ireland ( ie ) - bund

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe

8th Report 1999-2000 Country Reports: Ireland

BfR

IRELAND

Population: 3.626.087 (1996 census) Area: 70 283 km2

1. General information

In Ireland (country abbreviation: IE), foodborne disease surveillance is a partnership between clinicians, public health services and laboratories at the local level, public health departments at the regional level, and the National Disease Surveillance Centre and Food Safety Authority at the national level.

For the period of 1999- 2000, foodborne disease surveillance involved three systems:

• clinical notifications - data from National Disease Surveillance Centre (NDSC) • enhanced surveillance of certain sporadic cases - data from NDSC • outbreak surveillance - data from the Food Safety Authority of Ireland (FSAI)

Agencies

The National Disease Surveillance Centre (NDSC), set up in 1998, is Ireland’s specialist centre for surveillance of communicable diseases and collates all clinical notifications. NDSC works in partnership with health service providers and sister organisations in other countries to ensure that up-to-date information is available to contribute to the effective control of infectious diseases. In July 2000, the National Disease Surveillance Centre was assigned responsibility for the collation and analysis of weekly notifications of infectious diseases by statutory instrument, taking over from the Department of Health and Children.

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 199-2000

Country Reports: IRELAND

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The Food Safety Authority of Ireland (FSAI) is responsible for the enforcement of all food safety legislation in Ireland and operates the national food safety compliance programme by means of service contracts with the 47 governmental agencies currently involved in the enforcement of food legislation. FSAI is the competent authority for food alerts nationally. (www.fsai.ie/serv_contract.htm).

Statutory Notifiable Infectious Diseases

The 1947 Health Act entitles the Minister for Health and Children to specify by regulation those diseases which are infectious and covered by legislation. Should a medical practitioner become aware of or suspect that a person he or she is attending professionally suffers from or is a carrier of an infectious disease, the practitioner is required to transmit a written notification to the relevant Medical Officer (MOH) on his or her health board. Current notifiable infectious diseases should be notified to the Regional Director of Public Health. There is considerable under-reporting. There is no statutory requirement to date to provide laboratory data on infectious diseases, and any laboratory data are currently provided on a voluntary basis.

Table IE 1

Current list of notifiable diseases in Ireland with potential for foodborne spread

IRELAND 1999-2000

Notifiable diseases with potential for foodborne spread Anthrax Bacillary dysentery (Shigellosis) Cholera vCreutzfeldt Jakob Disease Food poisoning (bacterial other than salmonella) Gastroenteritis (when contracted by children under 2 years) Salmonellosis (other than typhoid or paratyphoid) Tuberculosis Typhoid & paratyphoid Viral haemorrhagic disease Viral hepatitis type A Viral hepatitis unspecified

Enhanced surveillance

Enhanced surveillance systems are in place for VTEC, Salmonella enterica, Campylobacter and Listeria and outbreaks.

Outbreak surveillance

There is no statutory responsibility to report outbreaks in Ireland. However, a voluntary reporting system for all investigated outbreaks of infectious intestinal disease (IID) was introduced by the Food Safety Authority in 1998 and maintained until July 2001. This included general and family outbreaks, although the latter were not normally subject to a formal investigation unless VTEC was implicated. Preliminary reports were received from Regional Directors in Public Health, who, on completion of the investigation, collated the

http://www.fsai.ie/serv_contract.htm



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relevant epidemiological, microbiological and environmental information into standardised questionnaires.

From July 2001, the NDSC assumed responsibility for the surveillance of all outbreaks of infectious disease, including foodborne outbreaks, in Ireland. FSAI continues to be informed of enteric, food- and waterborne outbreaks by the Specialists in Public Health Medicine (SPHM) and the NDSC. The data collected during outbreak investigations are listed in Table IE 2.

TABLE IE 2

Data collected during outbreak investigations

IRELAND 1999-2000

Data categories

Health Board, Community care area, name and position of notifier

Notification source

Outbreak type (family or general)

Principal mode of transmission

Location (e.g. guesthouse/hotel/hospital/crèche etc)

Pathogen

Details of exposure of cases and number at risk

Suspect food vehicles and basis for evidence - epidemiological, microbiological and circumstantial (descriptive and including environmental, inspection, chain of events etc)

Factors contributing to the outbreak covering the findings of the environmental inspection of structure and process, chain of events, HACCP etc:

-Grossly contaminated raw ingredients

-Inadequately trained / supervised staff

-Inadequate storage / refrigeration

-Inadequate hygiene facilities (toilets, sinks etc)

-Inadequate cooking

-Cross-contamination

-Infected food handlers

-Poor hygiene conditions in premises

A review of the Infectious Disease Regulations was recently conducted by NDSC, who recommended the list of notifiable diseases be extended to include Campylobacter, E. coli O157, Listeria and toxoplasmosis and outbreaks. The report was presented to the Department of Health and Children, and amendments to the legislation are expected.



