Report on Zoonoses and Zoonotic Agents in Austria in 2015

REPORT ON ZOONOSES AND ZOONOTIC AGENTS IN AUSTRIA IN 2015

Federal Ministry of Health and Women’s Affairs (BMGF) Austrian Agency for Health and Food Safety (AGES) LIST OF AUTHORS

Dr. Peter Much Austrian Agency for Health and Food Safety, AGES Data Statistics, Risk Assessment A-1220 Vienna, Spargelfeldstraße 191

Tel.: +43 (0) 664 8398065 Fax: +43 (0) 50 555 95 37303 E-Mail: [email protected] Homepage: www.ages.at

Priv.-Doz.in Dr.in Pamela Rendi-Wagner, MSc, DTM&H Federal Ministry of Health and Women’s Affairs, BMGF Head of Section III Public Health Care and Medical Affairs A-1030 Vienna, Radetzkystraße 2

Tel.: +43 (0) 1 711 00-4637 Fax: +43 (0) 1 713 4404-1100 E-Mail: [email protected] Homepage: www.bmgf.gv.at

Dr. Ulrich Herzog Federal Ministry of Health and Women’s Affairs, BMGF Head of Field II/B Field B – Consumer Health and Veterinary Public Health A-1030 Vienna, Radetzkystraße 2

Tel.: +43 (0) 1 711 00-4824 Fax: +43 (0) 1 710 4151 E-Mail: [email protected] Homepage: www.bmgf.gv.at

2 ACKNOWLEDGEMENT

AGES would like to thank all public health officers, veterinarians, food inspectors and staff members of the insti- tutes of human and veterinary medicine, as well as staff members of food and feed laboratories, who have taken part in the collecting and reporting of data for this brochure.

3 CONTENT

LIST OF ABBREVIATIONS 5

FOREWORD 6

INTRODUCTION 8

ZOONOSIS MONITORING IN AUSTRIA 10

ZOONOSES AND ZOONOTIC AGENTS SUBJECT TO MONITORING IN AUSTRIA 14

SALMONELLOSIS 14

CAMPYLOBACTERIOSIS 24

LISTERIOSIS 30

VEROTOXIN-PRODUCING ESCHERICHIA COLI (VTEC) 35

TUBERKULOSIS CAUSED BY MYCOBACTERIUM BOVIS 41

BRUCELLOSIS 46

TRICHINELLOSIS 49

ECHINOCOCCOSIS 52

TOXOPLASMOSIS 56

FOOD-BORNE OUTBREAKS IN AUSTRIA 60

LIST OF NATIONAL REFERENCE LABORATORIES/CENTRES WITH CONTACTS 66

4 LIST OF ABBREVIATIONS

AGES Agency for Health and Food Safety (Agentur für Gesundheit und Ernährungssicherheit) B. Brucella BMGF Federal Ministry of Health and Women’s Affairs (Bundesministerium für Gesundheit und Frauen) BSE Bovine spongiforme encephalopathy C. Campylobacter CPE carbapenemase-producing Enterobacteriaceae DT definitive type E. Escherichia ECDC European Centre for Disease Prevention and Control EFSA European Food Safety Authority EMS Epidemiologic Reporting System (Epidemiologisches Meldesystem) ESBL extended spectrum Beta-Lactamase-producing Enterobacteriaceae EU European Union FS feedstuff HUS haemolytic-uraemic syndrome CFU/g colony forming units per gram L. Listeria M. Mycobacterium MRSA methicillin-resistant Staphylococcus aureus MTC Mycobacterium tuberculosis complex NRL National Reference Laboratory NRZ National Reference Centre OBF officially brucellosis free OBMF officially Brucella melitensis free OIE World Organisation for Animal Health (Office International des Epizooties) OTF officially tuberculosis free PT phage type RDNC reaction pattern does not conform to the phage scheme S. Salmonella SARS Severe Acute Respiratory Syndrome T. Toxoplasma VTEC Verotoxin-producing Escherichia coli vtx-Gene Verotoxin Gene WHO World Health Organization °C degrees Centigrade / Celsius

5 FOREWORD

This Report on Zoonoses and Zoonotic Agents proof risk that pathogens may be introduced into the vides information on the occurrence and spread of livestock. zoonoses requiring monitoring in Austria in the year 2015. The situation has improved steadily in recent Farm animals and their produce, which are used as years. foods, are by no means germ-free. Therefore, it is important that during slaughtering and processing, Healthy livestock is the most important prerequisite as well as in the kitchen when preparing meals, that for being able to produce good quality foodstuffs. the necessary attention is paid to hygiene. Infections Welfare bolsters animal health, helps to avoid diseases associated with the most common zoonotic pathogens and thus reduces the therapeutic use of drugs. Animal such as Campylobacter or Salmonella, can in part be welfare also means that contact with wild animals avoided by adhering to simple rules. The occurrence is possible; this is associated with a certain element and the spread of zoonotic diseases are continually

FOREWORD 6 monitored. The monitoring programmes and the control objectives are coordinated with the EU. Reliable results from monitoring are an important prerequisite to allow control measures to be implemented in a targeted and efficient manner. Where control programmes are running, investigations are documen- ting programme progress in line with predetermined plans and thus allow an assessment of the impact of the measures taken. Another aim of monitoring is early detection. Here, monitoring is aimed at a broad spectrum of zoonoses, as well as new or re-emerging diseases. The 2015 Zoonoses Report, with the latest facts and figures about the occurrence of selected zoonotic agents in humans, foodstuffs, agricultural livestock and in animal feed, is already the 11th annual edition of the report to be published. It has most certainly met its aim of providing an up-to-date picture of the occurrence and spread of some important zoonotic diseases and in doing so of promoting understanding of the importance of zoonoses, as well as of monitoring and control measures. The Report on Zoonoses and Zoonotic Agents has established itself as a medium of information between science, industry and politics and facts and information contained in its pages have been quoted repeatedly as part of media reporting.

We would like to express our thanks and appreciation to all those involved for their work in the monitoring and control of zoonotic diseases.

Dr.in Sabine Oberhauser Federal Ministry of Health and Women’s Affairs

FOREWORD 7 INTRODUCTION

Zoonoses are infectious diseases that can be trans- New pathogens, so-called emerging zoonotic agents, mitted between animals and humans. Transmission appear on a regular basis. These have caused new may occur via direct contact with infected animals epidemics, such as the outbreaks of SARS (Severe following the consumption of contaminated food – pri- Acute Respiratory Syndrome, originating in Asia), marily food products of animal origin – or by indirect Influenza A (H1N1) in 2009 (“swine flu”) or the West contact (e.g. via a contaminated environment). In- Nile virus (in Romania or Greece). However, even fants, elderly people, pregnant women and individuals known pathogens may cause severe infections with with weak immune systems are particularly susceptib- newly acquired properties, such as verotoxin-produ- le to these diseases. cing Escherichia coli (VTEC) strains causing Haemo- lytic Uremic Syndrome (HUS) in humans. The VTEC The zoonoses that are animal diseases -- e.g. brucel- O104:H4 outbreak in 2011, which affected Germany losis or bovine tuberculosis -- have been controlled particularly strong, introduced a new strain of bacte- in Austria for decades based on EU law, the recom- ria: this strain had developed from a human ente- mendations of the World Organisation for Animal roaggregative Escherichia coli, which had acquired Health (OIE) and national legislation. As a result, various virulence genes that intensified its pathogenic our livestock population has been officially free of potential, such as forming specific organelles allowing brucellosis and bovine tuberculosis since 1999, thanks it to stick to human intestinal cells or build resistances to the successful control programmes that have been to various antibiotics and the ability to produce the undertaken. verotoxin 2. More than 3,800 people were infected by this bacteria strain in 2011, 53 of whom died. The most common zoonotic infectious diseases in humans are currently infections with the diarrhoea The BMGF imitates programmes to monitor the pathogens Campylobacter und Salmonella, which are incidence of infectious pathogens in such animals mainly ingested via food. Combatting these pathogens and foods that host these pathogens and could serve within animal stocks is difficult, as food-producing ani- as a vehicle for the infection for humans. The data mals may carry these bacteria without being diseased gathered is then used to design control and preventi- themselves. Thus, animals may be host to a large on strategies. number of these pathogens without showing signs of sickness, while humans may get infected as soon as Another risk potential for humans is pathogens they consume products coming from these animals or resistant to antibiotics: these are bacteria that are products that have come into contact with excrements not affected when treated with antimicrobial agents of such animals. that are usually effective when treating the same species of bacteria. Multidrug-resistant bacteria have There are specially designed programmes in place to resistances to three or more antimicrobial classes. monitor these bacteria. They are designed to combat Such bacteria include extended spectrum β-lactamase Salmonella in the most affected animal populations (ESBL) producing Enterobacteriaceae, carbapene- -- such as laying hens, broilers and turkeys and their mase-producing Enterobacteriaceae (CPE) and most parent generations. Additionally, monitoring program- strains of methicillin-resistant Staphylococcus aureus mes are used along the food chain, such as in the (MRSA) or Salmonella Typhimurium DT104. Data case of Campylobacter monitoring. The success of the on antibacterial resistance and the consumption of programmes depends on close cooperation between antimicrobial substances in Austria is published in the the Federal Government, in particular the Veterinary Austrian Resistance Report (AURES) commissioned Departments responsible and the Department of Food by the BMGF and compiled by AGES and the National of Division B of Section II (Consumer Health and Ve- Reference Centre for Antimicrobial Resistance and No- terinary Public Health) and Section III (Public Health socomial Infections ((Convent Hospital Elisabethinen, Care and Medical Affairs) at the Federal Ministry of Linz) (http://bmg.gv.at/home/Schwerpunkte/Krank- Health and Women’s Affairs (BMGF), the provincial heiten/Antibiotikaresistenz/ oder http://www.ages.at/ Public Health Directorates and the Agency for Health themen/arzneimittel/aures-berichte/). and Food Safety (AGES). In addition, the Federal Mi- nistry of Agriculture, Forestry, Environment and Water Should infections or diseases that can be traced back Management and local authorities are also included in to the consumption of the same food product or the the programmes. food products from one specific food company occur in two or more individuals, they are referred to as Specific surveillance programmes ensure nationwide food-borne outbreaks. The Zoonoses Law of 2005 inspections of animal health status by risk-based or obliges the responsible authorities to investigate randomised sampling plans. food-borne outbreaks and carry out the appropriate epidemiological and microbiological analyses.

8 A decrease in the number of human infections has The 2015 Zoonosis Brochure should give consumers a been recorded for many zoonotic pathogens, such basic overview of the situation in regards to zoonoses as Salmonella. This can be put down to the success among food-producing animals, food products and in zoonotic control in animal production, such as humans and provide information on the incidence of the Salmonella Control and Prevention Programme. food-borne outbreaks in Austria. This is also reflected in the strong collaboration work between veterinarians and food producers – from the farmers to the food industry – in their fight against food-borne infectious diseases.

9 ZOONOSIS MONITORING IN AUSTRIA

During the monitoring of zoonoses, a continuous member state contain the results of each country's stream of precise data about the occurence of zoo- surveillance activities. The European Food Safety notic pathogens is collected along the entire food Agency (EFSA) collects these reports, together with chain from the environment, farm animals and food the European Centre for Disease Prevention and products up to and including consumers. Targeted Control (ECDC), and publishes a Europe-wide report measures can be taken using these facts and figures on zoonoses in the EU. The latest version available is to interrupt the transmission chain of such pathogens “The European Union summary report on trends and to protect humans and animals from these types of sources of zoonoses, zoonotic agents and food-borne diseases. outbreaks in 2014”, which is available at the following link: http://www.efsa.europa.eu/en/efsajournal/ This 2015 Zoonosis Brochure is based on the data pub/4329. collected and compiled for the European Summary Report on Trends and Sources of Zoonoses in 2015. The annual zoonoses reports of each European Union

MONITORING-PROGRAMS

The term monitoring refers to the continual ob- The BMGF has been conducting an annual monitoring servation, assessment and reviewing of a situation programme in Austria according to the Monitoring or changes arising therefrom; data on health and Programme Ordinance for selected pathogens in environmental parameters is collected at public and cattle, sheep, pigs and poultry, together with public veterinary health authorities with the goal of recogni- veterinary officers, commissioned vets, and AGES zing changes in prevalence (= proportion of infected since 2004. In 2014, a new EU decision (2013/652/ or sick individuals in a population per defined unit of EU) came into effect, focusing on the surveillance of time) as early as possible. antibiotic resistance and to be implemented by all Member States. Resistance to antibiotics in specific Monitoring programmes are a system involving re- zoonotic and commensal bacteria was monitored in peated observations, measurements and evaluations animals supplying food and animal feeds in the retail to check predefined objectives. The selection of the sector, in line with this decision. samples to be tested is performed on a random basis in terms of the time and location of samples collected, taking into account epidemiological principles to provide results with the utmost level of meaningfulness and statistical reliability.

