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]
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[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.
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[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]
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[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]
Date: Wed 17 Aug 2016
Source: Statens Serum Institut Epi-News No 28-33 - 2016 [edited]
<http://www.ssi.dk/English/News/EPI-NEWS/2016/No%2028-33%20-%202016.aspx>

The period from January 2011 to June 2016 saw a total of 60 recorded cases of leptospirosis [in Denmark] overall that is, notified and/or laboratory-confirmed cases; 10 (17per cent) women and 50 (83 per cent) men aged 13-70 years with a median age of 44 years, figure 1 [figures and tables available at the URL above]. Among the recorded cases, 38 patients aged 13-69 were notified clinically. Among these, 33 (87 per cent) were men aged 16-69 years (median age 44 years). A total of 59 cases were laboratory-confirmed; these included 37 of the 38 clinically notified patients. For a total of 25 people (42 per cent), information was provided about infection in Denmark.

Eight of these had occupational exposure, including 4 following contact with sewage where rats were present, and in a total of 3 cases after direct contact to rats or rat urine, one at a fish farm and 2 at farms, table 1. The 8th person worked putting up animal fencing outdoors and came into contact with stagnant water. The people who were infected in Denmark and had no occupational exposure had most frequently become infected when cleaning their own cellars (6 people) and through contact with stream water (5) in connection with both intentional and unintentional stays in water. Another 4 had come into more direct contact with rats, either by being bitten or in connection with rat prevention.

Also, one patient was a hunter, and another reported having stood barefoot in sewage. A total of 26 people were infected abroad, 16 (61 per cent) of whom had travelled to Asia. Among those who were infected outside Denmark, 10 had been exposed to lake water and rivers; and among these, 3 had been infected doing river rafting. Only one person was believed to have become infected from sewage. For 9 people, cerebral symptoms were reported. Two of the 60 patients (one man and one woman) died due to their leptospira infections. Infection by the leptospira bacterium is renowned for seasonal variation, which depends on the temperature and on rat population density.

As in other years, the majority of leptospirosis cases were seen in late summer and in the autumn (Figure 2) which is when water temperatures peak. The bacterium survives poorly in water below 18 C [64 F] and does not tolerate drying out. In Denmark, Statens Serum Institut performs the laboratory diagnostics for leptospirosis. Diagnostics consist of serology (R-343) through micro-agglutination testing, MAT testing for 15 _Leptospira_ serovars, PCR for the _Leptospira_ species (R-065), and PCR and culture for leptospira (R-1350). The recommended materials for PCR are blood, urine or spinal fluid, if possible obtained before the initiation of antibiotic treatment.

In 38 per cent of cases, the serovar could not be determined. In 15 of these patients, the diagnosis was based on PCR exclusively. An additional 7 patients' sera yielded too many cross-reactions for the serovar to be determined. The most frequently established serovar was _L. interrogans_ serovar Icterohaemorrhagiae (20 per cent), Table 2, which is frequently found naturally in rat urine. Two patients had leptospira DNA detected in their spinal fluids, and serology identified _Leptospira interrogans_ of the serovar Sejroe, table 2. One of these patients recovered, whereas leptospira DNA was detected in the spinal fluid post-mortem in the other case (for a detailed description, see "Case stories"). A total of 46 people contacted hospitals directly, whereas only 6 people were seen by their GP. In 8 cases, the samples were ordered by private medical companies or by other Scandinavian healthcare facilities.

Commentary
--------------------------------
The number of patients who were infected with leptospirosis in the period from January 2011 to June 2016 -- a total of 60 people -- was considerably higher than the number recorded in the corresponding period from 2005-2010, when a total of 42 cases were registered, EPI-NEWS 34b/11. Only about half of the cases recorded in the entire period were notified on Form 1515.

The majority of the cases were reported in 2011, including 5 cases associated with the summer 2011 rainstorm, EPI-NEWS 5/12. The infection course with leptospira from the bloodstream to secretion in the urine and subsequent development of antibodies means that both laboratory methods (serology and PCR) may be needed to increase diagnostic sensitivity and specificity.

It is remarkable that the number of people who were presumably infected through farms or due to contact with sewage or freshwater in the period from January 2011 to June 2016 exceeded the number of people presumably infected at fish farms. Leptospirosis in pigs in Denmark is described by the Knowledge Centre for Agriculture. (byline: R Datcu, Microbiological Diagnostics and Virology; C Kjelsø, Department of Infectious Disease Epidemiology; M M Søndergaard, Department of Medicine, Svendborg Hospital; K A Krogfelt, Microbiology and Infection Control)
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[The above report on leptospirosis in Denmark, 2011-2016 has been condensed. The full report, including figures and tables, can be found at the source URL. For discussions of leptspirosis, see moderator comments in prior ProMED-mail posts below. - ProMED Mod.ML]

[A HealthMap/ProMED-mail map can be accessed at <http://healthmap.org/promed/p/111>.]
Date: Wed, 27 Jan 2016 09:38:18 +0100

Copenhagen, Jan 27, 2016 (AFP) - A Danish tourist returning from Latin America has been diagnosed with the Zika virus, which has been blamed for a surge in birth defects in the region, triggering a major health scare.   "A Danish tourist who travelled to Central and South America was diagnosed on his return with the Zika virus," Aarhus hospital in eastern Denmark said in a statement late Tuesday.

Britain has also reported a handful of cases in travellers returning from South America while the Netherlands has confirmed 10 cases of infection, also in travellers returning from the region.

The Zika virus, a flu-like disease that is transmitted by the Aedes aegypti mosquito, has been linked to a jump in the number of babies born in Latin America, particularly Brazil, with microcephaly, or abnormally small heads.   There is no cure or vaccine.   The Danish patient was a young man who was expected to make a full recovery, the head of Aarhus hospital, Lars Ostergaard told public broadcaster DR.
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