MICROBIAL CONTAMINANTS

Food monitoring, 1993-1997. Part 5.

Prepared by:
Sven Qvist
Institute of Food Research and Nutrition
Niels Ladefoged Nielsen
Institute of Food Safety and Toxicology

Food monitoring, 1993-1997

consists of five sub-reports:
Part 1: Nutrients
Part 2: Chemical contaminants
Part 3: Production aids (pesticides and veterinary drugs)
Part 4: Food additives
Part 5: Microbial contaminants

Ministry of Food, Agriculture and Fisheries

Danish Veterinary and Food Administration

MICROBIAL CONTAMINANTS
Food monitoring, 1993-1997. Part 5.
FdevareRapport 2001:21
1st Edition, 1st Circulation, September 2003
This report is an English version of FdevareRapport 2000:05, Mikrobiologiske
forureninger, Overvgningssystem for levnedsmidler 1993-1997. Del 5
Copyright: The Danish Veterinary and Food Administration
400 copies
Cover: Jeppe Hammerich
Printing office: The Danish Veterinary and Food Administration
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The Danish Veterinary and Food Administration

Mrkhj Bygade 19, DK-2860 Sborg
Tel. + 45 33 95 60 00, fax + 45 33 95 60 01
Web site: www.foedevaredirektoratet.dkT
The Danish Veterinary and Food Administration is part of the Danish Ministry of
Agriculture, Food and Fisheries. The Danish Veterinary and Food Administration is
responsible for the administration, research and control within food and veterinary
areas from farm to fork, as well as practical matters relating to animal protection
(otherwise under the Ministry of Justice).
Making of regulations, co-ordination, research and development, take place in the
Administrations center in Moerkhoej. The 11 Regional Authorities handle the practical
inspection of food and veterinary matters, including import/export etc.
The central administration of The Danish Veterinary and Food Administration employ
a staff of approx. 550 full-time employees, whilst the 11 regional authorities employ a
further approx.1 400 full-time employees.

PREFACE
A programme for monitoring nutrients and chemical contaminants in foods was established in
1983, and the Danish Veterinary and Food Administration is now carrying this programme
further within an expanded field. Results are being reported for periods of five years; thus, the
present report covers the third period, 1993-1997.
The reporting of the third period of the monitoring programme consists of the following subreports:
Part 1: Nutrients
Part 2: Chemical contaminants
Part 3: Production aids (pesticides and veterinary drugs)
Part 4: Food additives
Part 5: Microbial contaminants
The studies are co-ordinated by the Danish Veterinary and Food Administration. The major
part of the chemical analyses was carried out by the regional laboratories in Copenhagen,
Odense, Aalborg, and rhus; however, analyses for veterinary drugs were mainly carried out
by the Danish Veterinary and Food Administration. Microbiological analyses were carried out
by the Danish Veterinary and Food Administration and the municipal environmental and food
control units. The reporting was co-ordinated by Gudrun Hilbert, Institute of Food Research
and Nutrition.
The Danish Veterinary and Food Administrations monitoring programme for foods does not
include analyses of radionucleides; these analyses, as well as the publication of their results,
are being undertaken by Ris National Laboratory.
The text of the report does not take into account the fact that certain activities had a different
organizational placement prior to the re-organization of the Ministry of Food, Agriculture and
Fisheries in 1997, when the Danish Veterinary Service and the National Food Agency of
Denmark were united into the Danish Veterinary and Food Administration. All results from
these two institutions are being referred to as results of work carried out by the Danish
Veterinary and Food Administration.

December, 1999
Danish Veterinary and Food Administration

TABLE OF CONTENTS

1.

MONITORING PROGRAMME FOR FOODS................................................................ 6

2.

INTRODUCTION............................................................................................................. 9

3.

SALMONELLA.............................................................................................................. 11
3.1 Importance ................................................................................................................ 11
3.2 Ecology and occurrence............................................................................................ 12
3.3 Salmonella in eggs .................................................................................................... 12
3.4 Salmonella in broilers ............................................................................................... 13
3.5 Salmonella in pigs..................................................................................................... 13
3.6 Salmonella in cattle................................................................................................... 14

4.

CAMPYLOBACTER ..................................................................................................... 15
4.1 Importance ................................................................................................................ 15
4.2 Ecology and occurrence............................................................................................ 16

5.

YERSINIA ENTEROCOLITICA .................................................................................. 18

5.1 Importance ................................................................................................................ 18
5.2 Ecology and occurrence............................................................................................ 19

6.

ESCHERICHIA COLI O157.......................................................................................... 21

6.1 Importance ................................................................................................................ 21
6.2 Ecology and occurrence............................................................................................ 22

7.

LISTERIA MONOCYTOGENES.................................................................................. 25
7.1 Importance ................................................................................................................ 25
7.2 Ecology and occurrence............................................................................................ 26

8.

STAPHYLOCOCCUS AUREUS................................................................................... 29
8.1 Importance ................................................................................................................ 29
8.2 Ecology and occurrence............................................................................................ 29

9.

CLOSTRIDIUM PERFRINGENS ................................................................................. 31

9.1 Importance ................................................................................................................ 31
9.2 Ecology and occurrence............................................................................................ 31

10.

BACILLUS CEREUS..................................................................................................... 33
10.1 Importance .............................................................................................................. 33
10.2 Ecology and occurrence.......................................................................................... 33

11.

ANTIBIOTIC RESISTANCE ........................................................................................ 35

11.1 Monitoring of antibiotic resistance......................................................................... 35

12.

SUMMARY AND CONCLUSION ............................................................................... 37

13.

REFERENCES ............................................................................................................... 39

1. MONITORING PROGRAMME FOR FOODS

The object of the monitoring programme is, by means of systematic studies of foods and the
dietary habits of the Danish population,
to ascertain whether our foods are subject to any long-term changes in terms of contents of
desirable and undesirable substances and/or micro-organisms,
to assess the health significance of any such changes in relation to major changes of
dietary habits,
to disclose potential problems within the area and to provide background material and a
basis for decisions to remedy any problems which might have arisen.
The material provided may also serve as a documentation of the health quality of Danish
foods, and be used for updating the food composition data base of the Danish Veterinary and
Food Administration. Monitoring results are used also in other connections; e.g.,
microbiological results are reported to the Danish Zoonosis Centre, and results concerning
residues of pesticides and veterinary drugs are reported to the EU.
The work with the monitoring programme consists of the following:
to monitor, by means of analyses, the contents of desirable and undesirable
substances/micro-organisms in specific foods,
to investigate the dietary habits of the Danish population,
to carry out intake estimates (wherever relevant) by combining contents in foods and data
on the populations diet.
Subsequently, a nutritional and/or toxicological assessment can be made. Such an assessment
will be particularly important whenever changes are found.
Since changes in the contents of foods and changes in our dietary habits usually develop
slowly, the studies cover a considerable number of years. Every five years, the results are
reviewed, and the analytical results for the foods are compared with the dietary habits over
the period. This permits an assessment of whether the intake of desirable substances is
adequate, and whether the intake of undesirable substances or micro-organisms is acceptably
low.
Content findings and intake estimates are compared with earlier results, thus permitting an
assessment of the development of contents and intakes over time.

Results are evaluated continuously during the monitoring period, enabling reactions to
violations of existing limits, deviations from contents declarations, or other noteworthy
observations.
The monitoring programme consists of five sub-fields:
Nutrients, including vitamins, minerals, proximates, and dietary fibres.
Chemical contaminants, including trace elements, nitrate, organic environmental
contaminants, and mycotoxins.
Production aids, including residues of pesticides and veterinary drugs.
Food additives.
Microbial contaminants.
Initially, the monitoring programme covered only nutrients and chemical contaminants. The
remaining three subjects are new inclusions under the monitoring concept; these are
production aids (pesticides and veterinary drugs), which have been reported continuously
during several decades and during recent years have attracted increasing attention within the
international co-operation and in the public; food additives which, according to three EU
directives, shall be followed with a view to application and intake; and finally, microbial
contaminants, with an increasing number of reported disease cases which can be attributed to
pathogenic bacteria in foods.
With the merger in 1997 of the National Food Agency of Denmark and the Danish Veterinary
Service into the new Danish Veterinary and Food Administration it has become possible to
compile the data material, especially within the fields concerning microbial contaminants and
veterinary drug residues.
Unlike the first two monitoring periods (1983-1987 and 1988-1992), each of which was
reported as a whole [1, 2], the reporting of the third period has been divided into five subreports according to subject. Each sub-report comprises a number of analyses which,
depending on the subject matter, are carried out once or several times during a five-year
period. Thus, e.g. vitamins in meat are analysed once, while pesticide residues in fruits and
vegetables are analysed yearly. The difference reflects the fact that empirically, vitamin
contents in meat will not change within a short time, whereas the monitoring of pesticide
residues contains an appreciable element of control, and the use pattern for pesticides is
subject to greater fluctuations.
In 1996, the monitoring programme (nutrients and chemical contaminants) was subjected to
an international evaluation [3]. The main conclusion was that the monitoring programme was
good, but might be improved in some respects. The collection of diet data should be expanded
to include a larger number of methods and be effected continuously, and the use of statistical
expertise should be optimized, particularly for sampling and processing of results. Further, a
7

number of more specific suggestions was mentioned. The experience gathered from the
evaluation has been included in the reporting of the third period as well as in the planning of
the fourth period.
The Ministry of Food, Agriculture and Fisheries has to be informed on the immediate
situation concerning Danish foods, the health significance for Danish consumers, and the
direction in which matters are likely to develop. In this respect, the monitoring programme
can provide background material and a basis for decisions on actions in the form of national
or international regulations.