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Figure IE 1

Structure of the foodborne disease surveillance system in Ireland

IRELAND 1999-2000

2. Statutory notification

Table IE 3 Notifications of foodborne diseases

IRELAND 1999-2000 Disease 1999 2000

No. of cases

Incidence rate

No. of cases

Incidence rate

Salmonellosis 960 26.5 640 17.6 Campylobacteriosis* 2085 57.5 1613 44.5 Shigellosis 116 3.2 25 0.7 E.coli enteritis(VT E. coli O157)* 51 1.4 41 1.1 Listeriosis * NA NA 7 0.2 Cholera 0 0.0 1 0.0 Brucellosis 19 0.5 15 0.4 Other bacterial foodborne infections and intoxications (all bacterial other than Salmonella)

1665 45.9 1554 42.9

Hepatitis A 321 8.9 236 6.5 Echinococcosis 0 0.0 0 0.0 Trichinellosis 0 0.0 0 0.0

[*Enhanced Surveillance System (Lab confirmed cases)]



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The foodborne diseases with the highest incidence reported in 1999 and 2000 under the Irish mandatory notification scheme were campylobacteriosis and salmonellosis (Table IE 3). The overall number of salmonellosis cases notified decreased in 1999 and 2000 as compared to the number of cases notified in 1998 (Figure IE 2).

Figure IE 2

Number of Notified Salmonellosis, Shigellosis and Brucellosis Cases IRELAND 1992-2000

0200400600800

100012001400

1992 1993 1994 1995 1996 1997 1998 1999 2000

No. of cases

Shigellosis Salmonellosis Brucellosis

Figure IE 3

Salmonellosis Cases by Serotypes IRELAND 1996 - 2000

0

200

400

600

800

1996 1997 1998 1999 2000

No. of cases

S. Enteritidis S. Typhimurium S. Infantis S. Agona S. BredeneyS. Derby S. Virchow S. Hadar S. Saintpaul S. MontevideoS. Newport S. Anatum S. London S. Ohio



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Table IE 4 shows the Salmonella serotypes isolated by the National Reference Laboratory in 1999 and 2000. The predominant serotype in notified salmonellosis cases in 1999 and 2000 was S. Typhimurium (49% and 48% of serotyped salmonellosis cases), followed by S. Enteritidis (34% and 40%) and S. Bredeney (11% and 4%). While the number of notified salmonellosis cases caused by S. Typhimurium has decreased since 1998, the number of notified salmonellosis cases caused by S. Enteritidis has risen (Figure IE 3).

Table IE 4 Salmonella cases by serotypes

IRELAND 1999-2000

Serotype 1999 2000 No. of cases % No. of cases %

S. Enteritidis 193 34 239 40 S. Typhimurium 280 49 286 48 S. Infantis 3 1 7 1 S. Agona 1 0 6 1 S. Bredeney 63 11 24 4 S. Derby 2 0 0 0 S. Virchow 6 1 9 1 S. Hadar 8 1 11 2 S. Tennessee 0 0 0 0 S. Panama 0 0 0 0 S. Saintpaul 1 0 1 0 S. Montevideo 1 0 1 0 S. Newport 2 0 0 0 S. Anatum 0 0 2 0 S. London 0 0 0 0 S. Ohio 0 0 0 0 S. Muenchen 0 0 0 0 S. Arizona 1 0 0 0 S. Bareilly 2 0 0 0 S. Oranienburg 0 0 0 0 S. Kentucky 9 2 15 2 Total serotyped 572 60 601 94 Total notified 960 100 640 100

3. Epidemiologically investigated incidents

Twenty-eight and 36 outbreaks of foodborne diseases were reported in 1999 and 2000 respectively. In 63% of the outbreaks, transmission following a foodborne index case was foodborne and/or person-to-person and waterborne; in 20% of cases, the transmission occurred from person to person, in 2% through water. In 16% of the outbreaks reported, the means of transmission was unknown.

