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. 2024 Nov 18:152:e140.
doi: 10.1017/S0950268824001432.

Outbreak of the novel Cryptosporidium parvum IIγA11 linked to salad bars in Sweden, December 2023

Ioana Bujila  1   2 , Anna Ohlson  3   4 , Anette Hansen  3 , Lady Agudelo  1 , Sharon Kühlmann-Berenzon  5 , Ilias Galanis  5 , Ingela Hall  6 , Ann-Mari Gustavsson  7 , Marianne Lebbad  1 , Mats Lindblad  8 , Caroline Rönnberg  1   9 , Moa Rehn  3
Affiliations

Outbreak of the novel Cryptosporidium parvum IIγA11 linked to salad bars in Sweden, December 2023

Ioana Bujila et al. Epidemiol Infect. .

Abstract

We report a foodborne outbreak of the previously undetected Cryptosporidium parvum gp60 subtype IIγA11. In December 2023, notifications of cryptosporidiosis cases increased in Sweden, prompting the initiation of a national outbreak investigation, and a case-control study was performed to identify the source. We identified 60 cases between 15 December 2023 and 1 January 2024. The median age was 44 years (range: 16-81), and 73% were women. Controls were recruited from a national random pool; frequency was matched by age group and sex. Compared to controls, cases were more likely to have consumed items from salad bars in grocery stores (8% vs. 85%; adjusted odds ratios [aOR]: 58; 95% confidence interval [CI]: 22-186). In regards to food items from the salad bars, cases were more likely to have consumed kale mix salad compared to controls (62% vs. 32%; aOR: 3.6; 95%CI: 1.2-12). Trace-back investigations identified kale producers from Sweden, Belgium, and Spain, but no particular grower was identified, and no food samples were available for microbiological analysis. Our investigation indicates that leafy greens such as kale may contain Cryptosporidium spp. and cause outbreaks and it is important to understand how the contamination occurs to prevent future outbreaks and apply adequate preventive measures.

Keywords: case-control studies; cryptosporidium; disease outbreaks; molecular typing; protozoa.

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Conflict of interest statement

The authors declare no competing interests exist.

Figures

Figure 1.
Figure 1.
Number of suspected (n=47)and confirmed (n=13) Cryptosporidium outbreak cases, Figure 3by age group and sex in Sweden between 15 December 2023 and 1 January 2024 (n=60).
Figure 2.
Figure 2.
Number of suspected (n=47) and confirmed (n=13) Cryptosporidium outbreak cases by date of disease onset in Sweden between 15 December 2023 and 1 January 2024.
Figure 3.
Figure 3.
Phylogenetic relationships between C. parvum IIγA11 from the Cryptosporidium outbreak in Sweden between 15 December 2023 and 1 January 2024 (filled circle) andsequences from foodborne outbreaks linked to green leafy vegetables in Sweden, known Cryptosporidium spp. and subtypes detected in Sweden and closest sequence match to C. parvum IIγA11 retrieved from the NCBI GenBank database.
See this image and copyright information in PMC

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