WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe Country Reports: Austria BfR AUSTRIA Population 1999: 8 92 254 Population 2: 8 11 244 Area: 83 849 km 2 1. General information 1.1 Reporting In Austria (country abbreviation: AT), notification of disease outbreaks in humans is regulated by the Austrian Epidemic Act, BGBl. Nr. 186/195 idgf. Both confirmed and suspected cases of diseases and deaths due to cholera, bacterial foodborne disease, typhoid and paratyphoid fever, shigellosis, and trichinellosis are considered notifiable diseases. Since June 1996, official reports on bacterial foodborne diseases have provided specifications in regard to causative agents (e.g. Campylobacter, Salmonella, Yersinia enterocolitica, etc.). The attending physician is obliged to report these notifiable diseases to the local health authority (Bezirksverwaltungsbehörde) within 24 hours. Their reports are forwarded to the state health authority (Landessanitätsdirektion) and submitted monthly to the Ministry of Social Security and Generations. 1.2 Preventive and control measures Each incident or suspected case of a notifiable disease must be investigated epidemiologically. The competent authorities, assisted by physicians at their disposal, must undertake without delay investigations and collection of samples necessary for the diagnosis of the disease. In the case of bacterial foodborne diseases, a close check-up of the food establishments concerned comprises part of the epidemiological investigation, and samples are taken jointly with the local food controlling authority and the trade board (Marktamt).
1.3 Control of food handlers According to the Act on the Health Control of Food-handlers, only persons certified by an authorised medical officer to be free from acute and chronic infectious disease, parasites and otherwise objectionable medical conditions are allowed to work in food establishments. Food handlers must undergo a medical examination prior to and at defined intervals during their employment. 1.4 Salmonella surveillance In 1954, the Salmonella Centre was founded at the Federal Institute for Bacteriology and Serology in Vienna (Bundesstaatliche bakteriologisch-serologische Untersuchungsanstalt Wien). In 1965 it moved to the Federal Institute for Bacteriology and Serology in Graz (now part of the Austrian Agency for Health and Food Safety ). The Centre receives Salmonella strains from the entire territory of the Federal Republic for identification. The isolates originate from investigations carried out according to the Act on the Excretion of Bacteria, as well as from examinations of sick persons and their environment and also include non-human sources (e.g. foods, feeds, water, sewage, animals). An overview of Austrian reference centers and the diseases under their supervision is given in Table AT 1. Table AT 1 National Reference Centers involved in surveillance of foodborne diseases National Reference Centres Bundesstaatliche bakteriologisch-serologische Untersuchungsanstalt Innsbruck Bundesanstalt für veterinär-medizinische Untersuchungen Mödling Institut für Hygiene der Universität Graz Österreichische Agentur für Gesundheit und Ernährungssicherheit, Institut für Veterinärmedizinische Untersuchungen Mödling Institut für spezifische Prophylaxe und Tropenmedizin der Universität Wien Institut für Hygiene, Mikrobiologie und Tropenmedizin am Krankenhaus der Elisabethinen Linz Klinisches Institut für Virologie der Universität Wien Institut für Hygiene der Universität Innsbruck Klinisches Institut für Hygiene, Abteilung für med. Parasitologie Wien Foodborne disease Botulism, EHEC, Listeriosis Brucellosis Campylobacteriosis, Hepatitis A Cholera Hepatitis A Hepatitis A Hepatitis A Hepatitis A Echinococcosis Österreichische Agentur für Gesundheit und Ernährungssicherheit Institut für med Mikrobiologie und Salmonellosis, Shigellosis - 2 -