3.1 Causative agents

In 71% of the 28 outbreaks investigated in 1999 and in 75% of the 36 outbreaks investigated in 2000, the causative agent was identified. In 33 outbreaks, the identification of the agent was confirmed by laboratory diagnosis; in 10 outbreaks, the agent was presumed (these were viral outbreaks); for 21 outbreaks, no information as to how the agent was identified is



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available. The most important causative agent of outbreaks investigated in 1999 was S. Enteritidis, followed by S. Typhimurium and E. coli. In 2000, Norwalk virus caused the largest number of outbreaks, leading to 68% of all cases of intestinal infectious disease of that year, followed by E. coli and S. Enteritidis (Table IE 5). Compared to figures from previous years, the number of salmonellosis outbreaks has gradually declined following a peak in 1998 (Figure IE 4). Seventeen and 76 people respectively were hospitalised due to these intestinal infectious disease outbreaks in 1999 and 2000. The causative agents responsible for the largest number of hospitalisations were Norwalk virus and S. Typhimurium. Foodborne disease outbreaks were responsible for one death in 2000, caused by an E. coli infection (Table IE 6).

Table IE 5

Intestinal infectious disease outbreaks by causative agents

IRELAND 1999-2000

Causative Agent 1999 2000 No. of

outbreaks

% n

%

Cl. perfringens 2 7.1 1 2.8 E. coli 3 10.7 4 11.1 Histamine 1 3.6 0 0.0 Norwalk virus 1 3.6 14 38.9 Rotavirus 0 0.0 1 2.8 S. Enteritidis 6 21.4 3 8.3 S. Typhimurium 4 14.3 2 5.6 Salmonella spp. 2 7.1 1 2.8 Staph. aureus 1 3.6 1 2.8 Unknown 8 28.6 9 25.0 Total 28 100.0 36 100.0



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Figure IE 4

Intestinal Infectious Disease Outbreaks by Causative Agents IRELAND 1997 - 2000

0

5

10

15

20

1997 1998 1999 2000

No. of outbreaks

Cl. perfringens Salmonella (other than S. typhi and S. paratyphi) E. coli

Table IE 6

Morbidity and mortality of intestinal infectious disease outbreaks

IRELAND 1999-2000

Causative Agent Year No. of persons ill

No. of persons hospitalised

No. of persons dead

Mean duration of outbreak (d)

Cl. perfringens 1999 45 0 0 2000 9 0 0

E. coli 1999 9 1 0 2000 21 4 1 4.3

Histamine 1999 6 0 0 2000 0 0 0

Norwalk virus 1999 30 0 0 13 2000 950 34 0 4.6

Rotavirus 1999 0 0 0 2000 4 0 0

S. Enteritidis 1999 159 7 0 3 2000 48 6 0 3

S. Typhimurium 1999 34 8 0 39 2000 82 28 0 11

Salmonella spp. 1999 55 0 0 95 2000 3 3 0 9

Staph. aureus 1999 62 0 0 5 2000 7 0 0 2

Unknown 1999 232 1 0 8.3



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2000 256 1 0 3.7 Total 1999 632 17 0 18.6 Total 2000 1380 76 1 4.8

3.2 Food implicated in outbreaks

In 50% of the outbreaks reported in 1999, the food responsible for the illness was known; in the year 2000, the responsible food was identified in 37% of instances. In 46% and 41% of the outbreaks reported in 1999 and 2000 respectively, the food was confirmed epidemiologically and/or by laboratory test. The foods responsible for most outbreaks with a known food vehicle in 1999 included chicken, eggs, and egg products, whereas in 2000 there was no difference between the frequency of different foods implicated in outbreaks (Table IE 8). The involvement of different foods in outbreaks occurring from 1997 to 2000 is shown in Figure IE 4.

Table IE 7

Confirmation of food implied in intestinal infectious disease outbreaks

IRELAND 1999-2000

1999 2000 Total Confirmation of Food

No. of outbreaks

% No. of outbreaks

% No. of outbreaks

%

Epidemiologically confirmed

2

7.1

4

11.1

6

9.4

Epidemiologically and laboratory confirmed

5

17.9

1

2.8

6

9.4 Laboratory confirmed

6

21.4

3

8.3

9

14.1

No confirmation 1 3.6 5 13.9 6 9.4 Food unknown 14 50.0 23 63.9 37 57.8 Total no. of outbreaks

28

100

36

100

64

100



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Table IE 8

Food incriminated in intestinal infectious disease outbreaks

IRELAND 1999-2000

Incriminated Food 1999 2000 No. of

outbreaks% No. of

outbreaks%

Beef 0 0.0 1 2.8 Chicken 6 21.4 1 2.8 Crustac./shellf./moll. 0 0.0 2 5.6 Eggs/egg products 4 14.3 1 2.8 Fish 1 3.6 0 0.0 Ice/drinking water 0 0.0 1 2.8 Ice/drinking water/milk 0 0.0 1 2.8 Meat 1 3.6 0 0.0 Milk (unpasteurised) 0 0.0 1 2.8 Pasta 0 0.0 1 2.8 Pork (cooked ham) 0 0.0 1 2.8 Puddings/creams 1 3.6 1 2.8 Soups/gravies 0 0.0 1 2.8 Turkey 1 3.6 1 2.8 Unknown 14 50.0 23 63.9 Total 28 100.0 36 100.0