2. INTRODUCTION
Within the framework of the Danish Veterinary and Food Administration and with the
assistance of the municipal food control units, a number of microbiological mapping studies
has been carried out during recent years, with the objective of providing information on the
present occurrence of one or more bacteria. In addition, monitoring programmes for bacteria
such as Salmonella and Campylobacter have been initiated. The purpose of these monitoring
programmes is to follow the occurrence of particular bacteria in different foods over a period
of time.
In the following, a description is given of the pathogenic bacteria which are most important
under Danish conditions, as well as a list of results from study programmes carried out during
the period 1993-1997. It should be noted that such monitorings are not undertaken every year,
with the exception of Salmonella and Campylobacter.
A common feature of Salmonella, Campylobacter, Yersinia enterocolitica, and verotoxinproducing Escherichia coli O157 is their reservoir in the gastro-intestinal tract of production
and meat animals. From this reservoir, the bacteria may contaminate the foods during the
slaughtering process and further processing, thereby constituting a risk of disease in humans.
These pathogenic bacteria are responsible for a very large proportion of the total incidence of
food-borne diseases. During recent years, such bacteria have caused a yearly total of 7,0008,000 registered disease cases in Denmark. However, only a part of the food-borne disease
cases are diagnosed and registered. The actual incidence of such diseases is assumed to be at
least 10-20 times higher than the number of registered cases.
The prevention and control of these pathogenic bacteria are issues of very high priority.
Control must take place first and foremost in the primary production, but also the subsequent
steps from stable to table must be involved. Development of methods for measuring
antibodies in e.g. blood, meat juice, and eggs make it possible to establish the infection status
of herds with respect to bacteria such as Salmonella and Y. enterocolitica.
In addition to this, the spread of bacteria to foods must be prevented and controlled at the
food manufacturing as well as the wholesale and retail stages. At these stages, the prevention
is based on self-imposed control according to the Hazard Analysis Critical Control Point
(HACCP) principle. With the widespread occurrence of pathogenic bacteria in meat animals,
carcasses may very easily be contaminated. Modern industrialized slaughter methods tend to
increase the infection levels. Therefore, an effort is necessary in order to improve the hygiene
in critical processes on the slaughter line, such as removal of intestines, removal and hooking
of chest organs, lymph node incisions at meat inspection, and trimming of head meat.
In addition to improved hygiene on the slaughter line, separate slaughterings of infected and
non-infected animals may contribute to lower contamination levels in meat for consumption.

At the retail stages, prevention of cross-contamination from raw meat to other food items,
especially to consumption-ready products, is essential. Adequate heat treatment is another
essential factor for preventing the transmission of pathogenic bacteria to humans. Correct
refrigeration and application of other growth-inhibiting principles, including acidity and water
activity, are also important critical points in the preventive efforts.
Finally, in order to prevent disease, consumers must be advised about the correct handling
and storage of foods.
The identification of primary infection sources and their importance permits a targeted and
efficient prevention and control. Essential tools for this purpose are the collection and typing
of bacteria from humans, animals, and foods, case-control studies, and monitoring of the
occurrence of bacteria in various food groups.
Table 1 gives a list of the number of samples analysed in relation to the bacteria that are
discussed in the present report. Samples analysed in connection with routine control,
consumer complaints, and the like, are not included.
Table 1. Number of samples analysed in microbiological mapping and monitoring
programmes, 1993-1997.
Bacteria
Salmonella

Number of samples analysed

50,918

Campylobacter

5,696

Escherichia coli O157

4,012

Yersinia enterocolitica

1,326

Listeria monocytogenes

2,810

Staphylococcus aureus

1,309

Clostridium perfringens

1,262

Bacillus cereus

1,309

The decision to include the subject of microbiology in the monitoring programme was made
quite late in the monitoring period. Consequently, the reporting has not yet assumed its final
form; the report covering the next monitoring period is expected to contain, among other
things, literature references.

10

3. SALMONELLA

3.1

Importance

Salmonellosis has been one of the most frequently occurring food-borne diseases in many
countries for the last 20 years.
In the early 1980es, the number of salmonellosis cases in Denmark was approx. 1,000,
increasing to around 3,000 per year in the late 1980es. 4,300 cases were registered in 1994,
and in 1995 and 1996 the number decreased to 3,600 and 3,200, respectively. In 1997, 5,000
cases were registered, which is the highest number till now.
The majority of registered cases is assumed to be sporadic or minor outbreaks associated with
families or parties. Only a minor proportion is associated with more widespread outbreaks.
The genus Salmonella (S.) consists of two species: S. enterica, comprising more than 2,400
serotypes, and S. bongori, comprising approx. 20 serotypes. Generally speaking, all
Salmonella serotypes must be considered as pathogenic. However, 80-90% of all cases of
human salmonellosis are caused by the serotypes S. Typhimurium and S. Enteritidis. This is
due to the widespread occurrence of especially these serotypes in the primary production
systems. S. Typhimurium is found in all types of production animals, whereas S. Enteritidis is
found mainly in market egg-producing hens and in broilers. Also other serotypes may be
transmitted from production animals, but only occasionally cause serious problems. One such
case was the S. Infantis outbreak in 1993, where more than 500 people were infected after
having eaten pork from a minor slaughterhouse in Jutland.
In recent years, many countries have seen an increase in the number of registered cases as
well as outbreaks caused by S. Enteritidis. Thus, S. Enteritidis is now by far the most
frequently isolated serotype, whereas S. Typhimurium is the source of less than 20% of cases.
In the early 1980es, on the other hand, S. Typhimurium was the most frequently isolated
serotype in foods in Europe.
The incubation period (the period from infection to manifest symptoms) for food-borne
salmonella infections is reported to be -3 days in most cases. Salmonella causes enteritis in
95-99% of cases, while septicaemia is seen in approx. 1-5% of cases. The risk of developing
septicaemia depends on the serotype that is responsible for the disease. S. Dublin, for
example, typically associated with cattle, causes septicaemia 10-20 times more often than
other serotypes.
The symptoms of salmonellosis are diarrhoea, abdominal pains, fever, and headache. Other
symptoms may be nausea and vomiting. The duration of the symptoms may range from a few
days to several weeks. In cases of septicaemia, the course of the disease may be of longer
duration. Late complications in the form of arthralgia are seen in approx. 7% of patients,
11

especially in patients having a particular tissue type. The mortality rate of salmonellosis is
estimated to be approx. 0.1% of registered cases.
The infective dose depends on several factors such as age and immunological status. For
healthy persons, an infectious dose of 103-106 bacteria has been indicated. However,
infections caused by much lower numbers have been reported, especially in connection with
intakes of fatty products. Thus, an outbreak in the USA, caused by pasteurized ice cream
produced with raw egg yolks, showed that people had become ill after ingestion of less than
0.003 Salmonella per g of ice cream (corresponding to one bacterium per serving).

3.2

Ecology and occurrence

Salmonella has its growth optimum at 37C and growth interval from 5 to 46C. Salmonella
does not survive pasteurization, but is relatively resistant to freezing. The heat resistance of
Salmonella is highly dependent on environmental factors such as water activity and acidity.
Salmonella is facultatively anaerobic (i.e. capable of growth in the presence as well as
absence of oxygen) and is therefore not inhibited by vacuum packing or modified atmosphere
packing. Salmonella has its pH optimum at 6.5-7.5 with a growth range of 4.5-9.0. At water
activities (aw) below approx. 0.94, growth of Salmonella is not possible. The aw limit of
growth depends on factors such as pH and temperature.
The normal habitat of Salmonella is the intestinal tract of warm-blooded animals. Salmonella
is spread from production animals to raw meat, unpasteurized milk, and eggs, which are the
main causes of human infection. In Denmark, outbreaks caused by bean sprouts have also
occurred.
In Denmark, comprehensive monitoring programmes, including sampling of salmonella
bacteria from animals, foods, and humans, have permitted a specification of the relative
importance of individual animal species for disease in humans. The Danish Zoonosis Center
issues annual reports of sources of human salmonella infections.

