Tag Archives: belgium

Food worker delivers Morocco strain of shigella; sickens 52 in a Belgian cafeteria

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On Nov. 13, 2009, a Belgian physician notified authorities about an apparent cluster of Shigella sonnei; ultimately, 52 cases were identified over two months, and most were linked to a canteen in a public institution building. Best guess is that a food handler who travelled to Morocco shortly before detection of the first laboratory-confirmed case, picked up shigella, and then transmitted it through food.

The details can be found in the current issue of Epidemiology and Infection, where researchers report on a matched case-control study to test an association between shigellosis and canteen-food consumption.

The three food handlers working permanently in the canteen responded to the questionnaire. Food handler A travelled to Turkey from 23 September to
4 October 2009. She started working on 7 October. She prepared sandwiches, washed dishes and served food. She fell ill on 20 October, and had been exposed to canteen food during the 4 days prior to disease onset. Food handler B travelled to Morocco from 23 September to 1 October. This person started working on 4 October and was involved in vegetable washing, preparation of hot meals, sandwiches, cold dishes involving vegetables and cleaning the canteen. He did not declare having fallen sick. Food handler C was also involved in all activities except in hot meal preparation. He had not travelled, been absent or fallen sick.

Of the 52 shigella cases found in 708 employees of a public institution in Flemish Brabant province, Belgium, between September and November 2009, seven cases were confirmed as S. sonnei. There was a common PFGE profile which resembled those from archived specimens from Morocco. Cases of
shigellosis were associated with canteen-food consumption.

Investigators worked with three hypotheses: (i) waterborne transmission through a contaminated water dispenser, (ii) person-to-person transmission or via surfaces (toilets), or (iii) foodborne transmission (through previously contaminated food or during the preparation process by a contaminated food handler).

Foodborne transmission through canteen food is supported by the results of the employee survey and by the matched case-control study. This led us to think that a food handler might have been the source of the outbreak. Food handler B returned from Morocco shortly before the appearance of the first confirmed cases. He did not report any symptoms and worked continuously since his return.

Foodborne transmission might have happened had he been an asymptomatic case. Healthy carriers can shed 102 Shigella c.f.u./g of feces during 1 month.
Thus, food handler B could have unintentionally acted as an intermittent source of food contamination during the period of faecal shedding. Conversely, food handler A, who had travelled to Turkey, could not be the source of the outbreak, since her onset of disease happened after the onset of symptoms of some confirmed cases.

The researchers recommend:
• washing hands with soap and water before eating and after defecation for employees and food handlers;
• preventing sick food handlers from working until full recovery or until negative fecal culture in the case of laboratory confirmation;
• maintaining surveillance of further possible cases of shigellosis through the institution’s prevention service; and,
• collecting information on the workplace when interviewing notifiable cases in order to detect infectious disease clusters early.

Shigellosis outbreak linked to canteen-food consumption in a public institution: a matched case-control study
01.feb.11
Epidemiology and Infection
I. Gutiérrez Garitano, M. Naranjo, A. Forier, R. Hendriks, K. De Schrijver, S. Bertrand, K. Dierick, E. Robesyn, and S. Quoilin
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8024291
Abstract
On 13 November 2009, the authorities of Flemish Brabant, Belgium, received an alert concerning a potential outbreak of Shigella sonnei at a public institution. A study was conducted to assess the extent, discover the source and to implement further measures. We performed a matched case-control study to test an association between shigellosis and canteen-food consumption. Water samples and food handlers’ faecal samples were tested. The reference laboratory characterized the retrospectively collected Shigella specimens. We found 52 cases distributed over space (25/35 departments) and time (2 months). We found a matched odds ratio of 3·84 (95% confidence interval 1·02–14·44) for canteen-food consumption. A food handler had travelled to Morocco shortly before detection of the first laboratory-confirmed case. Water samples and food handlers’ faecal samples tested negative for Shigella. Confirmed cases presented PFGE profiles, highly similar to archived isolates from Morocco. Foodborne transmission associated with the canteen was strongly suspected.
 

Albert Amgar: The restaurant business, how to improve hygiene?

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Nikki Marcotte, a new student, tries out her translation skills on a piece from French food safety blogger, Albert Amgar.

In Conseil National de l’Alimentation’s newsletter No. 13, dated June 11, 2010, we learn about health safety: an increased effort between the three unions of the Groupement National de la Restauration.

“Given the issues with health safety and nutrition in the catering business, these three entities (the National Institutional Restaurant Services Union, the National Fast-Food and Food Union, the National Union of Themed and Commercial Restaurants, all three members of the GNR) have decided to combine forces and work together on these common problems. Three work groups have been created, each with two representatives from each syndicate, all experts in issues of ‘hygiene’, ‘nutrition’ and ‘quality’.”

One of the work groups has devoted their time to food safety. What is their objective?

The goal of the work group, in regard to regulatory requirements and their recent developments, is to pool together technical skills and the scientific expertise required to validate certain methods of disease control common to various restaurant activities: time-temperature combinations/storage temperatures of foods in certain conditions, microbiological monitoring methods…

According to the Ministry of Agriculture, “Industrial and restaurant catering is comprised of commercial food services (approximately 15% of meals served) and collective food services (85% of meals served). The latter represents close to 4 billion meals.”

Collective food service professionals contribute to three different areas: education (school catering, 1 billion meals, and university catering), health and social services (hospital, nursing home and prison catering), and the workforce (business and administrative catering). Likewise, process hygiene criteria have been implemented.

