Title: The European Union summary report on trends and sources of zoonoses, zoonotic agents and food‐borne outbreaks in 2016
Abstract: EFSA JournalVolume 15, Issue 12 e05077 Scientific ReportOpen Access The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2016 European Food Safety Authority, European Food Safety AuthoritySearch for more papers by this authorEuropean Centre for Disease Prevention and Control, European Centre for Disease Prevention and ControlSearch for more papers by this author European Food Safety Authority, European Food Safety AuthoritySearch for more papers by this authorEuropean Centre for Disease Prevention and Control, European Centre for Disease Prevention and ControlSearch for more papers by this author First published: 12 December 2017 https://doi.org/10.2903/j.efsa.2017.5077Citations: 208 Correspondence: [email protected] Requestor: European Commission Question number: EFSA-Q-2016-00572 Acknowledgements: EFSA and the ECDC wish to thank the members of the Scientific Network for Zoonoses Monitoring Data and the Food and Waterborne Diseases and Zoonoses Network, who provided the data and reviewed the report; the members of the Scientific Network for Zoonoses Monitoring Data for their endorsement of this scientific report; the EFSA staff members (Frank Boelaert, Yves Van der Stede, Krisztina Nagy, Valentina Rizzi, Raquel Garcia Fierro, Francesca Latronico, Domenico Deserio, Anca Stoicescu, Francesca Riolo, Michaela Hempen and Frank Verdonck), the ECDC staff members (Taina Niskanen, Celine Gossner, Johanna Young, Herve Zeller, Joana Gomes Dias and Vahur Hollo) and the EFSA contractors: the Istituto Zooprofilattico Sperimentale delle Venezie, Italy (and staff members: Antonia Ricci, Lisa Barco, Marzia Mancin, Patuzzi Ilaria, Lettini Antonia Anna, Losasso Carmen and Belluco Simone), the Istituto Superiore di Sanita, Italy (and staff members: Stefano Morabito, Gaia Scavia, Arnold Knijn, Ida Luzzi, Ilaria Di Bartolo, Antonella Maugliani, Paola Chiani, Fabio Minelli, Claudia Lucarelli, Edoardo Pozio and Adriano Casulli) and Apostolos Angelidis, School of Veterinary Medicine – Aristotle University of Thessaloniki, Greece, for the support provided to this scientific report. Approved: 13 November 2017 AboutSectionsPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract This report of the European Food Safety Authority and the European Centre for Disease Prevention and Control presents the results of the zoonoses monitoring activities carried out in 2016 in 37 European countries (28 Member States (MS) and nine non-MS). Campylobacteriosis was the most commonly reported zoonosis and the increasing European Union (EU) trend for confirmed human cases since 2008 stabilised during 2012–2016. In food, the occurrence of Campylobacter remained high in broiler meat. The decreasing EU trend for confirmed human salmonellosis cases since 2008 ended during 2012–2016, and the proportion of human Salmonella Enteritidis cases increased. Most MS met their Salmonella reduction targets for poultry, except five MS for laying hens. At primary production level, the EU-level flock prevalence of target Salmonella serovars in breeding hens, broilers, breeding and fattening turkeys decreased or stabilised compared with previous years but the EU prevalence of S. Enteritidis in laying hens significantly increased. In foodstuffs, the EU-level Salmonella non-compliance for minced meat and meat preparations from poultry was low. The number of human listeriosis confirmed cases further increased in 2016, despite the fact that Listeria seldom exceeds the EU food safety limit in ready-to-eat foods. The decreasing EU trend for confirmed yersiniosis cases since 2008 stabilised during 2012–2016, and also the number of confirmed Shiga toxin-producing Escherichia coli (STEC) infections in humans was stable. In total, 4,786 food-borne outbreaks, including waterborne outbreaks, were reported. Salmonella was the most commonly detected causative agent – with one out of six outbreaks due to S. Enteritidis – followed by other bacteria, bacterial toxins and viruses. Salmonella in eggs continued to represent the highest risk agent/food combination. The report further summarises trends and sources for bovine tuberculosis, brucellosis, trichinellosis, echinococcosis, toxoplasmosis, rabies, Q fever, West Nile fever and tularaemia. Introduction Legal basis of the EU-coordinated zoonoses monitoring The EU system for the monitoring and collection of information on zoonoses is based on the Zoonoses Directive 2003/99/EC,1 which obliges European Union (EU) Member States (MS) to collect relevant and, when applicable, comparable data on zoonoses, zoonotic agents, antimicrobial resistance and food-borne outbreaks. In addition, MS are required to assess trends and sources of these agents, as