Type E botulism associated with fish product consumption – Germany and Spain

Five cases of botulism caused by botulinum neurotoxin type E (BoNT E) have been diagnosed in November 2016 in two countries: three cases in males in Germany and two cases in partners (one male and one female) in Spain. Two German and two Spanish cases had symptom onset in early November and the third German case at the end of November. All five cases have a Russian background and they had all consumed dried and salted roach. Two samples taken from products at one of the patient’s homes have been confirmed to contain the BoNT E gene. This product was distributed to 15 European Union (EU) and European Economic Area (EEA) countries, including stores specialising in eastern European food. A sixth patient with a Kazakh background was reported by Germany with onset of illness on 11 December 2016. This patient had consumed dried and salted roach. Household leftovers of the fish product consumed by the patient were reported to be positive for BoNT E gene. For this outbreak, the populations at greatest risk are those who traditionally consume salted and dried roach (‘vobla’). The risk for other population groups is very low in EU/EEA. Extensive recalls of the implicated food product have been undertaken in the EU/EEA since 25 November 2016. Targeted public warnings have also been issued in Germany, Spain and the other countries where the implicated fish product was distributed. In view of the rapid initiation of recalls and targeted public warnings of the risk, the risk that new cases linked to the outbreak will appear in the EU/EEA is considered to be very low. The main potential residual risk of exposure relates to consumers still keeping the product at home who may not been made aware of the public warnings, or stores that may not have received notification of the recall and are continuing to sell the implicated fish product. There is no risk of person-to-person transmission. This cross-border botulism outbreak highlights the importance of rapid information exchange between food safety and public health authorities so that control measures can be implemented without delay.