3.3

Salmonella in eggs

In two studies carried out in 1994 and 1995-96, the occurrence of Salmonella in eggs was
found to be approx. 0.1%. 9 of 10 infected eggs were contaminated exclusively on the shells,
while 1 in 10 was contaminated internally. Eggs may be contaminated with all salmonella
types, but in cases of contaminated egg contents, S. Enteritidis is regarded as by far the most
important, if not the only one. In poultry, S. Enteritidis has a special ability to infect the
oviducts of laying hens, thus inoculating the egg before the shell is formed.
In 1997, a marked increase in egg-borne salmonellosis was observed, which might indicate an
increased occurrence in eggs. The large proportion of the total number of salmonellosis cases
accounted for by egg-borne salmonellosis, is explained by a high consumption of eggs. Thus,
12

every Danish person consumes approx. four eggs per week on average. On a yearly basis, this
totals more than one thousand millions of eggs which are used in Danish households.
The occurrence of S. Enteritidis in yolks and whites is believed to be the cause of the great
majority of human infections caused by this salmonella type. Non heat-treated fatty foods
containing raw eggs are assumed to be the main cause of egg-borne salmonella infections.
Salmonella will often be present in low numbers when the egg is laid, and any increase of the
numbers will depend on how and for how long the egg is stored. How great a risk an infected
egg may present, will depend on conditions of storage, handling, and preparation.
Action plans for the control of Salmonella in the market egg production have been initiated,
including, among other things, monitoring of Salmonella in breeding flocks and in production
flocks. If Salmonella is found in production flocks, or if a flock is suspected of being infected
with Salmonella, the eggs are sent to heat treatment.

3.4

Salmonella in broilers

Salmonella in broilers used to be an important source of human salmonellosis, but this

importance has been on the decrease in recent years. A voluntary action plan from 1989, and
the official action plan from 1994 for the control of Salmonella in poultry, has resulted in a
reduction in the number of salmonella positive broiler flocks sent to slaughter, from approx.
70% to approx. 10-15% by the end of 1997.
In 1997, the municipal food control units routine inspections of poultry meat at the retail
stages revealed that 5.7% of non heat-treated poultry products were contaminated with Salmonella (see Table 2).
Broilers are assumed to be the cause of only 1-3% of all salmonella infections. Among the
contributing causes to this may be mentioned consumer information campaigns pointing out
correct handling and heat treatment as the most important preventive measures.

3.5

Salmonella in pigs

An increasing occurrence of S. Typhimurium in pig herds has contributed noticeably to the

number of human salmonellosis cases since the beginning of the 1990es.
In 1995, a four-year action plan was initiated for the control of Salmonella in pig farming,
based on a monitoring of salmonella in finished produce that was started in 1992. The action
plan has brought about a reduction in the occurrence of S. Typhimurium in pig herds. Thus,
serological monitoring of all Danish pig herds has shown the number of salmonella infected
herds to be lower than 5% (spring, 1997).

13

The action plan has furthermore contributed to a reduction in the occurrence of Salmonella in
fresh pork from approx. 3% to approx. 1% in 1997. The occurrence of Salmonella in minced
pork at the retail stage is around 2%, or about twice that in pieces of fresh meat (see Table 2).

3.6

Salmonella in cattle

In general, beef is less often contaminated with Salmonella than poultry and pork. This may
be due to the fact that the slaughter process for cattle differs from those for pigs and poultry.
Analyses of beef at slaughterhouses and at the retail stage showed that Salmonella was
present in approx. 0.2-1% of samples in 1997. However, in minced beef the occurrence is
approx. 1%. S. Typhimurium and S. Dublin are the most frequent serotypes in cattle herds; but
the incidence is not known for a certainty, since Salmonella is not monitored in the primary
production. An action plan for Salmonella in cattle has not been established, but herds are
analysed whenever salmonellosis is indicated.
Table 2 shows findings of Salmonella in poultry and pork during the period 1994-1997.
Table 2. Occurrence of Salmonella in chicken and pork meat from the retail stage, 19941997.
Chicken

Pork

Non heat-treated

Heat-treated

Non heat-treated

% positive Number of % positive Number of % positive

samples
samples

Number of
samples

Heat-treated
% positive Number of
samples

1994

16.1

663

0.2

968

2.5

2,071

0.06

7,583

1995

6.9

492

0.3

1,294

1.2

3,733

0.1

12,090

1996

9.5

462

0.3

1,373

1.8

3,371

0.01

8,411

1997

5.7

404

624

1.4

2,235

0.06

5,144

14

4. CAMPYLOBACTER

4.1

Importance

Bacteria belonging to the genus Campylobacter are assumed to be one of the most important
causes of diarrhoea in humans all over the world today. In a number of European countries,
the number of registered cases of campylobacter infections exceeds the number of salmonella
infections.
Within the genus Campylobacter, the following species have most frequently been described
as the causes of campylobacteriosis in humans: C. jejuni subsp. jejuni, C. coli, C. lari, C. fetus
subsp. fetus, and C. upsaliensis. C. jejuni subsp. jejuni is reported to be the cause of 80-90%
or more of all registered cases.
Denmark has seen an increase in the number of registered campylobacter infections from
approx. 1,100 in 1992 to approx. 3,000 in 1996. In 1997, the number of registered cases was
approx. 2,700.
The infective dose for food-borne campylobacteriosis has not been established, but analyses
indicate that it may be as low as 500 bacteria.
The incubation period for food-borne campylobacter infections is reported to be 2-5 days in
most cases.
The symptoms are gastro-enteritis with watery diarrhoea, and in some cases, fresh blood in
the faeces is seen after 1-2 days. Concomitant to diarrhoea, affected general condition, fever,
and abdominal pains are often seen. Other symptoms may be nausea, vomiting, stomach
cramps, haemorrhagic diarrhoea, and arthralgia. The normal duration of symptoms is 5-10
days. Complications are relatively uncommon, but approx. 2% of patients develop a reactive
arthritis (incomplete Reiters syndrome). These symptoms may persist for weeks or months.
Reiters syndrome, comprising, in addition to reactive arthritis, conjunctivitis, ureteritis, and
dermatitis, is described as a sequela to acute campylobacteriosis. In rare cases, patients may
develop Guillain-Barrs syndrome (acute polyneuritis).
Only few mortality cases have been associated with campylobacter infections. International
assessments report one mortality case in 20,000 campylobacter infections.
The majority of human campylobacter infections occur as sporadic single cases or as minor,
family-related outbreaks. However, major outbreaks have been reported after ingestion of
unpasteurized milk, contaminated drinking water, or insufficiently heat-treated meat.
Sporadic cases occur most frequently in summer.

15

4.2

Ecology and occurrence

Members of the genus Campylobacter are microaerofilic (i.e. growing best in reduced oxygen
content in relation to atmospheric air). Oxygen tolerance varies within species and strains.
Human-pathogenic Campylobacter species do not grow at temperatures below 30C, with the
exception of C. fetus subsp. fetus, which is able to grow at 25C. Maximum growth
temperature is 42-43C. This means that Campylobacter does not propagate in refrigerated
foods. On the other hand, it has been demonstrated that Campylobacter survives better at 4C
than at room temperature. Campylobacter is more sensitive to heat treatment than most other
bacteria.
Campylobacter is sensitive to desiccation and to salt concentrations above 0.5%. Optimum
pH interval for growth is 6.5-7.5. Growth is inhibited at pH values below 5.1. Campylobacter
may, when exposed to physical or chemical stress factors, transform into so-called viable
non-culturable forms.
The natural habitat of the majority of Campylobacter species is the intestinal tract in warmblooded animals, including birds. The main reservoir of C. jejuni is probably poultry,
including chickens and turkeys. In 1997, the flock incidence in Danish broilers was 37%. Due
to intensive production methods and the horizontal transmission route of the bacteria, all
animals in infected flocks are likely to carry the bacteria. Poultry flocks may be infected via
drinking water, rodents, insects, dogs, cats, and humans (tools, footwear, work clothes). C.
jejuni is also frequently isolated from cattle, sheep, and goats.
C. coli is mainly associated with pigs, but is also isolated from chickens. C. lari is most
frequently found in the intestinal tract of birds. C. fetus subsp. fetus is mainly found in cattle
and sheep in which it is described as a cause of abortions.
The occurrence of Campylobacter in beef and pork for sale at the retail stages is usually low
(0.5-5%). Thus, in Danish mapping studies carried out in 1995, 1996, and 1997,
Campylobacter was demonstrated in 1% of samples of both beef and pork (see Table 3).
In similar mapping studies, the occurrence of Campylobacter in poultry meat was found to
range between 25 and 50% (see Table 3). The occurrence in poultry was found to be lower
during the winter months than in summer.
Campylobacter can be isolated from surface water as a result of faecal contamination from
wildlife, birds, and humans, or in ditches from fields where manure has been spread. In
countries where the water supply is based to some extent on surface water, outbreaks due to
contaminated water reservoirs have been described. Campylobacter has also been isolated
from seawater, and shellfish have been reported as causes of campylobacteriosis outbreaks.

