Bacteria

Salmonella by Any Other Name: Salmonellosis in Finland & How to Prevent the Next Outbreak

Author Chandana Balasubramanian , 08-11-2021

Table of contents
Food safety and quality assessment. Microbiologist testing poultry sample for the presence of salmonella and Escherichia coli,

Image: Microbiologist testing poultry sample for the presence of Salmonella

 

About 150 children in Finland and a total of 450 individuals have fallen ill from Salmonella poisoning. Most affected individuals are from daycare centers in the city of Jyväskylä. The cause of this outbreak is suspected to be lettuce imported from Germany via Sweden [1]. Though Salmonella outbreaks have been declining, the 2021 Finland outbreak is one of many reported worldwide this year. As our world continues to shrink due to globalization, it is getting harder for public health agencies to monitor and prevent Salmonella outbreaks from imported foods

This year, Sweden has also reported a national Salmonella outbreak that affected more than 30 people [2]. In June, melons sourced from Costa Rica, Honduras, or Brazil were the most likely cause of a Salmonella outbreak of 200 people across ten countries, including Finland, Denmark, Belgium, Germany, the Netherlands, Sweden, United Kingdom, Canada, and Switzerland [3]. In the United States, the CDC (Centers for Disease Control and Prevention) initiated a ‘Food Safety Alert’ after detecting 102 infected cases across 14 states due to contaminated seafood that originated in Colorado [4]. 

One of the biggest challenges in catching a Salmonella infection is the fact that the bacteria is mainly found in fresh produce and other foods with a short shelf life such as raw foods. This hurdle is made even more complex because of the popular hub-and-spoke model of centralized food distribution and food systems. In this model, one country in a region acts as a centralized hub that processes fresh produce,  raw meat, or poultry. This food is then exported to several countries simultaneously. By the time infections are reported, most of the contaminated inventory may have already been consumed – either on its own or mixed with other batches – or thrown away. This makes it difficult to obtain enough samples to test and trace the country of origin [5]. 

So we know in current times, food such as raw food plays a large role in foodborne infection development, especially in those with weakened immune systems. The questions that remain are: should those with a healthy immune system need to worry, what is the history behind the illness, and what symptoms can those experiencing these types of infections expect?

A History of Salmonellosis in Finland

Let’s take a closer look at Finland. At 9.29 cases per 100,000 population, Finland has the highest rate among Nordic countries despite its stringent controls and processes [6]. 

Nordic region Salmonellosis rates per 100000 graph

Image: Salmonellosis rates per 100,000 population for Finland, Sweden, Norway, Iceland, and Denmark. Copyright © GIDEON Informatics, Inc.

 

Before 2021, the biggest Salmonella outbreak in Finland was in 2008. Pre-chopped and ready-to-eat Iceberg lettuce happened to be the prime suspect for the 2008 Salmonella infection outbreak in Finland. There were 77 confirmed cases, and two elderly patients died [7]. 

 

Image: Salmonellosis in Finland. Cases from 1969 to 2021. Copyright © GIDEON Informatics, Inc.

Image: Salmonellosis in Finland. Cases from 1969 to 2021. Copyright © GIDEON Informatics, Inc.

 

Finland has seen a steady decline since 1995 when the country initiated its national Salmonella control program. The Finnish national Salmonella control program (FSCP) mandates regular testing of cattle, poultry, and pigs, including eggs and raw meat. Lab test results are evaluated by the Finnish Food Agency monthly. There are stringent checks and balances included throughout their entire supply chain. 

The FSCP measures have helped lower the rates of homegrown Salmonella infections. However, like many other countries, Finland needs a faster and more effective way to monitor and prevent the bacteria from being brought in from other countries, either through travel or cross-border food imports [8]. 

 

List of Prominent Salmonella outbreaks in Finland*: 

  • 1976: 550 cases were reported due to contaminated mayonnaise prepared in Spain and served on four international flights (Las Palmas-Helsinki, Las Palmas-Honover). 
  • 1986: 226 cases from packaged meals offered to train and air passengers. 
  • 1992: 224 cases due to contaminated mung beans.
  • 1994: 210 cases in Southern Finland due to alfalfa seeds.
  • 1995: 242 cases were reported in Finland (and the U.S.) due to alfalfa seeds imported from a Dutch supplier. 
  • 2001 – 2003: 666 cases reported in Norway, Finland, and Swedish tourists infected by contaminated poultry.
      • 2001: 303 cases
      • 2002: 164 cases
      • 2003: 199 cases.
  • 2007: 8,453 cases (almost 30% of the population) due to contaminated water in the town of Nokia, Finland. It is the largest reported water-borne outbreak in Finland [9].   
  • 2008: 107 cases in Newport and Reading, Finland due to contaminated lettuce. 
  • 2015: 122 cases in Finland due to an ice hockey team event in Latvia.
  • 2021: 450 cases due to contaminated lettuce imported from Germany via Sweden. 

*Data sourced from GIDEON. GIDEON also has case count maps.

Public health agencies worldwide continue to worry about keeping cases down in their respective countries. But in this hyper-connected world, it can prove challenging. A comprehensive database such as GIDEON that tracks outbreaks as they happen across the world may be a viable solution. 

 

Image: Salmonella outbreaks worldwide and list of Salmonella outbreaks in Finland. Copyright © GIDEON Informatics, Inc.

Image: Salmonella outbreaks worldwide and list of Salmonella outbreaks in Finland. Copyright © GIDEON Informatics, Inc.

 

 

What Is It and What Are the Symptoms? 

