all kitchen staff and their family doctors, and collected fecal samples and environmental and food samples. None of the kitchen staff reported gastrointestinal symptoms during the Riga Cup and all the samples were negative for S. Enteritidis. No cases of S. Enteritidis related to Riga Cup were registered in Latvia and the number of S. Enteritidis cases did not exceed the average level in March and April 2015.

Follow-up controls took place at arena A on 24 and 27 April. Members of one team playing at the tournament on the second weekend of the competition, with five suspected cases, had only eaten their meals in arena B, so arena B was inspected on 29 April. Menus were retrieved from all arenas and wholesale suppliers were identified via the purchase receipts. The arena restaurants had been contracted by the organiser and advised to serve the same lunch and dinner menus to the participating teams. The meals were mainly prepared at the tournament arenas. The caterers at the venues served the team members a separate menu than the public during the weeks in between the tournament weekends. Leftovers of the food served to the teams were discarded at the end of each day. Latvian teams did not take lunch and dinner at the venues.

Control measures

Physicians in Finland were alerted about the outbreak by news bulletins (on 15, 20 and 30 April) [11]. The Finnish ice-hockey teams scheduled to play on the last tournament weekend were prior advised to take standard hand hygiene and food safety precautions, such as eating only cooked foods and drinking bottled beverages.

In Latvia, two other junior ice hockey events took place in Riga, from 28 April to 2 May 2015 and from 14 to 16 May 2015 respectively. As some Finnish teams were to take part in these two events, the Finnish public health authorities informed these teams and the Finnish Ice Hockey Association on 27 April about the Riga Cup outbreak and ongoing investigation. Standard hand hygiene and food safety precautions were recommended and participants were also advised to notify THL in case gastrointestinal symptoms appeared during or after the competition.

On 30 April and 8 May the Latvian public health authorities contacted the organisers of both events and recommended to consume only well-cooked foods and maintain proper hand hygiene. In addition, a phone number to a specialist from the Latvian public health authority was provided in case any of the event participants would develop gastroenteritis symptoms.

Conclusions

This outbreak was first detected by municipal public health authorities in Finland. Due to budget cuts at THL since 2015 Salmonella isolates of foreign origin are no longer typed nor are the cases monitored in real time and outbreaks of foreign origin can only be identified at a local level. This will delay detection of Salmonella outbreaks among travellers. Cross-border outbreaks and outbreaks related to mass gatherings pose special problems [12-15] and cooperation between national authorities and ECDC is needed. The investigation to determine the source of the outbreak is ongoing and a retrospective cohort study among event participants from several EU/EFTA countries is underway in order to identify the source.

Acknowledgements

We would like to thank experts from THL, The Centre for Disease Prevention and Control of Latvia, Latvian Food and Veterinary Services, national focal points of affected countries and ECDC which are continuously contributing to the outbreak investigation.

Conflict of interest

None declared.

Authors’ contributions

Anne-Katrine Pesola, Triin Pärn, Sari Huusko, Jurijs Perevoščikovs, Jukka Ollgren, Saara Salmenlinna, Taru Lienemann, Celine M. Gossner, Niklas Danielsson and Ruska Rimhanen-Finne reviewed and approved the manuscript. Anne-Katrine Pesola acted as outbreak coordinator, Anne-Katrine Pesola, Triin Pärn, Sari Huusko, Jurijs Perevoščikovs, Jukka Ollgren, Celine M. Gossner, Niklas Danielsson and Ruska Rimhanen-Finne carried out the epidemiological investigation. Saara Salmenlinna and Taru Lienemann, carried out the microbiological investigation, Anne-Katrine Pesola, Triin Pärn and Ruska Rimhanen-Finne drafted the manuscript and data analysis. All co-authors critically reviewed the draft of the paper and approved the final version.

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Finnish food Safety Authority Evira. Elintarvike- ja vesivälitteisten ruokamyrkytysepidemioiden ilmoittaminen ja raportointi. [Food and waterborne outbreaks, notification and reporting]. Finland; 2014. Finnish. Available from: http://www.evira.fi/portal/fi/tietoa+evirasta/asiointi/sahkoinen+asiointi/elintarvikkeet/ruokamyrkytysepidemioiden+raportointi+rymy/

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Hopkins KL, Peters TM, de Pinna E, Wain J. Standardisation of multilocus variable-number tandem-repeat analysis (MLVA) for subtyping of Salmonella enterica serovar Enteritidis. Euro Surveill. 2011;16(32):19942. PMID:21871223

Hasenson LB, Kaftyreva L, László VG, Woitenkova E, Nesterova M. Epidemiological and microbiological data on Salmonella enteritidis. Acta Microbiol Hung. 1992;39(1):31-9. PMID:1632197

Kang ZW, Jung JH, Kim SH, Lee BK, Lee DY, Kim YJ, et al. Genotypic and phenotypic diversity of Salmonella enteritidis isolated from chickens and humans in Korea. J Vet Med Sci. 2009;71(11):1433-8. http://dx.doi.org/10.1292/jvms.001433 PMID:19959892

Gossner CM, de Jong B, Hoebe CJPA, Coulombier D, and European Food and

Multinational Outbreak Of Salmonella Enteritidis Infection During An International Youth Ice Hockey Competition In Riga, Latvia, Preliminary Report, March And April 2015

Eurosurveillance, Volume 20, Issue 20, 21 May 2015

A K Pesola, T Pärn, S Huusko, J Perevoščikovs, J Ollgren, S Salmenlinna, T Lienemann, C Gossner, N Danielsson, R Rimhanen-Finne

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21133

Over 1000 sick from Norovirus at four Finland beaches

The City of Tampere has announced on its web-page that its officials have removed the signs advising people against swimming in the four lakes linked to a recent outbreak of a stomach virus – Tohloppijärvi, Tesomajärvi, Suolijärvi and Kaukajärvi.

norovirus.swimOverall, over one thousand people fell ill with a stomach bug in Tampere. The city also revealed on Tuesday that traces of norovirus were found in the majority of stool samples taken from the affected swimmers.

Traces of Norovirus found in Finish patients’ tests

The first laboratory tests of fecal samples from individuals who went swimming around Tampere have yielded signs that the virus remains present in local waterways.  

norovirus-2Patient specimens were obtained from a total of 18 people, 15 of whose tests showed positive for the virus.

Tampere city’s Environmental Health Director Merja Bojang says that this indicates that the norovirus has spread though bathers from one beach to another.

Tampere City authorities want to identify the causes and consequences of the epidemic, which causes an upset stomach. The city website now hosts an online form inviting feedback from visitors to Tampere beaches between July 21 and August 6 – both those who remained healthy and those who fell ill.

They also hope to hear back from respondents who have earlier used the form or the telephone service to log details of their illness. It’s hoped that each individual would fill out their own form.

The electronic questionnaire can be answered until Friday, August 22.