France ( FR ) · 2003. 12. 12. · listeriosis and typhoid fever 2. National reference laboratory...

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

8th Report 1999-2000 Country Reports: France

BfR

FRANCE

Population 1999: 58 500 000 Population 2000: 58 700 000

Area: 547 026 km2

1. General information

In France (country abbreviation: FR), the surveillance of foodborne diseases relies on three systems (Figure 1):

1. Mandatory notification of foodborne outbreaks, botulism, brucellosis, listeriosis and typhoid fever

2. National reference laboratory (CNR) surveillance of salmonellosis, shigellosis, listeriosis

3. National hospital network for surveillance of Haemolytic Uraemic Syndrome (HUS)

1.1 Mandatory notification of foodborne outbreaks

An outbreak of a foodborne disease is defined as “the occurrence of at least two cases of a similar illness, usually gastro-intestinal, due to the consumption of a common food product”. In the case of botulism, listeriosis, typhoid fever and brucellosis, even single cases are notifiable.

Notifications are done by general practitioners, hospital physicians and medical laboratories. Foodborne outbreaks can also be notified by the head of the establishment (schools, restaurants, etc.) or the head of the family in which the cases occur. Outbreaks are

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 1999-2000

Country Reports: FRANCE

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investigated by the local public health authorities (DDASS = Direction Départementale des Affaires Sanitaires et Sociales) and veterinary officers (DSV = Services Vétérinaires Départementaux). Standardized reports are sent to the Public Health Institute (Institut de Veille Sanitaire) and the Department of Agriculture. These reports are pooled and analyzed on an annual basis after checking for double notifications. The results are published annually in the Bulletin Epidémiologique Hebdomadaire.

Notifications and investigations of outbreaks as well as collaboration between local public health authorities and veterinary services were strengthened in 1987 through the implementation of the following measures:

- Information was sent to 100 000 physicians regarding the need to improve notification

- Guidelines dealing with methodology of investigations and control measures were disseminated to local health and veterinary services

- The epidemiological software “TIAC” was developed to encourage case control studies and facilitate data analysis in foodborne disease outbreak management

Figure FR 1

National system for the surveillance of foodborne diseases

FRANCE 1999-2000

Laboratories Physicians

DDASS DSV Epidemiological studies Microbiological analyses (cases, food) Study of food chain

Identification : - microorganism - Food - contributing factors - lots - supply Control measures

Data Analysis

Surveillance of foodborne diseases

InVS

Mandatory Notification

CNR

Isolates

Trend analysis Establishing of alert thresholds

Heads of establishments Cases

Ministry of Agriculture



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1.2 Contribution of National Reference Centres

The contribution of National Reference Centers to surveillance of foodborne diseases consists of:

- Microbiological typing of strains sent by medical laboratories - Epidemiological surveillance - Early warning - Provision of technical advice

The National Reference Centers for Salmonella and Shigella, for example, receive strains of Salmonella from medical laboratories and epidemiological information about Salmonella strains isolated in laboratories performing serotyping. Analysis of data according to serotype, place (department) and date of isolation allows for the detection of an unusual increase of any serotype which may be due to the consumption of a contaminated food product.

In regards to foodborne infections, bacteria under surveillance by the National Reference Centers are Salmonella, Shigella, Yersinia, Campylobacter, Vibrio, anaerobic bacteria (Clostridium perfringens and Clostridium botulinum) and Listeria.

1.3 National hospital network

Since 1996, a surveillance system based on a national network of pediatric nephrology departments has been in operation for the monitoring of the haemolytic uraemic syndrome (HUS) in children under 15 years. The surveillance system is run by the Institut de Veille Sanitaire.

2. Notified cases of foodborne diseases

The figures presented in Table 1 include mandatory notifications, as well as cases recorded by laboratories and hospital networks.