well as outbreaks in their territory, submitting an annual report each year by the end of May to the European Commission covering the data collected. The European Commission should subsequently forward these reports to the European Food Safety Authority (EFSA). EFSA is assigned the tasks of examining these data and publishing the EU annual Summary Reports. In 2004, the European Commission entrusted EFSA with the task of setting up an electronic reporting system and database on monitoring of zoonoses (EFSA mandate No 2004-01782). The data collection on human diseases from MS is conducted in accordance with Decision 1082/2013/EU3 on serious cross-border threats to health. This Decision replaced Decision 2119/98/EC on setting up a network for the epidemiological surveillance and control of communicable diseases in the EU in October 2013. The case definitions to be followed when reporting data on infectious diseases to the European Centre for Disease Prevention and Control (ECDC) are described in Decision 2012/506/EU.4 ECDC has provided data on zoonotic infections in humans, as well as their analyses, for the EU Summary Reports since 2005. Since 2008, data on human cases have been received via the European Surveillance System (TESSy), maintained by ECDC. Reporting requirements According Annex I of the Zoonoses Directive 2003/99/EC data on animals, food and feed must be reported on a mandatory basis (list A of Annex I of the Zoonoses Directive) for the following eight zoonotic agents: Salmonella, Campylobacter, Listeria monocytogenes, Shiga toxin-producing Escherichia coli (STEC), Mycobacterium bovis, Brucella, Trichinella and Echinococcus. The general rules on monitoring of zoonoses and zoonotic agents in animals, food and feed are laid down in article 4 of Chapter II of the Zoonoses Directive 2003/99/EC, which prescribes that monitoring shall take place at the stage or stages of the food chain most appropriate to the zoonosis or zoonotic agent concerned, that is (a) at the level of primary production; and/or (b) at other stages of the food chain, including in food and feed. For food, monitoring schemes for Salmonella, L. monocytogenes and STEC are implied by EU Regulation 2073/20055 on microbiological criteria that have been in force since 1 January 2006. Specific rules for the coordinated monitoring programmes and for the food business operators are, respectively, laid down in Articles 5 and 6 of Chapter II ('monitoring of zoonoses and zoonotic agent's) of the Zoonoses Directive 2003/99/EC, while Article 8 of Chapter IV ('food-borne outbreaks') details rules for epidemiological investigation of food-borne outbreaks. The reporting requirements are described in Annex IV of the Zoonoses Directive 2003/99/EC. In addition and based on the epidemiological situations in the MS, data must be reported on the following agents and zoonoses (list B of Annex I of the Zoonoses Directive): (i) viral zoonoses: calicivirus, hepatitis A virus, influenza virus, rabies, viruses transmitted by arthropods; (ii) bacterial zoonoses: borreliosis and agents thereof, botulism and agents thereof, leptospirosis and agents thereof, psittacosis and agents thereof, tuberculosis other than in M. bovis, vibriosis and agents thereof, yersiniosis and agents thereof; (iii) Parasitic zoonoses: anisakiasis and agents thereof, cryptosporidiosis and agents thereof, cysticercosis and agents thereof, toxoplasmosis and agents thereof; (iv) Other zoonoses and zoonotic agents (such as Francisella, Cysticercus and Sarcocystis). Furthermore, MS provide data on certain other microbiological contaminants in food – histamine, staphylococcal enterotoxins and Cronobacter spp. (before Enterobacter sakazakii), for which food safety criteria are set down in the EU legislation. Terms of Reference In accordance with Article 9 of Directive 2003/99/EC, EFSA shall examine the submitted national reports and data of the MS 2016 zoonoses monitoring activities as described above, and publish an EU Summary Report on the trends and sources of zoonoses, zoonotic agents and antimicrobial resistance in the EU. The 2016 data on antimicrobial resistance in zoonotic agents submitted and validated by the MS are published in a separate EU Summary Report. General description of methods Data sources This EU Summary Report 2016 on zoonoses, zoonotic agents and food-borne outbreaks (FBO) was prepared by EFSA in collaboration with ECDC. MS, other reporting countries, the European Commission, members of EFSA's Scientific Panels on Biological Hazards (BIOHAZ) and Animal Health and Welfare (AHAW) and the relevant EU Reference Laboratories (EURLs) were consulted while preparing the report. The efforts made by the MS, the reporting non-MS and the European Commission in the reporting of zoonoses data and in the preparation of this