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. 2024 Mar;29(10):2300299.
doi: 10.2807/1560-7917.ES.2024.29.10.2300299.

Outbreak of Salmonella Typhimurium linked to Swedish pre-washed rocket salad, Sweden, September to November 2022

Karolina Fischerström  1   2 , Rikard Dryselius  1 , Mats Lindblad  3 , Sharon Kühlmann-Berenzon  1 , Nadja Karamehmedovic  1 , Stefan Börjesson  1   4 , Nasanin Hashemi  1 , Ingrid Gunn  5 , Ann-Mari Gustavsson  6 , Nilla Lindroos  7 , Joanna Nederby-Öhd  8 , Micael Widerström  9 , Ruska Rimhanen-Finne  10 , Anni Vainio  10 , Moa Rehn  1
Affiliations

Outbreak of Salmonella Typhimurium linked to Swedish pre-washed rocket salad, Sweden, September to November 2022

Karolina Fischerström et al. Euro Surveill. 2024 Mar.

Abstract

In September 2022, the Public Health Agency of Sweden observed an increase in domestic Salmonella Typhimurium cases through the Swedish electronic notification system, and an outbreak strain was identified with whole genome sequencing. Overall, 109 cases with symptom onset between 17 September and 24 November 2022 were reported from 20 of 21 Swedish regions. The median age of cases was 52 years (range 4-87 years) and 62% were female. A case-control study found cases to be associated with consumption of rocket salad (adjusted odds ratio (aOR) = 4.9; 95% confidence interval (CI): 2.4-10, p value < 0.001) and bagged mixed salad (aOR = 4.0; 95% CI: 1.9-8.1, p value < 0.001). Trace-back, supported by Finnish authorities who identified the Swedish outbreak strain in a Finnish cluster during the same time period, identified rocket salad, cultivated, pre-washed and pre-packed in Sweden as the likely source of the outbreak. No microbiological analyses of rocket salad were performed. Our investigation indicates that bagged leafy greens such as rocket salad, regardless of pre-washing procedures in the production chain, may contain Salmonella and cause outbreaks, posing a health risk to consumers. We emphasise the need for primary producers of leafy greens to identify possible contamination points to prevent outbreaks.

Keywords: Salmonella; case-control study; outbreak; rocket salad.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Confirmed cases of Salmonella Typhimurium sequence type 19 in an outbreak linked to pre-washed rocket salad, by date of symptom onset or date of sampling, Sweden, September–November 2022 (n = 109)
Figure 2
Figure 2
Confirmed cases of Salmonella Typhimurium sequence type 19 in an outbreak linked to pre-washed rocket salad, by age group and sex, Sweden, September–November 2022 (n = 109)
Figure 3
Figure 3
Minimum spanning tree of Salmonella Typhimurium sequence type 19 isolates from Denmark, Finland, Norway, Sweden and the United Kingdom, August 2021–January 2023 (n = 133)
Figure 4
Figure 4
Schematic overview of the production chain of rocket salad in the trace-back investigation of an outbreak of Salmonella Typhimurium sequence type 19 linked to pre-washed rocket salad, Sweden and Finland, September–November 2022
See this image and copyright information in PMC

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