Foodbome infections and intoxications in Poland in2011 - Epidemiological Review

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ABSTRACT

7+(385326(2)7+(678'< To assess the epidemiological situation of food poisoning and infections in 3RODQGLQ 0$7(5,$/6$1'0(7+2'67KHDVVHVVPHQWZDVEDVHGRQLQIRUPDWLRQIURPWKHIRUPVRIWKHHSLGHPLRORJLFDO LQYHVWLJDWLRQVLQRXWEUHDNVRIIRRGERUQHSRLVRQLQJDQGLQIHFWLRQVVHQWE\WKHVDQLWDU\HSLGHPLRORJLFDOVWDWLRQV WRWKH'HSDUWPHQWRI(SLGHPLRORJ\1,3+1,+1,=33=+DQGWKHUHVXOWVRIWKHDQDO\VLVRIDQQXDOEXOOHWLQV &]DUNRZVNL03HWDO³,QIHFWLRXVGLVHDVHVDQGSRLVRQLQJVLQ3RODQG´±:DUVDZ1,=33=+DQG*,6 5(68/76,QLWZDVREVHUYHGGHFUHDVHLQWKHQXPEHURILQIHFWLRQVDQGIRRGSRLVRQLQJRIEDFWHULDOHWLRORJ\ and steady marked increase in the incidence of those of viral etiology, classified as “viral and other intestinal infections.” ,QWKHUHZHUHUHJLVWHUHGRXWEUHDNVRISRLVRQLQJLQIHFWLRQRIIRRGZKLFKKDGDIIHFWHGSHRSOH LQFOXGLQJFKLOGUHQXQGHU$PRQJWKHPSHRSOHUHTXLUHGKRVSLWDOL]DWLRQ7KHSUHGRPLQDQWHWLRORJLF IDFWRULQRXWEUHDNVZHUHYLUXVHVRIRXWEUHDNVDQGRIFDVHVWKHQ]RRQRWLF6DOPRQHOODW\SHV RIRXWEUHDNVDQGRIFDVHV,QRIRXWEUHDNVHWLRORJLFDOIDFWRUZDVQRWHVWDEOLVKHG0RVWRIWKHRXW-EUHDNVRFFXUUHGLQKRXVHKROGVDQGLQKRVSLWDO±$VLQSUHYLRXV\HDUVWKHPRVWFRPPRQFDUULHURI LQIHFWLRQZDVIRRGSUHSDUHGIURPPLONDQGHJJVRIRXWEUHDNVDQGHJJRQO\GLVKHV,QPRUHWKDQ RIRXWEUHDNVHWLRORJLFIDFWRUKDVQRWEHHQHVWDEOLVKHG,QWKHUHZHUHILYHRXWEUHDNVLQZKLFKJRWLOO 100 people or more. &21&/86,216LQFHWKHVHDVRQDOLW\RIRXWEUHDNVRIXQNQRZQHWLRORJLFIDFWRULVVLPLODUWRRXWEUHDNVRIYLUDO HWLRORJ\ they occur in the autumn and winter, one should pay special attention to the testing samples taken for viral agents.

.H\ZRUGV: foodborne poisoning and infections, outbreaks of food poisoning and infections, epidemiology, Poland, 2011

5HJLVWHURIRXWEUHDNVRIIRRGERUQHSRLVRQLQJDQG LQIHFWLRQVFDXVHGE\IRRGERUQHSDWKRJHQVLVFDUULHG RXWLQ3RODQGDWWKH1DWLRQDO,QVWLWXWHRI3XEOLF+HDOWK ±1,=33=+VLQFH'DWDFROOHFWHGLQWKHUHJLV-try is used to assess the epidemiological situation of IRRGERUQHGLVHDVHVLQFOXGLQJWUDFNLQJFKDQJHVLQWKH QXPEHURIRXWEUHDNVLQHDFK\HDUDQGFKDQJHVLQWKH HWLRORJLFDJHQWVWKDWFDXVHWKHP,QWKHUHKDVEHHQ DFKDQJHLQWKHGHILQLWLRQRIDQRXWEUHDNDQGVLQFHWKHQ two or more cases to occur, under certain conditions, fulfill its definition.