SURVEILLANCE-PROGRAMS

Surveillance is the continual, systematic collection, (WHO). The EU legislation-based Surveillance Pro- analysis and interpretation of the health status of gramme for feeds and foods for animals and humans humans and animals to recognize changes at an is conducted by Sections II and III of the BMGF early stage for the purpose of control. A surveillance together with the BMLFUW. programme consists of the timely dissemination of results to risk managers so that they can initiate effective prevention and combative measures, as well as representative data collection and analysis. Such programmes are currently the most important concept and control methods for so-called “food-borne infectious diseases”, as well as for the control of notifiable animal diseases (e.g. BSE, bovine tuberculosis and rabies), according to the World Health Organisation

10 AUSTRIA: OFFICIALLY FREE OF SPECIFIC EPIZOOTICS

Notifiable animal diseases are controlled in Austria Live animal trading or of their products is regulated on on the basis of EU legislation, World Organisation an EU-wide basis. Austria has an “officially disease- for Animal Health (OIE) provisions and local legislati- free” status for certain infectious zoonoses (e.g. on. Exact knowledge of animal health status both in bovine tuberculosis, bovine brucellosis and Brucella the EU Member States and worldwide also prompts melitensis infections in small ruminants). Austria is ob- authorities to take rapid preventative measures – e.g. liged to conduct an annual combating programme, in trading restrictions for live animals – to prevent the line with EU provisions, to retain this official disease- fast spread of epizootic diseases. free status. The most important goal is to retain this official disease-free status, as well as ensure trading advantages for the Austrian economy, among others.

COOPERATION BETWEEN SPECIALISTS

The early recognition of new or repeatedly occurring (human medicine, veterinary medicine, food hygiene, infectious diseases (new-emerging – or re-emerging microbiology, epidemiology etc.), is vital to achieve infectious diseases) is a particular challenge. Intensi- this. International information transfer is needed to ve local and international cooperation, as well as the guarantee zoonosis surveillance is at the same level as networking of experts from different specialist fields current scientific knowledge.

11 NATIONAL REFERENCE LABORATORIES & CENTRES

National reference centres have been established in sumer Protection Act (Lebensmittelsicherheits- und the field of human medicine for the most important Verbraucherschutzgesetz). There, the exact identi- infectious pathogens as part of the European network fication of the isolate will be conducted to discover for epidemiological monitoring and surveillance. The the possible transfer paths of a strain along the food nomination of well-established reference laboratories chain. in the veterinary medicine and food testing fields followed. When reportable zoonotic pathogens from At the back of this brochure there is a list of the natio- human, animal or food materials are isolated, the nal reference centres and laboratories dealing with the laboratories are required to transfer this isolate to the zoonotic pathogens described here. There is a list of relevant national reference centre or laboratory, in line all the national reference centres and laboratories on with the Epidemics Act (Epidemiegesetz), Zoonoses the homepage of the BMGF (http://bmgf.gv.at). Act (Zoonosengesetz) and the Food Safety and Con-

INVESTIGATIONS OF INFECTIOUS DISEASES IN HUMANS IN AUSTRIA

The doctor consulted and medical microbiology la- Headquarters in each of Austria’s provinces monitors boratory have to report the diagnosis of a reportable and coordinates the activities of local administrative infectious disease to the appropriate district autho- authorities working in their field. The BMGF published rity. The staff of the district authority have to enter reports by the district authorities as monthly statistics every suspicion, illness and death into an electronic on reportable infectious diseases (Monatliche Statistik register system, known as the EMS (epidemiologic meldepflichtiger übertragbarer Infektionskrankheiten). reporting system; Epidemiologisches Meldesystem). At the beginning of the following year, the preliminary These reports are automatically brought together figures for the number of cases in the previous year and are forwarded to the district authority doctor are published and are reported and confirmed during for further investigation, as necessary. Measures to the course of the year (annual statistics for reportable prevent the further spreading of the illnesses are infectious diseases). taken, as necessary. The Provincial Medical Service

12 EU COMPARISON ON DISEASE STATISTICS IN HUMANS

A comparison of disease statistics in humans is made such Member States. As part of an EU-wide baseline with other EU states and the EU average, as part study on the frequency of Salmonella in different of which the number of reported cases per 100,000 farm animal populations, which particularly come into population per year is compared with each other. This question as a source for illnesses in humans – such comparison is only possible to a limited degree, as as egg-laying chicken flocks – all Member States were there is no reporting system harmonization among the required to use one and the same method to check different Member States. It can also be the case that their farm animal populations to allow EU-wide direct persons with diarrhoea-related illnesses seek medical comparisons. help to differing extents in different EU countries, doctors send stool samples to microbiological labora- Trends in human diseases and illnesses for most pa- tories to differing degrees in different countries and thogens can be evaluated over several years using the laboratories do not always report potentially positive incidence as indicator at a national level. infectious evidence to the appropriate authorities. This results in reports that incidences in some Member Sta- It is also noticeable that there are differing levels of tes are below EU average levels. However, this is still awareness for different zoonotic pathogens in some noticeable when tourists returning from holiday regi- Member States by EU comparison. Certain coun- ons with, for instance, supposedly very low inciden- tries have no or only weakly developed surveillance ces of salmonellosis have frequently higher levels of systems and/or a low level of awareness for infectious Salmonella-related illnesses in comparison to the local diseases that are given a high priority in Austria such population. Further observations reinforce the suspici- as salmonellosis, campylobacteriosis and diseases on of unreal Salmonella incidences, when Salmonella caused by VTEC. can be found frequently in the animal population of

13 ZOONOSES AND ZOONOTIC AGENTS SUBJECT TO MONITORING IN AUSTRIA

SALMONELLOSIS

Salmonellosis is a disease caused by bacteria of the S. Typhimurium are the main sources of food-borne species Salmonella (S.) and can affect both humans salmonellosis in humans throughout Europe. and animals. The two serovars S. Enteritidis and

OCCURRENCE

This infectious disease can be found around the chickens’ reproductive tract will result in eggs con- globe and the vectors for Salmonella are very diverse. taining Salmonella. If these eggs are not sufficiently Livestock can be infected by consuming feed con- heated before consumption, they could pose a health taminated with Salmonella. In chickens, Salmonella risk to humans. infection often does not clinically manifest itself and remains unnoticed. Occasionally, entire flocks of laying Salmonella generally grow at temperatures ranging hens may become permanently asymptomatic carrier from 10 to 47 °C and are not destroyed by freezing. capable of long-term shedding. Transmission of the A sure way to destroy the bacteria is heating the pro- bacteria to the unlayed egg after colonisation of the duct to over 70 °C for at least 15 seconds.

RESERVOIR

Domestic and farm animals (poultry, in particular), wild animals (birds) and reptiles

14 ROUTE OF TRANSMISSION

Salmonella are primarily transmitted by consuming such as cutting boards, knives and towels or even un- raw or insufficiently heated food of animal origin washed hands. Great attention should also be paid to (eggs, poultry, meat of other animals and raw milk). the continued refrigeration of the raw products when Additionally, home-made products containing raw egg preparing food, in addition to kitchen hygiene. -- such as tiramisu, mayonnaise, cream and ice cream -- may be contaminated with Salmonella bacteria. A small number of cases of salmonellosis are caused by smear infections, the involuntary acquisition of Sal- Raw or insufficiently heated meat (e.g. poultry meat, monella via contact with infected individuals, animals kebab meat, minced meat, raw sausages) may pre- or items that have been contaminated with faeces. sent a risk when processed if they get into contact Exotic pets (primarily tortoises and iguanas) must also with other products that are not going to be heated be considered as a source of such smear infections. again (e.g. potato salad). This contamination of other It is recommended to wash your hands thoroughly foods (cross contamination) may also be caused by with soap and warm water following any contact with insufficiently cleaned household items and utensils, animals.

INCUBATION PERIOD

6–72 hours, usually 12–36 hours.

SYMPTOMS

Symptoms of the disease may be the following: depending on the number of bacteria ingested and nausea, diarrhoea, fever, vomiting, cardiovascular the individual’s immune status, among other things. problems and abdominal cramps. These symptoms Salmonellosis could lead rapidly to a life-threatening generally only last a few days. In many cases, the condition in elderly individuals caused by the high loss symptoms are very weak or do not appear at all, of liquid and associated cardiovascular problems.

DIAGNOSTICS

The pathogen can be detected by growing the bacte- samples. Blood tests for specific antibodies yield no ria from stool samples, maybe also from blood or pus meaningful results.

TREATMENT

The treatment of patients with gastrointestinal pro- prolong the shedding of bacteria. In most cases, the- blems and no other risk factors by using antibiotics rapies to re-establish the body’s water and electrolyte should only be considered in exceptions, as this could balance are enough to ensure recovery.

PREVENTATIVE MEASURES

Foods, in particular meat, poultry, eggs or pasta with other kitchen and cooking tasks. The water left after cream fillings, should be heated well and not kept at defrosting meat should be disposed of in the sink im- room temperature for longer periods after cooking. It mediately and the sink rinsed with hot water. All work is highly important to wash your hands thoroughly af- surfaces and equipment that come in contact with ter handling raw chicken meat before continuing with raw poultry or other raw meat or raw eggs should be

15 cleaned using hot water and detergent. Freshly made Salmonellosis patients must not handle any food if food – if not consumed immediately - should be left to working during their illness. cool and then stored in the refrigerator.

SEROTYPING AND PHAGE TYPING

All Salmonella are recorded in the National Reference nor scheme. A further differentiation into phage types Centre for Salmonella (NRC S) at AGES Graz, using (PT) for S. Enteritidis and in definitive types (DT) for serotyping according to the White-Kauffmann Le Mi- S. Typhimurium is conducted using bacteriophages.

SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of 1,514 lab-confirmed cases were reported to caused by imported turkey meat that led to infections the Epidemiological Reporting System (EMS/NRC S) in primarily via kebabs from fast-food stands, . 2015 (as of 29.04.2016). Thus, Salmonella were the second most common cause of bacterial food poiso- The number of salmonellosis cases has been reduced ning in Austria, behind Campylobacter (campylobacte- by 82 % since 2002 (2002: 8,405 first isolates; Annual riosis: 6,259 confirmed cases; EMS, as of 21.01.2016). Report by the NRC S in 2002). This decline in salmo- The determined incidence of 17.7 cases per 100,000 nellosis has been achieved solely through the decre- inhabitants was below that of 2014 (18.9), but higher ase in S. Enteritidis infections (2002: 7,459 primary than that of 2013 (17.0) (fig. 1). The increase in 2014 isolates; 2015: 656 isolates) (fig. 1). The number of was caused by a food-borne outbreak of S. Enteritidis all remaining Salmonella serovars have actually slight- PT14b, during which infected eggs from inside the EU ly increased by comparison in recent years (2002:946 market were identified as infection vehicles. In 2015, isolates; 2001: 947; 2012: 955; 2013: 826; 2014: an Austrian-wide S. Stanley outbreak was reported, 815; 2015: 858 non-S. Enteritidis isolates).

16 120 Salmonella spp. 100 S . Enteritidis s t

n serotypes other than S . Enteritidis a t i

b 80 a h n i

0 60 0 , 0 0 1

e 40 p

s e s a

c 20

0 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 1: Incidence of salmonellosis cases per 100,000 inhabitants in Austria, 2000-2015, including illustration of the most important serovar S. Enteri- tidis and all other serovars (primary isolates of Salmonella up to 2008, since 2009 notification rates of salmonellosis cases; EMS/NRC S, as of 29.04.2016)

The spectrum of the most common Salmonella The main phage types (PT) of S. Enteritidis in humans serovars in human cases has changed slightly over were PT8, PT21 and PT4, the definitive types of recent years. S. Stanley, in animals primarily found in S. Typhimurium DT120, RDNC (reaction pattern does turkey flocks, the monophasic variant of S. Typhimu- not conform to the phage scheme) and DT1. rium (likely reservoir: pigs) and S. Infantis, the most common serovar in broilers, have become increasingly important (tab. 1).

17 Table 1: The most common Salmonella serovars in humans in Austria in 2015 (EMS/NRC S, as of 29.04.2016)

serotype number percent

S. Enteritidis 656 43,3 S. Typhimurium 192 12,7 S. Stanley 166 11,0 S. Infantis 69 4,6 S. Typhimurium, monophasic 1.4.[5].12:I:- 42 2,8 S. Paratyphi B var. L(+) tartrate+ (variant Java) 23 1,5 S. Group (B) O:4 21 1,4 S. Coeln 19 1,3 S. Thompson 16 1,1 S. Agona 13 0,9 S. Newport 13 0,9 other/unknown serovar 284 18,8

total of all salmonellosis cases 1.514 100,0

The highest number of cases were found in children with 11 to 13 cases per 100,000 individuals, depen- with 61 cases per 100,000 children in the age group ding on the relevant age group. Taking a closer look from 0 to 4 years, followed by 34 cases per 100,000 at the last five years reveals that the lowest number in children and teenagers in the age group from 5 to of cases achieved in the four age groups from 0 to 44 14 years and 26 cases per 100,000 individuals in the years was in 2013. In the age groups 45 to 64 years age group from 15 to 24 years. The number of cases and over 65 years, the numbers have declined from in the remaining age groups were relatively similar, 11.2 to 10.5 and from 16.2 to 11.3 respectively.

