Date: Thu 25 Oct 2018
Source: European Centre for Disease Prevention and Control (ECDC) [edited]
<https://ecdc.europa.eu/en/news-events/multi-country-outbreak-listeria-monocytogenes-infections-linked-consumption-salmon>

Ready-to-eat salmon products, such as cold-smoked and marinated salmon, are the likely source of an outbreak of listeriosis that has affected Denmark, Germany, and France since 2015. 12 cases, including 4 deaths, matched the outbreak strain identified by whole genome sequencing (WGS). A previous investigation and new WGS findings suggests a common source of contamination, states the latest report by ECDC and the European Food and Safety Authority (EFSA).

WGS-based analysis identified 12 patients with onset of symptoms between October 2015 and May 2018: 6 in Denmark, 1 in France, and 5 in Germany. The 1st cluster of cases reported by Denmark in September 2017 was linked to the consumption of salmon products produced in Poland.

Initial investigations suggested that contamination may have taken place at a Polish processing company but the lack of recent WGS data on the _Listeria monocytogenes_-isolates collected at the processing plant make it impossible to confirm this is the case.

Although control measures were implemented following the Danish outbreak investigation in September 2017, the same strain was found in a salmon product in France in October 2017 and in a patient in Germany in May 2018. This suggests that the source of contamination may still be active and that contaminated products may have been distributed to more EU countries. Until the source of contamination is identified and controlled, new invasive _L. monocytogenes_ infections associated with this outbreak may still occur.

It is likely that the extent of the outbreak is underestimated, since the use of sequencing to characterise _L. monocytogenes_ isolates is only used by a few EU countries. A recent EU-wide study coordinated by ECDC revealed that more than half of the severe listeriosis cases in the European Union belong to clusters, many of which are not being picked up fast enough by the current surveillance system.

Listeriosis is a relatively rare but potentially severe food-borne disease that has been reported in increasing numbers in the EU/EEA countries since 2008. In 2016, 2536 cases were reported, including 247 deaths. Pregnant women, the elderly and immunocompromised people are at higher risk of contracting listeriosis.
===================
[Refrigerated smoked salmon is a recognized potential source for listeriosis, similar to other cold cut meats and non-heat treated cured smoked meats, being a ready-to-eat product, that is, does not require further cooking before eating. The ECDC report said that more cases related to this outbreak are expected, despite a recall in 2017 by the Salling Group (formerly Dansk Supermarked Group/DSG) of cold-packed smoked salmon manufactured in Poland from 600 stores in Denmark and a limited number in Metro Poland, after the outbreak strain of _Listeria monocytogenes_ was identified in the product (see ProMED-mail post Listeriosis - Denmark, Poland: smoked salmon, recall http://promedmail.org/post/20170902.5290728). Salling Group consists of chains (fotex, Bilka, Netto, and Salling) with more than 1400 stores in Denmark, Germany, Poland, and Sweden. - ProMED Mod.ML]

[HealthMap/ProMED maps available at:
Denmark: <http://healthmap.org/promed/p/111>
Germany: <http://healthmap.org/promed/p/101>
France: <http://healthmap.org/promed/p/100>]
Date: Thu 26 Jul 2018
Source: Food Safety News [edited]
<http://www.foodsafetynews.com/2018/07/danish-botulism-outbreak-traced-to-homemade-savory-jelly/#.W1nfpdIzbIU>

Homemade savoury jelly caused an outbreak of foodborne botulism in Denmark last month [June 2018], according to the Statens Serum Institut (SSI). The agency, which is under the Danish Ministry of Health, said 9 people became ill after eating dinner at a private party in Sonderborg. Danish authorities previously said a sample from the homemade dish was positive with botulinum toxin type A. The same type was identified in the patients.

Experts from Fodevarestyrelsen (Danish Veterinary and Food Administration), SSI, and DTU Food - The National Food Institute found the outbreak was limited to those who ate dinner together. Foodborne botulism is extremely rare in Denmark. From1985 to 2017, SSI registered only 6 cases. Homemade canned, preserved, or fermented foods are often found to be the causes of foodborne botulism. Commercially processed food is another common cause.

Steen Ethelberg from SSI told Food Safety News that 7 of the patients were lab-confirmed and developed varying degrees of symptoms in the following days. All were hospitalized, and most have now recovered.

Authorities confirmed botulinum toxin type A in a mouse assay after collecting and combining leftover food from the party and a glass that it was prepared in. However, they could not explain exactly how the savoury jelly became contaminated or what ingredient was to blame.

_Clostridium botulinum_ is a bacterium that produces botulinum toxin. The toxin blocks nerve functions and can lead to respiratory and muscular paralysis. Symptoms are caused by the toxin that's produced by the bacterium and usually appear within 12-36 hours -- with a range of 4 hours to 8 days -- after exposure.  [Byline: Joe Whitworth]
=====================
[The paralytic intoxication botulism, or sausage poisoning, as it was originally termed, is caused by one of the neurotoxins produced by (primarily) _Clostridium botulinum_ bacteria in foods not properly prepared. It was 1st seriously studied following an outbreak in Wildbad, Germany, in 1793. The outbreak involved 13 people, 6 of whom died, and was associated with consumption of a locally produced blood sausage. Following this outbreak, the number of reported cases of sausage poisoning rapidly increased, prompting a study of the disease by local health officer Justinius Kerner (1829). He described 230 cases, most of which were attributed to the consumption of sausage. The illness became known as "botulism" after "botulus," the Latin word for sausage. - ProMED Mod.LL]

[HealthMap/ProMED-mail map:
Denmark: <http://healthmap.org/promed/p/111>]
Date: Wed 4 Jul 2018
Source: Food Safety News [edited]
<http://www.foodsafetynews.com/2018/07/homemade-food-responsible-for-botulism-outbreak-in-denmark/#.WzzRadIzbIU>

An outbreak of foodborne botulism in Denmark, with 6 confirmed cases, has been linked to a homemade dish served at a private party in June 2018. Fodevarestyrelsen (Danish Veterinary and Food Administration) said a sample from the homemade dish was positive with botulinum toxin type A. The same type was identified in the patients.