report are gratefully acknowledged. The present EU Summary Report on zoonoses and FBO focus on the most relevant information on zoonoses and FBO within the EU in 2016. If substantial changes compared with the previous year were observed, they have been reported. Human 2016 data collection The human data analyses in the EU Summary Report for 2016 were prepared by the Food- and Waterborne Diseases and Zoonoses programme at ECDC and were based on the data submitted via TESSy, hosted at ECDC. The numbers presented in the report may differ from national reports due to differences in case definitions used at EU and national level or to different dates of data extraction. The latter may also result in some divergence in case numbers presented in different ECDC reports. TESSy is a software platform that has been operational since April 2008 and in which data on 52 diseases and special health issues are collected. Both aggregated and case-based data were reported to TESSy. Although aggregated data did not include individual case-based information, both reporting formats were included when possible to calculate number of cases, country-specific notification rates and trends in diseases. Human data used in the report were extracted from TESSy as of 1 August, except for human tuberculosis due to M. bovis as of 3 October 2017. The denominators used for the calculation of the notification rates were the human population data from Eurostat 1 January 2017 update. Data on human zoonoses cases were received from 28 MS and also from two non-MS: Iceland and Norway. Switzerland sent its data on human cases directly to EFSA. The human data for Switzerland include data from Liechtenstein. The data should be interpreted with caution and take into account data quality issues and differences between MS surveillance systems. The reader should refrain from making direct comparisons between countries without taking into account the limitations in the data, which may differ between countries depending on the characteristics of their surveillance systems. Data collection on food, animals, feed, and food-borne outbreaks For the year 2016, 28 MS and four non-MS European Free Trade Association (EFTA) countries (Iceland, Norway, Liechtenstein and Switzerland) submitted data and national zoonoses reports on monitoring results in food, animals, feed and FBO.6 For some food, animal and feed matrices and FBO, EFSA received data and reports from pre-accession countries Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro and Serbia. Data were submitted electronically to the EFSA zoonoses database, through EFSA's Data Collection Framework (DCF). MS could also update data from previous years, before 2016. The deadline for data submission was 31 May 2017. Two data validation exercises were implemented, by 3 June 2016 and by 1 July 2016. Validated data on food, animals and feed used in the report were extracted from the EFSA zoonoses database on 19 July 2016. The draft EU Summary Report was sent to MS for consultation on 13 October 2017 and comments were collected by 3 November 2017. The utmost effort was made to incorporate comments and data amendments within the available time frame. The report was finalised by 13 November 2017 and published on-line by EFSA and ECDC on 7 December 2017. The detailed description of zoonoses models for data entry and of the terms used in the report is available in the EFSA's manuals for reporting on zoonoses (EFSA, 2017a,b,c,d). The national zoonoses reports submitted in accordance with Directive 2003/99/EC are published on the EFSA website together with the EU Summary Report. They are available on-line at http://www.efsa.europa.eu/en/biological-hazards-data/reports. The Appendix lists all summary tables and figures made for the production of this report. It is an Excel file allowing the user to filter by chapter the corresponding tables and figures with their abbreviated file name and titles. All tables and figures are published as supporting information to this report and are available in downloadable files at https://doi.org/10.5281/zenodo.1044742 Data analysis General principles and presentation The current summary report presenting monitoring data for the year 2016 has a harmonised structure for each chapter, including an abstract with the major findings. Next, a section describes the monitoring and surveillance in the EU for the specific zoonosis or for FBO. A results section summarises the major findings of 2016 as regards trends and sources. Each chapter also contains a discussion and ends with a list of related projects and links with useful information for the specific zoonosis. A summary table displaying the data of the last 5 years for human cases and for major animal and food matrices is presented. It presents all the MS that reported data during 