16

Unpasteurized milk has been described as the cause of several major outbreaks of human
campylobacteriosis. The presence of Campylobacter in raw milk is primarily due to faecal
contamination, but a few cases of campylobacter mastitis in dairy cattle have been described.
Eggs have not been described as a source of campylobacter infections in humans.
The different sources of human campylobacteriosis, and their relative importance, have not
yet been fully clarified. During the period from May 1996 to September 1997, the Danish
Zoonosis Center carried out a case-control study concerning sporadic human
campylobacteriosis. The result of the study indicates a number of factors causing increased
risk of campylobacteriosis. These are: foreign travel within four weeks of the onset of disease;
ingestion of inadequately heat-treated poultry; ingestion of beef or pork which has been
grilled/barbecued or roasted over open fire; ingestion of drinking water having a foul smell or
taste, in combination with private water supplies. The development and implementing of
suitable typing methods would contribute substantially to the assessment of the relative
importance of individual infection sources of human campylobacteriosis.
Results of mapping studies and monitoring programmes during the period 1995-1997 are
presented in Table 3.
Table 3. Occurrence of Campylobacter in foods, 1995-1997.
Product type

Danish
produce

Imported

1997

1996

1995

%
positive
samples

Number
of
samples

%
positive
samples

Number
of
samples

%
positive
samples

Number
of
samples

Non heattreated chicken

25

637

41

186

40

133

Non heattreated turkey

29

238

24

103

25

191

Other poultry

35

77

22

Non heattreated chicken

31

320

41

88

68

34

Non heattreated turkey

17

140

28

43

25

24

Other poultry

25

299

35

88

50

14

Beef

0.7

573

198

395

Pork

495

177

408

Venison

202

19

144

Vegetables

154

Fruits

138

Shellfish

186

17

5. YERSINIA ENTEROCOLITICA

5.1

Importance

Infections caused by Yersinia enterocolitica were largely unknown until the early 1960es,
when the first cases of gastro-enteritis caused by this bacterium were diagnosed.
Since then, yersiniosis has been diagnosed with increasing frequency until a culmination in
1985 with approx. 1,500 cases. Subsequently the number has gradually decreased, and 426
cases were registered in 1997. These figures comprise positive cultivations of faecal samples
from patients suffering from gastro-enteritis. To these should be added an unknown number
of diagnosed cases of increased antibody contents in serum. The true incidence is not known,
as the course of the disease varies from mild cases that are easily overcome, to severe cases
requiring hospitalization. There are indications that the infection is considerably more
widespread than evidenced by the number of diagnoses. Thus, antibodies have been found in
8% of Danish donor blood samples. In a German study, antibodies were found in up to 39%
of donor blood samples.
Yersiniosis in humans usually manifests itself as gastro-enteritis. The disease varies from a
slight stomach trouble to a severe and protracted course. In some cases the intestinal lymph
nodes are affected, which may cause severe pains similar to those of appendicitis.
Furthermore, localized infections elsewhere in the organism are sometimes seen, and in a few
cases septicaemia. The incubation period varies from approx. 3 to 10 days in most cases.
In some patients also a secondary symptom complex is seen, characterized by reactions from
especially skin and connective tissues. Among other things, tumefaction of joints may occur,
so-called reactive arthritis, of such severe nature that patients may be disabled for several
months. Characteristically, persons having the tissue type HLA-B27 are particularly exposed
to these sequelae. Thus, approx. 80% of patients with sequelae have this tissue type, which is
shared by only approx. 10% of the Danish population.
Especially the yersinia types O:3 and O:9 exhibit a tendency to incur late reactions. These
types are widespread in Europe, whereas in the USA, where type O:8 is predominant, late
reactions are rarely seen.
The sequelae, being caused by the reaction of the organism to liberation of endotoxin from
the cell walls of the bacteria, occur relatively frequently after yersinia infections. However,
such reactions may also be seen after other bacterial infections.
In Denmark, virtually all pathogenic strains belong to biotype 4, serotype O:3, while strains
belonging to biotype 1 are regarded as non-pathogenic environmental types.

18

The infective dose is believed to be in the order of 105-106 bacteria, but considerable variation
must be taken into account, depending on the immunological and overall health status of
exposed persons.

5.2

Ecology and occurrence

Y. enterocolitica is capable of growth at temperatures close to 0C, and may thus grow in
refrigerated foods. Due to its facultatively anaerobic properties (i.e. growing in the presence
as well as absence of oxygen), it is also capable of growing in vacuum packed or modified
atmosphere packed foods.
With respect to its salt and pH tolerance, Y. enterocolitica does not differ much from other
intestinal bacteria. It can grow in foods having a salt concentration up to 5-7% salt in the
aqueous phase; i.e. in relatively salty foods such as brine-pickled ham, bacon, or cured saddle
of pork. It grows in the pH interval of approx. 4-9, with its optimum at 7.2-7.4. Y.
enterocolitica is rather heat sensitive and will be inactivated by heat treatment at 60C for a
mere 1-3 minutes. It is also quite sensitive to ionizing radiation. Experiments seem to indicate
that Y. enterocolitica has a poor ability to grow in a mixed flora with other cold-tolerant
bacteria.
Light salting in connection with vacuum packing or modified atmosphere packing will,
provided optimum hygienic conditions of handling and packing, result in a long shelf-life for
refrigerated foods. This involves a risk of improved possibilities for cold-tolerant bacteria
such as Y. enterocolitica to multiply to infective levels even under marginal growth
conditions. In a Danish study of vacuum-packed delicatessen goods, carried out in 1990,
pathogenic types of Y. enterocolitica could not be demonstrated. On the other hand, nonpathogenic types were isolated in some cases, which seems to indicate growth conditions also
for pathogenic types.
In a mapping study of raw and non heat-treated pork products, Y. enterocolitica was
demonstrated in 1.2% of 508 samples of preserved, non heat-treated products such as bacon
and smoked fillet. In raw pork, the bacteria could be demonstrated in 3.5% of 398 samples of
minced meat. In cut-out pieces of meat, the bacteria were found in 1.4% of samples (see
Table 4).
Already in the early 1960es, pigs were associated with Y. enterocolitica, because these
bacteria were found in a study of the natural intestinal flora of pigs. Since then, numerous
studies have shown healthy slaughter pigs to be carriers of pathogenic types of Y.
enterocolitica. Occurrences of 25% in faeces and more than 80% in tonsils have been
demonstrated. In quantitative studies, levels up to 104-105 pathogenic Y. enterocolitica per g
of faeces have been found.
In a Danish study of the incidence in Danish pig herds, 82% were found to be infected. It was
not possible to demonstrate any relation between the occurrence of the bacteria and the

19

production system of the farms. Thus, the bacteria are also widespread within the SPF system
(specific pathogen-free pig stocks).
Pigs are symptom-free carriers, and Y. enterocolitica has been found to be widespread among
pigs in most countries where published studies have been carried out. This applies to
countries such as England, Japan, New Zealand, and the USA. The serotypes, however, vary
appreciably from one country to another. In the different countries, the types found in pigs
and the types found to cause human yersiniosis are coincident.
The transmission routes of Y. enterocolitica have not yet been fully clarified; but there can
hardly be any doubt that pigs constitute the primary source of human yersiniosis.
An obvious infection risk is cross-contamination from infected raw pork to foods which,
when refrigerated, have sufficient keepability to permit the bacteria to multiply to infective
levels. Studies have shown that this can happen within 4-5 days.
Milk has been the source of several major outbreaks; but in nearly all cases, a relation to pigs
has subsequently been found.
Results of the 1997 mapping study are presented in Table 4.
Table 4. Occurrence of Yersinia enterocolitica in pork from retail stages, 1997.
Product type