100

75 0 to 4 years 5 to 14 years 15 to 24 years 50 25 to 44 years 45 to 64 years

per age group age per over 65 years 25 cases per 100,000 inhabitants inhabitants per 100,000 cases

0 11 12 13 14 15 year

Figure 2: Incidence of reported salmonellosis cases for each age group per 100,000 inhabitants, 2011-2015 (EMS/NRC S, as of 29.04.2016)

18 A total of 74 % of salmonellosis cases reported – this was unidentified (fig. 3). The number of local cases corresponds to 13.1 per 100,000 inhabitants – were has decreased by 7 % compared to last year. The sourced to Austria. The share of autochthonous cases lowest incidence was recorded in 2013 with 12 auto- was between 71 % and 75 % of all recorded cases chthonous cases per 100,000 inhabitants. Salmonella in recent years, with the exception of 2011 when the infections acquired abroad were predominantly recor- share of autochthonous cases was clearly under this ded in Turkey (40 cases), Egypt (33 cases), Bosnia- mark at 64 %. This means that about 1/3 of patients Herzegovina (23 cases) and Croatia (22 cases). caught the infection abroad or the place of infection

30 total number of cases

0 25 autochthonous cases 0 , 0 0 1

r 20 e p nts

s a it e

s 15 a c

f b inha o

r 10 e b m u

n 5

0 11 12 13 14 15 year

Figure 3: Incidence of all salmonellosis cases and those caused in Austria per 100,000 inhabitants, 2011-2015 (EMS/NRC S, as of 29.04.2016)

Comparison Austria and the EU, 2014

The incidence of salmonellosis cases reported in from the following countries: Italy only reported preli- Austria in 2014 was at 19/100,000 inhabitants, below minary data and Belgium uses a sentinel surveillance the EU average1 of 23.4/100,000 inhabitants. The system, but without any data on the share of popula- Member States with the highest incidence were the tion covered. The ratio between autochthonous cases Czech Republic (126/100,000), Slovakia (75/100,000) versus cases associated with travelling varies consi- and Hungary (53/100.000) – countries that had been derably between Member States with locally sourced monitored strictly in previous periods, also in regards cases varying between 81.5 % to 99.9 % in the Czech to infectious diseases. The countries with the lowest Republic, Estonia, Germany, Greece, Hungary, Latvia, incidence rates of reported and confirmed cases Malta, the Netherlands and Slovakia. The share of were Portugal (2.5/100,000), Greece (3/100,000), infections associated with travelling was highest in the Ireland (6/100,000), Estonia (7/100,000), Romania Scandinavian countries (> 70 %). (8/100,000) and no incidence figures were available

1 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 19 Situation in Foods

The control and sample plan organised by the Federal for Salmonella (36 times S. Infantis, 5 times S. Mon- Ministry of Health and Women’s Affairs determines the tevideo, 3 times S. Enteritidis and five more for other annual number of companies and foodstuffs to be ins- serovars), so did 3 % (2 of 74) of raw turkey meat pected for each federal province (food producers, food samples examined and 9 % (12 of 134) of raw fowl retailers, restaurants etc.). The inspections include samples (duck, goose or undisclosed bird species). various samples and checks on processing methods, Evidence of Salmonella was even detected in 8 % (4 among others. of 52) of cooked, ready-to-eat poultry samples. None of the 107 beef samples (raw and cooked), 280 pork A total of 4,990 samples were tested for Salmonella samples (raw and cooked) and only four of 568 meat as part of the control and sample plan, as well as samples from other animals or mixed meats (raw and in targeted campaigns in 2015. Salmonella, mainly cooked) tested positive for Salmonella. Moreover, Sal- S. Infantis (44 times) was identified in 76 samp- monella was found in two of 138 samples from eggs les. Salmonella was also found in 67 of 473 poultry and egg products and in two other food products. No samples (fig. 4). Poultry specimens made up 9.5 % of Salmonella was detected in 171 cheese samples, 692 the entire sampled material tested for Salmonella and other dairy products, 36 milk samples, 278 confectio- 88.2 % of all Salmonella-positive results came from nary products and 159 fish, fish products and shellfish this food category. Twenty-three percent (49 of 213) samples, as well as in any other food samples that of raw chicken meat samples examined tested positive were tested.

3,000 samples tested 15% Salmonella detected S . Enteritidis 2,500 S . Typhimurium 12% S . Infantis s e

l 2,000 p m

9% samples a e s

1,500 ti v i o

r e

b 6% pos m 1,000 % u n 3% 500

0 0% 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 4: Total of poultry meat and poultry products tested in line with the control and sample plan and Salmonella prevalence and that of the serovars S. Enteritidis, S. Typhimurium and S. Infantis in Austria, 2001-2015

20 Situation in Animals

Foods of animal origin are the most important source Based on these studies, the EU has determined maxi- of Salmonella infections in humans. Standardised mum levels with which poultry flocks may be contami- baseline surveys on various animal populations were nated with S. Enteritidis and S. Typhimurium per year, carried out throughout the EU over recent years to including its monophasic variant: the maximum for record their importance as Salmonella reservoirs (see laying hens is set at 2 %, for broilers and turkey 1 % earlier editions of this brochure). These studies con- and 1 % for breeding hens (target includes S. Infan- firmed that poultry (eggs and meat) plays the most tis, S. Virchow and S. Hadar in addition to S. Enteriti- important role in Salmonella infections in humans in dis and S. Typhimurium). The target numbers for all Austria and all other animal species tested (except poultry populations (laying hens, broilers, turkey and reptiles) were rarely contaminated by Salmonella. breeding hens) subject to control were met in Austria in 2015 (fig. 5).

3 prevalence of target serotypes measured target determined s k

c 2 o l f

e v i t i s o p

% 1 0,8 0,7 0,4 0,02 0 breeders laying hens broilers turkeys (n = 149) (n = 2,768) (n = 4,146) (n = 365)

Figure 5: The targets specified by the EU in terms of prevalence of S. Enteritidis and S. Typhimurium including its monophasic variant in flocks of laying hens, broilers and turkeys, as well as S. Enteritidis, S. Typhimurium including its monophasic variant, S. Infantis, S. Virchow and S. Hadar in bree- dingr hens, the entire number of produced flocks in the control programme and the values reached in 2015

21 Infections caused by a strain of S. Stanley that is The EU Salmonella Control Programme intends to resistant to the two antibiotics ciprofloxin and nalidixic combat the Salmonella serovars in animal populations acid have occurred increasingly in Austria since 2011. that are the most important in terms of human infec- An EU-wide investigation was initiated when more cations. At present, they only include serotypes ses with the same outbreak strain occurred in several S. Enteritidis and S. Typhimurium (including its mo- EU Member States with over 400 patients in 2012. nophasic variant) in broilers and turkeys and laying The results showed that turkey meat was the likeliest hens, as well as S. Infantis, S. Virchow and S. Hadar infection vehicle. Further research confirmed that the in breeding hens. Given the fact that S. Stanley is not turkey meat came from Hungary, where the turkey among these serovars, there is no EU funding for con- flocks had been fattened and slaughtered and their trol measures such as the possible vaccination or cul- meat then sold to Austria and other Member States. ling of flocks. While all flocks are tested for Salmonella before slaughtering, there are no legal consequences S. Infantis is another important serovar: the fourth- should any serovars other than the target serovars be most important serovar in human diseases (69 cases), detected. However, more and more slaughterhouses the most common serovar in poultry meat (41 of 67 are generally refusing to slaughter Salmonella-positive Salmonella isolates) and as the most isolated serovar flocks. As a result, broiler flocks are not being slaugh- in broilers (in 84 of 129 Salmonella-positive flocks). tered, but culled. Increased measures to dispose of S. Infantis often is multidrug-resistant (resistant to this S. Stanley strain should be introduced as a con- more than three classes of antimicrobials). sequence to contain further spread of this outbreak strain among the poultry population.

22 Situation in Feedingstuffs

Feedingstuffs are subject to a permanent monitoring A total of 11 different serovars were found in feeding- programme in Austria. Samples are taken from farms, stuffs. S. Enteritidis, S. Typhimurium and its mono- warehouses, compound feed plants and retailers phasic variant could each be isolated once from pet as part of mandatory inspections. Both ready-made food and S. Typhimurium was isolated in one feed compound feed and individual components are tested sample for livestock. Further serovars identified were officially. S. Infantis and S. London (2 x each) and one case of S. Derby, S. Gaminara, S. Indiana, S. Reading, S. Salmonella was detected in two of 271 livestock feed Rissen and S. Llandoff each. samples (0.7 %) in 2015 (fig. 6). The most important Salmonella sources are protein-rich extraction meals The handling of pet food and, in particular, chew- or cakes (side product from the oil processing indus- ing toys poses a certain risk to humans. Thus, it is try). This is how Salmonella gets into the feed chain recommended to wash your hands after feeding cats and may contaminate the compound feed produced or dogs and basically after any direct contact with with these ingredients. Additionally, 67 samples of pet animals. food and chewing toys were officially tested in the reporting year, 12 of which tested positive for Salmo- nella (fig. 6).

feed samples (without pets) pet food 600 25% S a l m o nella detected (FS without pets) S a lm o nella detectable (pet food) 500 20% s e es l

p 400 m a 15% amp l s s

f e o

300 v

r iti e

b 10% o s p m 200 u n % 5% 100

0 0% 05 06 07 08 09 10 11 12 13 14 15 year

Figure 6: Number of officially tested feedstuff samples (FS) with detection rates of Salmonella in Austria, 2005-2015

23 CAMPYLOBACTERIOSIS

Campylobacteriosis is a disease caused by thermoto- 90 % of human cases. The bacteria are sensitive lerant bacteria of the species Campylobacter (C.). The to acidic pH values and are destroyed safely using most common species is C. jejuni, which results in pasteurisation.

OCCURRENCE

Campylobacter infections appear worldwide and occur from Salmonella. Campylobacteriosis also topped the with increasing frequency during warmer seasons. rankings of reported food-borne, bacterial diseases in They are considered the most important pathogens Austria in 2015. for bacterial intestinal diseases in humans, aside

24 RESERVOIR

Poultry, swine, cattle, pets – such as cats and dogs germs potentially inhabit the intestine of these ani- – and birds can be carriers of Campylobacter. These mals in which they rarely cause disease.

ROUTE OF TRANSMISSION

Campylobacteriosis in humans is considered predo- strict hygiene when preparing food to prevent cross minantly a food-borne infection. Insufficiently heated contamination between raw meat and other foods. poultry meat and raw milk are considered primary Direct transmission between humans (faecal-oral) is sources of infection. Special attention must be paid to rare.

INCUBATION PERIOD

Usually two to five days, depending on the number of ent to cause the illness in humans. bacteria ingested; around 500 pathogens are suffici-

SYMPTOMS

High fever, watery-to-bloody diarrhoea, frequent condition of the nervous system, may be developed as abdominal pain, headaches and tiredness for one to a result of a Campylobacter infection in rare instances. seven days. The Guillain-Barré Syndrome, a medical

DIAGNOSTICS

The pathogen is cultivated from stool samples for detection purposes.

TREATMENT

In general, the disease is self-limiting and should be temperatures or have a weakened immune system treated by re-establishing the body’s water and elect- may be treated additionally with antibiotics. rolyte balance. Infants and patients who develop high

SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of 6,259 lab-confirmed campylobacteriosis reported form of bacterial food poisoning in Austria cases were reported to the Epidemiological Reporting with an incidence of 73/100,000 inhabitants. The System (EMS/NRC C) in 2015 (as of 21.01.2016). steady increase in human campylobacteriosis cases Thus, campylobacteriosis remains the most frequently reached its peak in 2014 (6,520 cases).

