SPECIAL ISSUE ARTICLE
Viral outbreaks linked to fresh produce consumption: a
I.P. Chatziprodromidou , M. Bellou, G. Vantarakis and A. Vantarakis
Environmental Microbiology Unit, Department of Public Health, School of Medicine, University of Patras, Patras, Greece
fresh produce, hepatitis A, lettuce, norovirus,
raspberries, salad, strawberries.
Ioanna P. Chatziprodromidou, Department of
Public Health, School of Medicine, University
of Patras, Greece.
2018/0095: received 11 October 2017,
revised 21 February 2018 and accepted 21
Aims: Α systematic review to investigate fresh produce-borne viral outbreaks,
to record the outbreak distribution worldwide and to analyse the implication
of different types of fresh produce and viral types as well.
Methods and Results: Four databases (PubMed/Medline, Scopus, Eurosurveil-
lance Journal and Spingerlink electronic journal) and a global electronic
reporting system (ProMED-mail) were searched up to 2016. One hundred and
ﬁfty-two viral outbreaks linked to fresh produce consumption were identiﬁed.
The majority of the reported outbreaks was reported in Europe, followed by
North America, Asia, Australia, Africa and South America. A great number of the
outbreaks was recorded in Denmark and Finland. The most common viral
pathogens were norovirus (48Á7%) and hepatitis A virus (46Á1%). The most
frequent type of fresh produce involved was frozen raspberries (23Á7%).
Differences in the reporting of outbreaks were recorded between the scientiﬁc
literature and ProMED.
Conclusions: The number of reported illnesses linked to fresh produce has
increased in several countries. Consumption of contaminated fresh produce
represents a risk to public health in both developed and developing countries,
but the impact will be disproportionate and likely to compound existing health
disparities. For this reason, all countries should systematically collate and
report such data through a disease surveillance system, in order to adopt risk
management practices for reducing the likelihood of contamination.
Sales of fresh produce have signiﬁcantly increased during
the last decade, as consumers have increasingly become
concerned with healthy food and nutrition (The Organic
Industry 2008). Fruit and vegetables are considered as
important components of a healthy and balanced diet and
recognized as an important source of nutrients, vitamins
and ﬁbre for humans (Mulabagal et al. 2010; Odriozola-
Serrano et al. 2010). Thus, their consumption is encour-
aged in many countries by governmental health agencies
as a source of protection to protect against a range of ill-
nesses such as cancers and cardiovascular diseases (Piya-
sena et al. 2003; Berger et al. 2010; Birmpa et al. 2013).
Furthermore, from 1980 to 2004, the global produc-
tion per annum of fruit and vegetables has increased
by 94% (Wirsenius et al. 2010). Thus, it is of high
importance to ensure safe consumption of these prod-
ucts (European Union 2007). Consumption of fresh
produce has increased over the past two decades for
many reasons; for example, consumers always try to
meet the projected standard of healthy living and in
response to this demand, a large variety of domestic
and imported produce has become available during all
seasons (Warriner et al. 2009). Globally, fruit and veg-
etable consumption has increased on average by 4Á5%
yearly between 1990 and 2004 (European Union
2007). The annual consumption of fruits and vegeta-
bles in the United States during 1997–1999 was 25%
above the levels of years 1977–1979 (Food and Drug
Administration 2001). In Canada, from 1963 to 2010,
the annual consumption of fruits and vegetables had
Journal of Applied Microbiology 124, 932--942 © 2018 The Society for Applied Microbiology
Journal of Applied Microbiology ISSN 1364-5072