Abstract
BackgroundHealthcare-associated foodborne outbreaks (HA-FBO) may have severe consequences, especially in vulnerable groups.AimThe aim was to describe the current state of HA-FBO and propose public health recommendations for prevention.MethodsWe searched PubMed, the Outbreak Database (Charité, University Medicine Berlin), and hand-searched reference lists for HA-FBO with outbreak onset between 2001 and 2018 from Organisation for Economic Co-operation and Development (OECD) countries and HA-FBO (2012–2018) from the German surveillance system. Additionally, data from the European Food Safety Authority were analysed.ResultsThe literature search retrieved 57 HA-FBO from 16 OECD countries, primarily in the US (n = 11), Germany (n = 11) and the United Kingdom (n = 9). In addition, 28 HA-FBO were retrieved from the German surveillance system. Based on the number of outbreaks, the top three pathogens associated with the overall 85 HA-FBO were Salmonella (n = 24), norovirus (n = 22) and Listeria monocytogenes (n = 19). Based on the number of deaths, L. monocytogenes was the main pathogen causing HA-FBO. Frequently reported implicated foods were ‘mixed foods’ (n = 16), ‘vegetables and fruits’ (n = 15) and ‘meat and meat products’ (n = 10). Consumption of high-risk food by vulnerable patients, inadequate time-temperature control, insufficient kitchen hygiene and food hygiene and carriers of pathogens among food handlers were reported as reasons for HA-FBO.ConclusionTo prevent HA-FBO, the supply of high-risk food to vulnerable people should be avoided. Well working outbreak surveillance facilitates early detection and requires close interdisciplinary collaboration and exchange of information between hospitals, food safety and public health authorities.
Highlights
23 million foodborne disease illnesses and 5,000 deaths are estimated in the World Health Organization (WHO) European Region, and 41 foodborne Disability Adjusted Life Years (DALYs) per 100,000 population were estimated for the WHO Sub-Region EUR A in 2010 [1]
Healthcare-associated foodborne outbreaks (HA-foodborne outbreaks (FBO)) were reported from 16 Organisation for Economic Cooperation and Development (OECD) countries: Germany [31,32,34,35,36,37,38,39,40,41,42], US [43,44,45,46,47,48,49,50,51,52,53,54,55], United Kingdom (UK) [56,57,58,59,60,61,62,63], Spain [33,64,65,66], Japan [67,68,69,70,71], Austria [72,73,74], Australia [75,76], Canada [44,77,78], Denmark [79,80], France [81,82], Finland [83], Greece [84], Italy [85], Norway [86], the Netherlands [36,87], Turkey [88] and included three multinational outbreaks [36,44,56]
Between 2001 and 2018, there was no trend in time, except that no published HA-FBO was reported with outbreak onset in 2015, 2017 and 2018, most likely because of publication delay
Summary
23 million foodborne disease illnesses and 5,000 deaths are estimated in the World Health Organization (WHO) European Region, and 41 foodborne Disability Adjusted Life Years (DALYs) per 100,000 population were estimated for the WHO Sub-Region EUR A in 2010 [1]. In Europe, a total of 5,146 foodborne and waterborne outbreaks, including 48,365 cases of illness and 40 deaths were reported to the European Food Safety Authority (EFSA) in 2018 [2]. As the proportion of elderly people is projected to further increase, the share of the vulnerable population as patients in healthcare facilities (HCF) is likely to increase and thereby the risk associated with healthcare-associated foodborne outbreaks (HA-FBO). Personnel (medical and non-medical staff, food handlers etc) of HCF may be at risk for HA-FBO and be a source of further spread in healthcare settings and elsewhere. This can cause major disruption of services [5]. Well working outbreak surveillance facilitates early detection and requires close interdisciplinary collaboration and exchange of information between hospitals, food safety and public health authorities
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