International outbreak of Salmonella Oranienburg due to German chocolate

BACKGROUND: This report describes a large international chocolate-associated Salmonella outbreak originating from Germany. METHODS: We conducted epidemiologic investigations including a case-control study, and food safety investigations. Salmonella (S.) Oranienburg isolates were subtyped by the use of pulsed-field gel electrophoresis (PFGE). RESULTS: From 1 October 2001 through 24 March 2002, an estimated excess of 439 S. Oranienburg notifications was registered in Germany. Simultaneously, an increase in S. Oranienburg infections was noted in other European countries in the Enter-net surveillance network. In a multistate matched case-control study in Germany, daily consumption of chocolate (matched odds ratio [MOR]: 4.8; 95% confidence interval [CI]: 1.3–26.5), having shopped at a large chain of discount grocery stores (MOR: 4.2; CI: 1.2–23.0), and consumption of chocolate purchased there (MOR: 5.0; CI: 1.1–47.0) were associated with illness. Subsequently, two brands from the same company, one exclusively produced for that chain, tested positive for S. Oranienburg. In two other European countries and in Canada chocolate from company A was ascertained that also contained S. Oranienburg. Isolates from humans and from chocolates had indistinguishable PFGE profiles. No source or point of contamination was identified. Epidemiological identification of chocolate as a vehicle of infections required two months, and was facilitated by proxy measures. CONCLUSIONS: Despite the use of improved production technologies, the chocolate industry continues to carry a small risk of manufacturing Salmonella-containing products. Particularly in diffuse outbreak-settings, clear associations with surrogates of exposure should suffice to trigger public health action. Networks such as Enter-net have become invaluable for facilitating rapid and appropriate management of international outbreaks

Surveillance of infectious diseases at the EU level

Mit der im Jahr 1998 von EU-Parlament und Ministerrat getroffenen Entscheidung zur Etablierung eines EU-weiten Netzwerks zur Überwachung von Infektionskrankheiten wurde die Grundlage für die EUweite Surveillance geschaffen. Seit Mai 2005 hat das Europäische Zentrum für die Prävention und die Kontrolle von Krankheiten (ECDC) die Aufgabe, dieses Netzwerk zu koordinieren und weiterzuentwickeln. Eine der Hauptfunktionen des ECDC besteht darin, die europäische Infektionsüberwachung zu standardisieren und insbesondere die Verfahrensweisen der weitgehend voneinander unabhängigen Surveillance-Netzwerke zu vereinheitlichen. Als einer der ersten Schritte wurden in Zusammenarbeit mit den Mitgliedsstaaten die EU-Falldefinitionen für die Surveillance revidiert. Die Surveillance-Netzwerke werden derzeit nach einem standardisierten Protokoll evaluiert, bevor im ECDC eine Entscheidung über die Zukunft der einzelnen Netzwerkaktivitäten getroffen wird. Parallel wurde mit der Entwicklung eines einheitlichen Datenerfassungssystems (The European Surveillance System, TESSy) begonnen. Seit Beginn 2008 werden die Nutzer spezifisch geschult. TESSy ist seit April 2008 funktionsfähig. Zukünftig muss das Hauptaugenmerk auf die Qualität und Vergleichbarkeit der Daten gerichtet sein, da nur valide und vergleichbare Daten eine gute Grundlage für Entscheidungen im Gesundheitsbereich sind.The basis for EU wide surveillance was Decision 2119/98/EC of the European Parliament and the Council in 1998. Since May 2005 it is the task of the European Centre for Disease Prevention and Control to coordinate and further develop this network. One key function of the ECDC is to standardise European surveillance and especially to harmonise the procedures of the surveillance networks that developed independently of each other. As a first step, the EU case definitions have been revised jointly with the Member States and the Commission. All surveillance networks are evaluated with a standard protocol before a decision is made at the ECDC on the continuation of the individual network activities. Simultaneously, the development of The European Surveillance System (TESSy) progressed. Since the beginning of 2008 data users have been trained and TESSy has been in use since April 2008. In the future the main focus must be the improvement of the quality and comparability of the data as such data are the essential prerequisite for decision making in public health