25 9,000 salmonellosis cases

8,000 campylobacteriosis cases

7,000

6,000

s 5,000 e s a c

f 4,000 o

r e

b 3,000 m u

n 2,000

1,000

0 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 year

Figure 7: Incidence of campylobacterioses and salmonelloses reported per 100,000 inhabitants in Austria, 2000-2015 (EMS/NRC C, as of 21.01.2016; for previous years see appropriate zoonoses brochures)

The proportion of campylobacteriosis cases sourced of Campylobacter infections caused abroad occurred in Austria was between 82 % and 91 % – except in Italy (56 cases), Spain (49 cases) and Croatia (48 2011 (73 %) – considerably higher than the number cases). of salmonellosis cases (71 % to 75 %). The majority

total number of cases 90 autochthonous cases

0 80 0 0 ,

0 70 0 1

r 60 e p

s 50 e i ta tnts s b a

c 40

f a inh o

r 30 e b

m 20 u n 10 0 11 12 13 14 15 year

Figure 8: Incidence of all campylobacteriosis cases and those caused in Austria per 100,000 inhabitants, 2011-2015 (EMS/NRC C, as of 21.01.2016)

26 The seasonal incidence of cases of campylobacteriosis in slaughtered flocks of broilers, with peak rates in reported has revealed similar patterns over recent ye- the summer months, suggesting higher contaminati- ars, with the least infections between November and on rates in fresh chicken in retail following this time April and the most infections from June to September period and, thus, pointing to this type of food as most (fig. 9). An almost identical picture was provided by important bacteria vehicle for many campylobacterio- the isolation rates of thermotolerant Campylobacter sis cases.

cases of campylobacteriosis 2011, 2012, 2013, 2014, 2015 prevalence of C a m p y lo b a c t e r in broiler 2011, 2012, 2013, 2014 2000 100%

1800 90% -

1600 80% r s

e t c

a c

1400 70% fl o

o e l v 1200 60% i t

p y i s

1000 50% o p Ca m 800 40%

ie d 600 30% o f

er 400 20% no t

s e 200 10% num b a s c 0 0% jan feb mar apr may jun jul aug sep oct nov dec

Figure 9: Seasonal development of incidence of campylobacteriosis cases reported per 100,000 inhabitants, 2011 to 2015 and the isolation rate of thermotolerant Campylobacter from slaughtered flocks of broilers in Austria, 2011-2014

Comparison Austria and the EU, 2014

The incidence rate of notified campylobateriosis for Campylobacter, such as Portugal and Greece. cases reported was slightly higher in Austria at Bulgaria, Latvia, Poland and the Czech Republic have 77/100,000 inhabitants than that of the EU average2 an incidence rate of <2/100,000 inhabitants. The of 71/100,000 inhabitants in 2014. Campylobacter highest incidence rates can be found in the Czech Re- has been the most common bacterial pathogen in the public with 197/100,000 inhabitants, in Luxembourg gastro-intestinal tract throughout the EU since 2005. with 159, in Slovakia with 125 and in the UK with However, incidence rates vary strongly within the EU: 104/100,000 inhabitants. some EU Member States have no surveillance system

2 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 27 Situation in Foods

Thermotolerant Campylobacter were detected in samples of various animal species, fish, fruit, confec- 119 of 245 (49%) poultry meat samples tested in tionary or eggs and egg products. The reason why 2015, 83 of which were found in 130 (64 %) samples beef and pork are rarely tested for Campylobacter is taken from fresh, raw chicken meat and 8 in 25 (32 because the bacterium does not usually survive their %) fresh, raw turkey meat samples; and 31 % of production conditions (the meat is left to age; the processed poultry meat products tested (27 of 84) meat surface dries out), which makes these types of contained Campylobacter (fig. 10). No thermotolerant food only a minor source of infection in humans. Only Campylobacter could be isolated in any of the samples one of 16 ready-to-eat foods that were tested showed taken from milk, cheese and dairy products, meat evidence of Campylobacter contamination.

140 100 samples tested 90 120 Campylobacter detected 80 s %) e ( l 100 70 p es m

a 60 80 p l s

o 50

sa m r e

60 e b

40 v i t m u 40 30 n pos i 20 20 10 0 0 chicken, turkey, fresh non-ready-to-eat fresh poultry meat matrix tested

Figure 10: Poultry meat tested for thermotolerant Campylobacter in Austria, 2015

28 Situation in Animals

The BMGF carries out annual monitoring programmes in both these poultry populations be tested for their in Austria in line with the Surveillance Programme susceptibility to antimicrobials. No monitoring for Regulation with regards to selected pathogens in thermotolerant Campylobacter was carried out for any bovines, sheep, swine and chicken, in cooperation animal population in 2015. The results of previous ex- with public vets and AGES. A new EU Commission aminations were published in last year’s edition of the Implementing Decision came into effect in 2014, Zoonoses Brochure: Report on zoonoses and zoonotic which states that flocks of broilers and turkeys must agents in Austria in 2014 (http://www.ages.at/service/ be examined for evidence of thermotolerant Campy- service-oeffentliche-gesundheit/berichte-und-folder/ lobacter every two years and that C. jejuni isolated zoonosenberichte/).

29 LISTERIOSIS

Listeriosis is an infectious disease caused by the bacterium Listeria (L.) monocytogenes.

OCCURRENCE

The bacteria are frequently found in the environment, also processed meat products, such as cold meats, in sewage and waste water, the soil and on plants. packed cold meats and smoked fish, may be contami- Foods of animal origin, such as unpasteurised milk nated by L. monocytogenes. Listeria can even multiply and unpasteurised dairy products, as well as products when refrigerated, due to the unusual growth proper- made from pasteurised milk, such as spreadable ties of the bacteria, even at low temperatures. cheese or soft cheese, in addition to raw meat and

RESERVOIR

L. monocytogenes is frequently found in the environ- cessed food could be contaminated at such locations. ment, soil and water. Animals can carry the bacteria Furthermore, our fridge must also be considered without becoming sick. Food processing companies a possible reservoir for L. monocytogenes, as food may also be a possible reservoir, as (further) pro- stored there can become contaminated, too.

MODE OF TRANSMISSION

The pathogen is predominantly ingested through con- disease themselves. In rare cases, the pathogen may suming contaminated food of animal or plant origin. spread between humans (nosocomial infections of The bacteria can be transmitted to unborn children by newborns) and by direct contact with infected animals pregnant women who do not show any symptoms of a (skin infections).

30 INCUBATION PERIOD

The first symptoms may show between 1-70 days, days (median 9 days); cases associated with pregnan- following a food-borne infection. Septicaemic disease: cy: 17-70 days (median 27.5 days). 1-12 days (median 2 days); neurologic disease: 1-14

SYMPTOMS

The infection usually is symptomless or results in vasive listeriosis manifests in severe headaches, high some diarrhoea in healthy adults. In general, the fever, nausea and vomiting. Subsequently, it can lead human immune system protects against severe forms to encephalitis or meningitis or sepsis (blood poiso- of disease progression and many infections go un- ning), which ends fatally for about a quarter of all noticed or without any serious consequences. Severe patients. The bacteria may also cause inflammation in infections primarily affect patients with weak immune other body areas (e.g. vertebral inflammation), howe- systems (e.g. cancer patients, high-dose cortisone ver, such consequences are observed rarely. There is a therapy). Once listeriosis is diagnosed, there is almost risk of infection to the unborn child during pregnancy, always an invasive progression, which means that the which can lead to a premature or still birth. Meningiti- bacteria spread beyond the gastrointestinal tract. In- dis may develop in infected newborns.

DIAGNOSTICS

The pathogen is grown from samples taken from samples for detection purposes. blood and spinal fluid, as well as from pus or stool

31 TREATMENT

Administering antibiotics. However, up to about 25 % of all invasive listeriosis cases end fatal despite targeted treatment.

PREVENTATIVE MEASURES

General rules to mitigate the risk of food-related infections are:

• Wash fruit, berries and vegetables thoroughly with tap water before preparation or consumption • Heat meat and fish dishes properly • Boil unpasteurized milk before consumption • Do not eat raw minced meat • Always store potentially risky food, such as soft cheese, spreadable cheese, cut cold meats or smoked fish, separately from other foods and do not consume them once they have passed their use-by dates.

SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of 38 cases of invasive listeriosis were repor- doctor and to that of the diagnosing laboratory (the ted to the EMS in 2015 (EMS, as of 25.01.2016). This cases that were not confirmed by the Reference Cen- equals an incidence rate of 0.44 per 100,000 inha- tre were excluded from the evaluation in fig. 11). bitants. The National Reference Centre for Listeria at AGES examined Listeria strains from 37 invasive One of the cases in 2015 was a pregnancy-associated human infections (NRC L, as of 24.02.2016). Since listeriosis (still birth, newborn and mother count as isolates are not sent to the NRC L for each infection one single case at the NRC L). Infection-related mor- reported to the EMS, EMS numbers may deviate from tality among the cases recorded by the EMS was 34 the figures provided by the NRC L. The EMS data % (13 in 38). The 28-day mortality3 of listeriosis cases corresponds to the reporting data from the attending was 32 % (12 in 37 cases), according to NRC L data.

3 28-day mortality = total mortality within 28 days of diagnosis

32 0.6 60% listeriosis cases

0.5 28-day mortality 50% s t n ) a t i b ( %

a 0.4 40% y h t n i

ali 0 0

0 0.3 30% , mor t 0 y 0 1

d a r - e 0.2 20% p 28

s e s a

c 0.1 10%

0 0% 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 11: Incidence of culturally verified cases of invasive listeriosis and resulting fatalities (28-day mortality) in Austria, 2000-2015 (NRC L, as of 24.02.2016)

Comparison Austria and the EU, 2014

The incidence rate for listerosis cases reported was per 100,000 inhabitants). The most reports were slightly higher in Austria at 0.6/100,000 inhabitants recorded in Denmark, Finland, Sweden and Spain with than that of the EU average4 of 0.5/100,000 inhabi- 1.6; 1.3; 1.2 and 1.2 cases per 100,000 inhabitants, tants in 2014. An EU-wide increase in listeriosis cases respectively. The majority of cases were sourced in of 30 % was recorded compared to 2013 (0.4 cases the respective country (> 98 %).

Situation in Foods

The control and sample plan organised by the Federal meat and meat products (4.4 %); in 4 of 224 samples Ministry of Health and Women’s Affairs determines the of fish and fish products (1.8 %); in 6 of 681 pro- annual number of companies and foodstuffs to be ins- cessed foods examined (0.9 %); in 4 of 468 samples pected for each federal province (food producers, food of cheese made from pasteurised milk (0.9 %); in 2 of retailers, restaurants etc.). The inspections include 278 baked goods/confectionary products (0.7 %) and various samples and checks on processing methods, in one of 542 dairy products (excluding cheese; 0.2 among others. %) (fig. 12). There was no evidence of Listeria monocytogenes detected in all of the other samples tested, Listeria monocytogenes was found in 25 g of the tes- such as cheese made from cow’s milk, unpasteurised ted quantity of the following foods in 2015: in 2 of 19 (n = 100); goat’s and sheep’s cheese, unpasteurised samples of raw meat and meat products from various (n = 40); unpasteurised milk (n = 31); milk, pasteu- animal species (10.5 %); in 11 of 173 fermented sau- rised (n = 8); crustaceans and fish, raw (n = 30), as sages (6.4%); in 18 of 410 samples of ready-to-eat well as fruit, vegetables and salads (n = 207).

4 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 33 More than 100 colony-forming units of L. monocyto- meat from several animal species (including two sam- genes per gram of food examined (CFU/g) were found ples of fermented sausages) and one sample of soft in two samples: one sample taken from soft cheese cheese made from pasteurised cow’s milk. All other made from pasteurised cow’s milk and one sample of samples tested of L. moncytongenes positive foods fermented sausage made of meat from several animal (detectable in 25 grams) contained L. monocytogenes species. Four samples contained 10-100 CFU/g less than 10 CFU/g. L. monocytogenes: three meat products made of d e t s e t

s e l p m a s

f o

r e b m u n

Figure 12: Samples tested and detection rates of L. monocytogenes in foods in Austria, 2015

Situation in Animals

In most cases, L. monocytogenes is not transmit- with faeces is considered the most common source in ted via animals, but via the inanimate environment unpasteurised milk. A direct invasion of the pathogen during food processing. Thus, monitoring livestock is via mastitis as a source of infection could be proven in not considered effective for Listeria. Contamination individual cases.

34 VEROTOXIN-PRODUCING ESCHERICHIA COLI (VTEC)

Bacteria of the Escherichia (E.) coli species that have O26, O103, O111, O145, O121, O91, O104, O113 also the ability to produce a specific toxin are referred to occur on a more frequent basis as pathogens resul- as verotoxin-producing E. coli (VTEC), due to this to- ting in human diseases. The bacteria are susceptible xin. They can be classified in different serovars (about to heat, but survive well in frozen foods and acidic 180 different O-serotypes at present) based on their environments. The terms Shiga toxin-producing E. coli different antigen structure. VTEC O157:H7 is conside- (STEC) and enterohaemorrhagic E. coli (EHEC) are red the most important serovar. In addition, serovars used synonymously for VTEC.

OCCURRENCE

VTEC has been known as a cause of diarrhoea and kidney failure (haemolytic-uraemic syndrome) since 1982.

RESERVOIR

Ruminants (cattle, sheep, goats) and wild animals (roe deer and red deer)

35 MODE OF TRANSMISSION

The bacteria are predominantly transmitted through ruminants (petting zoos) if hands are not cleaned pro- consuming contaminated foods, such as raw minced perly afterwards (wash with soap); and human-to-hu- beef, raw beef sausages, salami, unpasteurised milk, man infection chains, which must be given particular but also plant-based foods that are cultivated in soils attention in community institutions (nursery schools, fertilised with cattle manure and that are eaten raw, old people’s homes etc.). It is assumed that 50-100 as well as industrially produced sprouts. Other signi- VTEC bacteria would be enough to cause illness in a ficant factors are transmission via direct contact with healthy individual.