MATERIAL AND METHODS

The assessment of the epidemiological situation RIRXWEUHDNVRIIRRGERUQHSRLVRQLQJDQGLQIHFWLRQVLQ 3RODQGLQZDVEDVHGRQDQDO\VLVRIGDWDIURPWKH annual newsletters (Czarkowski MP et al. “Infectious GLVHDVHVDQGSRLVRQLQJVLQ3RODQG´±:DU-saw, NIPH-NIH and GIS ), and data from the forms of RXWEUHDNVRISRLVRQLQJJDVWURLQWHVWLQDOWUDFWLQIHFWLRQ sent to the Department of Epidemiology, NIZP-PZH E\WKH6DQLWDU\(SLGHPLRORJLFDO6WDWLRQVIURPDOORYHU the country.

RESULTS

'HWDLOHGGDWDRQWKHQXPEHURIUHJLVWHUHGFDVHVDQG incidence of food poisoning and infections in the years ZLWKUHVSHFWWRWKHLUHWLRORJ\DUHVXPPDUL]HG LQ7DEOH,,QLQDJURXSRIIRRGSRLVRQLQJDQGLQIHF-WLRQVFDXVHGE\EDFWHULDODJHQWVIRUWKHPDMRULW\RIGLVHDVHV WKHQXPEHURIFDVHVDQGLQFLGHQFHZHUHDWWKHVDPHOHYHO DVLQDQGLWZDVPXFKORZHUWKDQWKHPHGLDQIRUWKH \HDUV,QLQDJURXSRIVRFDOOHG³%DF-WHULDOIRRGSRLVRQLQJ´FDXVHGE\]RRQRWLFSalmonella W\SHV$VWDSK\ORFRFFL$Clostridium botu-linum - A05.1, C. perfringens$DQGFHUWDLQRWKHU EDFWHULDLQFOXGLQJVibrio parahaemolyticus and Bacillus cereus$$DQGWKHIDFWRUVXQVSHFLILHG$ LWZDVUHJLVWHUHGFDVHVLQFLGHQFH 7KHQXPEHURIVXFKFDVHVLVVWHDGLO\GHFOLQLQJDQGLWZDV FRPSDUDEOHZLWKDQGORZHUWKDQLQDQGPXFK ORZHUWKDQWKHPHGLDQRIFDVHVIURPWKH\HDUV FDVHV,QPRVWSURYLQFHVWKHLQFLGHQFHZDVOHVV than 30 per 100 thousand.

,QWKHIRXUSURYLQFHVLWZDVDERYHWKLVYDOXHDQGWKH highest incidence was in Mazowieckie and Zachodnio-SRPRUVNLH7DEOH,,$7KHLQFLGHQFHRIEDFWHULDOIRRG SRLVRQLQJDQGLQIHFWLRQLQZDVVOLJKWO\KLJKHULQ the cities compared to the incidence in the country, re-VSHFWLYHO\DQG&DVHVOLNHLQSUHYLRXV\HDUV

were most common in the age group 0-4 and it accounted IRURIDOOUHJLVWHUHGFDVHV7DEOH,,,2QO\LQWKH age group of “0” and in people over 50 years of age the LQFLGHQFHZDVKLJKHULQUXUDODUHDVWKDQLQXUEDQDUHDV The incidence among women and men was very similar UHVSHFWLYHO\DQG+RZHYHU LQER\VXSWR\HDUVRIDJHLWZDVVOLJKWO\KLJKHUDQG DERYHWKLVDJHVOLJKWO\ORZHUWKDQLQIHPDOHV7DEOH,,,%

1XPEHURIFDVHVDQGLQFLGHQFHRIIRRGERUQHLQIHF-tions of viral etiology that are classified as “viral and RWKHULQWHVWLQDOLQIHFWLRQV´ZDVKLJKHUWKDQLQ and more than one and a half times higher than in the PHGLDQLQWKH\HDUV+RZHYHUWKHUHZDVD further significant decrease in the incidence of hepatitis A. The epidemiological situation of cases of hepatitis A are discussed in a separate article.

