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Overall, 1 412 cases have been found associated with this outbreak: 532 confirmed and 166 probable cases since 1 February 2017 and 343 historical-confirmed and 367 historical-probable cases between 2012 and 31 January 2017. In addition, no dates have been reported for four outbreak-confirmed cases, so they are unclassifiable as current or historical cases (Table 1).

Table 1. Distribution of cases by case classification and country, EU/EEA, February 2012 to November 2018 (n=1 420; 4 cases missing date of onset or sampling or receipt at reference laboratory), as of 12 November 2018

Most outbreak cases were reported during the summer months (Figure 1). Due to reporting delays, additional cases are expected to be reported with onset in recent months.

A total of 112 confirmed or historical-confirmed cases were reported with travel history in an EU country during the incubation period and therefore were likely infected there. Countries where infections likely took place were Poland (25 cases identified from 2016 to 2018), Bulgaria (22 cases from 2015 to 2018), Cyprus (14 cases in 2016 and 2018), Portugal (11 cases from 2015 to 2017) and Hungary (10 cases from 2016 to 2018). Additional travel-associated cases were also reported (<10 cases per country) with travel history to Austria, Belgium, Greece, Italy, the Netherlands, Romania, Slovenia and Spain.

Figure 1. Distribution of cases by month of onset* and case classification (n=1 412; 4 cases missing any date of report), EU/EEA, January 2012 to October 2018, as of 12 November 2018

The 2016 and 2017 European outbreak investigations identified eggs originating from Poland as the vehicle of infection in this outbreak (ECDC/EFSA rapid outbreak assessments published in March and December 2017). Outbreak-confirmed cases belong to four different WGS clusters.

Assessment

As reported in the previous ECDC/EFSA rapid outbreak assessment, in 2016 and 2017, evidence from epidemiological, microbiological, environmental and tracing investigations identified eggs originating from Poland as the vehicle of infections in this multi-strain outbreak. Control measures were implemented following these investigations. However, new outbreak cases were notified in 2017 and in 2018 with similar magnitude and temporal patterns. Based on the analysis of the travel-associated cases, it is likely that more countries where molecular typing is not performed routinely for human S. Enteritidis isolates are affected by the outbreak, including Bulgaria, Cyprus and Portugal.

Actions

ECDC monitors the occurrence of human cases associated with this threat and offers sequencing services for countries reporting probable cases of human S. Enteritidis isolates with MLVA profile 2-9-7-3-2 or 2-9-6-3-2 or
2-9-10-3-2 or 2-10-6-3-2 or 2-10-8-3-2 or 2-11-8-3-2. EU/EEA countries should consider interviewing new outbreak-confirmed cases.