INCUBATION PERIOD

Between 2 and 8 days, mainly 3-4 days.

SYMPTOMS

The disease starts with watery diarrhoea, which often potentially fatal haemolytic-uraemic syndrome (HUS). turns bloody after a few days and may be accompa- In this case, the toxin binds to specific receptors on nied by severe nausea, vomiting and abdominal pains. cell membranes, damaging them. The blood capilla- The disease is usually self-limiting and lasts for eight ries are destroyed, which may consequently result in to ten days on average. About 5-10 % of patients, in kidney failure (failing to produce urine), anaemia, a particular infants, may develop a characteristic follow- reduced number of thrombocytes, skin haemorrhages up disease days after the diarrhoea has begun – the and neurological disorders.

DIAGNOSTICS

The disease is diagnosed upon clinical suspicion by verotoxin in the stool or (only in HUS) by detecting growing the bacteria from stool samples, detecting evidence of specific antibodies in the blood.

36 TREATMENT

Treatment with antibiotics is considered contraindi- suffices to re-establish the body’s water and electroly- cated in general, as the bacteria produce more toxin te balance. Severe cases (e.g. HUS) must be treated under the influence of antimicrobials, which could intensively, such as via dialysis. increase the rate of complications. In most cases, it

PREVENTATIVE MEASURES

Foods: as farm animals and live, wild animals are not be present during the professional processing, considered the main reservoirs for these bacteria, treatment or distribution of foods in any way up to the adhering strictly to hygiene regulations, such as wa- point when the Health Department decides that there shing hands after contact with animals, is of utmost is no more risk that the individuals in question might importance. spread the disease. This is also the case for individuals working in the kitchens of restaurants, cafeterias, Avoiding contamination in food processing facilities: hospitals, baby nurseries, children’s homes and in the individuals suffering from a VTEC infection must fields of community catering.

SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of 107 VTEC cases were reported in 2015 the last 4 years (fig. 13). The serious complication (EMS/NRC VTEC, as of 21.06.2016). The incidence HUS occurred in 15 of these cases. rate was 1.25/100,000 inhabitants, lower than during

37 2,0 VTEC infections s t n

a HUS developed t i

b 1,5 a h n i

0 0 0 ,

0 1,0 0 1

r e p

s e s

a 0,5 c

0,0 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 13: Incidence of VTEC cases and HUS cases in Austria, 2001-2015 (EMS/NRC VTEC, as of 21.06.2016)

The largest number of cases affected children in depending on the age group (fig. 14). The same age the age group from 0 to 4 years, with 16 cases per distribution has been seen during the last five years, 100,000 children; 61 % of all cases occurred in this with a decrease in cases in the youngest age group (0 age group in 2015. The incidence per 100,000 indivi- to 4 years) (fig. 14). duals in all other age groups was between 0.3 and 1.3

25 s t n a

t 20 i b a h p n i 0 to 4 years

ro u

0 15 g 0

5 to 14 years 0 e , g 0 15 to 24 years a 0 r 1

10 e

r 25 to 44 years p e p

45 to 64 years s e

s 5 over 65 years a c

0 11 12 13 14 15 year

Figure 14: Incidence of VTEC cases reported per age group per 100,000 inhabitants from 2011-2015 (EMS/NRC VTEC, as of 21.06.2016)

38 Comparison Austria and the EU, 2014

A total of 5,955 confirmed VTEC cases were reported (5.5), Denmark and Sweden (each 5.0). Nine Mem- across the EU in 2014. The incidence of confirmed ber States reported incidence rates with each <0.1 VTEC infections in Austria was 1.5/100,000, slightly per 100,000 inhabitants: Bulgaria, Croatia, Cyprus, below the EU average5 of 1.6/100,000 inhabitants. Greece, Latvia, Lithuania, Poland, Romania and Slo- The highest incidence rates were documented in vakia. Ireland (12.4/100,000 inhabitants), the Netherlands

Situation in Foods

The control and sample plan organised by the Federal and in 12.3 % of raw game meat samples, as well as Ministry of Health and Women’s Affairs determines the in 4.7 % of ready-to-eat meat products tested (fig. annual number of companies and foodstuffs to be ins- 15). VTEC was not detected in any of the fermented pected for each federal province (food producers, food sausages examined. VTEC could be isolated from one retailers, restaurants etc.). The inspections include of 39 samples of unpasteurised milk (2.6 %) and from various samples and checks on processing methods, two of 255 processed foods (0.8 %). No VTEC was among others. found in fruit and vegetables (n = 62) and dairy products (excluding cheese, n = 35). The VTEC isolates A total of 787 meat samples (285 samples of fresh found were four serovars that regularly cause human meat excluding game, 57 game, 339 ready-to-eat diseases: once VTEC O157:H7 (raw meat), twice VTEC meat samples and 106 fermented sausages) were ex- O91 (once in raw and once cooked mixed meat) and amined for VTEC, 35 (4.5 %) of which tested positive once VTEC O103 (raw goat’s milk). Two VTEC isolates for VTEC. VTEC was detected in 12 samples of fresh carried the gene for the virulence factor initmin (VTEC meat (4.2 %; 2 of 9 samples of lamb meat, 6 of 153 O157 and VTEC O103). samples of mixed meats and 4 of 123 beef samples)

5 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 39 350 30,0% samples tested ) % d

300 ( e t VTEC detected s e

t 250

s 20,0% mples e l

p 200 e s a e m a ti v s

150 f o

10,0% pos i r -

e 100 b m TEC

u 50 V n 0 0,0% s s k d il d of cts es aw no l s e r ( raw u raw milk m e

ag e o

, raw , from d s f a b t

n , a d r o e d e) e t au s de sed eef , s me , p m e d g steur i s b

utt o g a ur i ea t rodu c es s eur i e m hee s e d , mixe d , , v e , ese np a t e m a e c t m u

ro c as t a s e s ea t en t ry p ru i p ch e p p f m r m da i u n ch e , milk f e

Figure 15: VTEC examinations and results for various foods in Austria, 2015

Situation in Animals

The BMGF carries out annual monitoring programmes monitoring for verotoxin-producing E. coli was carried in Austria in line with the Surveillance Programme out in 2015. The results of previous tests for VTEC in Regulation with regards to selected pathogens in bo- animals were published in last year’s edition of the vines, sheep, swine and chickens, in cooperation with Zoonoses Brochure: Report on zoonoses and zoonotic official public vets and AGES. A new EU implementa- agents in Austria in 2014 (http://www.ages.at/service/ tion decision came into effect in 2014, which focuses service-oeffentliche-gesundheit/berichte-und-folder/ on the monitoring of antimicrobial resistance and that zoonosenberichte/). must be implemented by all Members States. Thus, no

40 TUBERKULOSIS CAUSED BY MYCOBACTERIUM BOVIS

Tuberculosis (Tbc, consumption) leads global statistics losis pathogen is Mycobacterium (M.) tuberculosis, on fatal human infectious diseases, the pathogens an immobile, rod-shaped bacterium. M. bovis and M. of which belong to the Mycobacterium tuberculosis caprae are found less regularly in humans. complex (MTC). The most common human tubercu-

OCCURRENCE

Tuberculosis is spread globally, with clusters in Africa, isoniazid and rifampicin) strains have been documen- Asia and Latin America. People with close contact to ted over recent years. patients with open or active tuberculosis (i.e. infectious) have a high risk of infection. An alarming The bacterium can be deactivated using pasteurisati- increase in tuberculosis cases with multiresistant (at on (heat to 72 °C for a short time); however, it is not least unaffected by the two anti-mycobacterial drugs affected by dehydration or cold.

RESERVOIR

Humans are the only relevant reservoir for M. tuber- that date. This tuberculosis bacterium has not been culosis. The reservoirs for zoonotic mycobacteria M. detected in any Austrian cattle livestock since then. bovis and M. caprae are cattle, wild boar, goats or wild ruminants (mainly red deer). Cases of tuberculosis in red deer caused by M. caprae have been documented repeatedly in certain regions Austria’s cattle livestock was awarded the status “of- in the Austrian provinces of Tyrol and Vorarlberg in ficially tuberculosis free (M. bovis)” (OTF) by the EU recent years. As a result, M. caprae infections were in 1999 and this has been confirmed every year since also detected in cattle grazing on alpine pastures, due

41 to overlapping pasture and grazing areas for cattle have been tested for Tbc every year using simultane- and deer. ous tests (intracutaneous test) since 2008 in line with an order issued by the Federal Ministry of Health and The cattle in certain risk areas in Tyrol and Vorarlberg Women’s Affairs.

MODE OF TRANSMISSION

Factors such as the quantity and intensity of contact, or phlegm. the number of pathogens inhaled or ingested and the overall condition of the individual in question determi- Transmission via unpasteurised milk from infec- ne whether there will be an infection or not. Infection ted cattle is a possibility: however, no new cases is caused predominantly by inhaling aerosol droplets of intestinal tuberculosis, the source of which was released from a patient suffering from active tubercu- identified to be Austrian, have been recorded over losis via coughing or sneezing. Tuberculosis manifests recent decades. Still, this path of infection cannot be itself as pulmonary tuberculosis in 80 % of patients, excluded anymore as the incidence of M. caprae in but can affect any organ of the body. Open or active specific regions in Tyrol and Vorarlberg and appropri- pulmonary tuberculosis is a disease in which the ate control measures have been put in place (also see pathogens can be detected in the individual’s sputum chapter “Situation in Animals”).

INCUBATION PERIOD

The period from infection to outbreak can take from years and even decades. a few months – in particular in infants - up to several

42 SYMPTOMS

Within 3‒6 weeks following airborne infection, small of appetite, weight loss, and general malaise. If the foci of inflammation form in the lungs in response to respiratory tract is affected, cavern can be formed; the presence of bacteria; these lesions develop into cough, breathlessness, and blood-stained sputum are small encapsulated lumps (tubercles). This form is symptomatic for respiratory involvement and patients referred to as non-infectious tuberculosis; it is not are highly contagious. Miliary tuberculosis occurs contagious because no pathogens are emitted. An ac- when the bacteria spread into the lungs and other or- tive case of Tbc starts with the common symptoms of gans via the bloodstream. In such cases, tuberculous an influenza-like infection, including fever, fatigue, loss meningitis can develop.

DIAGNOSTICS

Tuberculin skin test: a tuberculin skin test in line with is usually backed up through a combination of several the Mendel-Mantoux method can be carried out to other examination methods. detect an infection. To do this, the immune reaction to the pathogenic components injected are tested. Bacteriological diagnostics: detecting nucleic acids The test already can yield positive results six weeks provides a first diagnosis within a few hours. The after infection before symptoms occur. This skin test is time-consuming growing of mycobacterial cultures will being increasingly replaced by the so-called interferon confirm the tuberculosis diagnosis. The advantage of gamma release assay, a blood test. growing cultures is the possibility to test the mycobacteria on their sensitivity to specific antimicrobials Imaging methods: characteristic images of a lung (resistance testing). The isolates gained are typed on infection can be illustrated using X-ray diagnostics. a molecular biological basis. This helps identify mat- An X-ray does not exclude other lung diseases from a ching strains and trace back sources of infections from differential diagnostic perspective. Thus, the diagnosis an epidemiologic perspective.

TREATMENT

Therapy takes several months and the risk of my- nation therapy of several specific antibiotics, so-called cobacteria developing resistances is very high as anti-mycobacterial drugs. Thus, the time over which the bacteria are difficult to reach in the tuberculous these drugs must be administered is relatively long granuloma with medication. As a result, patients with (over months) to avoid a possible relapse. confirmed tuberculosis must be treated with a combi-

43 PREVENTATIVE MEASURES

The most important measure is to identify infected environment of the patient (index case) is crucial to individuals as quickly as possible and treat them, as mitigate new infections. More details at: there is not effective vaccine against tuberculosis. http://www.bmg.gv.at/home/Leitlinie_Tuberkulose_ Once tuberculosis has been diagnosed, an active Umgebungsuntersuchung search for other, potentially infected individuals in the

SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of 437 confirmed human tuberculosis cases M. caprae infections established the first causal were reported in 2015 (National Reference Centre for connection between new infections and infections in Tuberculosis, as of 15.04.2016). There were three livestock or wild red deer population, respectively, in cases with infections of M. caprae and three with M. western Austria. Such a connection between human bovis, respectively. The closer analysis of two infec- M. caprae infections with occurrence of M. caprae tions caused by M. caprae in Vorarlberg revealed that in the animal population in western Austria could be both cases were caused by the same strain that is completely excluded between 2010 and 2014. found in infected red deer and livestock. These two

16 10 M. bovis 14 M. caprae cases of tuberculosis 8 12

M. caprae 10 6 or 8

6 4 bovis M.