:KHQFRPSDUHGZLWKWKHGDWDIRUDQGWKHHDU- OLHU\HDUVQXPEHURISDUDVLWLFLQIHFWLRQVVXFKDVWULFKL-QRVLVRUHFKLQRFRFFRVLVKDVEHHQPDUNHGO\UHGXFHG ZLWKDERXWWZRIROGGHFUHDVHLQLQFLGHQFH ,QZHUHUHFRUGHGFDVHVRIPXVKURRPSRL-VRQLQJLQFLGHQFH7KLVQXPEHULVORZHUWKDQWKH PHGLDQIRUWKH\HDUVDQGDOPRVWWKUHHWLPHV ORZHUWKDQWKHQXPEHUUHFRUGHGLQ7DEOH,,%

According to data from the Central Statistical Office LQWKUHHSHRSOHGLHGGXHWRLQIHFWLRQVFDXVHGE\ Salmonella. Rotavirus infection resulted in two deaths 7DEOH, )RRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVUHJLVWHUHGLQ3RODQGLQ1XPEHURIFDVHVDQGLQFLGHQFHSHU 100 000 population )RRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQV QXPEHURI0HGLDQ   cases incidence rate QXPEHURI cases incidence rate QXPEHURI cases incidence rate EDFWHULDO Typhoid/paratyphoid fever 6  6   0.01 Shigellosis 35 0.09 30   0.04 Salmonellosis  30.3     Staphylococcus aureus  1.1     Clostridium botulinum 46 0.1   35 0.09 Clostridium perfringens 4 0.0     2WKHUEDFWHULDOVSHFL¿HG  0.4   53 0.14 Listeriosis 33 0.06 64  64  Leptospirosis 6  4 0.01 4 0.01 2WKHUEDFWHULDOXQVSHFL¿HG 3 096   4.30   viral

Viral intestinal infections     44906 116.6

FKLOGUHQXQGHU\HDUVROG       Hepatitis A 109  155 0.41 65 0.41 parasitical Trichinellosis   51 0.13  0.06 Echinococcosis 34 0.09 36 0.09  0.09 other $FXWHGLDUUKRHDLQFKLOGUHQXQGHU\HDUV 9 610     1591.4 mushroom poisonings   93   

Berries or other parts of plants poisonings  0.03 5 0.013  

Pesticide poisonings  0.19 19 0.05 19 0.05

and “viral intestinal infection, unspecified” - one death. )XUWKHUPRUH³DEDFWHULDOLQIHFWLRQRIWKHLQWHVWLQHV RWKHUDQGXQVSHFLILHG´ZDVWKHFDXVHRIGHDWKVDQG ³GLDUUKHDDQGJDVWURLQWHVWLQDOLQIODPPDWLRQRISRVVLEO\ infectious origin – 50.

OUTBREAKS OF FOODBORNE POISONING AND INFECTIONS

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SHRSOHDQGJRWLOOLQFOXGLQJFKLOGUHQ up to 14. Out of them 1 364 people required hospitaliza-WLRQ0RVWRIWKHFDVHVDQGRXWEUHDNV ZHUH FDXVHG E\ YLUXVHV =RRQRWLFSalmonella types FDXVHGRIRXWEUHDNVDQGRIFDVHV,QWKH WRWDOQXPEHURIRXWEUHDNVWKRVHLQZKLFKQRHWLRORJLFDO DJHQWZDVGHWHFWHGDPRXQWHGWR7DEOH,9,Q DVLQWKHHDUOLHU\HDUVDPRQJ]RRQRWLFEDFWHULD dominated Salmonella(QWHULWLGLVRIRXWEUHDNV RIFDVHV7KHUHZHUHDOVRUHSRUWHGRXWEUHDNV FDXVHGE\S.7\SKLPXULXPRIRXWEUHDNV RIFDVHV7DEOH9 7DEOH,,$%DFWHULDOIRRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVUHJLVWHUHGLQ3RODQGLQ1XPEHURIFDVHVDQGLQFL-GHQFHSHUSRSXODWLRQE\SULYLQFH Province 0HGLDQ  

QXPEHURIFDVHV incidence rate QXPEHURIFDVHV incidence rate QXPEHURIFDVHV incidence rate

Polska  40,0 11464 30   'ROQRĞOąVNLH     595  Kujawsko-pomorskie 935 45,3 635    /XEHOVNLH 1 016  563    /XEXVNLH  30,9   133 13 àyG]NLH 933 36,4     0DáRSROVNLH       Mazowieckie  36,4   1956  Opolskie   155 15,1 139  Podkarpackie  51,6   615  Podlaskie 600   44,4   Pomorskie       ĝOąVNLH 1 655 35,5 1565  1550 33,5 ĝZLĊWRNU]\VNLH  33,5     :DUPLĔVNRPD]XUVNLH     610  Wielkopolskie 1 041    669 19,4 Zachodniopomorskie   590    'DWDVRXUFHV,QIHFWLRXVGLVHDVHVDQGSRLVRQLQJVLQ3RODQG1,=33=+0=L26*,6:DUVDZ$QQXDO5HSRUWV 7DEOH,,%0XVKURRPSRLVRQLQJVLQ3RODQGLQ1XPEHURIFDVHVDQGLQFLGHQFHSHUSRSXODWLRQE\SUR-vince Province 0HGLDQ  

