The number of foodborne infections in Germany declined in 2020, with the coronavirus pandemic likely affecting the numbers, according to a report.
The annual report on the epidemiology of infectious diseases provides a summary and assessment of notifications of diseases reported to the Robert Koch Institute (RKI). Another report has already shown the decline in foodborne outbreaks reported in 2020.
There has been a sharp reduction of about 80% in some gastrointestinal illnesses compared to before the COVID-19 pandemic. This has been particularly noted for rotavirus gastroenteritis, shigellosis and norovirus.
The pandemic has affected the occurrence and detection of other notifiable diseases in various ways, according to the report. The reasons for the reductions are complex and different for each pathogen. In addition to an actual decline in infectious diseases, a number of factors related to coronavirus measures, such as reduced travel and improved hygiene, may have led to changes.
In 2020, 423 potentially food-borne outbreaks (excluding norovirus) were reported to the RKI compared to 902 in 2019. Among the potential food outbreaks last year, 160 were confirmed affecting 774 people.
Campylobacter and Salmonella results
Overall, 225 potential food-borne outbreaks of Campylobacter were reported with 515 patients, compared to 387 outbreaks in 2019. A total of 97 food-borne outbreaks affected 236 people in 2020. The largest involved nine people and milk was listed as a suspected food category.
Last year, 46,519 cases of Campylobacter were transmitted. The incidence was 24% lower than in 2019. Five people died of illness. They were three men and two women aged 78 to 87.
Most infections have been in Germany, but some have originated in Austria, Croatia, Spain, Italy, France and Poland as well as Morocco, Thailand and India outside of Europe. The incidence has declined in all age groups except children aged 3 and 4 and in all but one federal state. Most cases were from June to September but a peak was also noted again earlier in the year.
In 2020, there were 109 possible food-related outbreaks of Salmonella with 592 cases compared to 277 outbreaks in 2019. A total of 47 were confirmed in 2020 with 404 patients. The largest affected 161 people in multiple states. Dried coconut from Mozambique was found to be the source of the outbreak of Salmonella Muenchen after a case-control study and detection of the epidemic strain in food.
A total of 8,743 cases of salmonellosis were recorded compared to 13,696 in 2019. Infections acquired outside of Germany, Egypt, Turkey, Poland and Thailand were most often mentioned. The highest incidence by age was observed in children under 5 years of age.
The most frequently mentioned serotypes were Salmonella Enteritidis and Salmonella Typhimurium (including the monophasic variant). Far behind were Salmonella Infantis, Muenchen, Derby, Brandenburg and Bovismorbificans.
Thirteen deaths were linked to salmonellosis. They were seven men and six women aged 43 to 89. Four deaths each were attributed to Salmonella Typhimurium and Enteritidis, and one to Salmonella Infantis.
E. coli and findings of HUS
There have been 19 outbreaks of E. coli with 78 patients with the greatest disgusting 31 people. Three were listed as foodborne affecting 36 people.
Most epidemics have sickened two to four people and have occurred in private households. The largest affected 31 people in four daycares supplied by the same caterer. Children, family members, staff and caterer employees have had E. coli O26 confirmed for 16 people.
A total of 1,370 cases of E. coli were reported, which is a decrease of 27% from the previous year. Two deaths were noted in women aged 72 and 88.
The proportion of E. coli infections for which serogroup information was known was 15% in 2020, which is lower than in previous years. This information is important in identifying any links between infections that appear to be sporadic, experts said. The most frequently mentioned serogroups were O26, O157, O103 and O91.
The number of people infected abroad has fallen, but Egypt, France and Italy have been the most cited. As in previous years, the incidence in children under 5 was much higher than in other age groups.
Sixty diseases of hemolytic and uremic syndromes (HUS) were declared against 73 in 2019. This decrease is due to the decrease in the number acquired abroad. Three HUS-related deaths have been recorded in a man and two women aged 67, 75 and 89.
Three outbreaks each included one case of HUS and one to two cases of E. coli. In a case involving two adults and a child, raw donkey’s milk drunk on vacation in France was the suspected source of infection.
The incidence in children under 5 was higher than in other age groups. Eight cases of HUS in children aged 5-14 and 11 in those aged 15 and over and adults have been reported. As in the previous year, serogroup O157 was identified the most at 10 times while O26, O111 and O145 were identified three times each.
Listeria and other diseases
In 2020, 11 Listeria epidemics affected 56 patients. Three were of food origin and 39 sick. In one outbreak, 42 patients were infected from a common source. Nineteen women and 23 men aged 0 to 93 with a median age of 80 were involved. There have been two cases of listeriosis associated with pregnancy and three people have died. A fillet of smoked trout from Denmark was identified as the likely food vehicle and after a product recall infections were reduced.
A total of 575 cases of listeriosis were recorded against 592 the previous year. There were 31 deaths. The incidence increased with age, with people over 80 being mostly ill.
In 2020, three cases of foodborne botulism were reported compared to eight in 2019. All were contracted in Germany. It affected two women in their 50s and a man in their 60s. Two cases of botulinum toxin type E have been linked to fish and one case of type B botulism to vegetables.
A total of 19 cases of brucellosis were reported in 2020, 18 fewer than the previous year. At least nine people have been infected in other countries, including Iraq, Bosnia and Herzegovina, Turkey, Ethiopia and Jordan.
In 2020, 557 cases of hepatitis A were recorded, 316 fewer than the previous year. The majority of those infected were not vaccinated. Two deaths in men over 60 have been reported. Sixteen outbreaks were recorded with 79 patients. In one of them, 41 cases occurred during a local outbreak linked to a bakery.
RKI received 3,246 cases of hepatitis E compared to 3,728 in 2019. Four deaths included two men and two women aged 48 to 74 years. Four outbreaks affected eight people.
For Yersinia, 1,873 illnesses were reported in 2020 compared to 2,171 in 2019. Most infections occurred in Germany. The incidence by age was highest in children less than 5 years old, with a peak in children 1 and 2 years old. There have been 10 epidemics with 20 cases including five related to food.
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