The ministry also tells us that there are more than “…30,000 inspections conducted annually in the three large collective food service sectors, including nearly 13,000 in the school catering area. In particular, these checks are aimed at ensuring:
– good food preparation practices (in terms of the hygiene and handling of the equipment), transport and storage (with respect to the hygiene and handling of the equipment);
– the cold chain;
– the recommendations concerning the use of pasteurized eggs to prevent foodborne illnesses associated with salmonella.”

“More than 30,000 inspections…” of which we know nothing about, not even one annual statistic… (transparency, where are you?).

This blog, which is always ready to help food service professionals with these excellent initiatives, wishes to make a contribution with this recent publication from the barfblog team, see, “Food safety information posted in restaurant kitchens can improve meal safety.” Source: Chapman, Benjamin; Eversley, Tiffany; Fillion, Katie; MacLaurin, Tanya; Powell, Douglas. Assessment of Food Safety Practices of Food Service Food Handlers (Risk Assessment Data): Testing a Communication Intervention (Evaluation of Tools). Journal of Food Protection®, Volume 73, Number 6, June 2010, pp. 1101-1107(7).

This blog could also suggest to the Ministry of Food less opacity in these inspections so that the consumer is fully informed, and to maybe also think about the scoring system or grades on the doors of restaurants or to start slowly putting the inspection results online. Also look at the “smiley” example in Belgium (above right).
 

Lost in translation; going public with food safety information – France edition

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Albert Amgar, blogmaster of France’s coolest food safety blog, wrote me after I posted about the 88 people sick with Salmonella from dry sausage in France.

What I had missed was that although the outbreak had been on-going for at least 10 weeks, the French Institute for Public Health Surveillance did not publicly report the outbreak until May 28, 2010, and used a Salmonella naming system that would mean nothing to most people (Salmonella 4,12 :i :-).

No company was named, no statement was released by anybody telling consumers to beware certain foodstuffs.

It was the Belgians who did that, through a press release entitled, La société Salaisons du Lignon adopte le principe de precaution et lance un plan de rappel sur un produit: Saucisse sèche droite La Pause Auvergnate, that identified the Lou Mountagnard brand of dried sausages.

The pdf press release file is linkable through Albert’s blog at http://amgar.blog.processalimentaire.com/?p=8937, where he asks, in my broken English summation, why do French citizens, 88 who are confirmed ill, have to learn details about contaminated product from a city in Belgium? (The image, below left,  is from Albert’s blog.

Listeria outbreak in Belgium, 2006-2007, especially dangerous for pregnant women

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Yesterday’s issue of Eurosurveillance contained an excellent piece of epidemiological field work concerning an outbreak of listeria in Belgium in 2006 and 2007. Edited excerpts below:

A total of 11 cases appear to have been involved in this episode (six in 2006 and five in 2007). Of the positive cultures of these patients, nine were from blood and two from cerebrospinal fluid; four cases were pregnant women or newborns. One pregnant woman had a twin stillbirth. The episode was not geographically clustered, as the isolates were received from three different regions in Belgium: Flanders, Wallonia and Brussels.

The episode was first recognised by the BLRC in November 2006. Only on four occasions were patients asked about their food habits. No standardised questionnaire was used. Suspected food samples were taken from the patients’ refrigerators or from the same batch of the suspected food at the retail level. Smoked salmon was sampled because in a case of preterm birth, the mother remembered having eaten smoked salmon. Raw beef brains were the only suspected food item in a case of septicaemia. The woman with the twin stillbirth reported having eaten pre-packed lasagne; this food item was suspected after some of her housemates presented with gastroenteritis. However, L. monocytogenes could not be detected in any of these samples.

The combination of serotyping, metal resistance typing and PFGE led to the identification of 11 identical isolates. The episodic strain was of serovar 4b, sensitive to arsenic and cadmium and belonged to pulsovar A. Six of them were isolated within a period of a few weeks which is exceptional for a small country like Belgium. Besides the cluster isolations in 2006, the episodic strain was isolated from a further five patients in 2007, indicating a long extension of the episode which went on until July 2007.

The source of contamination was not detected. Two factors may have contributed to this failure: no systematic interviewing of the patients and unsuccessful food sampling. During this episode only four patients were contacted by community health inspectors and only three different food samples were taken which proved to be negative for L. monocytogenes in 25 g.

Serovar 4b is not unusual. In Europe and North America, most published outbreaks of listeriosis in the past 20 years have involved 4b. In addition, strains of serovar 4b tend to be overrepresented in perinatal listeriosis, suggesting that they may have special virulence attributes for pregnancy and breach of the blood-placenta barrier. In the cluster described here, four of the 11 cases were pregnancy-related.

It is presumed that the episodic strain was particularly virulent because it involved a relatively high number of pregnancy-related cases and meningitis cases, four of 11 and two of 11 respectively. According to annual data from the BLRC, strains from cases with maternal-neonatal listeriosis represent 10% of the total number of clinical strains; a similar proportion is observed for cases with meningitis.

This episode would have passed unnoticed had not the BLRC performed strain typing. Efficient monitoring of listeriosis requires systematic interviewing of the patients using a standardised questionnaire. Close cooperation between community health inspectors, the Belgian Federal Agency for the Safety of the Food Chain (FASFC) and the BLRC would result in a rapid linking of sporadic cases and enhance the chance of finding the infection source in outbreaks.