title: Outbreak of trichinellosis due to wild boar meat and evaluation of the effectiveness of post exposure prophylaxis, Germany, 2013.
abstract: BACKGROUND
  Food safety authorities discovered that wild boar meat products contaminated with Trichinella spiralis had entered the food chain in Germany in March 2013. Public health authorities issued guidelines for health professionals including post-exposure prophylaxis (PEP) using mebendazole and advised the public to seek medical advice if exposed. Our objective was to identify factors associated with the development of trichinellosis and to evaluate post exposure prophylaxis.
  
  
  METHODS
  Persons who reported to local public health departments as exposed were interviewed concerning exposure, symptoms, and medication. Serum samples were tested by an in-house Trichinella-specific enzyme-linked innunosorbent assay. Cases were defined as persons presenting with myalgia and/or periorbital edema and Trichinella-specific immunoglobulin M and immunoglobulin G antibodies after exposure to implicated products.
  
  
  RESULTS
  Of 101 persons interviewed, 71 were exposed and serologically tested. Antibodies were detected in 21/71 (30%) and 14/71 (20%) met the case definition. Attack rates were positively correlated to the amount of implicated product consumed. Among n = 37 persons who received anthelmintics as PEP, 6 persons developed trichinellosis. These cases exclusively occurred among persons starting PEP 6 days or later post-exposure. Exposure to implicated products and delaying PEP were also significantly associated with developing trichinellosis (P < .01) in a multivariable analysis.
  
  
  CONCLUSIONS
  Concerted efforts by food safety and public health authorities lead to timely outbreak control and facilitated the provision of early PEP. PEP appears to be effective in preventing trichinellosis when given early, preferably within 6 days. We therefore recommend initiating PEP without delay in similar settings and encourage public health professionals to fast-track this intervention.
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Mirko
authors.initials: M
authors.lastname: Faber
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany Postgraduate Training for Applied Epidemiology (PAE), affiliated to the European Programme for Intervention Epidemiology Training (EPIET), ECDC, Sweden.
authors.forename: Susanne
authors.initials: S
authors.lastname: Schink
authors.affiliation: Department for Biological Safety, Federal Institute for Risk Assessment, Berlin.
authors.forename: Anne
authors.initials: A
authors.lastname: Mayer-Scholl
authors.affiliation: Public Health Department, Görlitz Administrative District.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ziesch
authors.affiliation: Food Inspection and Veterinary Department, Görlitz Administrative District, Germany.
authors.forename: Ralph
authors.initials: R
authors.lastname: Schönfelder
authors.affiliation: Department for Biological Safety, Federal Institute for Risk Assessment, Berlin.
authors.forename: Heidi
authors.initials: H
authors.lastname: Wichmann-Schauer
authors.affiliation: Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Stark
authors.affiliation: Department for Biological Safety, Federal Institute for Risk Assessment, Berlin.
authors.forename: Karsten
authors.initials: K
authors.lastname: Nöckler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000969:Antinematodal Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008460:Meat / Q000469:parasitology*; D008463:Mebendazole / Q000008:administration & dosage / Q000627:therapeutic use; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis; D012307:Risk Factors; D034421:Sus scrofa / Q000469:parasitology; D013552:Swine; D014235:Trichinellosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D055815:Young Adult
chemical_list: D000969:Antinematodal Agents; D008463:Mebendazole
keywords: Germany; mebendazole; outbreak; post-exposure prophylaxis; trichinellosis