A decade of Lm in Denmark

Posted on February 24, 2016 by Ben Chapman

Kvistholm Jensen and colleagues analyzed 559 clinical Listeria monocytogenes isolates from 2002-2012 using 2-enzyme PFGE and conducted serotyping. They found clustering of some common patterns that could either be a large linked source. or maybe a few types from unrelated foods. Not sure.

In Denmark, the annual incidence of listeriosis increased from 0.5 cases per 100,000 population in 2002–2003 to a peak of 1.8 cases in 2009 and 0.9 cases in 2012, and is now among the highest incidences reported globally (8,9). Similar increasing trends have been reported from other European countries during the same period (4). The high but variable incidence calls for further examination of the possible explanations. We retrospectively analyzed trends related to patient data and PFGE- and MLST-types of L. monocytogenes strains occurring in Denmark during 2002–2012. In addition, we assessed the possible association between clinical aspects of the disease and strain genotype.

Our findings show that retrospective typing of isolates gives new insight into the epidemiology of listeriosis. By PFGE typing, we found a high diversity of L. monocytogenes in clinical cases but also a small number of frequent types representing a substantial fraction of all cases. Possibly, these types represent epidemiologically linked cases (outbreaks) or, alternatively, ubiquitous types present in many unrelated food sources and infections

It can happen: Surveillance artefacts

Posted on October 17, 2015 by Douglas Powell

In 1991, 1999 and 2006, randomly selected individuals from the Danish Central Personal Register provided a serum sample. From individuals aged 30 years and above, 500 samples from each year were analysed for Campylobacter IgG, IgA and IgM antibodies using a direct ELISA method.

We applied a seroincidence calculator available from the European Centre for Disease Prevention and Control to perform a mathematical back-calculation to estimate the annual Campylobacter seroincidence in the Danish population. The estimated Campylobacter seroincidence did not differ significantly between the 1991, 1999 and 2006 studies although the reported number of culture-confirmed cases of Campylobacter infection increased 2.5 fold from 1993 to 1999 among individuals aged 30 years and above.

This suggests that Campylobacter was widely present in the Danish population before the increase in poultry-associated clinical Campylobacter infections observed from 1993 to 2001 among individuals of this age groups.

Was the increase in culture-confirmed Campylobacter infections in Denmark during the 1990s a surveillance artefact?

Euro Surveill. 2015;20(41):pii=30041

Emborg H-D, Teunis P, Simonsen J, Krogfelt KA, Jørgensen CS, Takkinen J, Mølbak Kåre

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21277

Foodborne illness in Denmark

Posted on August 27, 2015 by Douglas Powell

I have a soft spot for the Danes. Spending five summers hammering nails with a couple of Danish homebuilders in Ontario taught me the value of being well-read and beer at morning coffee, lunch, and afternoon coffee. My friend John Kierkegaard would say, the beer is nice, but the work, it isn’t really so good.

When I went to Copenhagen for a scientific meeting, sure enough, there was beer at morning coffee.

The Technical University of Denmark reports that almost every other registered salmonella infection in Denmark in 2014 was brought back by Danes travelling overseas. Travel thus remains the largest cause of salmonella infections. An outbreak of salmonella from Danish eggs was also recorded in 2014, which is the first time in five years and illness was again attributed Danish chicken meat.

These are some of the findings presented in the annual report on the occurrence of diseases that can be transmitted from animals and food to humans. The report was prepared by the National Food Institute, Technical University of Denmark, in cooperation with Statens Serum Institut, the national institute of public health, and the Danish Veterinary and Food Administration.

In 2014 a total of 1,122 salmonella infections were reported among Danes, which is equivalent to 19.9 infected cases per 100,000 inhabitants. The figure is in line with the previous year when a historically low number of Danes was infected with salmonella.

In all, 48% became ill with salmonella after travelling overseas in 2014. Most of those who returned home with a travel-related infection had been to Thailand (17.5%), Turkey (15.4%) and Spain (6.4%).

