HUNGARY ( HU ) - Bundesinstitut für Risikobewertung · In Hungary (country abbreviation: HU), data...

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe

8th Report 1999-2000 Country Reports: Hungary

BfR

HUNGARY

Population: 10 100 000 (1998) Area: 93 030 km2

1. General information

In Hungary (country abbreviation: HU), data on foodborne infections and intoxications are collected according to two legally controlled reporting systems.

The first is a reporting system for foodborne infections and intoxications, under which each outbreak in which food or beverages are suspected or confirmed must be reported irrespective of the number of persons who fall ill and the causative agent.

Laboratory examinations must be conducted for each outbreak. Outbreaks involving two or more persons in which the laboratory examination of the person and/or the food fails to identify the causative agent but epidemiological evidence exists are also considered as foodborne. First notice is usually given by the physician who observes the disease, but managers of food production, trade and catering establishments are also obliged to report any information they have about persons falling ill.

Reports may also come from the Laboratory of Sanitary and Epidemiological Service at county level; even in such cases, the investigation of the origin of the disease is the task of the local level authority. Details of the reporting system can be seen in Figure HU 1.

Under the second existing reporting system, data are reported on all cases of notifiable communicable diseases, including foodborne infections. Figure HU 1 describes the latter reporting system, as well as illustrates the connection between the two systems.

WHO Surveillance Programme for Control of Foodborne Infections and Intoxications in Europe 8th Report 1999-2000

Country Reports: HUNGARY

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Figure HU 1

National reporting system for communicable diseases

HUNGARY 1999-2000

Data of communicable disease cases including foodborne diseases

Detailed outbreak data is communicated immediately by phone, fax etc. and in writing

Detailed outbreak data provided monthly in writing

Annually

Rapid report in case of outbreaks with following characteristics: 30 or more people ill; >10 people hospitalised; fatal cases; illness of foreigners; botulinum toxin, toxic chemicals; intoxication caused by toxic animals or toxic plants (except mushrooms); intoxication caused by mushrooms bought in shop, open-air market or from peddler

RR



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2. Statutory notification

In 1999, a total of 51633 of cases of foodborne infections and intoxications were reported under the communicable disease notification system. In 2000, this figure reached 57292. In 50% of the cases of infectious enteritis reported in 1999, the origin was known, while in 2000, the origin was known in 39% of cases. Salmonellosis was the most frequently reported disease, representing 27% of all reported cases in 1999 and 20% in 2000, followed by campylobacteriosis, comprising 17% of cases in 1999 and 15% in 2000. Details can be seen in Table HU 1. An overview of some foodborne infections reported between 1993 and 2000 is shown in Figure HU 2.

Table HU 1

Notified cases of some communicable diseases

HUNGARY 1999 - 2000

Disease 1999 2000 Number of notified cases

Incidence rate

Number of notified cases

Incidence rate

Salmonellosis 14109 139.8 11507 114.6Staphylococcosis 38 0.4 42 a 0.4Botulism b n.n. - n.n. -Campylobacteriosis 8968 88.9 8644 86.1Shigellosis 610 6.0 440 4.4E.coli enteritis 345 3.4 305 3.0Listeriosis 14 0.1 4 0.0Cholera 0 0.0 0 0.0Brucellosis 2 0.0 1 c 0.0Other bacterial foodborne infections and intoxications

0 0.0 0 0.0

Yersiniosis 125 1.2 102 1.0Toxoplasmosis 310 3.1 292 2.9Hepatitis A d 1361 13.5 779 7.8Other viral enteritis 0 0.0 0 0.0Echinococcosis 11 0.1 13 0.1Trichinellosis 7 0.1 3 0.0Giardiasis 0 0.0 0 0.0Amoebiasis 104 1.0 80 0.8Infectious Enteritis of unknown origin e

25629 254.0 35080 349.3

Total 51633 57292 a = Including imported case, b = Notification not obligatory in this system, c = Imported case, d = All hepatitis infectiosa cases, e = no infectious agent detectable n.n.: not notifiable



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Figure HR 2

Notified Cases of Communicable Diseases HUNGARY 1993 - 2000

02468

101214

1993 1994 1995 1996 1997 1998 1999 2000

Year

No. of cases

050001000015000200002500030000

No. of salmonellosis and shigellosis cases

Echinococcosis Trichinellosis Salmonellosis Shigellosis

3. Epidemiologically investigated incidents

In 1999, 265 outbreaks of foodborne diseases involving 3016 cases were investigated. In 2000, 232 outbreaks involving 2389 cases were examined. In addition to these outbreaks, 182 and 316 single case incidents were reported in 1999 and 2000. Information on causative agents, food, places and contributing factors has been collected for 447 incidents involving 3198 cases in 1999 and 548 incidents involving 2705 cases in 2000.