QXPEHURIFDVHV incidence rate QXPEHURIFDVHV incidence rate QXPEHURIFDVHV incidence rate

  93    'ROQRĞOąVNLH  0,1 4 0,14 3 0,1 Kujawsko-pomorskie 4   0,39 3 0,14 /XEHOVNLH  0,4  1,11   /XEXVNLH 3 0,3 9  6 0,59 àyG]NLH 15 0,6 6    0DáRSROVNLH    0,06 4  Mazowieckie 4 0,1  0,04 1  Opolskie 1 0,1 1 0,1 - -Podkarpackie 5   0,33  0,09 Podlaskie 4,5 0,4 1  - -Pomorskie 4,5  3 0,13 - -ĝOąVNLH 3 0,1 6 0,13  0,04 ĝZLĊWRNU]\VNLH 5 0,4 3  - -:DUPLĔVNRPD]XUVNLH 1 0,1 3  1  Wielkopolskie 5  5 0,15 1 0,03 Zachodniopomorskie 5,5 0,3 9 0,53 - -'DWDVRXUFHV,QIHFWLRXVGLVHDVHVDQGSRLVRQLQJVLQ3RODQG1,=33=+0=L26*,6:DUVDZ$QQXDO5HSRUWV

,QWKHUHZHUHILYHRXWEUHDNVLQZKLFKJRWLOO people or more. In two of them etiologic factor was noro-virus in two consecutive S. HQWHULWLGLVEXWLQRQH causative IDFWRUKDVQRWEHHQHVWDEOLVKHG,QWRWDOLQWKHVHRXWEUHDNV SHRSOHIHOOLOORIZKLFKIRXUZHUHKRVSLWDOL]HG-XVW DVLQWKHPRVWFRPPRQSODFHZKHUHWKHRXWEUHDN RFFXUUHGZDVDSULYDWHDSDUWPHQWRXWEUHDNV FDVHVDQGKRVSLWDORXWEUHDNVFDVHV 7DEOH,,,%DFWHULDOIRRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVUHJLVWHUHGLQ3RODQGLQ1XPEHURIFDVHVSHUFHQWDJHDQG LQFLGHQFHE\DJHJHQGHUDQGUHVLGHQFHXUEDQUXUDO $XUEDQDQGUXUDODUHDV Age group

8UEDQDUHD Rual area Total

QXPEHURI cases % incidence rate QXPEHURI cases % incidence rate QXPEHURI cases % incidence rate 0 - 4  40.1  1 536    39.6  0 433 6.3   9.3     1  9.6          9.5      9.0  3     6.5 146.3    4    199 5.0    159.3 5 - 9 940  93.4  13.0   13.4  10 - 19 659 9.6   11.3   5.4        11.5  3.9  30 - 39  5.6 10.5  5.6 9.9 610 3.1 10.3 40 - 49  4.1 9.9  5.0 10.0   9.9 50 - 59 435 6.3 11.6       60 i >  13.1  496      Total  100.0   100.0   100.0 

B. men and women

Age group

Men Women Total

QXPEHURI cases % incidence rate QXPEHURI cases % incidence rate QXPEHURI cases % incidence rate 0 - 4        39.6  0      194.4    1  10.9         519   455    9.0  3          4 336 6.4 166.1  5.3    159.3 5 - 9        13.4  10 - 19  9.9   10.5   5.4        14.1  3.9  30 - 39    334 6.0 11.4 610.0 3.1 10.3 40 - 49  4.0    11.1   9.9 50 - 59 306  10.9   13.3    60 i >  10.6   15.1     total  100.0  5 559 100.0   100.0  'DWDVRXUFHV,QIHFWLRXVGLVHDVHVDQGSRLVRQLQJVLQ3RODQG1,=33=+0=L26*,6:DUVDZ$QQXDO5HSRUWV 7DEOH,92XWEUHDNVRIIRRGERUQHDQGZDWHUERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVLQ3RODQGLQ1XPEHUDQGSHU-FHQWDJHRIRXWEUHDNVDQGFDVHVE\HWLRORJLFDODJHQW Etiological agent  