Thus, foreign travel is still the largest cause of salmonella infections among Danes.

In the annual source account which the National Food Institute calculates, salmonella infections were attributed Danish chicken meat for the first time since 2011. In total 2% of the infections were estimated to be attributed this source.

“For two decades Danish producers, authorities and researchers have successfully worked hard to make fresh chicken salmonella-free. It is not allowed to sell fresh meat from Danish chickens if the flock is positive for salmonella. There will always be a small risk that positive fresh meat goes under the surveillance radar and makes its way to store refrigerators. This is why it is important to continue to have a close monitoring,” Senior Academic Officer Birgitte Helwigh from the National Food Institute says.

The first salmonella outbreak from Danish eggs for five years has also been registered in 2014. “It has been five years since we last had a foodborne outbreak caused by Danish eggs. The outbreak was associated with an outbreak of acute salmonella illness in the flock, which is extremely rare. The results show how important it is that producers and authorities continue to focus on maintaining the low incidence of salmonella in the egg production,” says Birgitte Helwigh says.

Danish pork was the food source associated with the most infections among persons infected in Denmark. Overall 15% of the reported illness cases were attributed to Danish pork. There were three outbreaks where Danish pork was registered as the source of infection, which contributed 4.6% of the cases.

Approximately one fifth of all salmonella cases in Denmark were not attributed to a specific food source. The reason may be that the cases were caused by foods which were not included in the salmonella source account, e.g. fruit and vegetables, or other sources of infection such as contact with livestock and pets.

With 3,782 cases registered in 2014, campylobacter still causes the most cases of foodborne bacterial illnesses in Denmark. In 2014 a total of 92 listeria infections were registered, which is an increase of 84% compared to the year before. The increase is mainly due to an outbreak in “rullepølse” (a Danish cold cut ready-to-eat speciality) with 41 reported cases.

In 2014, a total of 60 foodborne disease outbreaks were registered compared with 74 outbreaks the year before. An outbreak is when several people become sick from the same food source. As in previous years, norovirus caused the most outbreaks (40%). These outbreaks usually take place in restaurants, where a total of 363 people were infected in 24 of the recorded outbreaks.

Whole genome sequencing to detect foodborne illness in Denmark

Posted on May 23, 2015 by Douglas Powell

The National Food Institute, Technical University of Denmark, is promoting the creation of global databases for WGS results to facilitate intelligent use of this data.

Debate in the media around foodborne outbreaks often deteriorates to simplified descriptions of unsafe foods and nobody taking action. But that is not the case. In a 2014 Salmonella enteritidis outbreak fx that affected several European countries the source was identified through the use of whole genome sequencing, WGS, in which an organism’s entire DNA-profile is mapped out. This is just one example of the work to track down and prevent people from eating unsafe food.

In August 2014 a listeria outbreak hit headlines in Denmark. The outbreak had broken out in November 2013 and went on for months making at least 38 people sick and claiming 16 lives. The fact that this event was recognized as an outbreak stems partly from the fact that Danish labs used WGS technology to compare the listeria isolates from humans with bacterial strains isolated from food, thereby enabling linking the outbreak to a food source.

The use of WGS technology is making it possible for scientists to more quickly link many more cases of foodborne disease to an outbreak. The National Food Institute is working to make WGS data widely available through the creation of global databases for WGS results.

The use of WGS in solving foodborne outbreaks is described in greater detail in two articles in Pan European Networks Science & Technology: Foodborne outbreaks, not the whole story and Microbiology 2.0. The article is written by Jørgen Schlundt, former director of the National Food Institute, now professor at DTU Management Engineering.

The National Food Institute is part of the Global Microbial Identifier network, which works to create a global system of DNA genome databases that can be used for microbial and infectious disease identification and diagnostics. The databases will enable the identification of relevant genes and the comparison of genomes to outbreaks and emerging pathogens.