3.1 Causative agents In 1999 and 2000, the causative agent was identified in 91% and 93% of the investigated outbreaks respectively. Two-thirds of the investigated outbreaks were caused by Salmonella in both years, while toxic mushrooms were responsible for 9.4 and 11.2% of the investigated outbreaks in 1999 and 2000. Fifty-six and 70% of cases in outbreaks were caused by Salmonella in 1999 and 2000, whereas Staphylococcus aureus was the agent in 8.2 and 4.4% of cases in outbreaks for those same years. The most frequently identified agent causing single numbers of cases was Salmonella, implicated in 65% and 53 % of such cases in 1999 and 2000, followed by Campylobacter, representing the agent in 18% and 36% of such cases. The number of foodborne incidents of 1999 and 2000 by causative agent is shown in Table HU 2. Figure HU 3 gives an overview of the foodborne disease outbreaks investigated between 1993 and 2000 by causative agent.



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Table HU 2

Foodborne disease outbreaks by causative agents* investigated

HUNGARY 1999 - 2000

Causative agent 1999 2000 No. Of

outbreaks No. of cases in outbreaks

No. of single cases

No. of outbreaks

No. of cases in outbreaks

No. of single cases

Aeromonas spp. 1 11 0 0 0 0Bac. cereus 4 139 0 2 88 0Campylobacter jejuni 14 53 33 17 40 115Cl. botulinum 5 14 6 3 6 8Cl. perfringens 2 137 0 1 10 0Pseudomonas 1 42 0 0 0 0Salmonella 175 1684 119 155 1662 167Shigella flexneri 1 12 0 0 0 0St. aureus 10 248 1 9 106 2Enterococcus faecalis 0 0 0 1 31 1Toxic mushrooms 25 78 16 26 103 16Toxic plants 1 9 1 1 9 0Toxic chemicals 2 6 1 0 0 0Not identified ** 22 576 5 17 334 4Not investigated ** 2 7 0 0 0 3Total identified 241 2433 177 215 2055 309Total 265 3016 182 232 2389 316

* = based on identification of agent in food and/or patient ** = considered as foodborne based on epidemiological findings

Figure HU 3

Foodborne Disease Outbreaks by Causative Agents HUNGARY 1993 - 2000

0

5

10

15

20

25

30

1993 1994 1995 1996 1997 1998 1999 2000Year

No. of outbreaks

050100150200250300350

No. of outbreaks due to salmonellosis and toxic

mushrooms

Bac. cereus Campylobacter Cl. botulinumCl. perfringens St. aureus Enterococcus faecalisToxic chemicals Salmonella Toxic mushrooms



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3.1.1. Salmonella serotypes

Of the 1803 and 1829 cases of salmonellosis submitted for serotyping in 1999 and 2000, more than 99% were identified. The most frequently isolated serotype was S. Enteritidis, found in 91% and 89% of the outbreaks in 1999 and 2000, followed by S. Typhimurium, involved in 4% of the outbreaks in both years. The number of Salmonella serotypes in foodborne disease outbreaks investigated in 1999 and 2000 is shown in Table HU 3. An overview of Salmonella serotypes identified in foodborne disease outbreaks between 1993 and 2000 is shown in Figure HU 4.

Table HU 3

Salmonella serotypes in foodborne disease outbreaks investigated

HUNGARY 1999 - 2000

Serotypes 1999 2000 No. of

outbreaks No. of cases in outbreaks

No. of outbreaks

No. of cases in outbreaks

S. Enteritidis 266 1692 286 1751 S. Typhimurium 11 18 13 27 S. Infantis 2 26 4 19 S. Saintpaul 1 1 0 0 S. Derby 1 1 0 0 S. Give 2 13 0 0 S. Bredeney 1 1 3 9 S. Heidelberg 1 5 0 0 S. Hadar 3 5 2 2 S. Virchow 0 0 2 2 S. Bovis 1 12 0 0 S. Cholerae suis 0 0 1 2 S. Blockley 2 2 4 4 S. Essen 0 0 1 1 Not identified serotypes 3 27 6 12 Total 294 1803 322 1829



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Figure HU 4

Salmonella Serotypes in Foodborne Disease Outbreaks Investigated HUNGARY 1993 - 2000

0

2

4

6

8

10

12

14

1993 1994 1995 1996 1997 1998 1999 2000Year

No. of outbreaks

050100150200250300350400450500

No. of S . Enteritidis outbreaks

S. Typhimurium S. Infantis S. Hadar S. BlockleyS. Bredeney S. Virchow S. Bovis S. Enteritidis

3.2 Incriminated foods The food responsible for foodborne disease incidents was identified in 95% and 96% of the incidents investigated in 1999 and 2000 respectively. Eggs and egg products accounted for 32% and 29% of the investigated incidents, followed by meat and meat products, linked with 18% and 26% of incidents in the years mentioned. Most of the cases in 1999 were linked to the consumption of sweets (19% of all cases), while the most frequently identified single food in 2000 was mayonnaise (18% of cases). The number of incidents and cases caused by different agents in 1999 and 2000 is shown in Table HU 4. Figure HU 5 gives an overview of the foodborne incidents reported between 1993 and 2000 by causative agent.