All 6 confirmed infections and one possible case attended a private party in Danish town Sonderborg in June 2018 and were later hospitalized. DVFA said investigations are ongoing to find out how the toxin developed in the dish. Statens Serum Institut (SSI), an agency under the Danish Ministry of Health, confirmed the diagnosis in patients. A statement from DVFA reported the agency took samples for analysis from leftovers at the private households involved.

"Since it was a homemade dish served at a private party, it is outside of our jurisdiction to take action. With homemade dishes, it is very hard to fully investigate, since we don't have the same data as with in a professional kitchen," the agency told Food Safety News.

"We have gone through a series of investigational steps concerning the ingredients used in the dish to ensure that no commercially available food items on the market could be suspected of being unsafe. With the last results still coming in, we have no information so far that could indicate that general food safety is jeopardized."

_Clostridium botulinum_ is a bacterium that produces botulinum toxins. Foodborne botulism is caused by consumption of improperly processed food. Homemade canned, preserved or fermented foods are common sources. Botulinum toxin type A is normally not related to fish or maritime products.

Symptoms are caused by the toxin produced by the bacterium. They usually appear within 12 to 36 hours -- with a range of 4 hours to 8 days -- after exposure. The toxin affects multiple systems in the body, including paralyzing muscles. Most patients require intubation because muscles used for breathing are usually paralyzed.  [Byline: Joe Whitworth]
=====================
[The specific food involved in this cluster of botulism is not stated. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of Sonderborg, Region South Denmark, Denmark:
<http://healthmap.org/promed/p/7943>]
Date: Fri 22 Jun 2018
Source: Foedevarestyrelsen [Danish Food Administration, in Danish machine trans., edited]
<https://www.foedevarestyrelsen.dk/Leksikon/Sider/Udbrud_med_botulisme_poelseforgiftning.aspx>

There is an outbreak of clinically confirmed botulism (sausage poisoning) in South Jutland [Sydjylland]. The Food Administration has been involved in the case since Sunday morning [17 Jun 2018]. It is normal for the Board of Patient Safety to involve the Food Administration in cases of suspected food.

The Danish Food Agency has taken samples of the leftover food that the individuals ate and they are now being analyzed. The result is expected in about 5 days. The information obtained suggests that the source of infection should be found in a food that only the poisoned patients have ate.

Manufactured foods are basically very safe in relation to botulism, as pH and salt content are controlled in production. Cases of botulism are very rare in Denmark.
=====================
[The copyrighted website <https://www.foodnavigator.com/Article/2018/06/22/Foodborne-botulism-outbreak-at-private-party-in-Denmark#> reports that there are 6 cases and one possible case among 11 individuals who attended a private dinner in the town of Sonderborg on 15 Jun 2018. The suspected vehicle of the intoxication is not yet stated. ProMED would appreciate more information regarding this outbreak.

The paralytic intoxication botulism, or sausage poisoning as it was originally termed, is caused by one of the neurotoxins produced by (primarily) _Clostridium botulinum_ bacteria in foods not properly prepared. It was first seriously studied following an outbreak in Wildbad, Germany in 1793. The outbreak involved 13 people, 6 of whom died, and was associated with consumption of a locally produced blood sausage. Following this outbreak, the number of reported cases of sausage poisoning rapidly increased, prompting a study of the disease by local health officer Justinius Kerner (1829). He described 230 cases, most of which were attributed to the consumption of sausage. The illness became known as "botulism" after "botulus", the Latin word for sausage. - ProMED Mod.LL]

[HealthMap/ProMED-mail map of North Jutland, Denmark:
<http://healthmap.org/promed/p/16381>]
Date: Fri 9 Feb 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/denmark-investigates-hepatitis-outbreak-dates-suspected-94776/>

Since the end of January 2018, the State Serum Institute has investigated a disease outbreak of hepatitis caused by hepatitis A virus infections, according to Fødevarestyrelsen (computer translated). The outbreak thus far includes 14 patients, 7 women and 7 men aged 17-79 years. Patients have become ill from December 2017 onwards.

Patients are residents throughout the country and 13 have been hospitalized. Virus from 7 of the patients has been typed as type 3A, and for the time being, genetic studies have shown that 4 of these are identical, which supports the suspicion of a common source of infection. It is still expected that more patients will come, as about 4 weeks from eating the contaminated dates until you get sick with hepatitis A.

To investigate the source of infection for the outbreak, the State Serum Institute has conducted extensive interviews with the patients and made a case-control study. During the initial interviews, dates, as several of the patients indicated to have eaten, were suspected. The dates are described by most patients as ones purchased in Rema1000. The dates were recalled on [Tue 6 Feb 2018]. [Byline: Robert Herriman]
=====================
[A copyrighted website <https://www.foodqualitynews.com/Article/2018/02/09/RM-Import-hits-back-after-dates-linked-to-Hepatitis-A-outbreak> reported that the dates were imported from Iran and were also imported to Germany and Norway.

A map of (Denmark): <http://healthmap.org/promed/p/111>. - ProMED Mod.LL]
More ...