2 dead, 3 sickened from Listeria in Denmark

Posted on April 29, 2015 by Douglas Powell

Five people were infected with listeria within a one-week span earlier this month, the Danish State Serum Institute (SSI) said on Tuesday. Two of them died within 30 days of the bacteria’s discovery.

The institute said that two of the new cases resemble the same type of listeria that was present in batches of the popular deli meat rullepølse produced by the company Jørn A. Rullepølser last year. That outbreak began in August and infected a total of 41 individuals, 17 of whom died.

Two of the other new cases resemble previous minor outbreaks while the fifth is infected with a type of listeria that has not yet been seen.

“It’s unusual to have five cases in one week. Normally we see one case of listeria per week. But it is also unusual that we were able to so quickly determine the type of listeria. That is a sign that our monitoring of listeria has gotten better,” SSI spokesman Kåre Mølbak said.

The Jørn A. Rullepølser listeria outbreak led to a total of 30 products – including variations of rullepølse, salami and hot dogs – being recalled from stores nationwide. The company was shut down as a result.

The source of the new cases was not immediately known, Mølbak said.

New Listeria discovery in Danish supermarkets

Posted on December 30, 2014 by Douglas Powell

As a year that has been plagued by food scandals comes to an end, a new batch of listeria-infected deli meat has been detected and recalled from supermarkets.

As was the case with a listeria outbreak that has thus far killed 17 people, a new outbreak of the bacteria has been found in the popular spiced deli meat rullepølse.

Nearly 60 kilos of the infected meat was produced by the Aarhus-based company Defco and delivered to Bilka and Føtex supermarkets nationwide. The contaminated batch of meat has an expiration date between December 24-29 and has been recalled by the company.

Defco CEO Knud E. Czaja said he was surprised by the Listeria discovery.

“We send between 100 and 200 tests into the lab every month to be checked and in one of the tests here at Christmas time, there was a Listeria suspicion. Therefore, we are recalling the product,” Czaja told Ritzau.

“I have no idea how it happened. It could have come through the air or through a person. It is after all found everywhere and this isn’t something we have experienced before,” he added.

Czaja said that the outbreak that began in August at the food company Jørn A. Rullepølser has caused Defco’s sales of rullepølseto drop by 30 percent. Jørn A. Rullepølser has since been shut down by the food authorities.

3,000 Copenhagen kids get listeria-infested food

Posted on November 18, 2014 by Douglas Powell

As many as 3,000 school children in 40 schools throughout Copenhagen were served listeria-infected food, city officials have warned.

In a letter to parents, the City of Copenhagen said that listeria was found in tzatziki served to school kids as part of a public-run lunch program.

“We are writing to you because your child has eaten EAT [the name of the school food programme, ed.] on Tuesday, November 11th and it has now been found that there was listeria in the tzatziki,” the letter reads, according to broadcaster DR.

The EAT programme delivers lunch to 40 different schools and the infected tzatziki was one of two lunch options offered on November 11th. According to a city official, around 3,000 of the up to 5,000 children who get their meals from the programme are through to have chosen the infected dish.

“We are clearly taking this very seriously, and are currently following all of the recommendations from Fødevarestyrelsen [the Danish Food and Veterinary Administration, ed.] in order to ensure it doesn’t happen again,” Lina Maria Johnsson, the head of the city’s health department, told DR.

It is uncertain if the listeria stems from the cucumber, garlic or yoghurt used in the tzatziki, or from unhygienic conditions at EAT’s kitchens.

Denmark has seen numerous listeria outbreaks this year. The most serious of which, an outbreak that was traced to the deli meat rullepølse, has killed 17. In another incident, listeria in a soup served at two public hospitals killed three.

Campy is tops: Disease burden of foodborne infections in Denmark

Posted on November 13, 2014 by Douglas Powell

Campylobacter is the foodborne bacteria that contributes most to the burden of disease in Denmark. This is the finding of a study from the National Food Institute, Technical University of Denmark, which for the first time in Denmark ranks three foodborne bacteria according to the burden of disease they impose on society as a whole. The study provides authorities and other decision makers with the scientific basis to prioritize initiatives aimed at increasing food safety and reducing the health consequences of infection with one of the three bacteria.

