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Salmonella Enteritidis
In early January 2023, Salmonella Enteritidis was diagnosed in an individual who was hospitalized due to a severe gastrointestinal infection. His coworkers had also experienced similar symptoms, and they linked the infection to meals delivered to their workplace. Upon further investigation, it was revealed that a large group of customers of the food production company, who had received meals at the same time, had experienced symptoms but had not reported them. Several types of meals were involved, but all were produced by the same company. Salmonella Enteritidis infection was confirmed through the cultivation of stool samples from ten individuals, although many more had experienced symptoms, suggesting the infection was more widespread. Samples were sent for genotyping, which confirmed that the same strain, Salmonella Enteritidis ST11, was involved in the outbreak. The source of the contamination could not be traced to any specific food products.
Norovirus
In May, a report was received regarding a group outbreak in a private home where a group of people gathered, and eight out of nine individuals became ill with gastrointestinal symptoms. Initially, the case was thought to be related to meals consumed, but it later became clear that the infection likely spread from a child in the group who had exhibited gastrointestinal symptoms the day before the gathering. Norovirus was confirmed as the causative agent.
In early July, a gastrointestinal infection occurred in two groups of tourists on the East Coast. The source of the infection was believed to be a restaurant visited by both groups, as illness had also affected staff at the restaurant. One group consisted of French tourists, and the other was a group of elderly people from Northern Iceland. A total of twelve individuals became ill, and four of them required hospitalization due to severe illness. Norovirus was determined to be the causative agent.
In July, the Reykjavík Health Authority and the Chief Epidemiologist were notified of illness among individuals who had eaten at a popular restaurant chain operating at two locations in Reykjavik. Most people fell ill between July 7-9. An extensive investigation revealed that over 190 guests at these restaurants developed gastrointestinal symptoms (vomiting, diarrhea, and fever for approximately 1-3 days) during this period. Stool samples were collected from ten individuals, and norovirus was identified in eight of them. The source of the outbreak could not be determined. See news published on the website of the Director of Health on July 20, 2023.
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Norovirus
In the fall of 2022, there were reports of two large-group infections associated with confirmed norovirus infections. In the previous outbreak, 46 people became ill, either after a party with home-cooked meals or after consuming food leftovers from the same party at work. It turned out that the people who prepared the meals had symptoms of intestinal infection, and therefore, noroviruses could have been introduced into the meals from them. In the second incident, 47 individuals became ill after consuming meals at a workplace (several separate workplaces), but the food came from a single manufacturing company. Since research on norovirus in food is not conducted in Iceland, no such tests were conducted to investigate these two group infections. Therefore, the origin of the infection was not attributed to specific foods. It is common for people to become infected with norovirus by consuming food contaminated with norovirus, but infection is also transmitted between people. Since noroviruses are highly contagious, it is essential to be careful when handling food. You should not cook food for others if symptoms of intestinal infections are present or in the first few days after.
Enteropathogenic E. coli (EPEC)
A notification was received in autumn 2022 about an illness after a meal in a restaurant. Further investigation revealed that about 12 people in three separate groups had become ill within 24 hours of eating at the restaurant that same evening. The main symptoms were abdominal pain, fever, and diarrhoea that lasted up to a week. Microbiological studies of stool samples from some of those who became ill were positive for Enteropathogen E. coli (EPEC). No pathogenic micro-organisms were detected in the samples taken from the food. Still, it is considered likely that EPEC infection was transmitted through food eaten in the restaurant that evening.
Unknown pathogen
In the spring of 2022, a notification was received of five people who became ill after eating in a restaurant. More groups fell sick after a meal at this restaurant that evening, but no reports were received. The illness started 2-3 days after the meal with fever, nausea, and vomiting and lasted for about a week. The pathogen causing these symptoms could not be identified, and several days passed between the meal and the announcement. It was impossible to trace the infection to the consumption of certain foods.