Salmonellosis is the infection acquired from ingesting the zoonotic bacteria Salmonella. The most common way to get it is by eating raw or undercooked meat, eggs, or fruit and vegetables that have not been washed and handled correctly. 

The illness is highly contagious, and you can get sick from any person, animal, or thing that carries the Salmonella bacteria, even if you are healthy. The bacteria are transmitted to our mouths from contaminated humans or animals feces fecal-oral transmission). Other risk factors for Salmonella poisoning are travel to high-risk countries with poor sanitation and exposure to birds and reptiles being kept as pets. 

Symptoms include: 

  • Diarrhea
  • Stomach cramps or pain
  • Fever

The symptoms usually last four to seven days and begin within 12 to 72 hours of consuming the contaminated food [10]. If you happen to be experiencing symptoms that are incredibly severe, it is not a bad idea to head to a hospital or doctor for treatment. There are medicine options for those with this type of infection.

 

Image of profile of sick woman having a stomach ache, left side

Image: a woman experiencing stomach cramps

 

How is It diagnosed?

Here is where local laboratory test results play a significant role in helping curb the spread of Salmonella. Usually, stool or blood samples are used to test for Salmonella. Once detected, many countries have protocols that require these labs to report positive incidences of Salmonella to approved public health laboratories for serotyping and DNA fingerprinting.

Around the world, we can also enable on-ground clinicians to play a stronger role in identifying Salmonella cases early and preventing its spread. Having access to data on outbreaks as they happen can help public health officials detect the origin of infection much sooner and more effectively.  It can make all the difference in the field of medicine to have all the information and facts in advance.

 

How Does Modern Medicine and Medical Practice Prevent Salmonellosis? 

Good immunity and remaining healthy is the best line of defense against Salmonella. Our natural stomach acid can help fight Salmonellosis. However, there is a greater risk of infection for those with impaired immune functioning due to: 

  • the overuse of antacids, 
  • effects of antibiotics, 
  • age – infants and the elderly, 
  • pregnant women, and 
  • lowered immunity from chronic illnesses like Irritable Bowel Syndrome (IBS) and other conditions like AIDS, Malarial infections, and more. 

Other ways to minimize the risk of getting Salmonella is to:

  • always wash your hands before you eat, after touching animals, using the toilet, or changing diapers,  
  • clean food preparation areas, and 
  • minimize the intake of raw and uncooked food like eggs and meat. If fresh produce is to be consumed raw, then it must be washed thoroughly. 

Note: Foods containing Salmonella do not smell or look different from uncontaminated food. Washing hands and following food safety guidelines is your best bet to mitigate risk.   

Use GIDEON for Public Health and Microbiology Research

GIDEON is one of the most well-known and comprehensive global databases for infectious diseases. Data is refreshed daily, and the GIDEON API allows medical professionals and researchers access to a continuous stream of data. Whether your research involves quantifying data, learning about specific microbes, or testing out differential diagnosis tools– GIDEON has you covered with a program that has met standards for accessibility excellence.

You can also review our eBooks on Latin American Arboviruses, Melioidosis and Glanders, Necrotizing Soft Tissue Infections, and more. Or check out our global status updates on countries like Guinea Bissau, Liechtenstein, Mauritius, New Caledonia, and more!

 

References 

[1] yle, “Imported lettuce confirmed as cause of Jyväskylä salmonella outbreak,” yle.fi, 07 07 2021. [Online] [Accessed 10 10 2021].
[2] GIDEON Database (Global Infectious Diseases and Epidemiology Online Network), “Salmonellosis in Sweden,” GIDEON, 2021.
[3] FSN, “Large Salmonella outbreak linked to melons,” Food Safety News, 01 06 2021. [Online][Accessed 10 10 2021].
[4] CDC (Centers for Disease Control and Prevention), “Salmonella Outbreak Linked to Seafood – Food Safety Alert,” CDC, 08 10 2021. [Online][Accessed 10 10 2021].
[5] K. G. J. A. R. O. M. A. M. E. W. B. Rebecca L. Bell, “Recent and emerging innovations in Salmonella detection: a food and environmental perspective,” Microb Biotechnol. , vol. 9, no. 3, p. 279–292, 2016. 
[6] GIDEON Database (Global Infectious Diseases and Epidemiology Online Network), “Salmonella in Finland – Country Note,” GIDEON, 2021.
[7] T. N. S. G. A. S. M. K. R. R.-F. TARU LIENEMANN, ” Iceberg Lettuce as Suggested Source of a Nationwide Outbreak Caused by Two Salmonella Serotypes, Newport and Reading, in Finland in 2008.,” Food Prot, vol. 74, no. 6, p. 1035–1040, 2011. 
[8] J. R. E. S. J. P. Riitta Maijala, “The efficiency of the Finnish Salmonella Control Programme,” Food Control, vol. 16, no. 8, p. 669, 2005. 
[9] E. H. M. J. V. M. S. J. L. P. R. E. K. R. V. T. P. I. M. J. H. O. L. J. A. J. H. M.-L. H. L. M. J. M. a. M. K. • J. LAINE, “An extensive gastroenteritis outbreak after drinking-water contamination by sewage effluent, Finland,” Epidemiology and Infection, vol. 139, no. 7, pp. 1105-1113, 2011. 
[10] Centers for Disease Control and Prevention, “Salmonella Homepage,” CDC, 08 10 2021. [Online][Accessed 11 10 2021].

 

Author
Chandana Balasubramanian

Chandana Balasubramanian is an experienced healthcare executive who writes on the intersection of healthcare and technology. She is the President of Global Insight Advisory Network, and has a Masters degree in Biomedical Engineering from the University of Wisconsin-Madison, USA.

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