Table FR 1

Notified cases of foodborne diseases

FRANCE 1999-2000

Disease 1999 2000 Salmonellosis 13668 12883 Listeriosis 262 256 Haemolytic Uraemic Syndrome (HUS) 98 81 HUS due to E.coli O157+other serogroups 41 32 HUS due to E.coli not O157 7 0 Trichinellosis 2 0 Brucellosis 56 44

2.1 Mandatory notification

2.1.1 Botulism

Botulism is notifiable whether it occurs as a single case or if more than one person is involved. Incidents are reported by the DDASS and the National Reference Centre for



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Anaerobic Microorganisms at the Institut Pasteur. The number of botulism incidents in 1999 and 2000 is given in Table FR 2.

Table FR 2

Botulism incidents reported through the mandatory notification system

FRANCE 1999-2000

1999 2000 No. of incidents 21 15 No. of cases 32 28

2.2 Foodborne disease outbreaks

In France, foodborne disease outbreaks are notified within the framework of the mandatory notification system. Outbreaks of salmonellosis and shigellosis are also reported by the National Reference Centre (CNR). Data collected from mandatory notification and data collected from the CNR may be partially overlapping inasmuch as a specific outbreak may have been recorded in both systems, which are not linked to one another. Further to this, the CNR provides data for salmonellosis and shigellosis outbreaks in humans without any confirmation of the foodborne origin of the outbreak. Because of this, epidemiological characteristics of outbreaks are presented only for foodborne outbreaks reported through the mandatory notification system.

Salmonellosis outbreaks notified by the CNR are used to assess the exhaustivity of the mandatory notification framework for salmonellosis outbreaks. In 2000, the exhaustivity of the mandatory notification system for salmonellosis outbreaks was estimated at 26%.

The number of outbreaks reported in 1999 and 2000 through the mandatory notifications system and the number of cases in the outbreaks is shown in Table FR 3. Table FR 4 shows the number of salmonellosis and shigellosis outbreaks reported by the National Reference Center.

Table FR 3

Foodborne outbreaks reported in the mandatory notification system and number of cases involved

FRANCE 1999 - 2000

1999 2000No. of outbreaks 640 627No. of cases 7281 10097

Table FR 4

Salmonellosis and shigellosis outbreaks reported by the CNR

FRANCE 1999 - 2000

1999 2000No. of salmonellosis outbreaks 549 447No. of shigellosis outbreaks 52 39



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3. Epidemiological characteristics of outbreaks

3.1 Causative agents

A total number of 640 and 627 outbreaks of foodborne diseases were notified under the mandatory notification system in 1999 and 2000. In 43% and 41% of the outbreaks of the years in question, the causative agent was laboratory confirmed. The causative agent was epidemiologically suspected in 47% of the outbreaks in 1999 and 41% in 2000 (Table FR 5).

Table FR 5

Identification of causative agent in outbreaks reported in the mandatory notification system

FRANCE 1999-2000

Reported outbreaks 1999 2000 n % n %

Total no. of outbreaks reported 640 100 627 100 No. of outbreaks with laboratory confirmed agent

274 42.8 256 40.8

No. of outbreaks with epidemiogically suspected agent

301 47.1 259 41.3

No. of outbreaks with agent not confirmed or unknown

65 10.2 112 18

The number of outbreaks with laboratory-confirmed causative agents reported under the mandatory notification system in 1999 and 2000 is shown in Table FR 6. In both years, Salmonella was the most frequently identified agent in foodborne disease outbreaks, followed by Staphylococcus aureus. The numbers of outbreaks caused by the different agents reported in the period from 1993 to 2000 can be seen in Figure FR 2.

Table FR 6

Laboratory confirmed causative agents in foodborne outbreaks reported in the mandatory notification system

FRANCE 1999- 2000

1999 2000 No. of

outbreaks % No. of

outbreaks %

Salmonella 175 63.87 163 63.67 Clostridium perfringens 19 6.93 8 3.13 Staphylococcus aureus 40 14.60 45 17.58 Histamine 9 3.28 11 4.30 Bacillus cereus 2 0.73 13 5.08 Shigella 6 2.19 2 0.78



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Others 19 6.93 9 3.52 DSP* 4 1.46 4 1.56 Trichinella 0 0.00 0 0.00 Hepatitis A - 1 0.39 Clenbuterol - - Total 274 100 256 100

*DSP=Diarrheic Shellfish Poisoning.

