The World Health Organization has linked the recent salmonella outbreak to Kinder chocolate, causing the company to recall its products.
Since February of this year, multiple countries have reported cases of salmonellosis affecting young children. As of 25th April, a total of 151 cases have come forward from across 11 countries. These include Belgium (26), France (25), Germany (10), Ireland (15), Luxembourg (1), the Netherlands (2), Norway (1), Spain (1), Sweden (4), the United Kingdom (65) and the United States of America (1). Scientists have linked all cases of the salmonella outbreak to the consumption of Kinder chocolate.
The first cluster of cases occurred in the UK. On 27th March, the country notified the World Health Organization (WHO) of a cluster of cases in the region. According to investigations, all nine cases contained the monophasic Salmonella Typhimurium sequence type 34. This particular strain demonstrated genotypic markers of an unusual antimicrobial resistance pattern that is generally rare in livestock, food or human disease cases in the UK. Moreover, all cases except one occurred in children younger than 10 years. As of 5th May, the UK has linked 101 cases to the salmonella outbreak. A huge majority of these cases have affected children under 5 years of age.
Most cases are children under 10 years of age, with many being hospitalised.
European Centre for Disease Prevention and Control
Epidemiological and food chain investigations revealed evidence of contamination at the company’s production site in Belgium. As a result, Belgian authorities stopped production at the facility. Moreover, in April, the WHO/FAO International Food Safety Authorities Network (INFOSAN) issued a global alert notifying 77 countries to establish a global recall of implicated products. Thus, resulting in one of the largest chocolate product recalls in European commercial history.
The recall includes the following Kinder products:
- 20g and 3x 20g Kinder Surprise
- 100g Kinder Surprise
- Egg Hunt
- Mini Eggs
- Schoko-Bons
WHO Recommends Strict Control Measures
Salmonella bacteria have more than 2,500 serotypes that result in salmonellosis. The Typhimurium serotype, along with Enteritidis, is responsible for a majority of infections in humans. These bacteria are commonly present in farm animals such as poultry, cattle, and pigs; in pets such as cats, birds, dogs, and turtles. Humans contract an infection through the consumption of contaminated food such as meat, poultry, milk, or eggs. However, human-to-human transmission is also possible. Moreover, Salmonella also passes through the food chain from animal feed and primary production all the way to homes and food-service institutions.
Although the majority of salmonellosis cases are mild or self-resolving, some can result in severe infections that can result in death. Especially among children, pregnant women, elderly patients and others with low immunity. Symptoms mostly begin within 6-72 hours of consumption of contaminated food or water and can last for up to a week. The infection typically presents with fever, nausea, vomiting, abdominal pain, and bloody diarrhoea.
The risk of spread in the WHO European region and globally is assessed as moderate until the information is available on the full recall of the products.
World Health Organization
Although no deaths have occurred with the outbreak, authorities have reported a high hospitalization rate (43%). The WHO believes further investigations will help give an accurate assessment of the disease severity.
Since salmonella easily spreads from human-to-human, health authorities recommend good hygiene practices. Such as washing hands after contact with animals, or after using the toilet; washing fruits and vegetables thoroughly, properly cooking food, consuming only clean water, drinking milk that is boiled or pasteurized.
Furthermore, WHO believes that control measures at all stages of the food chain, from agricultural production to processing, manufacturing and preparation of foods in both commercial establishments and at home can help prevent salmonellosis.
What Caused the Salmonella Outbreak?
The WHO first became aware of the outbreak in late March when the UK reported a cluster of cases in the region. Although the source was initially unclear, investigations soon revealed a link to chocolate products in Belgium.
In late December and January, authorities had identified the outbreak strain in buttermilk tanks at a Ferrero factory in the Belgian city of Arlon. However, after Salmonella testing and implementation of hygiene measures, the factory resumed manufacturing and distributing Kinder products across Europe.
Historically, chocolate-associated outbreaks have been protracted and usually of large scale, probably reflecting both the long shelf life of chocolate and the long survival of Salmonella in these products, as well as difficulties in detecting and resolving such outbreaks.
study authors
According to the United Kingdom Health Security Agency (UKHSA), the outbreak strain has demonstrated multidrug resistance. The strain is resistant to several antibiotics including penicillins, aminoglycosides (streptomycin, spectinomycin, kanamycin, and gentamycin), phenicols, sulfonamides, trimethoprim, tetracyclines. However, it is susceptible to fluoroquinolones, azithromycin and third-generation cephalosporins.
Severe salmonellosis is typically treated using supportive therapy such as electrolyte replacement for dehydration. Routine antibiotic therapy is generally not recommended as it can result in resistant strains and may not entirely eliminate the microorganism.
The WHO recommends that countries with insufficient or no genome sequencing capabilities should remain on alert for probable cases.
Reference:
Larkin et al, Investigation of an international outbreak of multidrug-resistant monophasic Salmonella Typhimurium associated with chocolate products, EU/EEA and United Kingdom, February to April 2022, Eurosurveillance (2022). DOI: 10.2807/1560-7917.ES.2022.27.15.2200314.