Number of samples

Y. enterocolitica
demonstrated
(% positive)

Cut-out pieces

279

1.4

Minced meat

398

3.5

Processed minced meat

128

1.6

508

1.2

1,326

2.0

Preserved, non heat-treated products

(e.g. bacon, fillet)
Total

20

6. ESCHERICHIA COLI O157

6.1

Importance

Since the early 1980es, verotoxin (VT)-producing Escherichia coli, serotypes O157:H7 and
O157:H-, (VTEC O157) has been known as an important food-borne pathogenic zoonotic
bacterium. It has caused a number of very large outbreaks in various countries; and VTEC
O157 infections are characterized by occasionally concomitant severe complications that
ultimately may be lethal.
VT-producing E. coli serotypes O157:H7 and O157:H- are characterized by producing toxins
which may kill vero cells, which is a renal cell line from the African Vero monkey. The
toxins, designated VT1 and VT2, are closely related to the shigatoxin, which is produced by
the bacterium Shigella dysenteria type 1, and are referred to as verotoxin, verocytotoxin,
Shiga Like Toxin (SLT), or merely shigatoxin (ST).
Verotoxin is formed by several different E. coli serotypes, collectively referred to as VTproducing E. coli (VTEC). More than 160 different serotypes are known as VT-producing,
but their pathogenic potential has not been clarified for all serotypes. At the international
level, increasing attention is focused on serotypes other than O157:H7 and O157:H-.
Primarily, this goes for the serotypes O26:H11, O26:H-, O104:H21, O111:H-, and O145:H-,
all of which have been reported as causes of food-borne infections.
In Denmark, serotype O157 was the cause of one-third of all VTEC cases in 1997, while
types other than O157 were responsible for two-thirds of cases. However, international
experience shows E.coli O157:H7 to be by far the most frequent cause of VTEC outbreaks.
E. coli O157 is demonstrated by identification of the O157 antigen. Since serotype O157 is
not inevitably VT-producing, it is necessary always to analyse for toxin production and a
number of other virulence characteristics associated with pathogenic VTEC. Diagnostic
means of demonstrating VTEC serotypes other than O157 in foods are as yet limited, and the
elucidation of infection sources of disease in humans is therefore difficult.
Those serotypes of VTEC that are most often associated with disease cases, are also referred
to as enterohaemorrhagic E. coli (EHEC). The term enterohaemorrhagic refers to the typical
symptoms of VTEC O157 infection, haemorrhagic diarrhoea. However, the symptoms may
also be non-complicated watery diarrhoea or asymptomatic excretion. The incubation period
of the infection varies from 1 to 7 days, 3-4 days being typical. In some cases (0-10%) the
infection is attended by potentially lethal complications in the form of acute renal failure and
anaemia: haemolytic uraemic syndrome (HUS). Children seem to be particularly susceptible
to HUS, and the infection may be lethal.

21

The first registration of VT-producing E. coli O157:H7 as the cause of food-borne disease
outbreaks was in 1982 in the USA, where contaminated hamburgers from a fast-food
restaurant chain resulted in haemorrhagic diarrhoea. Since then, numerous small and large
outbreaks of VTEC O157 have been reported. The largest outbreak till now was registered in
Japan in the summer of 1996, involving more than 9,000 persons of which approx. 800 were
hospitalized, and 11 died.
In many countries, the number of VTEC O157 cases has shown an increasing tendency
through the 1990es. In England and Wales, 411, 792, and 660 cases were reported in the years
1994, 1995, and 1996, respectively, corresponding to between 0.8 and 1.52 cases per 100,000
inhabitants. However, the actual number is assumed to be considerably higher.
Among the Nordic countries, Finland and Sweden have reported outbreaks. In Sweden, a
pattern of outbreaks was observed for the first time in the autumn of 1995, with up to 10-15
registered disease cases within a few weeks. The sources of the outbreaks were never brought
to light, but some of the cases were ascribed to raw milk from a dairy herd infected with
VTEC O157. Until the 1995 outbreak, Sweden had reported 0-3 cases per year; but after the
outbreak, 1-2 cases per week were diagnosed.
Till now, Denmark has been spared outbreaks of VTEC, and only few sporadic disease cases
are registered every year. During the period 1986-1996, the Danish Serum Institute reported
60 cases, of which 23 involved serotype O157. In 1997, 12 sporadic cases of VTEC O157
were diagnosed. This figure, being high in relation to Danish conditions, is primarily ascribed
to improved diagnostics and increased awareness of the bacteria.
The infective dose of VTEC O157 is low. A few hundred bacteria may cause disease; thus,
propagation in foods is not necessary. There have also been reports of communicative
infection, which fact is of special importance in relation to outbreaks in families with young
children. Infection between siblings and dissemination in kindergartens are well-known
phenomena. Healthy carriers may therefore present a considerable infection risk.

6.2

Ecology and occurrence

E. coli O157:H7 grows at temperatures between 8 and 45C, and survives refrigeration and
freezing for months with no substantial reduction. By pasteurization or heating of foods to a
core temperature of 75C, elimination is ensured.
The lower pH limit for growth is stated to be around 4-4.5, but the pH tolerance range is
considerably wider. Thus, E. coli O157:H7 may survive in standard culture media at pH 2.
The growth of the bacteria is inhibited by 4% NaCl at 10C, and at a NaCl concentration of
8%, growth at 37C in standard culture media will cease.
E. coli is an intestinal bacterium of normal occurrence in humans and in most warm-blooded
animals. In ruminants it is also usual that a portion of the intestinal flora consists of different

22

VTEC serotypes. This fact is illustrated in analyses of beef, where 5-20% of samples being
contaminated with different VTEC serotypes is not an unusual occurrence.
VTEC serotype O157 is often demonstrated in cattle, sheep, and red deer. In foreign studies, a
VTEC O157 incidence of 0-4.9% in cattle is reported; and studies in Denmark seem to
indicate an essentially similar incidence in Danish cattle. The figures do not reveal the facts
that there are significant seasonal fluctuations, and that the incidence in cattle also appears to
decrease with increasing age. In studies of one high-level infected English cattle herd it was
reported that up to 68% of heifers and 14% of lactating cows may excrete E. coli O157.
E. coli O157 may be demonstrated in foods; but in general, available studies indicate low
occurrences, often less than one per cent. A Danish mapping study in 1996 showed that
among 2,112 samples of minced beef and pork from the retail stage, 7 samples were
contaminated with E. coli O157, including 4 samples contaminated with VTEC O157. In
1997, one of 1,100 beef samples was found to be contaminated with VTEC O157, and 4
samples with non-VT-producing E. coli O157 (see Table 5).
VTEC O157 has been isolated from pigs in a few cases; but pigs are not normally regarded as
a reservoir of VTEC O157, and findings in pork may quite well be due to cross-contamination
from other meat types.
At the international level, the majority of outbreaks are associated with foods containing beef,
and insufficiently heat-treated minced beef is often the most exposed food item.
Unpasteurized milk, yoghurt, water, apple cider (juice), sprouts, lettuce, salami, venison,
bathing water, etc. have likewise been reported as sources of outbreaks, and all potentially
faecally-contaminated foods must be considered likely to cause outbreaks. Accordingly, the
majority of E. coli O157:H7 infections are classical food-borne zoonotic infections.
Cattle infected with E. coli O157:H7 will rarely exhibit clinical symptoms. In many herds,
individual animals excrete bacteria, but the excretors will be different animals in each case.
However, there is a need of studies to provide sufficient insight in the spreading of the
bacteria in the animal reservoir and to form the basis of a regular eradication plan. As yet,
methods for an adequately certain identification of infected animals are not available.
Results of mapping studies during the period 1996-1997 are shown in Table 5.

