title: Consumption of fresh fruit juice: how a healthy food practice caused a national outbreak of Salmonella Panama gastroenteritis.
abstract: In spring 2008, 15 Salmonella Panama laboratory-confirmed cases were reported within 2 weeks, twice the average annual number of reported cases of this infrequent serotype in The Netherlands. To identify the source responsible for this national outbreak, we carried out an epidemiological, microbiological, and trace-back investigation. In total, 33 cases were reported, and a matched case-control study (23 cases/24 controls) identified consumption of fresh (unpasteurized) fruit juice purchased from a large retailer (X) as the only significant risk factor for illness (matched odds ratio: 7.4, 95% confidence interval: 1.5-37.2). Though the bacterium could not be isolated from fruit juice, the minimal pH value for growth of the causative strain of the outbreak (3.4) was compatible with survival in fruit juice from X. The outbreak strain showed acid resistance and adaptive properties that may explain how it could have caused infection through fresh orange juice. To our knowledge, this is the first documented outbreak related to fresh fruit juice consumption in western Europe since 1922. A growing number of consumers who are seeking healthy food practices are exposed to the infectious risks related to unpasteurized fresh fruit juice. Labeling regulations should be adapted to properly indicate to the consumers that unpasteurized fresh fruit juices remain vulnerable to microbial contamination. Frequent microbiological screening and strict compliance with food safety procedures should reduce the infectious hazards of fresh fruit juices.
authors.affiliation: Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. harold.noel@rivm.nl
authors.forename: Harold
authors.initials: H
authors.lastname: Noël
authors.forename: Agnetha
authors.initials: A
authors.lastname: Hofhuis
authors.forename: Rob
authors.initials: R
authors.lastname: De Jonge
authors.forename: Annet E
authors.initials: AE
authors.lastname: Heuvelink
authors.forename: Aarieke
authors.initials: A
authors.lastname: De Jong
authors.forename: Max E O C
authors.initials: ME
authors.lastname: Heck
authors.forename: Carolien
authors.initials: C
authors.lastname: De Jager
authors.forename: Wilfrid
authors.initials: W
authors.lastname: van Pelt
mesh_terms: D015373:Bacterial Typing Techniques; D001628:Beverages / Q000382:microbiology*; D016022:Case-Control Studies; D015169:Colony Count, Microbial; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005515:Food Labeling; D005516:Food Microbiology; D005519:Food Preservation / Q000379:methods; D005638:Fruit / Q000382:microbiology*; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006863:Hydrogen-Ion Concentration; D009426:Netherlands; D012034:Refrigeration; D012478:Salmonella Food Poisoning / Q000453:epidemiology* / Q000517:prevention & control; D019779:Salmonella enterica / Q000145:classification / Q000254:growth & development / Q000302:isolation & purification*; D011795:Surveys and Questionnaires; D013997:Time Factors