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.