Ernährungssicherheit, Institut für med. Mikrobiologie und Hygiene Graz Österreichische Agentur für Gesundheit und Ernährungssicherheit, Institut für med. Mikrobiologie und Hygiene Linz Yersiniosis 2. Statutory notification Table AT 2 Statutorily notified cases of foodborne diseases Disease 1999 2 No. of cases Incidence No. of cases Incidence rate rate Salmonellosis 762 87.3 6553 8.8 Staphylococcosis 3. 13.2 Botulism.. Campylobacteriosis 3252 4.2 3471 42.8 Shigellosis 239 3. 115 1.4 E.coli enteritis (and EHEC) 38.5 16.2 Listeriosis - - Cholera 1.. Brucellosis 2. 2. Parathyphus 1. 3. Typhus (abdominalis) 13.2 12.1 Yersiniosis 9 1.1 12 1.5 Other bacterial foodborne infections and intoxications 13.2 3. Hepatitis A 34 4.2 222 2.7 Other viral enteritis - - Echinococcosis 47.6 21.3 Trichinellosis 3. 2. Giardiasis - - Amoebiasis 13.2 6.1 Infectious Enteritis of unknown origin - - Other (please specify) - - Total 11117 137.4 1559 13.2-3 -
The foodborne disease with the highest incidence notified in 1999 and 2 was salmonellosis, followed by campylobacteriosis (Table AT 2). The number of notifications of campylobacteriosis cases has gradually increased in recent years, reflecting an improvement in the surveillance of campylobacter rather than a true rise in human infections. An overview of the number of cases of foodborne diseases notified in Austria in the period 1993 to 2 is given in Figures AT 1 and 2. Figure AT 1 No. of cases 12 1 8 6 4 2 Notified Bacterial Foodborne Diseases AUSTRIA 1993-2 Bacterial foodborne diseases Campylobacteriosis Salmonellosis Other bacterial foodborne diseases - 4 -
Figure AT 2 3 25 2 15 1 5 No. of cases Notified Foodborne Diseases AUSTRIA 1993-2 Cholera Typhoid and paratyphoid fever Shigellosis Botulism Yersiniosis Staphylococcosis E. coli * Brucellosis Amoebiasis Trichinellosis * notified cases of ECEH 1993-1998; all notified E. coli enteritis and ECEH cases 1999 and 2 A total of 777 and 763 salmonellosis cases were serotyped in 1999 and 2 respectively. In 9 % of these cases, S. Enteritidis was isolated. S. Typhimurium was responsible for about 5% of the cases serotyped in both years (Table AT 3). An overview of the frequency of Salmonella serotypes isolated from 1993 to 2 is given in Figures AT 3 and 4. Table AT 3 Salmonella cases by serotypes Serotype 1999 2 No. of cases Incidence No. of cases Incidence rate rate S. Enteritidis 722 86.8 6364 78.5 S. Typhimurium 412 5.1 385 4.7 S. Infantis 47.6 63.8 S. Agona 12.1 18.2 S. Bredeney 12.1 5.1 S. Derby 14.2 13.2 S. Virchow 41.5 45.6 S. Hadar 9 1.1 75.9 S. Tennessee 3. 2. S. Panama 9.1 4. - 5 -
S. Saintpaul 9.1 21.3 S. Montevideo 9.1 15.2 S. Newport 27.3 24.3 S. Anatum 21.3 7.1 S. London 5.1 1. S. Ohio 4. 5.1 S. Muenchen 5.1 5.1 S. Bareilly 4. - S. Oranienburg 24.3 11.1 Total 777 96. 763 87.1 Figure AT3 1 8 6 4 2 No. of cases Frequency of Salmonella Serotypes AUSTRIA 1993-2 S. Typhimurium S. Virchow S. Braenderup S. Infantis S. Agona S. Bredeney S. Montevideo S. Hadar - 6 -
Figure AT 4 1 No. of cases Frequency of S. Enteritidis Cases AUSTRIA 1993-2 8 6 4 2 S. Enteritidis 3. Epidemiologically investigated incidents As in previous years, data from investigations of foodborne disease outbreaks in Austria 1999 and 2 is only available for those outbreaks caused by Salmonella sp. For 1999, 12 salmonellosis outbreaks with a total of 281 cases were reported; in 2, details of eight salmonellosis outbreaks involving 123 cases were provided. 3.1 Causative agents The most frequently isolated serotype in foodborne salmonellosis outbreaks reported in 1999 and 2 was S. Enteritidis (1 % in 1999 and 87.5 % in 2). S. Typhimurium accounted for 12.5 % of salmonellosis outbreaks investigated in 2 (Table AT 4). Table AT 4 Foodborne outbreaks of salmonellosis by serotype 1999 2 Total n % N % n % S. Enteritidis No. of outbreaks 12 1 7 87.5 19 95 No. of cases 281 1 113 91.9 394 97.5 S. Typhimurium No. of outbreaks 1 12.5 1 5 No. of cases 1 8.1 1 2.5 Total No. of outbreaks 12 1 8 1 2 1 Total No. of cases 281 1 123 1 44 1-7 -
Figure AT 5 gives an overview of the foodborne salmonellosis outbreaks caused by different serotypes from 1993 to 2. A total of 64 salmonellosis outbreaks were reported to the Salmonella Reference Center during that period. In each year, the predominant serotype was S. Enteritidis. Figure AT 5 Frequency of Foodborne Salmonellosis Outbreaks by Serotypes AUSTRIA 1993-2 No. of outbreaks 14 12 1 8 6 4 2 S. Enteritidis S. Hadar S. Newport S. Typhimurium S. Virchow 3.2 Food implicated in foodborne salmonellosis outbreaks The food responsible for outbreaks of foodborne salmonellosis was unknown in more than 6% of the outbreaks reported in 1999 and 2. Eggs and egg products were most frequently registered as being responsible for the outbreak in both years; this coincides with the frequency of S. Enteritidis (Table AT 5). - 8 -