2XWEUHDNV Cases 2XWEUHDNV Cases

QXPEHU % QXPEHU % QXPEHU % QXPEHU %

zoonotic Salmonella types      35.5  

Staphylococcus aureus 5 1.3 145  1  19 0.3 Escherichia coli 5 1.3 133 1.9 5 1.0 30 0.5 RWKHUEDFWHULDODJHQWV  0.5 16  14  105 1.6 viruses 100   30.0  36.5  40.6 poisonous muschrooms - - - - 3 0.6  0.3 parasites 1 0.3 4 0.1 5 1.0 13  unknown 150   43.3 109    total  100.0 6994 100.0 490 100.0  100.0

,WZDVUHJLVWHUHGRXWEUHDNVLQZKLFKWRWDORI 1,404 people fell ill in which the cause was food con-VXPSWLRQLQUHVWDXUDQWV7DEOH9,

7KHUH KDYH EHHQ  RXWEUHDNV  FDVHV WKDW occurred after the occasional parties (such as wed-dings, christenings, communion) held in places other than houshold, in which 16 of them were related to parties which were held in places such as restaurants, RUZHGGLQJKDOOV,QWKRVHRXWEUHDNVIHOOLOODOWRJHWKHU SHRSOH7KHUHPDLQLQJQLQHRXWEUHDNVFDVHV occurred after the parties organized in places such as a fire station and a common room.

As in previous years, the most common carrier of infection was food prepared from milk and eggs (11.4% RIRXWEUHDNVRIFDVHVDQGHJJRQO\GLVKHV RIRXWEUHDNVRIFDVHV,QRXWEUHDNV ZKLFKDFFRXQWHGIRURIFDVHVLQIHFWLRXVIDFWRU KDVQRWEHHQHVWDEOLVKHG7DEOH9,,,QLQ RIRXWEUHDNVRIIRRGERUQHSRLVRQLQJLQIHF-tion the stage of food handling of preparaRIRXWEUHDNVRIIRRGERUQHSRLVRQLQJLQIHF-tion at which contamination occurred, that lead to infection, has not EHHQ HVWDEOLVKHG$W WKH HSLGHPLRORJLFDO LQYHVWLJD-WLRQVLWZDVIRXQGWKDWLQRXWEUHDNVODFN RULQDGHTXDWHKHDWWUHDWPHQWKDYHFRQWULEXWHGWRWKHLU occurrence. The clinical presentation of disease, as in 7DEOH9 2XWEUHDNVRIIRRGERUQHDQGZDWHUERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVFDXVHGE\6DOPRQHOOD3RODQG

1XPEHUDQGSHUFHQWDJHRIRXWEUHDNVDQGFDVHVE\VHURW\SH Zoonotic Salmonella types

 

2XWEUHDNV Cases 2XWEUHDNV Cases

QXPEHU % QXPEHU % QXPEHU % QXPEHU %

S. Enteritidis   1309  160   96.9 S. Typhimurium 3  51  4    S. Infantis 6     1.1  0.4 S. Saintpaul 3    - - - -S. 0EDQGDND 1  5 0.3 - - - -S. Stanley - - - - 1 0.6  0.1 S. group B - - - - 3  14  S. group D 3  56 3.6 1 0.6  0.1 S. Enteritidis + S. group D 1  11  - - - -S. Enteritidis + -S. spp. - - - - 1 0.6 11 0.6 S. Enteritidis + S. Typhimurium - - - - 1 0.6 5 0.3 S. 7\SKLPXULXP6'HUE\ - - - - 1 0.6  0.1 Salmonella - total  100.0  100.0  100.0  100.0 7DEOH9, 2XWEUHDNVRIIRRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVLQ3RODQGLQ1XPEHURIFDVHVLQRXWEUHDNVE\YHKLFOH of infection. Etiological agent Vehicle of infection milk and eggs eggs poultry and eggs red meat and eggs red meat mixed food other

food unknown total %

Salmonella RXWEUHDNV   4 16 3  39  35.5

cases   35 140     

Escherichia coli RXWEUHDNV 1 1 3 5 1.0

cases  3 19 30 0.5

Staphylococcus aureus RXWEUHDNV 1 1 

cases 19 19 0.3 RWKHUEDFWHULDODJHQWV RXWEUHDNV 1 3 10 14  cases 4  94 105 1.6 viruses RXWEUHDNV 1 1 1 5 1   36.5 cases 5  39 151    40.6 parasites RXWEUHDNV 3 3 0.6 cases   0.3

poisonous muschrooms RXWEUHDNV 5 5 1.0

cases 13 13 

unknown agent RXWEUHDNV 3 1 1 1 15   109 

cases    6      total RXWEUHDNV % 56 11.4   1.05 19 3.9 9   13 303 490  cases % 555    0.959    13.4   4036 