4 2 2 cases due to to cases due

cases of tuberculosis per 100,000 inhabitants cases of tuberculosis 0 0 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 16: Tuberculosis cases per 100,000 inhabitants and cases caused by M. bovis and M. caprae in Austria, 2001-2015 (NRC tuberculosis, as of 15.04.2016)

Comparison Austria and the EU, 2014

One case of human M. bovis and M. caprae were cases for 2014 were documented throughout the en- reported in Austria in 2014. Only the human M. bovis tire EU6, 145 cases in nine Member States. Most cases

6 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 44 were documented in Germany (n = 47), the UK (n = Finland, France, Germany, Latvia, Luxembourg, the 39) and Spain (n = 34). Netherlands, Poland, Slovakia, Slovenia, Sweden and several provinces in Italy and Portugal’s Algarve The cattle population of the following countries is region, as well as Scotland within the United Kingdom, “officially tuberculosis free” (OTF), at present: Austria, and Norway, Switzerland and Liechtenstein; Hungary Belgium, the Czech Republic, Denmark, Estonia, was awarded this status for the first time in 2014.

Situation in Foods

No cases of M. bovis were found in sheep, goats, of animals in line with EU and national laws in Austria swine and cattle – to confirm Austria’s official tuber- in 2015. culosis free status – in the post-mortem examinations

Situation in Animals

Bovine tuberculosis is a notifiable animal disease in bovines from four cattle farms in 2015. M. bovis could Austria. Austria has been considered “officially free” of not be detected at all. The populations affected were bovine tuberculosis since 1999 in line with the Com- located in Vorarlberg and Tyrol. mission Decision No. 467/1999/EC. The nationwide examination of ruminants using intracutaneous tests An appropriate control area was defined and establis- has been halted since May 2000; the monitoring of hed in Tyrol in 2011, on the legal basis of the red deer the disease is carried out as part of the ante-mortem tuberculosis regulation for the first time. Evidence of and post-mortem inspections of slaughter animals. M. caprae infections was found in 27 red deer in this However, special inspection areas and special surveil- control area in 2015. lance areas (in line with the national regulation on bovine tuberculosis) have been identified to determi- Additionally, Tyrol has been carrying out red deer ne the situation in the cattle population in individual screening since 2012 (2015: districts in the Karwendel regions of Tyrol and Vorarlberg, based on the fact that and the districts Innsbruck-Land, Schwaz, Landeck transmission from red deer to cattle have occurred as and Kufstein), during which M. caprae was detected in a result of the use of the same grazing areas since two red deer in 2015. 2008 – in particular during the period when the cattle grazes on alpine pastures. Cattle are examined in the- The Province of Vorarlberg has been carrying out a se regions for tuberculosis using a tuberculin skin test province-wide red deer tuberculosis monitoring pro- before and after they have been on alpine pastures. gramme since 2009, setting up a control area in the The tests are adapted to the epidemiologic situation Bludenz District in 2013. In this control area, the red determined and relevant area-adjustments made, as deer areas affected are differentiated into core, sur- required. veillance and observation areas, similar to the control area in Tyrol. An M. caprae infection could be detected The tuberculosis pathogen M. caprae was detected in 43 of a total of 603 red deer tested in Vorarlberg in and confirmed using microbiological methods in five 2015.

45 BRUCELLOSIS

Brucellosis is a disease caused by the bacteria genus Brucella (B.).

OCCURRENCE

The species B. melitensis occurs predominantly in B. abortus causes epizootic abortions in cattle and sheep and goats in Mediterranean regions. When Bang’s Disease in humans. B. suis is rare in Europe humans are infected, it is referred to as Malta fever. and is found mainly in hares, in addition to swine.

RESERVOIR

Infected livestock (cattle, goats, sheep, swine)

MODE OF TRANSMISSION

The disease is mainly transmitted to humans via food Austria’s cattle population has been officially free of contaminated with Brucella (unpasteurised milk and B. abortus since 1999 and the sheep and goat popu- products made from this) or directly via contact with lation has been officially free of B. melitensis since infected animals and their faeces. Direct transmission 2001. As a result, the infection risk is very low in between humans is very rare (only in individual cases Austria. via breastfeeding or blood transfusions).

INCUBATION PERIOD

Between five and 60 days in general.

46 SYMPTOMS

Up to 90 % of all infections progress sub-clinically; followed by influenza-like symptoms, combined with they are only recognised by detecting specific an- temperature increases of up to 40 °C in the evenings tibodies in the patients and are an expression of a and massive sweats, often in combination with low successful immune reaction. Acute brucellosis, on blood pressure and swellings of the liver, spleen the other hand, includes unspecific symptoms such and lymph nodes. The disease may subside without as fatigue, slight fever, headaches and arthralgia its antibiotic treatment, but may become chronic with early stage. After a brief symptom-free interval, this is returning fever without therapy.

DIAGNOSTICS

Blood samples should be taken repeatedly – ideally and other tissue samples are also suitable for cultiva- before the start of any therapy with antibiotics - for tion of the pathogen. In addition, serological tests for detecting the bacteria by culture; bone marrow, urine specific antibodies are also useful diagnostics.

TREATMENT

Treatment with antibiotics.

SITUATION IN AUSTRIA, 2015

Situation in Humans

Brucellosis is only found sporadically as a human in- as of 18.01.2016). This case was confirmed to be fectious disease in Austria. One laboratory-confirmed imported. case was documented in 2015 (EMS/NRL Brucellosis,

5 5 5 4 3 3 2 2 2 2 2 1 1 1 1

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 17: Number of human brucellosis cases, 2000-2015 (from 2009 EMS, as of 18.01.2016)

47 Comparison Austria and the EU, 2014

The incidence of human brucellosis cases confirmed in fewest cases are documented in countries the cattle Austria in 2014 was 0.01/100,000 inhabitants, lower population of which has been awarded the status than the EU average7 of 0.08/100,000 inhabitants. “officially brucellosis free” and where small ruminants The number of cases reported decreased EU-wide in have been awarded the status officially Brucella 2014 (-20 %). Ten Member States did not record any melitensis free, as expected. These countries also cases and Italy and Denmark did not report any data. reported that all their cases of human brucellosis had Greece and Portugal accounted for 69 % of all human been imported. brucellosis cases documented in the EU in 2014. The

Situation in Foods

Foods is not tested for Brucella, as the Austrian ru- (OBF) and officially Brucella melitensis free (OBmF) minant population has been officially brucellosis free since 1999 and 2001, respectively.

Situation in animals

Austria’s disease free status has to be confirmed Brucellosis in sheep and goats (caused by via surveillance programmes in the relevant animal B. melitensis): populations every year to retain the country’s OBF and every year proof that less than 0.2 % of all sheep and ObmF status. goat populations are infected by B. melitensis must be produced so that Austria retains its officially Brucella Bovine brucellosis (caused by B. abortus): melitensis free (OBmF) status. The blood samples new regulations on testing for Bang’s disease came from 19,216 sheep and goats from 1,543 herds across into effect in 2008. Bulk milk tests were used in a Austria were tested in line with a risk-based sample nationwide surveillance programme for all dairy cow plan in 2015. All serologically questionable samples farms up to 2012. Only bulk milk samples from dairy turned out negative following further examinations. farms selected according to a risk-based plan have been examined for B. abortus antibodies since 2013: bulk milk samples from 1,345 farms were tested in 2015, none of which tested positive for Brucella antibodies. A total of 1,329 non-dairy cattle farms were selected for testing, according to a risk-based sample plan. There, blood samples of 11,753 cattle were taken that were older than two years of age and tested using serological methods. No evidence of B. abortus was found in any of the samples after further testing. It was also found that of 344 stillbirths reported, none were caused by Brucella.

7 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 48 TRICHINELLOSIS

Trichinellosis is caused by the larvae of roundworms agent is referred to as Trichinella or trichina worm. – in particular of the species Trichinella spiralis. The

OCCURRENCE

Trichinellosis is a mammalian zoonosis that is pre- losis is rare in Central Europe; the incidence levels in valent globally and occurs under no specific climatic the eastern EU Member States are higher (see below, conditions. Humans are considered an incidental host, EU average). as the infestation is not passed on to others. Trichinel-

RESERVOIR

Wild boars, domestic pigs, and horses are intermedia- Swine are definitive hosts. te hosts. Rodents and foxes are considered reservoirs.

MODE OF TRANSMISSION

Infestation occurs by consuming raw or undercooked larvae pass through the wall of the small intestine meat that contains encysted Trichinella larvae. The and migrate to the muscle tissue via the host’s blood larvae are set free by digestive enzymes and reach vessels, where they encyst and are able to survive maturity in the mucosa cells of the small intestine, for several years. Muscles that are well supplied with where they develop into small worms. Females start blood and oxygen, such as the diaphragm, neck and to release up to 1,500 larvae within four to seven chewing muscles, shoulder muscles or upper arms, days after being ingested by the host. The young are preferred tissues.

INCUBATION PERIOD

The incubation period is five to 15 days and depends infestation in humans – over 70 larvae will most likely on the number of Trichinella larvae ingested. There trigger diseases. Transmission between humans is not are different opinions on the number of Trichinel- possible. la larvae that must be ingested to result in clinical

49 SYMPTOMS

The severity of the disease depends on the number of rhoea, vomiting and gastrointestinal conditions within larvae ingested and the individual’s immune reaction. the first week. This may be followed by high fever, Higher number of larvae ingested may lead to diar- chills, swollen eyelids, headaches and muscle pains.

DIAGNOSTICS

A tentative diagnosis can be confirmed by testing for of a massive infestation, larvae might even be detec- specific antibodies in the patient’s blood. In the case ted in the tissue.

TREATMENT

Patients with mild symptoms recover without compli- infestations are treated by anthelmintic medication. cations through resting and taking painkillers. Severe

PREVENTATIVE MEASURES

Heat of over 70 °C will destroy the larvae. Deep-free- ness; smoking, curing and drying are not suitable zing at minus 15 °C reduces the parasite’s infectious- ways to destroy the larvae.

SITUATION IN AUSTRIA, 2015

Situation in Humans

All cases of trichinellosis reported in the past three de- cumented in Austria in 2015 (EMS, as of 12.02.2016). cades were imported. No human trichinellosis was do-

3 2 0 1 0 0 0 0 0 0 1 0 0 0 0

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 18: Human trichinellosis cases in Austria, 2000-2015 (EMS, as of 12.02.2016; previous years: data of the NRC Toxoplasmosis, Echinococcosis, Toxoca- rosis and other parasitoses)

50 Comparison Austria and the EU, 2014

No trichinellosis cases were documented in Austria sharp rise in cases in Romania and Bulgaria (1.1 and and 14 other Member States in 2014. The EU average8 0.8 cases per 100,000 inhabitants). The case volume is 0.07 cases per 100,000 inhabitants, an increase of in these two countries made up 88 % of the total for 40 % in comparison to 2013 -- caused mainly by a the entire EU.

Situation in Foods

The following slaughter animals were tested for and 25,406 free ranging wild boars, as well as 769 Trichinella as part of mandatory meat inspections in wild boars from farms. None of these animals tested Austria in 2015: 5,381,689 domestic pigs; 783 horses positive for Trichinella.

Situation in Animals

Swine held in sties or buildings are considered Trichi- been questioned critically by the EFSA. Wild boars, nella free because the animals have no opportunity to on the other hand, must be considered as potentially consume infested fresh meat. The practicality of man- harbouring trichinae. datory Trichinella inspections for domestic pigs has

8 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 51 ECHINOCOCCOSIS

Echinococcosis is a disease caused by the larvae of the agent of alveolar echinococcosis, and the tapeworm species Echinococcus. The two forms E. granulosus, the cause of cystic echinococcosis. present in Europe are Echinococcus (E.) multilocularis,

OCCURRENCE

The fox tapeworm E. multilocularis is prevalent in Aus- clustering in Europe in the Mediterranean region and tria, France, Germany, northern Italy and Switzerland. the Balkan countries. The United Kingdom, Norway, It is found in about every third to fourth fox on ave- Finland, Malta and Ireland are officially rage in Bavaria. E. granulosus has global prevalence, E. multilocularis free.

PATHOGEN RESERVOIR

E. multilocularis: intermediate host: small rodents definitive host: fox E. granulosus: intermediate host: sheep, swine, cattle definitive host: dog

MODE OF TRANSMISSION

E. multilocularis (fox tapeworm): the 2‒3 mm long gans, especially the liver; larval growth remains indefi- five-segmented worms are found in the small intesti- nitely in the proliferative stage, resulting in invasion of nes of foxes. Cats and dogs are only rarely infested. the surrounding tissues similar to a malignant tumour. Every 1‒2 weeks, the final segment of each tapeworm, which contains up to 500 eggs, detaches and is E. granulosus (dog tapeworm): the 3-6 mm long released into the environment via the host’s faeces. If adult worms reside in the small bowel of the defini- adequate intermediate hosts (rodents) ingest tape- tive hosts, dogs or other canids. Gravid proglottids worm eggs in the contaminated ground, the eggs (segments of the worm) release up to 1,500 eggs hatch and release larvae invading the host’s intestinal via faeces into the environment. After ingestion by a mucosa and reaching via the blood stream inner or- suitable intermediate host (under natural conditions:

52 sheep, goat, swine, cattle) grazing, the egg hatches in The definitive host becomes infested by ingesting the the small bowel and releases an oncosphere (lar- cyst-containing organs of the infested intermediate va) that penetrates the intestinal wall and migrates host, developing new adult tapeworms. through the circulatory system into various organs, especially the liver, heart, spleen and lungs. In these Humans may become infected via accidental ingestion organs, the oncosphere develops into a hydatid cyst of tapeworm eggs present on food contaminated with that enlarges gradually, producing protoscolices (small faeces of affected definitive hosts. heads) and daughter cysts that fill the cysts´ interior.