23

Table 5. Occurrence of Escherichia coli O157 in fresh meat products from the retail stage,
1996 and 1997.
Product type

Number of
samples
1997 / 1996

Results (% positive samples)

VT E. coli O157
1997
1996

non-VT E. coli O157

1997
1996

Minced beef

1,100 /1,584

0.1

0.1

0.4

0.1

Minced pork

300 / 528

0.4

0.4

Mutton and lamb

300 /

0.7

Deer

200 /

1.0

0.3

0.2

Total number of
samples

24

1,900 / 2,112

0.2

0.1

7. LISTERIA MONOCYTOGENES

7.1

Importance

Listeriosis is a severe disease caused by L. monocytogenes. Listeriosis manifests itself as

meningitis and encephalitis, or as septicaemia. The disease mainly affects persons who are
decrepit or immunodeficient due to other disorders; but also healthy persons may be attacked.
The mortality rate may be above 50% for patients in high-risk groups, but only a few per cent
in otherwise healthy patients. Pregnant women constitute a particular high-risk group. The
woman rarely has any symptoms, or only slight flu-like symptoms, whereas the foetus will be
infected and is aborted or born prematurely with infection. L. monocytogenes may also cause
transitory gastric infection, but this disease form is rarely diagnosed.
The incubation period of human listeriosis is reported to be between 1 and 70 days.
The infective dose for humans is more or less unknown; but the general presence of the
bacteria in numbers below 100/g in many raw foods is not assumed to constitute any risk of
disease, even for specially exposed persons. When the occurrence of L. monocytogenes in
foods is compared with the number of listeriosis cases, it seems obvious that many people are
capable of tolerating far higher bacterial levels without being ill. No actual dose/response
curves exist; but internationally there is a general agreement on a safety limit of 100/g.
However, some countries still require the absence of L. monocytogenes in ready-to-eat
products.
In the first half of the 1980es, approx. 10-20 cases of human listeriosis were registered in
Denmark every year. In 1985-1986, an epidemic was registered, after which the number of
diagnosed listeriosis cases increased to approx. 30-40 per year. This level remained
unchanged until 1992. Prior to the first epidemic in 1986, listeriosis was not registered
systematically, so it is not known whether the number of listeria infections actually did
increase during the 1980es.
Many of the cases in 1985-1986 and in 1989-1990 were caused by a particular type of L.
monocytogenes: serotype 4b, the so-called EPI type. This type is also known to have caused
several major outbreaks in other countries. From 1992 through 1995, less than 30 cases were
registered per year, but in 1996 a total of 39 cases was diagnosed, the largest number since the
1986 epidemic. Typing of isolates from 1996 has shown many different types, but only a few
of the EPI type. 33 cases were diagnosed in 1997.
The majority of human infections are sporadic, but several major outbreaks have been
described. Dairy products, particularly including soft cheeses, coleslaw, meat products such
as pt, sausages, and gas-packed delicatessen goods, are examples of food items which have
caused outbreaks of human listeriosis in other countries. In Denmark, it has not been possible

25

to demonstrate any relation between the intake of any particular food item and cases of human
listeriosis.
Even though the EPI type is predominant in relation to outbreaks of listeriosis, all types of L.
monocytogenes must be considered potentially pathogenic. Thus, in connection with sporadic
listeriosis cases, many different types are isolated. In experimental studies, the EPI type was
not found to be particularly virulent in comparison with other types.

7.2

Ecology and occurrence

A number of characteristics enable L. monocytogenes to grow in many different

environments. Its nutrient demands are very modest, it grows in the presence as well as the
absence of oxygen (facultatively anaerobic), has a wide pH range for growth (approx. 4.5-9),
grows at temperatures between 0 and 45C, and is able to multiply at high salt concentrations
(10% salt in the aqueous phase, corresponding to an aw value of 0.92). It does not survive low
pasteurizing (72C for 15 seconds) and is furthermore usually sensitive to most disinfectants.
L. monocytogenes is widely distributed in the nature: in wildlife, plants, and soil, its natural
habitat being earth and decaying plant material. Survival and growth of L. monocytogenes in
the earth depends on soil type, moisture, and temperature. L. monocytogenes occurs with
varying frequencies in faeces from healthy animals and humans; consequently, it is also
usually found in sewage and surface water. The occurrence in faeces varies considerably
between different animal species. Danish studies have shown that among cattle, approx. onethird of the animals are healthy excretors of L. monocytogenes. Among pigs, on the other
hand, only a few per cent are healthy excretors, and among humans, only a few per cent of the
healthy population excrete L. monocytogenes in faeces.
L. monocytogenes occurs naturally in all raw foods.
In the mapping studies of the municipal food control units concerning vegetables, lettuce, and
sprouts in 1996-1997, L. monocytogenes was demonstrated in 7% of 351 samples by
qualitative analysis. In analyses of 737 samples by a semi-quantitative method, L.
monocytogenes was demonstrated in 11 samples at levels above 10/g, including 9 samples at
levels above 100/g. Two samples contained L. monocytogenes at levels above 10,000/g.
The average occurrence of L. monocytogenes in raw milk is 2.2%, determined on the basis of
5,100 samples collected worldwide. L. monocytogenes has favourable conditions of growth in
milk and soft cheeses.
In raw meat, it is usually found in low numbers, due to the fact that pigs and cattle are natural
carriers of L. monocytogenes in the throat and intestinal tract. Since L. monocytogenes is coldtolerant and at the same time relatively resistant to unfavourable external conditions, it may
readily settle in the food production environment and is often isolated from production
premises and cold-storage rooms at slaughterhouses. It adheres easily to surfaces such as
stainless steel, forming a bio-film that may be difficult to remove.
26

L. monocytogenes is often present in minced beef and minced pork, where it has occasionally
(3-4%) been found in numbers above 100/g.
A Danish study has shown that 9% of heat-treated meat products from the retail stage contain
L. monocytogenes (see Table 6). This incidence is predominantly due to cross-contamination
of meat products after the heat treatment, especially through handling such as slicing and
packing. The occurrence of L. monocytogenes in heat-treated products constitutes a special
problem, because it has particularly favourable conditions of growth when the competing
flora has been eliminated. This is illustrated by a Danish study showing that 3% of samples of
heat-treated meat products contain more than 100 per g. For preserved, non heat-treated meat
products, the corresponding percentage was only 0.6, in spite of the fact that 23.5% of the
products in this category contained L. monocytogenes (see Table 6).
L. monocytogenes is not likely to occur on raw fish caught in non-contaminated waters; but
on the other hand, it quite readily settles in the cool fish processing environment, on crates,
tools, machinery, etc.
L. monocytogenes is often found in cold-smoked salmon. Studies from many different
countries show that 10-15% of analysed samples are L. monocytogenes positive. A few
studies show occurrences in as much as one-third of samples.
In a Danish study in 1995-1996, L. monocytogenes was isolated in 34% of 190 samples of
cold-smoked salmon from 10 different manufacturers immediately after production. The
levels were low, however; usually less than 10/g. At the expiry of the use-by date (after 3-8
weeks), 41% of the samples were L. monocytogenes positive. In 8% of the samples, the levels
were higher than 100/g (see Table 6).
The mapping study showed comparative results for cold-smoked Greenland halibut and for
pickled salmon and pickled Greenland halibut.
A previous study of heat-treated fish products showed an L. monocytogenes occurrence of 5%
of 74 samples analysed during the first days after production.
In a mapping study of delicatessen goods, L. monocytogenes was demonstrated in 3-12% of
the heat-treated products (see Table 7). The lowest occurrence, 3%, was found in saveloy.
None of the samples had contents above 10 L. monocytogenes per g. The highest occurrence,
12%, was found in pork roll and poultry sausage. 2% of pork rolls and 7% of poultry sausages
contained more than 100 L. monocytogenes per g. These studies indicate that for this type of
foods, which are often sold with a relatively long shelf-life, there is a need of initiatives to
prevent growth of L. monocytogenes. Similar considerations may apply to preserved, non
heat-treated fish products.
Results of the mapping studies are presented in Tables 6 and 7.

27

Table 6. Occurrence of Listeria monocytogenes in foods from the retail stage in Denmark,
1995.
Product type

Number of
samples

Found in 25 g
(%)

>10/g
(%)

>100/g
(%)

Raw meat

343

30.9

12.6

3.6

Meat products, heat-treated

431

9.0

5.2

2.4

Pt

341

1.8

0.3

0.3

Preserved meat products,

non heat-treated

328

23.5

2.4

0.6

Raw fish

232

14.2

3.2

0.5

Preserved fish products,

non heat-treated

335

10.8

5.1

1.8

Table 7. Findings of Listeria monocytogenes in delicatessen goods, 1994/95.

