Yearly, 23 million foodborne disease illnesses and 5,000 deaths are estimated in the World Health Organization (WHO) European Region, and 41 foodborne Disability Adjusted Life Years (DALYs) per 100,000 population were estimated for the WHO Sub-Region EUR A in 2010 . In Europe, a total of 5,146 foodborne and waterborne outbreaks, including 48,365 cases of illness and 40 deaths were reported to the European Food Safety Authority (EFSA) in 2018 . Vulnerable populations, including elderly patients, immunocompromised patients, children younger than five years old and pregnant women are more susceptible to foodborne infections and are more prone to develop severe courses of disease compared with healthy people . Therefore, healthcare is a setting where foodborne outbreaks (FBO) can cause considerable morbidity and mortality. In 2020, 20.6% of the European Union (EU) population was aged 65 years and older . As the proportion of elderly people is projected to further increase, the share of the vulnerable population as patients in healthcare facilities (HCF) is likely to increase and thereby the risk associated with healthcare-associated foodborne outbreaks (HA-FBO). Personnel (medical and non-medical staff, food handlers etc) of HCF may also be at risk for HA-FBO and be a source of further spread in healthcare settings and elsewhere. This can cause major disruption of services .
So far, literature reviews have covered pathogens responsible for HA-FBO, including Salmonella , Listeria monocytogenes [7–9] and norovirus [10,11] and focused on microbiological food safety issues in healthcare settings [5,12]. Between 2014 and 2019, a listeriosis outbreak in Germany affected 13 cases who had an inpatient stay in 12 different HCF during the incubation period . In the United Kingdom (UK) in 2019, nine listeriosis cases of which seven died, had consumed sandwiches in seven HCF during the incubation period .
We conducted a literature review to describe the causative agents including bacteria, viruses, parasites and fungi, the incriminated food vehicles and other outbreak characteristics of HA-FBO in 37 countries that are members of the Organisation for Economic Cooperation and Development (OECD) . Furthermore, we analysed German surveillance data and data from the EFSA on HA-FBO. The aim of this article is to describe the current status of HA-FBO in order to improve surveillance and provide public health recommendations for prevention.