Figure FR 2

Foodborne Disease Outbreaks by Causative Agents France 1993 - 2000

0

10

20

30

40

50

60

70

1993 1994 1995 1996 1997 1998 1999 2000

No. of outbreaks

0

50

100

150

200

250

300

No. of Salmonella outbreaks

Clostridium perfringens Staphylococcus aureus Histamine Bacillus cereusShigella Others DSP TrichinellaHepatitis A Clenbuterol Salmonella

In a large proportion of salmonellosis outbreaks (81% in 1999 and 85% in 2000) the serotype was identified. As in previous years, the predominant serotype was S. Enteritidis, followed by S. Typhimurium (Table FR 7). Figure FR 3 shows the number of salmonellosis outbreaks by serotype over the period from 1993 to 2000.



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Table FR 7

Laboratory confirmed Salmonella serotypes in foodborne outbreaks reported in the mandatory notification system

FRANCE 1999–2000

Salmonella serotype 1999 2000 No. of

outbreaks % No. of

outbreaks %

S. Enteritidis 102 72.3 98 70.5 S. Typhimurium 23 16.3 28 20.1 S. Heidelberg 2 1.4 1 0.7 S. Virchow 3 2.1 4 2.9 S. Hadar 5 3.5 2 1.4 Other serotypes 6 4.3 6 4.3 Serotypes identified 141 80.6 139 85.3 Serotype not identified 34 19.4 24 14.7 Total Salmonella 175 100 163 100

Figure FR 3

Number of Salmonellosis Outbreaks by Serotype France 1993 - 2000

0

50

100

150

200

1993 1994 1995 1996 1997 1998 1999 2000

Year

S. Enteritidis S. Typhimurium S. Heidelberg S. Virchow S. Hadar Other serotypes

3.2 Incriminated food Data on the number of outbreaks caused by different food categories (lab confirmed and epidemiologically suspected) is presented in Table FR8. In 1999 the causative agent was isolated from the incriminated foodstuff in 18% (118/640) of outbreaks. In 58% (372/640) of the outbreaks, the food was epidemiologically suspected to be responsible for the outbreak. The food was either laboratory confirmed or epidemiologically suspected in 77% (490/640) of the outbreaks notified in 1999.

In 2000, the causative agent was isolated from the incriminated foodstuff in 18% (115/627) of outbreaks. The food was epidemiologically suspected to be responsible for the outbreak in



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55% (344/627) of the outbreaks. Food was laboratory confirmed or epidemiologically suspected in 73% (459/627) of the outbreaks notified in 2000.

Table FR 8

Foodborne disease outbreaks by incriminated food

FRANCE 1999 - 2000

Food 1999 2000 No. outbreaks %* No. outbreaks % Milk/ Milk products 36 7.3 27 5.9

Eggs/ Egg products 130 26.5 130 28.3

Meat/ Meat products 90 18.4 94 20.5 Poultry 45 9.2 32 7 Fish/ Shellfish 92 18.8 82 17.9 Other foods 97 19.8 94 20.5 Unknown 150 168

Total no. of outbreaks with food identified

490 459

Total no. of outbreaks reported

640 627

* % calculated among outbreaks with identified foodstuff Table FR 9

Foodborne outbreaks by incriminated foods and confirmed or suspected causative agents reported to D.D.A.S.S. or D.S.V. in 1999

FRANCE 1999

Food S. Enteritidis

S. Typhi-murium

Other serotypes

Not sero-typed Salmonella

Cl. perfr.

Staph. aureus

Other agents

Un-known

Milk/Milk products

1 0 0 1 0 25 7 2

Eggs/Egg products

77 7 4 27 1 9 2 3

Meat/Meat products 5 6 5 13 21 23 13 4

Poultry 6 1 3 8 8 12 6 1

Fish/ Shellfish 3 2 1 4 7 7 64 4

Other foods 1 1 0 9 28 32 19 7

Unknown 9 6 3 16 12 41 19 44

Total 102 23 16 78 77 149 130 65



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Table FR 10

Foodborne outbreaks by incriminated foods and confirmed or suspected causative agents reported to D.D.A.S.S. or D.S.V. in 2000

FRANCE 2000

Food S. Enteritidis

S. Typhi-murium

Other serotypes

Not sero-typed Salmonella

Cl. perfr.