Product
type

Packing date

Number
of
samples
Qualitatively

Number
%
of
positive
positive samples
samples

Expiry date

Quantitatively, per g

Quantitatively, per g

<10

10-100

>100

<10

10-100

>100

Hot dog

175

12

175

160

Pork roll

155

18

12

154

150

Smoked

140

20

14

140

140

Saveloy

165

165

165

Poultry

130

16

12

125

121

35

11

31

34

34

fillet

sausage
Smoked
breast of
turkey

28

8. STAPHYLOCOCCUS AUREUS

8.1

Importance

Staphylococcus aureus is an occasionally pathogenic micro-organism which is present as a

natural part of the flora on skin and mucous membranes, and which therefore often occurs in
low numbers in foods. Some S. aureus are capable of producing a toxin which is called
staphylococcal enterotoxin because the most pronounced symptoms affect the intestinal tract;
but the majority of S. aureus strains are not enterotoxin-producing. Actually, the toxin is a
neurotoxin which acts on the vomit centre of the central nervous system. The toxin is formed
during the growth of the bacterium, and intoxications occur when a food item containing preformed toxin is ingested. Accordingly, S. aureus causes food-borne intoxication in contrast to
food-borne infection.
S. aureus is known to cause wound infections and abscesses. Therefore, S. aureus
intoxications may also occur when a person, infected by an enterotoxin-producing strain on
his/her hands, transfers the bacteria to foods during handling or preparation.
Staphylococcal intoxications are relatively frequent as well as unpleasant. Characteristically,
intoxication symptoms set in shortly after the ingestion of a toxin-containing food item
(normally after 1-6 hours), with acute malaise, headache, shivering, vomiting, and diarrhoea.
Normally, the intoxication is of short duration, usually with full recovery within 24 hours.
It is difficult to state any number of cases. Every year a modest number of outbreaks is
reported, but due to the brief course of the intoxication, with full recovery after a day or so,
the great majority of cases will never come to the notice of the health authorities.
Normally it is assumed that the number of S. aureus must reach 106 per g of food in order to
cause an intoxication.

8.2

Ecology and occurrence

S. aureus has its growth temperature optimum around 37C and growth range from approx.10
to 45C. It is relatively sensitive to heat treatment and will be eliminated by a heat treatment
equivalent to low pasteurizing. The toxin, on the other hand, is highly heat stable and will not
be inactivated by less than prolonged boiling.
S. aureus is characterized by its ability to grow at very low water activities (aw), down to 0.86.
Thus, it is the most salt tolerant of the known pathogenic bacteria.
S. aureus is highly resistant to desiccation, which is part of the reason for its frequent
presence on surfaces such as skin and mucous membranes, as well as in dust. It is so
commonly occurring that it must be assumed to be present in low numbers in most raw foods.
29

S. aureus is capable of growth within the pH interval from approx. 4 to 9.

Salted foods, favouring salt tolerant micro-organisms, constitute a risk of growth of S. aureus,
resulting in potential toxin formation. Bacon, pasta products, and salted mushrooms are
examples of salted or desiccated products that have given rise to intoxications.
Staphylococci grow best in foods where the competition from other bacteria has been
eliminated, e.g. heat-treated foods. Characteristically, it does not compete successfully with
other bacteria, which is why it is normally not assumed to present any problem in raw,
unsalted foods. Whenever a heat-treated food item is handled, there is a risk of transferring
staphylococci from their primary reservoir, skin and mucous membranes. If such food items
are inadequately refrigerated or frozen, there is a risk that any staphylococci present will have
an opportunity for propagation and toxin formation.
Intoxications from many different foods have been seen. Among numerous examples, the
following may be mentioned: hash kept hot at too low a temperature; hard-boiled eggs used at
an Easter egg hunt; hot-stored barnaise and hollandaise sauce not boiled; desserts left to
stand too long on the kitchen worktop; and boiled potatoes kept outside the fridge overnight
and subsequently used in potato salad.
Results from the 1997 mapping study [4] of Staphylococcus aureus in hot-stored, ready-to-eat
dishes from the retail stage are shown in Table 8.
Table 8. Occurrence of Staphylococcus aureus in samples of hot-stored dishes from the retail
stage, 1997.
Staphylococcus aureus
Number of analyses
Number of positive analyses

1,309
1

% positive analyses

0.08

Viable counts in positive analyses

100

Storage temperature (C)

60

30

9. CLOSTRIDIUM PERFRINGENS

9.1

Importance

Clostridium perfringens is one of the most frequent causes of food-borne disease. The disease
in an intoxication caused by a toxin which the bacterium liberates in the small intestine. The
symptoms mainly occur in the posterior part of the intestinal tract, with intense stomach pains
and violent diarrhoea. Furthermore, headache and fever are often seen, but rarely vomiting.
The course of the disease, which is caused by a sub-type of C. perfringens, type A, is usually
brief and non-complicated. The incubation period is normally from about 8 to 12 hours.
It takes a large number of bacteria, approx. 106 per g of food, to bring about intoxication.
A less frequent type of food-borne C. perfringens infection is caused by type C. This type
causes an infection which gives rise to a necrotizing enteritis (i.e. necrosis of intestinal
tissues). The disease is very serious, often lethal. Symptoms set in suddenly in the form of
violent stomach pains. The disease is very rare and has been observed only a few times in
Europe since the early 1960es.

9.2

Ecology and occurrence

C. perfringens has its growth temperature optimum around 37C and growth range from
approx. 10 to 50C. The bacterium is spore-forming. When present in spore form in foods, it
is very resistant to heat treatment; however, the heat resistance of the spores varies
considerably. Thus, some spores are readily killed by boiling, whereas others will be able to
survive boiling for a long time. The vegetative bacteria are easily inactivated by heat
treatment. Under favourable conditions, the bacterium grows very rapidly, for which reason
spores, having survived heat treatment, will have a good opportunity of growth during the
cooling phase. Its very wide growth range enhances its opportunities of multiplication.
C. perfringens is anaerobic (i.e. growing best in the absence of oxygen), but tolerates the
presence of oxygen better than most other clostridia. Thus, it will be able to grow
immediately below the surface of foods, preferably together with other bacteria helping to
reduce the oxygen concentration.
C. perfringens occurs naturally in the intestinal tract and in faecally contaminated material.
Due to its spore-forming ability, it is capable of surviving under unfavourable conditions
through long periods of time; consequently, it is often found in dry environments, e.g. in earth
and dust. It is common in raw meat, vegetables, and dried foods such as spices.
An interesting feature of C. perfringens is the fact that its toxin formation takes place
especially in relation to sporulation, i.e. the transformation of the vegetative bacterial cell to a
spore. This process, which is effected only with difficulty in foods or in the laboratory,
31

preferably takes place in the alkaline environment in the anterior part of the intestinal tract.
The highly acidic environment in the ventricle will kill a large proportion of the vegetative
bacteria, which fact explains why it takes approx. 106 bacteria per g of food to bring about an
intoxication.
It follows from the above that a thorough re-heating of foods containing C. perfringens will
eliminate the vegetative cells and thereby prevent intoxication. Furthermore, the toxin is heat
sensitive, so any pre-formed toxin will be inactivated by thorough heat treatment.
Analyses of foods that have given rise to intoxications often reveal only modest numbers of
bacteria, since C. perfringens often dies off, autosterilizes, during storage of the food.
Food, e.g. meat, which gives occasion for a C. perfringens intoxication, often contains a low
initial number of spores and has been exposed to a slow and inadequate cooling during
preparation, or has been kept hot at too low a temperature. Furthermore, the food has typically
often been insufficiently re-heated. Large portions of mixed stew, difficult to cool down and
difficult to re-heat, is a typical example of a food type which has given rise to intoxication.
Lasagne is another typical example.
Results of the 1997 mapping study [4] of C. perfringens in hot-stored ready-to-eat dishes
from the retail stage are shown in Table 9.
Table 9. Occurrence of Clostridium perfringens in samples of hot-stored dishes from the
retail stage, 1997.
Clostridium perfringens
Number of analyses
Number of positive analyses
% positive analyses
Viable counts in positive analyses; average (min.-

1,262
3
0.2
1,200 (10-2,700)

max.)
Storage temperature (C); average (min.-max.)

32

57 (48-65)

10. BACILLUS CEREUS

10.1

Importance

Bacillus cereus gives rise to two different types of food intoxication. The emetic syndrome,
dominated by rapidly occurring vomiting, and the diarrhoeic syndrome, dominated by later
occurring diarrhoea.
In the diarrhoeic syndrome, the symptoms usually set in 8-16 hours after the ingestion of food
containing B. cereus. Stomach pains, watery diarrhoea, and rectal cramps occur. Nausea and
vomiting are rare. The symptoms, seldom lasting for more than 12 hours, are caused by an
enterotoxin, a large protein molecule which is sensitive to trypsine.
In the emetic syndrome, vomiting occurs very soon, from less than 1 hour to approx. 5 hours,
after the intake of contaminated food. Diarrhoea is also observed in many cases. The emetic
syndrome is caused by a small peptide having a molecular weight of less than 5,000. The
toxin is highly heat resistant as well as stable towards trypsine and pepsine. It is not antigenic
and cannot be demonstrated by immunological methods.
A relatively large number of bacteria must be ingested before symptoms of intoxication set in.
For intoxications of the emetic type, a requirement of 105-108 B. cereus per g of food has been
described; and according to various studies, the diarrhoeic type requires the ingestion of a
similar number.

