Public health officials in Norway have warned that a severe E. coli outbreak is not over and have urged people to take precautions.

The Norwegian Institute of Public Health (FHI) reported that E. coli O26:H11 had been detected in 20 people, up from 17 in the previous update. It is one of the country’s most serious E. coli outbreaks.

Overall, 11 of those infected are children under 13, and seven have developed hemolytic uremic syndrome (HUS). HUS is a severe complication associated with E. coli infections that causes kidney failure.

Patients live across the country and became ill from July to September. They range in age from 1 to 55 years old.

Product recalls
The outbreak strain has been found in a hamburger, but other minced (ground) meat products wher the same raw materials have been used have also been withdrawn.

People have been told to cook burgers, minced (ground) meat thoroughly, and other meat products and to wash their hands and equipment, such as chopping boards and utensils, after handling fresh and frozen meat. They are also being advised that freezing does not kill E. coli.

The USDA says ground beef needs to be cooked to an internal temperature of 160 degrees F, as measured with a food thermometer.

The outbreak is being investigated by FHI, municipal chief medical officers, the Norwegian Food Safety Authority (Mattilsynet), and the Veterinary Institute.

Nordfjord Kjøtt has issued three recalls of meat products sold at Rema 1000 stores nationwide. Some products have shelf life dates up to June 2024. Others have expired, but officials are concerned people may still have items at home in their freezers.

Infections and outbreak summary
Norway has also published its 2022 zoonoses report. In humans, the incidence of several diseases increased after the decline seen during the COVID-19 pandemic. As in past years, campylobacteriosis had the most reported cases, followed by salmonellosis.

A total of 712 cases of salmonellosis were reported. The number of infections has increased compared to 2020 and 2021 but is still lower than before the pandemic. This is mainly because of a decrease in travel-associated cases. In Norway, food-producing animals are rarely infected with Salmonella.

Of 2,983 cases of campylobacteriosis, almost 1,000 contracted the infection in Norway, but for 1,282 cases, the place of infection was unknown. Surveillance showed that 106 flocks tested positive for Campylobacter. Carcasses from the positive flocks were either heat-treated or frozen for at least three weeks before being marketed.

Yersiniosis cases increased from 85 in 2021 to 117 in 2022, and Listeria infections rose from 20 to 31. Five of 373 samples in the surveillance program for ready-to-eat foods in 2021 were positive for Listeria monocytogenes, but concentrations were all below 100 CFU/g. One was a salad, and two were meat products and smoked fish.

518 E. coli infections were recorded, up from 438 in 2021. The number of HUS cases in recent years was between two to 10 annually. In a surveillance program for wheat flour with samples collected in 2021, STEC was isolated from three of 151 samples. Isolates were STEC O187:H28, O155:H21, and O154:H31.

In 34 outbreaks, 628 people became sick. The number of affected people in each incident varied between two and 100. Norovirus caused eight outbreaks, Salmonella five, Cryptosporidium three, and Yersinia three. In 11 epidemics, the causative agent was not identified.