2012–2016 is made available, with key summary statistics. However, for the summary tables, unless stated otherwise, data from industry own-control programmes and Hazard Analysis and Critical Control Point (HACCP) sampling as well as data from suspect sampling, selective sampling and outbreak or clinical investigations are excluded. If MS reported only regional data without reporting statistics at the national level, these were not extracted in the summary tables. When possible, statistical trend analyses were carried out to evaluate the significance of temporal variations in the EU and the specifications of these analyses are explained in each separate chapter. Spatial trends in food and animals were visualised using R software (www.r-project.org); packages ggplot2, lattice and tmap as well as ArcGIS from the Economic and Social Research Institute (ESRI) were used to map the data. Choropleth maps with graduated colours over a continuous scale of values were used to map the proportion of positive sample units across the EU and other reporting countries. Comparability and quality of the data Humans Regarding data on human infections, please note that, as mentioned above, the numbers presented in this report may differ from national zoonoses reports due to differences in case definitions used at EU and national level or because of different dates of data extraction. Results are generally not directly comparable between MS and sometimes not even between different years in one country. Food, animals, feed, and food-borne outbreaks Regarding data on food, animals, feed and food-borne outbreaks, the numbers presented in this report may differ from national zoonoses reports due to different dates of data extraction. The zoonoses and food-borne outbreaks monitoring data obtained in the EFSA DCF, respectively according Chapter II ('monitoring of zoonoses and zoonotic agent's) and Chapter IV ('food-borne outbreaks') of the Zoonoses Directive 2003/99/EC) vary according to the level of data quality and harmonisation. Therefore, the types of analyses that can be done with these monitoring data and suggested by EFSA, strongly depend on those levels of data quality and harmonisation. These data analyses can either be a descriptive summary, or trend watching, or a full trend analysis. To make this clear for the reader, EFSA proposed throughout the report the types of analyses according to Table 1 and adapted from Boelaert et al. (2016). For each chapter in this report, the applied category according to Table 1 is explained. Table 1. Categorisation of zoonoses and food-borne outbreaks monitoring data used in EUSR 2016 (adapted from Boelaert et al., 2016) Category Type of analyses Type/comparability between MS Examples I Descriptive summaries at national level and EU-level EU trend watching (trend monitoring) Spatial and temporal trends analyses at the EU-level Programmed and harmonised monitoring or surveillance Comparable between MS; results at EU-level are interpretable Salmonella national control programmes in poultry Bovine tuberculosis Bovine and small ruminant brucellosis Trichinella in pigs at the slaughterhouse Echinococcus granulosus at the slaughterhouse II Descriptive summaries at national level and EU-level EU trend watching (trend monitoring) No trend analysis at the EU-level Not fully harmonised monitoring or surveillance Not fully comparable between MS; caution needed when interpreting results at EU-level Food-borne outbreaks data Monitoring of compliance with process hygiene and food safety criteria for L. monocytogenes, Salmonella and E. coli according Reg No 2073/20055 Monitoring of rabies III Descriptive summaries at national level and EU-level No EU trend watching (trend monitoring) No trend analysis at the EU-level Non-harmonised monitoring or surveillance data with no (harmonised) reporting requirements Not comparable between MS; extreme caution needed when interpreting results at EU-level Campylobacter Yersinia Q fever Francisella tularensis West Nile virus Taenia spp. other zoonoses Toxoplasma Summary human zoonoses data EUSR, 2016 The numbers of the confirmed human cases of 13 zoonoses presented in this report are summarised in Figure 1. In 2016, campylobacteriosis was the most commonly reported zoonoses, as it had been since 2005, representing almost 70% of all the reported cases. Campylobacteriosis was followed by other bacterial diseases: salmonellosis, yersiniosis and STEC infections in being the most frequently reported. The severity of the diseases was analysed based on hospitalisation and outcome of the reported cases (Table 2). Based on data on severity, listeriosis was the most severe zoonoses with the highest hospitalisation and mortality rate followed by West Nile fever. Almost all confirmed cases with data available on hospitalisation