Table AT 5 Food implicated in foodborne salmonellosis outbreaks Incriminated food 1999 2 Total n % n % n % Cheese Outbreaks. 1 12.5 1 5. Cases. 16 13. 16 3.2 Eggs/Egg products Outbreaks 3 25. 2 25. 5 25. Cases 33 11.7 48 39. 81 16.1 Fancy cakes Outbreaks 1 8.3. 1 5. Cases 5 1.8. 5 1. Unknown Outbreaks 8 66.7 5 62.5 13 65. Cases 243 86.5 59 48. 32 59.9 Total Outbreaks 12 1. 8 1. 2 1. Total Cases 281 1. 123 1. 54 1. An overview of the food responsible for foodborne salmonellosis outbreaks reported between 1993 and 2 is given in Figure AT 6. Eggs, egg products and food containing egg (i.e. mayonnaise, fancy cakes and puddings) were responsible for most of the outbreaks in which the food was known in each year. Figure AT 6 1 8 6 4 2 No. of outbreaks Food Implicated in Foodborne Salmonellosis Outbreaks AUSTRIA 1993-2 Cheese Chicken Eggs/Egg products Fancy cakes Ice cream Mayonnaise/Dressings Mayonnaise/Puddings Meat/Potato salad Puddings/Creams Unknown - 9 -
3.3 Site of contamination or consumption of food in foodborne salmonellosis outbreaks reported In all outbreaks of foodborne salmonellosis reported to the Salmonellosis Reference Center in 1999 and 2, information on the place of consumption was available. A quarter of the reported outbreaks occurred in the private home, whereas 5% occurred in the restaurant sector, schools and kindergartens (Table AT 6). Figure AT 7 gives an overview of the places of consumption implicated in foodborne salmonellosis outbreaks registered between 1993 and 2. Table AT 6 Foodborne salmonellosis outbreaks by place of consumption Place of consumption 1999 2 Total n % n % n % Other Outbreaks 3 25 1 12.5 4 2 Cases 35 12.5 8 6.5 43 1.6 Private home Outbreaks 3 25 1 12.5 4 2 Cases 2 7.1 15 12.2 35 8.7 Restaurant/hotel Outbreaks 3 25 3 37.5 6 3 Cases 42 14.9 55 44.7 97 24. School/kindergarten Outbreaks 3 25 3 37.5 6 3 Cases 184 65.5 45 36.6 229 56.7 Total Outbreaks 12 1. 8 1. 2 1. Total Cases 281 1. 123 1. 44 1. Figure AT 7 6 5 4 3 2 1 Places of Consumption Implicated in Foodborne Salmonellosis Outbreaks AUSTRIA 1993-2 No. of outbreaks Canteen Food supply from central kitchen Mass cat. for spec. g. Medical care fac. Private home Other Restaurant/Hotel Picnic School/Kindergarten Unknown - 1 -
4. Additional information S. Enteritidis is by far the most prevalent serotype of human salmonellosis in Austria. The predominant phage type is PT 4. Raw or unsufficiently heated egg and poultry dishes are the main source of human salmonellosis. Table AT 7 Figure AT 8 S. Enteritidis PT 4 isolated from non-human sources 1999 2 Chicken domestic 93 84 imported 3 25 *Turkey domestic 3 imported 5 *Other poultry domestic 17 17 imported 1 4 *Eggs, egg products domestic 6 5 imported 2 *Other food 9 6 Animals 28 62 Water, sewage, others 166 182 Total PT 4 isolates 369 385 % of all S. Enteritidis isolates 41.8 46.1 Total S. Enteritidis isolates 882 835 *food isolates, mainly from random samples processed by federal food laboratories 8 6 4 2 No. of isolates S. Enteritidis PT 4 Isolated from Non-Human Sources AUSTRIA 1993-2 Chicken, eggs for hatching domestic Other poultry domestic Other food items Water, sewage, others Turkey domestic Eggs, egg products domestic Animals - 11 -
Human isolates (Table 8) originate from examinations of sick persons as well as from investigations carried out according to the Act on the Excretion of Bacteria (food-handlers). Table AT 8 Year Multi-drug-resistant S. Typhimurium strains isolated from humans S. Typhimurium S. Typhimurium DT 14 S. Typhimurium DT 14 isolates R-Type ACSSuT* n n % of total S. Typhimurium % of total S. Typhimurium 1993 1124 214 19.4 n.a. 1994 574 26 18.29 n.a. 1995 47 54 13.3 2.4 1996 558 185 33.1 48.1 1997 392 126 31.9 (67)53.1 1998 377 137 36.3 (66)48.2 1999 412 91 22.1 (61)67. 2 385 122 31.7 (83)68. For further reference on national and international data on foodborne diseases, please visit the web page http://www.euro.who.int/foodsafety/surveillance/2294_1. - 12 -