Anne Linda Bisp

Human trichinellosis outbreak in Vojvodina and Montenegro. At the end of year 2001 (December 30) and at the beginning of the year 2002 (first half of January) a large outbreak of human trichinellosis has occurred in [the former] Yugoslavia. Clinical cases reported so far are 247. The centre of the epidemic was in Zrenjanin, a town 90 km northeast of Belgrade, headquarters of North-Banat district of Autonomy Province Vojvodina, Republic of Serbia. Apart from the Health Centre Zrenjanin, the infected people were diagnosed in Novi Becej, Zitiste, Novi Sad, Belgrade as well in Niksic (Montenegro) and at a military campus in South Serbia where 15 soldiers were infected and diagnosed by the Military Medical Academy.

The source of the infection was "domestic smoked sausages" that were made, produced and distributed by the owner of a small slaughterhouse in Kumane (village close to Zrenjanin). The slaughterhouse slaughters up to 100 swine per day and processes meat. The thermal processing of the products is performed in a smoked chamber by heating wood, without control of temperatures. The sausages contained pork, fat, and additives stuffed in dry pork intestine.

Upon outbreak of trichinellosis, the infectivity of the sausages was detected by enzymatic digestion in the Specialized Veterinary Institute in Zrenjanin. This finding has been verified in the Institute for Meat Technology and Hygiene, Belgrade, where 19 larvae of Trichinella were recovered per gram of sausages from the same lot. Further analysis of the sausage from this lot was performed by enzymatic digestion in the Centre for Experimental Parasitology, Royal Veterinary and Agricultural University, Copenhagen, Denmark, where 23 larvae of Trichinella per gram were recovered. This Centre also performed species typing of the Trichinella isolated from the sausages by multiplex PCR and identified the larvae as Trichinella spiralis.

In the slaughterhouse the pork had been inspected for Trichinella by enzymatic digestion performed by the owner's daughter, who had trained for 10 days at the Veterinary Faculty in Belgrade.

The artificial digestion method in use in this slaughterhouse has subsequently been found to have several flaws. The sieve was more then 50 percent obstructed, and the sedimentation of the larvae was so poorly performed that a very high percentage of larvae was probably lost. The slaughterhouse owner is now being sued by the district attorney for the marketing of pork not officially veterinary inspected for the production of the sausages. The local state veterinary inspector is also being cited for the neglect of professional responsibilities

Anne Bisp Centre for Experimental Parasitology Royal Veterinary and Agricultural University Copenhagen, Denmark

Steve Berger

Croatia reported 25 cases in 1993; 63 in 1994; 115 in 1995; 156 in 1996; 49 in 1997; 298 in 1998. 52 food-borne outbreaks were reported during 1993 to 1998. Trichinella spiralis accounts for most cases of domestic infection. T. britovi is encountered in some cases of sylvatic trichinosis. Macedonia reported 3 cases in 1985, and 6 in 1992. Slovenia reported a single outbreak (8 cases from pork sausage served in a private home) in 1994. Yugoslav Republic: Until recent years, most cases were reported from Srem, Macva and Negotinska (Krajina); however, additional areas are increasingly involved. 555 cases of human infection were attributed to pork ingestion in 1999. Although infection of horses has not been detected in Serbia, Serbian horses have been implicated as a source for human infection in France and Italy. 0.17 percent of slaughtered swine are infested (1999). 1806 cases (2 fatal) were reported during 1996 to 1996 - most from pork. 210 cases were reported in 1993; 493 in 1994; 803 in 1995; 598 in 1996; 804 in 1997; 471 in 1998. Rates per 100,000: 1.9 in 1993; 4.6 in 1994; 7.4 in 1995; 5.5 in 1996; 7.4 in 1997; 4.4 in 1998. Rates during 1995 to 1998 included 24.8/100,000 in the Federal Republic of Yugoslavia, 13.9/100,000 in Montenegro, 17.3/100,000 in the Republic of Serbia, 4.6/100,000 in Voivodina and 0.23/100,000 in Kosovo. Horsemeat imported from Yugoslavia was responsible for 2 outbreaks in France during 1998 (128 cases, 79 confirmed). An additional outbreak in the same region that year involved 404 cases (37 hospitalised), also from a horse imported from Yugoslavia. In 1999, 8 cases were diagnosed among Yugoslavian immigrants in the United Kingdom (West London and Hertfordshire) - ascribed to salami imported from the town of Sombor (northern Serbia). Forty to 80 local residents of Sombor were also infected during the outbreak. 0.12% of slaughtered swine are infested (1999).

Martin Haditsch, MD, PhD
3 Feb 2002

Travellers and Trichinellosis. Although the region practically doesn't see any classical tourists at the moment I think it is also important news for colleagues involved in travel medicine: Experience with Trichinella-infections/infestations is small in most countries of the western hemisphere (I saw one case originating from this region 10 years ago) but especially foreign workers based in central Europe belong to the highest risk group: VFRs (visiting friends and relatives - persons who practically cannot escape this way of transmission being hosted and served all day long with local food).