for these two diseases were hospitalised. One out of every six and one out of nine confirmed and reported listeriosis and West Nile fever cases, respectively, with known data was fatal. Figure 1Open in figure viewerPowerPoint Reported numbers and notification rates of confirmed human zoonoses in the EU, 2016 Note: Total number of confirmed cases is indicated in parenthesis at the end each bar. Exception: West Nile fever where the total number of cases was used. Table 2. Reported hospitalisation and case fatality rates due to zoonoses in confirmed human cases in the EU, 2016 Disease Number of confirmeda human cases Hospitalisation Deaths Status available (%) Number of reporting MSsb Reported hospitalised cases Proportion hospitalised (%) Outcome available (%) Number of reporting MSsb Reported deaths Case fatality (%) Campylobacteriosis 246,307 27.4 17 19,265 28.5 72.6 16 62 0.03 Salmonellosis 94,530 33.5 14 12,182 38.4 55.2 16 128 0.25 Yersiniosis 6,861 24.1 14 521 31.5 63.5 15 5 0.11 STEC infections 6,378 42.6 18 940 34.6 58.9 20 10 0.27 Listeriosis 2,536 38.8 18 962 97.7 60.1 20 247 16.2 Q-fever 1,057 NAc NA NA NA 54.3 15 3 0.30 Tularaemia 1,056 12.3 11 130 54.6 15.8 12 0 0.0 Echinococcosis 772 26.2 14 119 58.9 25.4 13 1 0.51 Brucellosis 516 39.7 12 146 71.2 26.0 12 1 0.75 West Nile fevera 240 65.1 7 147 93.6 99.2 9 28 11.7 Trichinellosis 101 45.5 7 30 65.2 50.5 8 0 0.0 Rabies 0 NAc NA NA NA 0.0 0 0 0.0 MS: Member State; STEC: Shiga toxin-producing Escherichia coli. a Exception: West Nile fever in which the total number of cases was included. b Not all countries observed cases for all diseases. c NA: Not applicable as information is not collected for this disease. 1 Campylobacter The Appendix lists all summary tables and figures made for the production of this section. It is an Excel file allowing the user to filter by chapter the corresponding summary tables and figures with their abbreviated file name and titles. All tables and figures are published as supporting information to this report and are available in downloadable files at https://doi.org/10.5281/zenodo.1044742 1.1 Abstract In 2016, Campylobacter was the most commonly reported gastrointestinal bacterial pathogen in humans in the European Union (EU) and has been so since 2005. The number of reported confirmed cases of human campylobacteriosis was 246,307, with an EU notification rate of 66.3 per 100,000 population. This represented an increase of 6.1% compared with 2015. There was a significantly increasing trend over the period 2008–2016, however, in the last 5 years (2012–2016) the EU/EEA trend has not shown any statistically significant increase or decrease. Half of the MS reported increasing trends in both in the long term (2008–2016) and in the short term (2012–2016). While the high number of human campylobacteriosis cases, their severity in terms of reported case fatality was low (0.03%), even though this was the third most common cause of mortality amongst the pathogens considered. Few MS reported 2016 monitoring results of Campylobacter in food, mainly from fresh meat from broilers and turkeys, and from their meat products. In these foods, the occurrence was, respectively, 36.7% and 11% in fresh meat from broilers and fresh meat from turkeys. Campylobacter in milk and milk products (including cheeses) for the year 2016 was reported by nine MS. The occurrence was comparable between milk products and cheeses and was around 1%. Few MS reported 2016 monitoring data on Campylobacter in animals. Sixty-five per cent of the samples originated from broilers, from 14 MS, and from turkeys, from 5 MS. In addition to the low volumes of food and animal monitoring data reported from investigations on Campylobacter, the sampling and reporting rules are not harmonised, thus precluding trend analyses and trend watching. Together these deficiencies prevent inference being made, beyond the sample statistics, on trends or sources of Campylobacter in foods or animals. 1.2 Surveillance and monitoring of Campylobacter in the EU 1.2.1 Humans The notification of campylobacteriosis is mandatory in most MS, Iceland, Norway and Switzerland, except for seven MS, where notification is based on a voluntary system (Belgium, France, Italy, Luxembourg and the Netherlands) or other systems (Spain and the United Kingdom). No surveillance system exists in Greece. The surveillance systems for campylobacteriosis cover the whole population in all MS except four (France, Italy, the Netherlands and Spain). The coverage of the surveillance system is estimated to be 20% in France and 52% in the Netherlands. These proportions of populations were used in the calculation of notification rates for these two MS. No estimate of population coverage in Italy and Spain was provided, so notification rates were not calculated for these two MS. Diagnosis of human infection is generally based on culture from human stool samples and both culture and non-culture methods (polymerase chain reaction (PCR)) are used for confirmation. Biochemical tests or molecular methods are used for species determination of isolates submitted to the National Reference Laboratory. 