7DEOH9,, 2XWEUHDNVRIIRRGERUQHLQIHFWLRQVDQGLQWR[LFDWLRQVLQ3RODQGLQ1XPEHURIRXWEUHDNVE\HWLRORJLFDO agent and setting

Setting

Etiological agent

total total %

Salmonella E.coli S. aureus

other EDFWHULDO

agents

visuses parasites poisonous muschrooms unknown agent household, domestic kitchen 131  (6)  (19) 60  (14) 5 (13)  (93)    UHVWDXUDQWEDUKRWHO catering  (335) 10  1  50  kindergarden, creche 6  (19)1 3    (4,6) school   1 (111)1  (49) 6  (3,5) school trip, camp 1

(101) 1 (14)  (56) 10  14 (5,4) FKLOGUHQ¶VKRPHERDUG-ing schools 1  5 (99)3 9  (4,3) social care 1  1 6 3 11 (6,0) hospital 3 (19) 1  (46)5      VDQDWRULXPUHKDELOLWD-tion center 6  5 (400)11  (6,3) prison 1 (143) 3  (410)4  (6,4) other setting   3 (49)5   (4,3)4,1 total   (30)5 1 (19) 14 (105)   3 (13)5 109  490  total % 35.5  (0.5)1.0  (0.3)  (1.6) 36.5 (40.6) 0.6 (0.3) 1.0    QXPEHURIRXWEUHDNV QXPEHURIFDVHV

previous years, depended on the etiological agent, and were as follows:

 ,QWKHGLVHDVHVFDXVHGE\Salmonella GRPLQDWHG GLDUUKHDDEGRPLQDOSDLQDQGIHYHU - In cases of staphylococcal etiology - vomiting in

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 ,QWKHGLVHDVHVFDXVHGE\YLUXVHVSUHGRPLQDWHGGLDU-UKHDLQRISDWLHQWVDQGYRPLWLQJLQ

Figure 1. shows the seasonal occurrence of out-EUHDNVFDXVHGE\GLIIHUHQWHWLRORJLFDOIDFWRUV&OHDUO\ PDUNHGLQFUHDVHLQWKHQXPEHURIIRFLLQWKHDXWXPQDQG ZLQWHUPRQWKVLVFKDUDFWHULVWLFRIRXWEUHDNVFDXVHGE\ YLUXVHVQRURYLUXVHVDQGURWDYLUXV+RZHYHURXWEUHDNV FDXVHG E\ ]RRQRWLF Salmonella, occurred primarily in the summer, with a peak incidence in July, August DQG6HSWHPEHU7KHUHZHUHQRRWKHURXWEUHDNVRIVHD-VRQDORFFXUUHQFH6HDVRQDOLW\RXWEUHDNVLQZKLFKQR etiologic factor was identified is very similar to that of viral etiology. This may indicate that most of them are FDXVHGE\WKHVHSDWKRJHQVEXWQRWGLDJQRVHG)LJ ,QIRUPDWLRQDERXWWKHRXWEUHDNVLVDOVRWUDQVIHUUHGWR WKH(8GDWDEDVHUXQE\()6$LQDFFRUGDQFHZLWKWKH FULWHULDDGRSWHG7RWKH()6$LWZDVVXEPLWWHGWRWDORI RXWEUHDNVGDWDIURPLQFOXGLQJRXWEUHDNV WKDWPHHWWKHFULWHULDRIFRQILUPHGRXWEUHDNVFDXVHGE\ food contamination.

SUMMARY AND CONCLUSIONS

,QDVLQSUHYLRXV\HDUVLQFUHDVHGWKHQXPEHU DQGSURSRUWLRQRIRXWEUHDNVRIIRRGERUQHSRLVRQLQJ / infection, in which viruses were an etiologic factor 3DUWLFXODUDWWHQWLRQLVSDLGWRVHDVRQDORXWEUHDNVZLWKQR

HVWDEOLVKHGHWLRORJLFDOIDFWRUZKLFKSDWWHUQLVVLPLODU WRWKHRXWEUHDNVRIYLUDOHWLRORJ\7KLVLQGLFDWHVWKDWLQ these those seasons particular attention should pay to the diagnosis of the samples taken for viral factors.

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