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Table HU 4

Foodborne disease incidents by incriminated foods

HUNGARY 1999 - 2000

Food 1999 2000 No. of

incidents No. of cases in incidents

No. of incidents

No. of cases in incidents

Milk 4 8 9 15Milk products 0 0 3 4Egg/egg products 143 489 159 310Meats/meat products 84 481 143 237Sausages, white and black puddings 5 12 10 17Ice cream 1 1 0 0Sweets 62 594 50 425Mayonnaise, dressings, salads 14 104 32 499Pasta 12 371 14 170Mushrooms 45 101 48 128Fruit/vegetables 3 48 2 27Ready-to-serve-meals 53 702 59 632Unknown 21 287 19 241Total 447 3198 548 2705

Figure HU 5

Foodborne Diesease Incidents Investigated by Incriminated Foods HUNGARY 1993 - 2000

050

100150200250300

1993 1994 1995 1996 1997 1998 1999 2000Year

No. of incidents

Eggs, egg products Meat, meat products Sweets, ice creamMayonnaise, dressings,salads Pasta MushroomsReady-to-serve-meals



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3.3 Place of contamination, acquisition or consumption of incriminated food The place where the incriminated food was acquired, consumed or contaminated was identified in 99% of the incidents investigated in 1999 and 2000. Eighty-four and 87% of the incidents reported in 1999 and 2000 were linked to the private home, followed by restaurants and hotels, the site of 6% of the outbreaks in both years. Thirty-five and 37% of the cases reported in 1999 and 2000 occurred in the private home, whereas schools and kindergartens were involved in 25% and 21% of the cases for those same years. Table HU 5 shows the number of foodborne incidents investigated in 1999 and 2000 by place. Figure HU 6 gives an overview of the number of foodborne incidents reported between 1993 and 2000 by place.

Table HU 5

Foodborne disease incidents by place where food was contaminated, acquired or eaten

HUNGARY 1999 - 2000

Place 1999 2000 No. of


No. of incidents


Restaurant/hotel 25 324 32 537 Factory, other workplace canteen

4 204 8 221

School, kindergarten 24 801 14 569 Medical care facility 3 378 0 0 Private home 374 1103 475 1008 Meat processing plant 0 0 0 0 Dairy 2 4 0 0 Confectionery 7 152 0 0 Other food processing plants

0 0 0 0

Retail store, market 0 0 0 0 Holiday home, camp 3 164 6 134 Social establishment 3 64 6 161 Other 1 1 1 59 Unknown 1 3 6 16 Total 447 3198 548 2705



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Figure HU 6

Foodborne Disease Incidents by Place where Food was Contaminated, Acquired or Eaten

HUNGARY 1993 - 2000

0

10

20

30

40

50

1993 1994 1995 1996 1997 1998 1999 2000Year

No. of incidents

0100200300400500600700

No. of incidents in private homes

Restaurant/hotel Factory, other work place canteenSchool, kindergarten Medical care facilityConfectionery Retail store, marketHoliday home, camp Social establishmentPrivate home

3.4 Contributing factors The factors contributing to foodborne disease incidents were identified in 73% and 76% of the incidents investigated in 1999 and 2000.The most frequently identified factor was inadequate heating/cooking, which was reported in 37% and 45% of incidents respectively, followed by infected raw material, linked to 18% and 15% of the incidents in the years mentioned. The number of foodborne disease incidents reported in 1999 and 2000 by contributing factor is shown in Table HU 6. An overview of the foodborne disease incidents investigated between 1993 and 2000 by contributing factor is given in Figure HU 7.



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Table HU 6

Foodborne disease incidents by contributing factors

HUNGARY 1999 - 2000

Contributing factor 1999 2000 No. of


No. of incidents


Inadequate heating/cooking 164 663 244 663Inadequate cooling (without or after heat processing)

25 262 31 267

Inadequate hot holding 3 214 4 63Improper storage 1 88 1 3Improper preparation of raw materials (lack of egg-shell disinfection, vegetable cleaning etc.)

1 94 1 14

Infected raw material 80 554 80 632Poisonous raw material (mushrooms, weed-seed, botulotoxin etc.)

47 103 47 134

Contamination by infected person 3 83 4 187Contaminated equipment 2 206 2 35Other 4 16 0 0Unknown 117 915 134 707Total 447 3198 548 2705

Figure HU 7

Foodborne Disease Outbreaks Investigated by Contributing Factors HUNGARY 1993 - 2000

0

10

20

30

40

50

60

1993 1994 1995 1996 1997 1998 1999 2000Year

No. of incidients

0

50

100

150

200

250

300

No. of incidents with infected or poisonous raw

material or inadequate heating/cooking

Inadequate cooling Inadequate hot holding Improper storage

Improper preparation of raw materials Contamination by infected person Contaminated equipment

Other Inadequate heating/cooking Infected raw material

Poisonous raw material



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4. Additional Information

The National Registry of Communicable Diseases, the “Béla Johan” National Center of Epidemiology, publishes the weekly epidemiological information paper “Epinfo”. It is sent to all institutes and departments of the National Public Health and Medical Officers’ Services in Hungary. The paper is available on the internet at http://www.antsz.hu/oek

For further reference on national and international data on foodborne diseases, please visit the web page http://www.euro.who.int/foodsafety/Surveillance/20020904_1

http://www.antsz.hu/oek

http://www.euro.who.int/foodsafety/Surveillance/20020904_1

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