1.2.2 Food and animals Monitoring data on Campylobacter from food and animals and submitted to EFSA (according Chapter II ('monitoring of zoonoses and zoonotic agent's) of the Zoonoses Directive 2003/99/EC) are collected without harmonised design. These data allow for descriptive summaries at EU-level to be made. They preclude trend analyses and trend watching at EU-level (Table 1). Detection of Campylobacter from food and animals is generally based on culture and both biochemical and molecular methods (PCR and matrix assisted laser desorption ionisation-time of flight (MALDI-TOF)) are used for confirmation. 1.2.3 Food-borne outbreaks of human campylobacteriosis The reporting of FBO of human campylobacteriosis is mandatory according the Zoonoses Directive 2003/99/EC. Further details are provided in the chapter on FBO. 1.3 Results 1.3.1 Overview of key statistics along the food chain, EU, 2012–2016 Table 3 summarises EU-level statistics related to human campylobacteriosis, and to Campylobacter occurrence and prevalence in food and animals, respectively, in the EU, during 2012–2016. A more detailed description of these statistics is in the results section of this chapter and in the chapter on food-borne outbreaks. Table 3. Summary of Campylobacter statistics related to humans and major food categories, EU, 2012–2016 2016 2015 2014 2013 2012 Data source Humans Total number of confirmed cases 246,307 232,134 236,818 214,710 214,300 ECDC Total number of confirmed cases/100,000 population (notification rates) 66.3 62.9 66.5 61.4 61.7 ECDC Number of reporting countries 27 27 26 26 26 ECDC Infection acquired in the EU 122,806 142,536 135,822 120,521 124,070 ECDC Infection acquired outside the EU 6,347 6,838 7,401 7,481 7,513 ECDC Unknown travel status or unknown country of infection 117,154 82,760 93,595 86,708 82,717 ECDC Total number of food-borne outbreaks (including waterborne outbreaks) 461 399 454 417 503 EFSA Number of outbreak-related cases 4,606 1,488 2,082 1,836 1,555 EFSA Food Meat and meat products Number of sampled units 18,048 16,134 15,758 21,383 25,348 EFSA Number of reporting MS 19 18 20 20 20 EFSA Milk and milk products Number of sampled units 1,896 2,126 2,708 3,324 3,313 EFSA Number of reporting MS 10 10 10 10 9 EFSA ECDC: European Centre for Disease Prevention and Control; EFSA: European Food Safety Authority; MS: Member States. Food data of interest reported were classified into the major categories 'Meat and meat products' and 'Milk and milk products', and aggregated by year over the period 2012–2016 to get an annual overview of the amount of data submitted. In the summary table, data from suspect and selective sampling and from industry own-control programmes and Hazard Analysis and Critical Control Point (HACCP) sampling were excluded. The number of sampled units reported tends to generally decrease since 2012, and originated for 'Meat and meat products' and 'Milk and milk products' from, respectively, two-thirds and one-third of the MS. 1.3.2 Human campylobacteriosis For 2016, campylobacteriosis data were reported by 27 MS. The number of confirmed cases in 2016 of human campylobacteriosis in the EU was 246,307, which represents an increase of 14,173 cases (6.1%) compared with 2015 (Table 4). Twenty MS reported an increase in the number of cases and notification rates compared with 2015. The EU notification rate was 66.3 per 100,000 population in 2016, an increase by 6.1% compared with 2015 (62.9 per 100,000 population). The highest country-specific notification rates in 2016 were observed, as in previous years, in the Czech Republic (228.2 cases per 100,000), Slovakia (140.5), Sweden (111.9) and the United Kingdom (90.2). The lowest rates in 2016 were reported by Bulgaria, Cyprus, Latvia, Poland, Portugal and Romania (≤ 4.6 per 100,000). In most MS, campylobacteriosis was mainly a domestically acquired infection with ≥ 90% of cases reported as domestic. Almost half of the cases (46.9%), however, were reported as being of unknown origin (Table 3). The highest proportions of domestic cases (> 99%) were reported in the Czech Republic, Hungary, Latvia, Malta, Poland, Portugal, Romania and Slovakia. The highest proportions of travel-associated cases were reported by three Nordic countries – Finland (65.4%), Iceland (51.4%) and Norway (53.5%). Sweden, which in previous years reported most of the campylobacteriosis cases as travel associated, experienced an increase in domestic cases by 46.5% compared with 20