Even in countries like Denmark which have sound health surveillance systems it is unknown exactly how many people get a foodborne infection. This is partly because Danes – just like people all over the world – do not necessarily go to the doctor when they get an upset stomach, and partly because laboratory tests do not always identify which bacteria is making people sick. Therefore diseases are not always recorded and subsequently included in official statistics. As such their true impact is underestimated.

For the first time in Denmark researchers at the National Food Institute, together with colleagues from Statens Serum Institut, have calculated the real burden of disease from infections caused by salmonella, campylobacter and verotoxin-producing escherichia coli (VTEC). In their calculations the researchers corrected for underreporting and underdiagnosis, thereby putting a number on how many people actually get sick from the three bacteria.
The burden of disease is reported in DALYs, which stands for disability adjusted life years. DALYs are a measure of how many years of life the total Danish population loses when people have to live with a reduced quality of life and/or die earlier than expected due to disease – in this case foodborne infections.

“Our calculations provide the authorities with comparable and – as such – better measurements of the impact these diseases have on society. The results can support decisions about where to best intervene to ensure that as few people as possible become sick from the food they eat,” senior researcher Sara Pires from the National Food Institute says.

The study is based on surveillance data from 2012. The calculations estimate that for every reported salmonella case, seven cases of disease were not reported. For campylobacter infections it is estimated that one out of 12 cases were reported, while the figures for VTEC infections is one out of 31 cases. This means that the actual number of sick in 2012 is estimated at 8,386 for salmonella, 44,736 for campylobacter and 5,890 for VTEC.

The total burden of disease was highest for campylobacter with 1,593 DALYs, followed by salmonella (389 DALYs) and VTEC (113 DALYs). For both campylobacter and salmonella infections the disease that contributed the most to the total burden of disease was irritable bowel syndrome, while for VTEC it was renal failure.

Using data from the source account for salmonella and campylobacter, the researchers estimated which sources contributed most to the total burden of disease for the two infections.

For campylobacter infections 38% of the total number of DALYs were associated with foreign travel, while the major source of the burden of disease in Denmark was broilers – either from direct consumption of chicken meat or from environmental contamination.
“There could be substantial benefits to our society in terms of fewer sick days and lower costs to our health system from focusing efforts on minimizing infection with campylobacter in broilers,” Sara Pires explains.

41 sick including 17 deaths in Denmark’s listeria outbreak

Posted on November 8, 2014 by Douglas Powell

Almost three months after the confirmation of a listeria outbreak that has claimed a total of 17 lives, another new patient has been infected.

The listeria outbreak that began in August is not fully contained yet.

The Danish State Serum Institute (SSI) said on Thursday that a new case of listeria infection traced to the original outbreak has been found.

With the new patient, the total number of infected individuals increases to 41. Of those, 17 have died.

The outbreak has been traced to the deli meat rullepølse produced by the company Jørn A. Rullepølser, which has been shut down.

A total of 30 products – including variations of rullepølse, salami and hot dogs – were recalled.

SSI said that there have been an additional 38 cases of listeria infection not connected to the rullepølse outbreak. In late September, three people died from listeria in an asparagus soup served at Odense University Hospital.

Norway Seafoods recalls products in Denmark over Listeria risk

Posted on November 4, 2014 by Douglas Powell

Norway Seafoods has recalled products sold in Denmark at the supermarket chains Irma and DognNetto, citing potential risk of Listeria, reported iLaks.no.

Products were also recalled from Fotex and Bilka.

Listeria was found at one of the production sites. The affected products were made on Oct. 21, with an expiry date of Nov. 17.

It is the second time within a short period of time that Norway Seafoods has had to recall products, noted iLaks, adding the listeria was detected by the company’s own control system.

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