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In a follow-up on the Salmonella Agona outbreaks in Norway, Sweden and the Netherlands, Norway health authorities report the results of the outbreak investigation show that certain batches of cucumber from a Spanish supplier stand out as a likely source of infection. These batches of cucumber are no longer on the market, and we have therefore not been able to test the product for the outbreak bacteria, says senior advisor at Folkehelseinstituttet (FHI) Heidi Lange.

Image by Krzysztof Jaracz from Pixabay

The outbreak is probably over, but we cannot rule out that more individual cases may appear. We are following the situation closely, she says.

In total, there are 72 people living across the country who have been diagnosed with the gastrointestinal bacterium Salmonella Agona. All fell ill with salmonellosis during a short period, from the end of October to the beginning of December, with a peak in weeks 45 and 46. Cases with the same outbreak strain have also been reported in Sweden and the Netherlands in the same period.

The suspicion has therefore been directed at an imported food product that is available throughout the country, has a relatively short shelf life and is common for many people to eat, says Heidi Lange.

The Institute of Public Health has analyzed over 50 patient interviews and purchase information. The institute has also carried out a case-control study comparing what the infected have eaten with what a random selection of other people have eaten. Almost 90 per cent of those infected report having eaten cucumber the week before they became ill, but since cucumber is commonly eaten in Norway, this product does not show up in the case-control study. In contrast, this study helps to disprove other hypotheses as a source of infection in this outbreak.

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In addition, the Norwegian Food Safety Authority has carried out extensive tracing work where certain batches of cucumber from a Spanish supplier have been identified as the most likely source of infection.

The outbreak investigation has been carried out in collaboration with local municipal chief medical officers, the Norwegian Food Safety Authority and the Veterinary Institute.

The infected are aged 1–88 years, the median age is 36 years, and 37 of the infected are women. 24 of the infected have been admitted to hospital.

Bacteria with the same genetic profile have been detected in 58 out of 72 infected people. For the remaining 14 infected, the sequencing results (results from examinations in the laboratory) are not yet clear.

The persons live in Viken (18), Vestland (15), Vestfold and Telemark (14), Oslo (8), Innlandet (5), Rogaland (3), Trøndelag (3), Troms and Finnmark (3), Møre and Romsdal (2) and Nordland (1). It is only Agder county that has no registered infected people in the outbreak.

Salmonella Agona is a rare serovariant of salmonella, both in Norway and the rest of Europe.

Salmonella Agona has previously been detected in Norway, but then only as isolated cases and often related to infection abroad.