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Salmonella typhimurium
In September, there was an increase in notifications to the Chief Epidemiologist about salmonella infections. Upon closer inspection, all strains were found to be Salmonella typhimurium and of the same serotype. In a few weeks, 13 people, seven women and six men were diagnosed with salmonella. The average age was 55, but the age range was from 21 to 72. These individuals lived across the country, but most were in the southwest or had recently stayed there. The samples were sent to Denmark for sequencing to confirm that it was a group infection with the same Salmonella strain. That study demonstrated that the same strain caused the thirteen Salmonella infections. It has not been possible to trace the infection to the consumption of certain foods.
Salmonella Chester and Salmonella Napoli
In three months, three people were diagnosed with an intestinal infection caused by a rare pathogen called Salmonella Chester, which has not been diagnosed in Iceland for many years, and another three people were later diagnosed with an intestinal infection with Salmonella Napoli. The source of these infections is unknown, as there are few cases and no apparent connection to certain foods. However, sequencing abroad showed that the three S. Chester cases were from the same strain, suggesting a common origin. No increase in S. Chester cases has been seen elsewhere in Europe, but the same strain has been detected abroad.
Unknown pathogen
Three group infections in restaurants were reported in 2021. The number of infected was between four and twelve persons, but it was not possible to identify the origin of these infections or the source of infection.
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Cryptosporidium
In December 2020, a group infection occurred in the capital area, linked to a commercial building where several companies share the same canteen. A total of 45 people thought they had felt the symptoms of an intestinal infection, but all of them had consumed meals from the canteen a few days before. Some workers submitted stool samples, and Cryptosporidium was detected in nine of them. It was impossible to trace the infection's origin to certain foods. This group infection was interesting since Cryptosporidium has not often caused group infections in Iceland, and strict quarantine measures were in force at the workplace due to COVID-19. Among other things, food trays were distributed around the building in separate work rooms for ten people, but the food was not eaten in the dining room itself.
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Enterohemorrhagic E. coli (STEC)
During July 13–16, 24 people were infected by Shiga-toxin-producing enterohemorrhagic E. coli (STEC). The age range of those infected was from 5 months to 41 years, but the average age was over six years. Nine children came to the emergency department of Landspitali Hospital, the children's department and four were admitted. Seven of the children were diagnosed with Hemolytic uremic syndrome (HUS), which is characterised by abdominal pain and bloody diarrhoea. An epidemiological study revealed that everyone (except a 5-month-old child infected by a sibling) had eaten ice cream on a cow farm that operates a tourist service. The pathogen was found in calves, soil, and one of the farm's employees, but it seems to have gotten into the ice somehow. Various measures were taken, and this group's infection was eradicated.
Clostridium perfringens
In mid-December 2019, 15 people became infected after eating ham and side dishes in a workplace canteen. Most people got sick 12 hours after the meal with diarrhoea and abdominal pain, but the illness lasted about 24 hours. Bacillus cereus and Clostridium perfringens were bacteriologically tested on leftover ham. However, a much larger amount was grown by Cl. perfingens, which was therefore considered the probable cause of the group infection.
Aeromonas veronii
Nine persons between the ages of 50 and 94 and living across the capital area were diagnosed with an intestinal infection, probably caused by Aeromonas veronii, over several weeks in the fall of 2019. There were no interrelationships between these individuals, and a food consumption survey yielded no decisive results about relationships with certain foods. The origin of the infections was, therefore, unclear.
Norovirus
Norovirus was detected in a group that ate the same meal at a restaurant. Nine people out of eleven fell ill about 1½ days after the meal with vomiting, diarrhoea, and fever. A study showed that norovirus was present in stool samples from four people. The research did not reveal the source of infection in certain foods, but food remains from the meal in question were absent.
Unknown pathogen
In the fall of 2019, a significant group infection occurred at a company in Reykjavik with about 200 employees. A survey revealed that of the 145 employees who responded to the survey, 70 had fallen ill with vomiting, diarrhoea, and fever at the same time. However, the symptoms passed quickly and were over when the report was received. The health inspectorate investigated the company's canteen but found nothing wrong.