Figure IE 4

Food Incriminated in Intestinal Infectious Disease Outbreaks IRELAND 1997 - 2000

02468

10

1997 1998 1999 2000

No. of outbreaks

Egg/Mayonnaise Meat/Poultry Cheese



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3.3 Place of acquisition/consumption

The place where the food implicated in these outbreaks was acquired and/or consumed was known in most of the outbreaks reported in 1999 (93%) and 2000 (100%). The mass catering sector was responsible for 60 % of the outbreaks in 1999 and 50 % of those registered in 2000, whereas only 11% and 17% of the outbreaks for the years mentioned occurred in the private home (Table IE 9). An overview of the places of acquisition/consumption from 1997 to 2000 highlights the role of restaurants and hotels in outbreaks in Ireland ( Figure IE 5).

Table IE 9

Places of acquisition/consumption implicated in intestinal infectious disease outbreaks

IRELAND 1999-2000

1999 2000 Place of Acquisition/Consumption

No. of outbreaks

% No. of outbreaks

%

Canteen 1 3.6 1 2.8 Medical care facility 4 14.3 4 11.1 Other 0 0.0 5 13.9 Private home 3 10.7 6 16.7 Restaurant/hotel 13 46.4 16 44.4 Retail store 1 3.6 0 0.0 School/kindergarten 1 3.6 3 8.3 Take away 3 10.7 1 2.8 Unknown 2 7.1 0 0.0 Total 28 100.0 36 100.0



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Figure IE 5

Place of Acquisition/Consumption Implicated in Intestinal Infectious Disease Outbreaks

IRELAND 1997 - 2000

0

5

10

15

20

1997 1998 1999 2000

No. of outbreaks

Private home Restaurant/Hotel CanteenSchool/Kindergarten Medical care fac. Retail storeUnknown

3.4 Contributing factors

The factors contributing to the outbreaks in both 1999 and 2000 were known in about 35% of the reported outbreaks. The most frequently reported factors were improper storage and inadequate cooking in 1999, and inadequate refrigeration and the use of contaminated ingredients in 2000 (Table IE 10). An overview of contributing factors of outbreaks reported from 1997 to 2000 is given in Figure IE 6.

Table IE 10

Factors contributing to intestinal infectious disease outbreaks

IRELAND 1999-2000

1999 2000 Total No. of

outbreaks% No. of

outbreaks% No. of

outbreaks %

Contam./inf. pers. 2 7.1 2 5.6 3 4.7 Cross contamination 0.0 1 2.8 1 1.6 Improper storage 3 10.7 0.0 3 4.7 Inadeq. refrigeration 0.0 5 13.9 5 7.8 Inadequate cooking 3 10.7 0.0 3 4.7 Poor hygiene 0.0 1 2.8 1 1.6 Prep. food in advance 2 7.1 0.0 2 3.1 Use of contam. ingred. 0.0 3 8.3 3 4.7 Unknown 18 64.3 24 66.7 42 65.6 Total 28 100.0 36 100.0 64 100.0



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Figure IE 6

Factors Contributing to Intestinal Infectious Disease Outbreaks

IRELAND 1997 - 2000

02468

1997 1998 1999 2000

No. of outbreaks

Food prepared too far in advance Improper storage

Inadequate cooking/ reheating Cross contamination

Infected person

4. Further information

As the surveillance system in Ireland was evolving during the time period covered in this report and different data collection tools were used in 1999 and 2000, questions concerning contributing factors have been amended.

Information on communicable disease surveillance in Ireland may be obtained from the webpage of the Irish National Disease Surveillance Centre at http://www.ndsc.ie/, which also publishes reports on infectious diseases in its monthly bulletin “EPI-Insight” at http://www.ndsc.ie/Publications/EPI-Insight/.

The Food Safety Authority of Ireland provides consumer advice as well as research and industry information on food safety and hygiene issues on its webpage at http://www.fsai.ie/.

For further reference on national and international data on foodborne diseases, please visit the web page http://www.euro.who.int/foodsafety/Surveillance/20020904_1

http://www.ndsc.ie/

http://www.ndsc.ie/Publications/EPI-Insight/

http://www.fsai.ie/

http://www.euro.who.int/foodsafety/MainActs/20011128_1

http://www.euro.who.int/foodsafety/MainActs/20011128_1

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