Almost 300 people have been sickened in six countries and two have died in an outbreak of Salmonella infections linked to eggs.

More than 210 cases have been reported in France with 22 in Spain, 12 each in the Netherlands and the United Kingdom, seven in Norway and three in Denmark in 2021. The most recent patient was in Norway with a sampling date of Dec. 22, according to an assessment by the European Centre for Disease Prevention and Control (ECDC) and European Food Safety Authority (EFSA).

Additional  patients are likely to be identified because of the time it takes for infections to be identified and confirmed and then reported to authorities. ECDC said the risk of new infections caused by the outbreak strain and contaminated eggs remains high.

Infections were recorded in all age groups from less than 1 to 93 years old. A 66-year-old man in France and a 58-year-old man with underlying conditions in Spain have died. Of 80 cases with known information, 25 were hospitalized.

Consumption of eggs in some form was reported by all 60 interviewed cases, and of poultry products by 39 of 42 patients.

Some patients in France had eaten at restaurants serving eggs distributed by a common supplier, a Spanish packing center. Eggs came from three Spanish farms and one tested positive for the outbreak strain of Salmonella. It was found in an official dust sample collected in late July 2021.

Fresh table eggs from these farms were withdrawn and only used in heat-treated products. No other countries received eggs from the farms via this packing center during summer 2021. So, the source of infection for patients in late 2021 and in countries except Spain and France could not be identified.

Salmonella Enteritidis was also detected in an official fecal sample from a flock of another Spanish farm in September 2021. It is owned by and adjacent to the packing center. Spanish authorities found that no own-check sampling had been done at the farm as part of the National Salmonella Control Program since November 2019.

Link to past infections
The 2021 outbreak is microbiologically linked to a cross-border incident reported by the Netherlands in 2019. Eggs consumed by cases in the Dutch outbreak were traced to a Spanish farm, but investigators did not find an epidemiological connection between the outbreaks.

According to analyses in France, the Netherlands and Spain, no common operator could be identified between the outbreak in France in 2021 and the one in the Netherlands in 2019. The farms and packing centers involved are also located in geographically different areas.

Findings suggest a wide distribution of the outbreak strain that could affect the supply chain or earlier steps in the production chain. There may be multiple sources of this type of Salmonella Enteritidis, and it could be circulating at other farms in Spain or in other countries, said ECDC.

Another 801 genetically close historical patients were reported before 2021. This includes more than 300 in France, 56 in the Netherlands, 75 in Norway, 70 in Spain, and 255 in the UK.

In the Netherlands, 17 historical cases have been identified from 2020; 36 in 2019 and three in 2018. Spain reported one case in 2020, 39 in 2019, and 30 in 2018.

Eleven patients were previously detected in Denmark: two in 2020, four in 2019, three in 2018, one in 2014 and one in 2013. Norway had 35 cases in 2020, 29 in 2019 and 11 in 2018.

In the UK, 33 cases were identified in 2020, 144 in 2019, 73 in 2018 and five in 2017. Germany had two cases in 2020, 17 in 2019, three in 2018, one in 2017, and one in 2016. Ireland had five patients that had been to Spain with sampling between October 2018 and January 2020.

Overall, more than 1,000 Salmonella Enteritidis cases have been recorded in seven EU countries and the UK from 2013 to 2021. However, there was only one in 2013, 2014, 2016 and six in 2017. This shot up to 192 in 2018, 381 in 2019, 219 in 2020 and 272 in 2021.

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