In December 2019, an epidemiologist was alerted to a group infection at a residential facility in Reykjavík. A total of 6 out of 18 residents and 7 out of 10 employees fell ill after eating Christmas food bought on-site. The illness started about 1½ days after the meal and manifested as acute diarrhoea, vomiting, and fever. The sickest individual was hospitalised, and norovirus was detected in his stool sample. The health inspectorate investigated foods and their production sites, but no signs of infectious agents were detected. The source of the infection could not be identified.
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Norovirus
Norovirus was confirmed in three foodborne outbreaks in 2018. The largest outbreak was attributed to oysters contaminated with norovirus. In mid-November 2018, the epidemiologist received information indicating a group infection after a meal at a restaurant in Reykjavík. Most of the group of 18 had diarrhoea, vomiting and fever about 1½ days after the meal, but the symptoms lasted for 2-3 days. A case-control study revealed an association with oysters contaminated with norovirus. It was found that over 19 days, 54 individuals had become ill from norovirus following the consumption of oysters.
Two other group infections caused by norovirus were reported in 2019. The second event was related to a meal ordered by a group of thirteen employees from a restaurant, seven of whom became ill with diarrhoea, vomiting and fever. No connection with certain foods was found during the investigation, but two of the employees were diagnosed with norovirus infection. The third group infection occurred following a party held in a restaurant. Out of about 100 visitors, 20 fell ill with diarrhoea, vomiting and fever about 1½ days later. An investigation did not reveal the source of the infection, but there had been illness among the staff.
Salmonella typhimurium
In May, a group infection occurred when all eleven crew members of an Icelandic cruise ship fell ill with gastroenteritis after the ship left a port abroad. Three were hospitalised, and Salmonella typhimurium was cultured from seven crew members. The same pathogen was grown from both sauce (cooked from eggs) and pork, but the meat was believed to be cross-contaminated from the sauce. It was clear that it was a foodborne infection. More detailed studies of the salmonella strain were carried out abroad, but no relationship was found with strains associated with foodborne outbreaks abroad.
Unknown pathogen
Ten of a family of eleven who ate a meal together at home fell ill with diarrhoea, abdominal pain, and vomiting one to three days later. Tests on stool samples and food (supermarket soup) were negative.
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Aeromonas hydrophila
In late August 2017, a group infection with enteric illness broke out among 130 employees of two elementary schools in the capital area. The infection was thought to be caused by the bacterium Aeromonas hydrophilia. The bacterium grew in large quantities in imported and packaged leaf lettuce served by school kitchens, but the lettuce was labelled "unwashed". Although A. hydrophilia is not a notifiable pathogen, this was a significant group infection of public health importance. Infections caused by A. hydrophilia can cause disease in marine animals and humans, although rare.
Norovirus
On August 10, a group infection caused by norovirus broke out among foreign scouts who stayed at a summer camp in Iceland. A total of 81 people got sick, but the main symptoms were vomiting, stomach cramps and diarrhoea. Two days before the outbreak of the group infection, one scout fell ill with an intestinal infection. The source of the infection was not found, but it was thought likely that the disease was transmitted between people near each other.
Shigella sonnei
At the end of November 2017, a shigella infection was reported in a preschool child in Suðurnes. There had been some cases of colic among the children and workers, and the main symptom was vomiting. Bacteriological tests were negative in other individuals, but Shigella was considered the likely cause of this cluster infection.
Salmonella Typhimurium, monophasic
Eight people were diagnosed with an intestinal infection caused by Salmonella typhimurium in August 2017, and the infections appeared to be domestic. Research revealed that it was the same strain found on a pig farm in Iceland in seven cases.
Unknown pathogen
In November 2017, there was a group infection with stomach flu among the employees of a company in Reykjavík. Of around 200 workers, 50 fell ill with diarrhoea, abdominal pain, and fever. The symptoms lasted 3 to 6 days, but no one required hospitalisation. A detailed examination of stool samples did not reveal a causal agent. The Epidemiologist organised a case-control study to investigate possible links to food, and the Icelandic Health Authority examined conditions within the company. Still, these studies did not lead to a definite conclusion about a cause.
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