INCUBATION PERIOD

Alveolar echinococcosis: 5–15 years Cystic echinococcosis: Months to years

SYMPTOMS

Alveolar echinococcosis: the most common symptoms Cystic echinococcosis: often cause pain in the right are abdominal pains and jaundice, sometimes fatigue, upper-abdomen due to larval parasites grow large weight loss or an enlarged liver – caused by the inva- enough (cysts size up to 30 cm in diameter) in the sive and tumor like growth of the cysts. liver; if the lung is affected breathing difficulties and coughing appear.

DIAGNOSTICS

Alveolar echinococcosis: imaging methods such as calcified – changes in the tissue. A special antibody ultrasound, chest x-rays or CT scans can produce detection method is used on the patient’s blood samp- visual images of the differently structured – and often les to verify a tentative diagnosis.

THERAPY

Alveolar echinococcosis: the goal of the treatment is Cystic echinococcosis: the goal is the complete the complete surgical removal of the parasitic tissue. surgical removal of the Echinococcus cysts, usually in However, this is often (almost) impossible at an ad- combination with drug therapy. vanced infestation stage. As a result, therapy includes a combination of surgery and the administering of medication.

PREVENTATIVE MEASURES

Echinococcus eggs have a relatively high resistance to with soap and warm water after contact with foxes or cold and can, therefore, remain infectious for several fox fur. months. However, dryness and high temperatures will destroy them within a short period of time. Dogs should be de-wormed on a regular basis and not be fed offal from contaminated sheep to avoid The following preventative measures should be taken infections of E. granulosus. to avoid E. multilocularis infestations: washing hands

53 SITUATION IN AUSTRIA, 2015

Situation in Humans

A total of eight laboratory-confirmed cases of human tapeworm cases and one of dog tapeworm case were echinococcosis were reported in Austria in 2015 (EMS, autochthonous -- the remaining cases were imported as of 18.01.2016). Four of these cases were cystic (one case each) or of unknown status. and the other four, alveolar echinococcosis. Two fox

30 cystic echinococcosis cases 25 alveolar echinococcosis cases s e s a c

f 20 o

r e b

m 15 u n

0 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 19: Number of human echinococcosis cases (cystic and alveolar) in Austria, 2002-2015 (EMS, as of 18.01.2016; previous years: data from the NRC Toxoplasmosis, Echinococcosis, Toxocarosis and other parasitoses)

54 Comparison Austria and the EU, 2014

A total number of 14 echinococcosis cases were (4.2/100,000) and Lithuania (0.8/100,000). Reports documented in Austria in 2014. This corresponds to to the EU do not differentiate between the cystic an incidence of 0.17 per 100,000 inhabitants. The and alveolar form, as the EU case definition does not EU average9 was almost the same at 0.18/100,000. separate the two clinical forms. The highest incidences were reported in Bulgaria

Situation in Foods

Each slaughtered potential intermediate host is also Three slaughtered cattle carcasses were diagnosed as tested for tapeworm cysts, as part of mandatory highly infested with cyst and not suitable for human meat inspections. A total of 695,174 cattle, 136,256 consumption. The other slaughtered carcasses were sheep, 7,763 goats and 5,381,689 pigs were tested classified as infested with only a low number of cycts as part of routine meat inspections in 2015. Tape- and made fit for consumption via deep-freezing under worm cysts were found in 117 cattle, 212 sheep and the supervision of the official veterinarian. two pigs. No species differentiation was carried out.

Situation in Animals

Dogs are generally considered free of E. granulosus berg and Tyrol; however, infected foxes have been infestation in Austria. A high percentage of foxes in found in all Austrian provinces. Austria carry E. multilocularis, in particular in Vorarl-

9 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329

55 TOXOPLASMOSIS

Toxoplasmosis is caused by the obligate intracellular, infection). About half of all toxoplasmosis cases are parasitic protozoa Toxoplasma (T.) gondii. Unborn considered food-borne. children can be infected during pregnancy (congenital

OCCURRENCE

Infections with T. gondii are prevalent in humans and intermediate hosts. Cats and other felines are definiti- animals on a worldwide basis, with almost all warm- ve hosts. blooded creatures, including humans, being potential

PATHOGEN RESERVOIR

Intermediate hosts: the spectrum of potential inter- Definitive hosts: if definitive hosts (cats and other mediate hosts, which can be infected by oocysts or felines) eat contaminated rodents or birds or are fed by ingesting muscle or brain tissue containing cysts, raw meat containing Toxoplasma cysts, the parasites includes humans, sheep, goats, rodents, swine, cattle, go through a sexual reproduction cycle in the animal’s chicken and birds. intestinal tract and are shed as oocysts in the faeces.

MODE OF TRANSMISSION

Intermediate hosts, including humans, will be infected ber of different intermediate hosts (reptiles, rodents, by orally ingesting oocysts as part of any direct con- mammals, birds, etc.) tact with infected cats or by consuming food contaminated by cat faeces, as well as via the oral ingestion Toxoplasma may be transmitted to the unborn child of cysts in the tissue of an intermediate host (e.g. via the bloodstream diaplacentally as part of a primary undercooked mutton). The oocysts shed by definitive infection with parasitaemia (content of parasites in the hosts (cats and other felines) are infectious for a num- blood) during pregnancy.

56 INCUBATION PERIOD

Ten to 23 days following the consumption of cysts in oocysts (e.g. by vegetables contaminated with cat raw meat or 5-20 days following the consumption of faeces).

SYMPTOMS

Healthy adults rarely show visible symptoms or have die in the majority of cases. A clinical manifestation uncharacteristic symptoms when infected with T. gon- in the foetus reaches its peak following the prima- dii. An infection is eventually followed by the forming ry infection of the future mother during the second of Ttoxoplasma cysts in the tissue -- in particular in trimester, mostly with hydrocephalus, calcifications in the brain, retina, heart and skeletal muscles -- as a re- the brain or serious eye damage. An infection during sult of an immune reaction. A latent, lifelong infection the last trimester often results in babies born with no with T. gondii will remain in most cases. visible clinical symptoms. However, long-term complications and damage may only appear months or years The probability of a congenital Toxoplasma infection later, in the form of development disorders, mental as part of the primary infection of pregnant women retardation or eye disorders, including blindness. depends on the point of time that the infection occurs during pregnancy. The later the infection, the higher is An infection in individuals with compromised immu- the probability that the pathogen will reach the foetus ne systems (e.g. AIDS) could lead to an unlimited via the placenta. However, the severity of the infection proliferation of Toxoplasma cysts, resulting in cerebral in the child is inversely proportional to this: an infec- toxoplasmosis in the form of encephalitis. tion during the first trimester will cause the foetus to

DIAGNOSTICS

Serological antibody detection in blood samples is the reaction (PCR) for amniotic fluid, spinal fluid, bronchial primary routine method used in diagnostics. There are lavage, eye liquid or placenta material, in addition to also direct, microscopic detection methods and nucleic the indirect pathogen detection method. acid detection methods using the polymerase chain

TREATMENT

Symptoms are treated with antiprotozoal drugs.

PREVENTATIVE MEASURES

Preventing an initial infection in seronegative preg- Freezing meat at -20 °C for 24 hours will ensure the nant women by avoiding contact with new cats (cats destruction of any cysts potentially present. Lamb or that have not been living in the same household for mutton is considered a main source of food-borne a longer period of time and cats, the eating habits of toxoplasmosis. which you do not control) and not eating undercooked meat (which pregnant women should avoid anyway). Wear protective gloves when working in the garden to Rinse vegetables thoroughly before eating to wash off avoid direct contact with cat faeces. Cats should gene- potential oocysts from cat faeces. rally be kept away from kitchens and areas in which food is prepared.

57 SITUATION IN AUSTRIA, 2015

Situation in Humans

There is not mandatory obligation to report toxoplas- total number of 83 cases of maternal infections and mosis in Austria. The toxoplasmosis laboratory of the seven prenatal toxoplasomosis cases were diagnosed Department of Pediatrics and Adolescent Medicine10 in 2015 (fig. 20). The infection status in three more prepares amniotic fluid for PCR analysis from Aust- children, who are being treated with antiparasitic rian prenatal centres and examines the blood of the drugs (as of 06.06.2016), could not be confirmed yet umbilical cord of children of infected pregnant women given their age (under 9 months) -- i.e. more congeni- as part of the quality control programme. This allows tal cases will be added (toxoplasmosis laboratory and a follow-up for children of infected mothers and the follow-up care, as of 06.06.2016). documentation of the children’s infection status. A

maternal infections 119 congenital infections 106 96 97 s

e 87

s 83 a

c 78

f o

r e b m u n

9 9 7 6 8 5 7*

09 10 11 12 13 14 15 year

* Congenital infections, 2015: the infection status in three more children who are being treated with antiparasitic drugs (as of 06.06.2016) has not been confirmed yet given their age (under 9 months).

Figure 20: Confirmed cases of maternal and congenital toxoplasmosis cases in Austria, 2009-2015 (toxoplasmosis laboratory at the Department of Paediatrics and Adolescent Medicine, AKH, as of 06.06.2016)

10 National Toxoplasmosis Register Clinical Department of Neonatology, Pediatric Intensive Care and Neuropediatrics University Department of Pediatrics and Adolescent Medicine MedUni Vienna 1090 Vienna, Währinger Gürtel 18-20 Contact: Univ.-Prof. Dr. Michael Hayde

58 Comparison Austria and the EU, 2014

No data was published on this issue in the EUSR11. Member States and Iceland (Austria is not included) The Surveillance Atlas of Infectious Disease of the Eu- (http://ecdc.europa.eu/en/data-tools/atlas/Pages/at- ropean Health Agency ECDC, documents 1.6 reported las.aspx, last access on 16.06.2016). cases per 100,000 children under 1 year of age for 15

Situation in Foods

Foodstuffs are generally not tested officially for To- berries) were tested for Toxoplasma oocyst DNA as xoplasma cysts in Austria. A total of 119 samples of part of a study conducted by AGES12 in 2015: traces plant-based foods (vegetables, salads, mushrooms, of Toxoplasma DNA were found in 31 samples (26 %).

Situation in Animals

Animal samples of livestock and cats are only sent to sheep, 295 from goats and seven from cats were ex- the laboratory for tests for Toxoplasma upon clinical amined between 2008 and 2015. Toxoplasma antibo- suspicion, such as following stillbirths or out of private dies or T. gondii (direct and indirect detection, fig. 21) interest. One-hundred and ten samples from cattle, were found in three cattle, two pigs, eight wild boars, 31 from domestic pigs, 41 from wild boars, 316 from 121 sheep, 77 goats and one cat. s l a m i n a

f o

r e b m u n

Figure 21: Cattle, domestic pigs, wild boars, small ruminants and cats tested for Toxoplasma cysts or antibodies in Austria, 2008-2015

11 Taken from The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 12 Taken from the study: Prewein B, Allerberger F, Ruppitsch W. Zum Vorkommen von Toxoplasma gondii-Oozysten auf Gemüse und Beeren, 2015"; unpublished data 59 FOOD-BORNE OUTBREAKS IN AUSTRIA

Consumers expect food products have impeccable many foods consumed. However, if a larger number hygiene standards and the food industry puts great of people are affected during so-called “food-borne stress on the quality of its products. If humans get outbreaks”, there is a better chance of finding the sick from consuming food contaminated by bacteria food product that served as a vehicle for the causative or other pathogens, investigations should attempt to agent, by analysing associations between exposures determine the cause. In individual cases, it is almost and illnesses. impossible to find out the infection source among the

DEFINITION

The Zoonoses Act of 2005 defines food-borne out- the observed number of cases exceeds the expected breaks as follows: an incidence, observed under given number and where the cases are linked, or are proba- circumstances, of two or more human cases of the bly linked, to the same food source. same disease and/or infection, or a situation in which

WHY MUST OUTBREAKS BE INVESTIGATED?

