Healthcare-associated foodborne outbreaks in high-income countries: a literature review and surveillance study, 16 OECD countries, 2001 to 2019*

Abstract

Background Healthcare-associated foodborne outbreaks (HA-FBO) may have severe consequences, especially in vulnerable groups. Aim The aim was to describe the current state of HA-FBO and propose public health recommendations for prevention. Methods We searched PubMed, the Outbreak Database (Charité, University Medicine Berlin), and hand-searched reference lists for HA-FBO with outbreak onset between 2001 and 2018 from Organisation for Economic Co-operation and Development (OECD) countries and HA-FBO (2012–2018) from the German surveillance system. Additionally, data from the European Food Safety Authority were analysed. Results The literature search retrieved 57 HA-FBO from 16 OECD countries, primarily in the US (n = 11), Germany (n = 11) and the United Kingdom (n = 9). In addition, 28 HA-FBO were retrieved from the German surveillance system. Based on the number of outbreaks, the top three pathogens associated with the overall 85 HA-FBO were Salmonella (n = 24), norovirus (n = 22) and Listeria monocytogenes (n = 19). Based on the number of deaths, L. monocytogenes was the main pathogen causing HA-FBO. Frequently reported implicated foods were ‘mixed foods’ (n = 16), ‘vegetables and fruits’ (n = 15) and ‘meat and meat products’ (n = 10). Consumption of high-risk food by vulnerable patients, inadequate time-temperature control, insufficient kitchen hygiene and food hygiene and carriers of pathogens among food handlers were reported as reasons for HA-FBO. Conclusion To prevent HA-FBO, the supply of high-risk food to vulnerable people should be avoided. Well working outbreak surveillance facilitates early detection and requires close interdisciplinary collaboration and exchange of information between hospitals, food safety and public health authorities.

Spatio-temporal distribution and influencing factors of norovirus outbreaks in Beijing, China from 2016 to 2020

“…In Japan and South Korea [ 24 , 25 ], similar to Beijing and various Chinese provinces [ 22 , 26 ], outbreaks generally occur in childcare centers and schools. However, in developed countries, norovirus outbreaks mainly occur in healthcare facilities, [ 2 , 11 , 27 , 28 ], which may reflect the differences in the sensitivity and coverage among surveillance systems. A specific norovirus surveillance system has not been established for healthcare facilities in China [ 26 ].…”

Catering of high-risk foods and potential of stored food menu data for timely outbreak investigations in healthcare facilities, Italy and Germany

“…Only the information related to the hospital was retained in the analysis. 2 All food preparation steps from raw ingredients to the final food served to patients were prepared in-house by the healthcare facility. 3 Outsourcing: all the services, preparation, and cooking steps were undertaken by an external company.…”

“…Among foodborne outbreaks, healthcare-associated foodborne outbreaks (HA-FBOs) are of public health concern. Indeed, a literature review on HA-FBOs in 37 members countries of the Organisation for Economic Cooperation and Development (OECD) retrieved 85 outbreaks occurring between 2001 and 2018, which were mainly associated with the consumption of food contaminated with Salmonella (24 outbreaks), norovirus (22 outbreaks) and Listeria (19 outbreaks) [2]. HA-FBOs result from the consumption of contaminated food served in healthcare facilities (HCFs) and represent a risk, especially for vulnerable patients (children up to the age of five years, elderly people, pregnant, immunosuppressed) [2,3].…”

“…HA-FBOs are likely underreported due to the lack of systematic surveillance of foodborne outbreaks in HCFs, since food is rarely considered a potential vehicle for healthcareassociated outbreaks, as compared to other routes of transmission [2]. Moreover, outbreaks with relatively low numbers of cases distributed across different HCFs or protracted outbreaks (e.g., listeriosis outbreaks) can only be detected by systematic surveillance and by routine whole genome sequencing [4].…”

Epidemiological Features of Foodborne Disease Outbreaks in Catering Service Facilities — China, 2010–2020

“…One of the most prevalent locations for foodborne illness outbreaks is a catering service facility. The estimated cost of a single outbreak of foodborne illness in a restaurant may exceed 1 million US dollar (USD) (4). Research has shown that factors such as inadequate time-temperature control, insufficient kitchen hygiene, and the presence of disease carriers among food handlers in catering service facilities, including restaurants, contribute to foodborne illnesses (5).…”