Staph. aureus

Other agents

Un-known

Milk/milk products

0 0 0 0 1 22 2 2

Eggs/egg products

80 11 3 21 2 7 2 4

Meat/Meat products 2 8 2 6 26 31 8 11

Poultry 1 0 5 5 12 2 0 7

Fish/ Shellfish 4 0 1 1 6 9 53 8

Other foods 2 1 2 5 24 25 23 13

Unknown 9 8 0 12 14 30 28 67

Total 98 28 13 50 85 126 115 112 3.3 Place where food was acquired or eaten Two-thirds of the outbreaks for which information on the place where the incriminated food was acquired or eaten is available were linked to mass catering facilities (Table FR 11). In recent years, restaurants in particular are increasingly being implicated in foodborne disease outbreaks (Figure FR 4).

Table FR 11

Number of foodborne outbreaks by place where food was acquired or eaten

FRANCE 1999-2000

Place 1999 2000 No. outbreaks % No. outbreaks %

Private Home 230 36 199 32 School 91 14 108 17 Social/Medical Institutions * 34 5 42 7 Canteen 37 6 35 6 Restaurant 185 29 160 26 Other communities ** 57 9 72 11 Larger communities *** 6 1 2 0 Unknown 0 0 9 1 TOTAL 640 100 627 100

* hospitals, homes for elderly people, kindergarten, etc. ** holiday resorts, prisons, gatherings *** several establishments or families with the same source of contamination



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Figure FR 4

Place of Acquisition/Consumption of Food Implicated in Foodborne Disease

FRANCE 1993 - 2000

0

50

100

150

200

250

300

1993 1994 1995 1996 1997 1998 1999 2000

Number of outbreaks

Private Home School Social/Medical Institutions * Canteen

Restaurant Other communities ** Larger community *** Unknown

The majority of the salmonellosis outbreaks were reported to have occurred in private homes. This reflects the efficacy of the control measures that have been implemented to reduce salmonellosis hazards in the mass catering sector. Salmonella laboratory confirmed or epidemiologically was suspected to be responsible for 36% (67/185) of outbreaks that occurred in commercial restaurant in 1999 and 31% (49/160) in 2000.

Education programmes (e.g. on storage and cooking practices) targeting private homes may be needed as complementary measures to limit the transmission of salmonellosis.

3.4 Contributing factors The most important factors contributing to foodborne disease outbreaks reported in 1999 and 2000 were contamination of food through equipment, inadequate cooling and the use of contaminated raw material.

Table FR 12



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Foodborne disease outbreaks by contributing factors reported

FRANCE 1999-2000

1999 2000 No. outbreaks No. outbreaks

Contaminated raw material 96 77 Contamination by personnel 4 7 Contamination by equipment 90 119 Processing faults 94 66 Prepared too far in advance 81 87 Inadequate heating 45 35 Inadequate cooling 98 95 Total outbreaks with information on contributing factors

249 262

Figure FR 5

Factors Contributing to Foodborne Disease Outbreaks FRANCE 1995 - 2000

020406080

100120140

1995 1996 1997 1998 1999 2000

No. of outbreaks

Contaminated raw material Contamination by personnel Contamination by equipmentProcessing faults Prepared too far in advance Inadequate heatingInadequate cooling



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4. Additional Information

The French National Institute for Public Health Surveillance (Institut de Veille Sanitaire) publishes a weekly electronic epidemiological bulletin (B.E.H) that can be found at: http://www.invs.sante.fr/

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.invs.sante.fr/

http://www.euro.who.int/foodsafety/Surveillance/20020904_1

France ( FR ) · 2003. 12. 12. · listeriosis and typhoid fever 2. National reference laboratory...

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