Is there a necessity to investigate outbreaks? Are this agent. Thus, the objective of outbreak analysis is such investigations not much more than academic not only to halt any current outbreak, but to prevent exercises? Is all this effort just put in because the such an outbreak in the future. Zoonoses Act requires it? Detailed and systematic search could help identify both the infection vehicle – The following historical example illustrates the pre- i.e. the food source that transmits the infectious agent ventative potential of food-borne outbreak studies: it to humans – and its reservoir i.e. the habitat for an was possible to identify a flock of laying hens as the infectious agent. In the end, this is what enables the reservoir of Salmonella Enteritidis phage type 36 – a authorities to develop and introduce targeted and sen- very rare type of Salmonella in Austria – in 2004, sible intervention measures. These activities should which had caused a food-borne outbreak affecting result in the source of the outbreak – the pathogen 38 individuals in four provinces. The flock was culled, causing the infection – being eliminated from the food the farm thoroughly cleaned and sterilised and an chain so that the consumers are no longer exposed to entirely new flock of laying hens brought in. Not one

60 further infection caused by S. Enteritidis PT 36 has measures taken (fig. 22). been documented in Austria since then, thanks to the

July 2004: flock of laying hens culled 36 s e

s S . Enteritidis PT36 cases a c

f o 17 r e b m u n 4 3 1 0 0 0 0 0 0 0 0 0 0 0

00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 22: Human infections caused by S. Enteritidis PT 36, Austria 2000-2014

WHO CARRIES OUT THE OUTBREAK INVESTIGATIONS?

Regional district administrations are obliged to begin not proven very successful in the past. In the majority any investigations and examinations that could help of cases, the original food product (or the affected, identify the disease and infection source immediately contaminated batch of the infectious food source) is via their official public health officers and veterinari- not available for microbiological examinations anymo- ans upon any notification or suspicion of a notifiable re. In such instances, an epidemiologic study could disease and, thus, also in the case of food-borne yield results that could enable the use of preventative outbreaks. Moreover, the Zoonoses Act of 2005 obli- measures to avoid similar incidents in the future. The ges the relevant authorities to investigate food-borne findings of successfully identified national and interna- outbreaks and carry out the appropriate epidemio- tional outbreaks over recent years have dispersed any logical and microbiological examinations. To do this, doubt about the necessity and benefits of epidemiolo- authorities may seek the help of external experts. A gic investigations. mere increase in untargeted food sample taking has

61 FREQUENCY OF FOOD-BORNE OUTBREAKS IN AUSTRIA

In Austria 78 food-borne outbreaks were recorded in als in 96 outbreaks). As a result, the incidence of 9.3 2015. There were no fatalities reported in connection patients linked to food-borne outbreaks per 100,000 with food-borne outbreaks in 2015. A decrease in inhabitants in 2014 plummeted to 3.9 in 2015. In outbreaks by 87 % has been documented since 2006 comparison, 30.7 individuals per 100,000 inhabitants (tab. 2). A total of 333 individuals were affected by were affected by outbreaks in Austria in 2006. these outbreaks, far fewer than in 2014 (790 individu-

Table 2: Number of reported food-borne outbreaks in Austria, 2006-2015

Year 06 07 08 09 10 11 12 13 14 15

Food-borne outbreaks 609 438 368 351 193 232 122 133 96 78 - caused by Salmonella 452 305 223 208 98 100 53 44 47 34 - caused by Campylobacter 137 108 118 120 82 116 61 58 40 32 Number of cases affected by an outbreak 2.530 1.715 1.376 1.330 838 789 561 568 790 333 Cases affected by an outbreak per 100,000 30,7 20,7 16,5 15,9 10,0 9,4 6,7 6,7 9,3 3,9 inhabitants - Number hospitalised 493 286 338 223 155 179 97 108 121 119 - Number of deaths 3 1 0 6 2 0 0 0 1 0

62 700 35 food-borne outbreaks

600 patients connected to outbreaks per 100,000 inhabitants 30 nts t a s

k 500 25 a e nhab i r i b t

u 400 20 o ,000

f o

r 300 15 10 0 e b per m u

n 200 10 ients a t

100 5 p

0 0 06 07 08 09 10 11 12 13 14 15 year

Figure 23: Number of confirmed food-borne outbreaks and outbreak cases per 100,000 inhabitants in Austria, 2006-2015

The decrease in salmonellosis outbreaks of 92 % causing 44 % of outbreaks, Campylobacter 41 % (fig. (454 to 34) between 2006 and 2014 was particularly 23). Further outbreaks were caused by Shigella (five remarkable. Additionally, the number of campylobac- outbreaks), norovirus (three), botulinum toxin (two) teriosis outbreaks has gone down to 32. Salmonella and one by Staphylococcus aureus enterotoxin and were the most common outbreak agents in 2015, tick-borne encephalitis (TBE) virus, respectively.

63 100 Sa l mo n e l la spp. C a m p y lo b a c t e r spp. VTEC ) 75 norovirus % (

t other n e g a

50 r e p

s k a e

r 25 b t u o

0 04 05 06 07 08 09 10 11 12 13 14 15 year

Figure 24: Outbreak percentage by agent, 2004-2015

Seventeen of the 34 salmonellosis outbreaks were These outbreaks were examined retrospectively at caused by S. Enteritidis PT 8, with 42 patients. A total the time, by classifying selected outbreak isolates, of 297 cases caused by this serovar were reported isolates from individual cases and non-human isolates in Austria in 2015. This corresponds to 19 % of all using molecular-biological methods, to find a potential salmonellosis cases in Austria that year. Thirteen of connection between the different outbreaks and ca- the 17 S. Enteritidis outbreaks occurred between July ses, thus, putting together the cases to one potential and October, as household outbreaks in six Austrian large, general outbreak (outbreak affecting 2 or more provinces (Tyrol 4, Vienna 3, Lower Austria 3, Burgen- provinces, see further below). land, Carinthia and Upper Austria 1 outbreak each).

TYPES OF FOOD-BORNE OUTBREAKS

The Austrian Zoonoses Act obliges AGES to collect being the likely outbreak vehicle or that the evidence outbreak data and forward the data to the EU on an for a specific food being the source is very vague. annual basis. There are specific classifications within Strong evidence would include a statistically signifi- this reporting: outbreaks in which only members of cant association in an analytic-epidemiologic study one single household are affected are counted as or convincing, descriptive evidence, microbiological household outbreaks. Should the outbreak affect proof of the outbreak source in all cases and in the individuals from several households, this is counted food product or environment of the produced food, or as a general outbreak. Household outbreaks make up evidence from tracing back the product to its source. the majority of cases every year, as it is often impossible to find an epidemiological link between different Six strong-evidence outbreaks (7.7 %) were reported household outbreaks by identifying one single food to the EU in 2015. This figure is still lower than that of source as the cause. In 2015, 80 % of all outbreaks 2014 (13.5 %) and 2013 (18 % of outbreaks showed were classified as household outbreaks. strong evidence), but above that of previous years (2-4 %). A total of 155 human cases (47 %) were Outbreaks are also classified as strong- and weak-evi- affected by strong-evidence outbreaks. This number dence outbreaks in line with the EU reporting system, corresponds with that of the years before when the meaning whether a specific food could be identified as number of strong-evidence outbreaks shot up to 76 %

64 in 2014. The following foods were identified as infec- Fourteen outbreaks with a total of 29 patients could tion sources in the strong-evidence outbreaks: turkey be connected to stays abroad. meat and turkey meat products, sweets and chocola- tes, pork and pork products, beef and beef products, milk and tinned food.

FOOD-BORNE OUTBREAKS AFFECTING TWO OR MORE PROVINCES, 2015

Only one suspicious, outbreak affecting more than one one in July/August in Tyrol). Descriptive epidemiology province was recorded in 2015: an outbreak caused and microbiological examinations identified turkey by a S. Stanley strain that showed resistance to the kebab meat as the most likely source of infection quinolones nalidixic acid and low-level resistance to in at least 36 cases. Tracing back the origin of the ciprofloxacin. This strain had caused an Austrian-wide suspected turkey meat pointed to turkeys fattened outbreak in 2011 and further outbreaks in the EU in and slaughtered in Hungary and sold via a Slovak 2012 and 2014 (also see chapter Salmonella, Situation food retailer to the kebab stands affected. Five more in Animals). The 2015 outbreak affected 141 individu- Member States (Germany, Hungary, Luxembourg, the als from eight provinces (no recorded case in Vorarl- Netherlands and Slovenia) also sent S. Stanley isolates berg). Eighty cases were allocated to three regionally to the European Surveillance System, all showing a and chronologically separate clusters (one in January molecular profile that could not be differentiated from and one from April to June in Upper Austria, as well as the outbreak strain in Austria.

Comparison Austria and the EU, 2014

A direct comparison between the individual Member agents, causing 20.4 % of all outbreaks. However, a States is not possible, as the quality of the reporting decrease in salmonellosis outbreaks could be recorded systems used within the European Union for food-bor- across the EU, falling from 1.168 outbreaks in 2013 to ne infections differ greatly and there are no EU-wide 1,049 in 2014. The share of salmonellosis outbreaks standardised systems to investigate outbreaks. An has been going down since 2008. Other frequent EU-wide total of 5,251 food-borne outbreaks (2013: causes for food-borne outbreaks were bacterial toxins 5,196) with 45,665 human cases and 27 fatalities and Campylobacter. No agent could be identified for were reported in 201413. For the first time, food-borne 1,531 outbreaks that were reported in the Member viruses were counted as the most common outbreak States (29 %).

13 Taken form The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2014. EFSA Journal 2015;13(12):4329, 191 pp. doi:10.2903/j.efsa.2015.4329 65 LIST OF NATIONAL REFERENCE LABORATORIES/CENTRES WITH CONTACTS14

National Reference Centre and National Reference Laboratory for Salmonella Institute for Medical Microbiology & Hygiene, Graz Centre for Food-borne Infectious Diseases Austrian Agency for Health and Food Safety 8010 Graz, Beethovenstraße 6 Contact: Dr. Christian Kornschober

National Reference Centre for Campylobacter/National Reference Laboratory for Campylobacter Institute for Medical Microbiology & Hygiene, Graz Centre for Food-borne Infectious Diseases Austrian Agency for Health and Food Safety 8010 Graz, Beethovenstraße 6 Contact: Mag. Dr. Sandra Jelovcan

National Reference Centre and National Reference Laboratory for Brucella Institute for Veterinary Disease Control, Mödling Austrian Agency for Health and Food Safety 2340 Mödling, Robert-Koch-Gasse 17 Contact: Dr. Erwin Hofer

National Reference Laboratory for Listeria Institute for Medical Microbiology & Hygiene, Graz Centre for Food-borne Infectious Diseases Austrian Agency for Health and Food Safety 8010 Graz, Beethovenstraße 6 Contact: Mag. Dr. Ariane Pietzka

National Reference Centre for Listeria (Binational Conciliar Laboratory for Listeria Germany/Austria) Institute for Medical Microbiology & Hygiene, Vienna Centre for Anthropogenic Infections Austrian Agency for Health and Food Safety 1090 Vienna, Währinger Straße 25a Contact: Dr. Steliana Huhulescu

National Reference Centre for Toxoplasmosis, Echinococcosis, Toxocariasis and other Parasitic Diseases Department for Medical Parasitology Institute for Specific Prophylaxis and Tropical medicine Centre for Pathophysiology, Infectiology and Immunology Medical University of Vienna 1090 Vienna, Kinderspitalgasse 15 Contact: Univ.-Prof. Dr. Herbert Auer or Univ.-Prof. Dr. Ursula Wiedermann-Schmidt

14 The list of Reference Laboratories and Centres in the human fields and according to Chapter 3 of EC Decision 2009/712/EG can be found of the homepage of the Federal Ministry of Health and Women’s Affairs (http://bmgf.gv.at) 66 National Toxoplasmosis Register, Toxoplasmosis Laboratory and Out-Patient Clinic Toxoplasmosis Diagnostics during Pregnancy and Paediatric Follow-Up Division of Neonatology, Intensive Care Medicine and Neuropediatrics Department of Pediatrics and Adolescent Medicine Medical University of Vienna 1090 Vienna, Währinger Gürtel 18-20 Contact: Univ.-Prof. Dr. Michael Hayde

National Reference Laboratory for Trichinella in Animals Institute for Veterinary Disease Control, Innsbruck Austrian Agency for Health and Food Safety 6020 Innsbruck, Technikerstraße 70 Contact: Dr. Walter Glawischnig

National Reference Centre for Tuberculosis Institute for Medical Microbiology & Hygiene, Vienna Austrian Agency for Health and Food Safety 1096 Vienna, Währinger Straße 25a Contact: PD Mag. Dr. Alexander Indra

National Reference Laboratory for Bovine Tuberculosis Institute for Veterinary Disease Control, Mödling Austrian Agency for Health and Food Safety 2340 Mödling, Robert-Koch-Gasse 17 Contact: Dr. Erwin Hofer

National Reference Centre and National Reference Laboratory for Escherichia coli including Veroto- xigenic E. coli Institute for Medical Microbiology & Hygiene, Graz Centre for Food-borne Infectious Diseases Austrian Agency for Health and Food Safety 8010 Graz, Beethovenstraße 6 Contact: Mag. Dr. Sabine Schlager

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