10.2

Ecology and occurrence

B. cereus is capable of growth in the temperature interval from approx. 10 to 48C, with its
optimum at 37C. Some strains, however, are able to grow at lower temperatures, from 5-7C
to around 37C. B. cereus is spore-forming. The spores are resistant to physical effects and
can survive boiling. Spores of the cold-tolerant types survive boiling for some minutes,
whereas spores of the other types survive for somewhat longer, up to 30 or 60 minutes. B.
cereus does not compete successfully in mixed cultures, but grows better in pure culture.
B. cereus is widely distributed and is commonly found in a large number of foods such as
dairy products, rice, spices, and other dried products. Due to its spore-forming ability, it is
highly resistant to physical effects such as desiccation, which is why it is widespread in earth
and dust. Thus, it also forms a normal part of the flora in cereals, spices, and vegetables.
The diarrhoeic syndrome is caused by a large number of foods, such as meat and vegetable
dishes, custards, puddings, and other desserts that have undergone a form of heat treatment.
Since the bacterium is so commonly occurring and resistant to heat treatment, it will be
present in many heat-treated dishes in relatively low numbers, but without any competing
concomitant flora. Slow cooling or too warm storage possibly in combination with
33

insufficient re-heating will provide opportunity for growth and may result in finished dishes
containing very high numbers of B. cereus. While the emetic toxin, which is a small
molecule, is highly heat resistant, the diarrhoeic toxin sensitive to heat. Therefore, thorough
heating will inactivate vegetative bacteria as well as any diarrhoeic toxin that might be
present.
The emetic syndrome is almost invariably related to rice dishes that have been kept nonrefrigerated for too long. B. cereus is to be regarded as a natural part of the flora in raw rice.
The spores of serotype H1, which is most frequently associated with outbreaks caused by rice
dishes, are considerably more heat resistant than those of other serotypes.
Results from the 1997 mapping study [4] of the occurrence of Bacillus cereus are presented in
Table 10.
Table 10. Occurrence of Bacillus cereus in samples of hot-stored dishes from the retail stage,
1997.
Bacillus cereus
Number of analyses

1,309

Number of positive analyses

10

% positive analyses

0.8

Viable counts (per g) in positive analyses;

1,500 (100-11,000)

average (min.-max.)
Storage temperature (C); average (min.-max.)
* Sampled directly from the oven.

34

69 (48-126*)

11. ANTIBIOTIC RESISTANCE

11.1

Monitoring of antibiotic resistance

In Denmark, a national monitoring of antibiotic resistance in bacteria from production animals,

foods, and humans has been carried out since 1996, as well as a monitoring of the consumption of
antibiotics. The monitoring is a joint co-operation between the Danish Veterinary Laboratory, the
Danish Veterinary and Food Administration, the Danish National Serum Institute, the Danish
Plant Directorate, and the Danish Medicines Agency.
As part of the monitoring, the trends in the consumption of antimicrobial agents for veterinary
and human therapeutic use are followed, as well as the trends in the consumption of those
antimicrobial agents that are used as growth promoters in animal feedstuffs. Furthermore, the
incidence of resistance in a number of pathogenic bacteria, including Enterococci, Streptococci,
Staphylococci, Listeria monocytogenes, Salmonella, Campylobacter, and Yersinia enterocolitica,
is monitored. Likewise, resistance conditions in the indicator bacteria Escherichia coli,
Enterococcus faecium, and Enterococcus faecalis are monitored. Table 11 lists those bacterial
species from animals, foods, and humans, which are routinely monitored for antibiotic resistance.
The monitoring provides data that can be used as a support in the selection of antibiotics for the
treatment of diseased animals and humans. Further, the monitoring results can be used to identify
any resistance problems that might be due to inappropriate uses of antibiotics.
The monitoring results are summarized in annual reports: Consumption of antimicrobial agents
and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in
Denmark [5].

35

Table 11. List of bacteria included in the antibiotic resistance monitoring from stable to
table in Denmark.
Bacteria

Animals

Foods

Healthy

Diseased

E. coli

Enterococci

Streptococci

Staphylococci

L. monocytogenes

Healthy

Diseased

(+)

(+)

+
+

+
+

Salmonella

Campylobacter

Y. enterocolitica

36

Humans

12. SUMMARY AND CONCLUSION

Sub-report No. 5, dealing with microbial contaminants, describes background data and
analysis programmes for the most important pathogenic food-borne bacteria in Denmark,
carried out during the period 1993-1997. At present, actual monitoring programmes have
been initiated only for Salmonella and Campylobacter, which are the two bacterial species
causing the largest number of gastro-intestinal infections. The results for Yersinia
enterocolitica, Escherichia coli O157, Staphylococcus aureus, Bacillus cereus, Clostridium
perfringens, and Listeria monocytogenes were based on mapping studies illustrating the
current situation with respect to the occurrence in foods.
The results for the occurrence of Salmonella in chicken products (non heat-treated) from the
retail stage show a decrease from 16.1% in 1994 to 5.7% in 1997. In pork products (non heattreated), the occurrence was reduced from 2.5% in 1994 to 1.4% in 1997. Since Salmonella
Typhimurium DT104, multi-resistant, has not caused any human disease cases in Denmark
during the period 1993-1997, the occurrence of this bacterium in foods has not been analysed.
The occurrence of Campylobacter in poultry products (non heat-treated) from the retail stage
was around 25% on an average throughout the period. In beef and pork products, the
occurrence of Campylobacter was approx. 1% during the period 1995-1997.
In the mapping studies, occurrences of Yersinia enterocolitica in 3.5% of minced pork and in
1-2% of other pork products were demonstrated. Escherichia coli O157 was demonstrated in
0.3% of samples of beef, pork, deer, mutton, and lamb.
In a mapping study, Listeria monocytogenes was demonstrated in 23.5% of preserved, non
heat-treated meat products. In 0.6% of samples, L. monocytogenes was present in numbers
above 100/g. In the same study, L. monocytogenes was demonstrated in 10.8% of samples of
preserved, non heat-treated fish products, and 1.8% of samples had contents above 100/g.
In another mapping study, L. monocytogenes was demonstrated in 3-12% of heat-treated
delicatessen goods. The lowest occurrence, 3%, was found in saveloy. None of the samples
contained levels above 10/g. The highest occurrence, 12%, was found in pork roll and poultry
sausage. 2% of pork rolls and 7% of poultry sausages contained levels above 100/g. These
studies seem to indicate that for this type of foods, often sold with a long shelf-life, initiatives
preventing the growth of L. monocytogenes are needed. Similar considerations may apply to
preserved, non heat-treated fish products.
In a mapping study concerning ready-to-eat, ready-prepared dishes from the retail stage,
Bacillus cereus, Staphylococcus aureus, and Clostridium perfringens were demonstrated in
0.8%, 0.2%, and 0.08%, respectively, of the analysed samples.
Mapping studies and monitoring programmes for the most important pathogenic food-borne
bacteria will be continued in the next period. Information on the occurrence of pathogenic
37

bacteria in foods is essential with regard to the risk assessments that are to be carried out in
the years to come concerning relevant bacteria and foods. Thus, the risk assessment includes
information on the occurrence of the bacteria as well as data on dietary habits in an
assessment of the exposure of the population.
Likewise, updated information on the occurrence of pathogenic bacteria is of great
importance in relation to the implementation and evaluation of prevention and control
initiatives.

38

13. REFERENCES
1. The National Food Agency of Denmark. Food monitoring in Denmark. Nutrients and
Contaminants, 1983-1987. Publication No. 195, September 1990.
2.

The National Food Agency of Denmark. Food monitoring, 1988-1992. Publication No.
232, December 1995.

3.

National Food Agency of Denmark. Danish Food Monitoring Programme, 1996 Review,
based on the report Food Monitoring 1988-1992. Publication No. 239, June 1997.

4.

Veterinr- og Fdevaredirektoratet (Danish Veterinary and Food Administration).

Aerobt kimtal samt forekomst af Bacillus cereus, Clostridium perfringens og
Staphylococcus aureus i varmholdte retter i detailleddet i 1997 (Aerobic viable counts
and occurrence of Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus
in hot-stored dishes at the retail stage). Mad & Mikroorganismer, No. 4, ISSN 13975404.

5.

Consumption of antimicrobial agents and occurrence of antimicrobial resistance in

bacteria from food animals, food and humans in Denmark. Danish Integrated
Antimicrobial Resistance Monitoring and Research Programme (DANMAP), No. 1,
February 1997, ISSN 1397-078X.

39