New outbreak of trichinellosis in the Midi-Pyrénées region of France , September-October 1998

Le 6 octobre 1998 onze cas de trichinellose survenus, en France, dans les départements de la Haute Garonne et du Tarn ont été déclarés aux autorités sanitaires de la région Midi-Pyrénées (1). Les toutes premières informations fournies par les médecins suggéraient que la viande de cheval pouvait être le véhicule de l’infection, tous les cas ayant consommé de la viande de cheval achetée dans deux boucheries, l’une à Toulouse et l’autre à Castres. Une enquête épidémiologique, vétérinaire et parasitologique a été menée afin d’évaluer l’importance de cette épidémie et d’identifier le véhicule et la source de l’infection.


Introduction
Eleven cases of trichinellosis in the Haute-Garonne, and Tarn districts of France were reported to the regional health department of Midi-Pyrénées region on 6 October (1).All cases had eaten horse meat, bought in one butcher's in Toulouse and one in Castres.An epidemiological, veterinary and parasitological investigation was conducted to assess the outbreak's importance and identify the vehicle and source of infection.

Methods
Cases were defined as residents of Tarn and Haute-Garonne districts who had presented with the following features since 1 September 1998 : Confirmed case : fever (> 38°) with myalgia or facial oedema with a Trichinella positive serology or muscle biopsy.
Suspected case: hypereosinophilia > 1000/mm 3 alone or associated with fever or myalgia.
Cases were sought actively by the Cellule Interrégionale d'Epidémiologie d'Intervention du Sud-Ouest (CIREI) among medical laboratories, general practitioners and hospital physicians in the Haute-Garonne and Tarn districts.They were asked to report hypereosinophilia (> 1000/mm 3 ) and patients who had consulted for symptoms suggestive of trichinellosis since 1 September.Hospital pharmacists were also asked to report prescriptions for albendazole.
A standardised questionnaire was administered by telephone to the cases identified who could be contacted at the time of the study.Subjects were asked about clinical features, dates of onset of symptoms, laboratory tests performed, consumption of meat products, and where and when they had bought meat in September.
The departmental veterinary services took samples from meat bought by cases in September and kept in their freezers.The distribution channels were identified from the purchasing sites reported by cases.Biopsies were taken from pets of two cases, a cat and a dog, that had been fed horse meat.The samples were tested using the enzymatic digestion method.Larvae isolated by trypsin digestion were typed by the Trichinella International Centre in Rome, Italy.

Results
Four hundred and four cases were identified who lived in the two districts of the Midi-Pyrénées region and had become ill between 20 September and 27 October.Thirty seven cases were admitted to hospital and one case suffered neurological complications.The epidemic curve suggested the contamination had a point source in time in the third week of September (figure).All cases had eaten horse meat and larvae of trichinella spiralis were found in samples of mixed horse meat ®

TRAINING FELLOWSHIPS FOR INTERVENTION EPIDEMIOLOGY IN EUROPE
The European Programme for Intervention Epidemiology Training (EPIET) started in 1995.The programme is funded by the EU and by various EU member states, Norway and the World Health Organisation.Subject to agreement for another round of funding, a fifth cohort of fellows is planned, starting in September 1999.The programme invites applications for eight fellowships for this 24-month training programme in communicable disease field epidemiology.

FELLOWSHIPS
Applicants for the 1999 cohort should have experience in public health, a keen interest in field work, and be pursuing a career involving public health infectious disease epidemiology.They should have a good knowledge of English and at least one other EU language, and be prepared to live abroad for a period of 24 months.The appropriately experienced professional is likely to be below 40 years of age.

AIM OF THE TRAINING
The aim of the training is to enable the fellow to assume service responsibilities in communicable disease epidemiology.The in-service training will focus on outbreak investigations, disease surveillance, applied research, and communications with decision makers, the media, the public and the scientific community.
Fellows will attend a three-week intensive introductory course and then be located in a host institute in one of the 15 participating European countries, Norway or WHO.Further training modules are organised during the two year programme, normally in one of the participating national institutes with responsibility for communicable disease surveillance.
Detailed information can be obtained from Dr Alain Moren or the EPIET programme office at the address below.Letters of application accompanied by a curriculum vitae should be submitted by February 15 1999.
Cet épisode souligne les limites des protocoles et des méthodes utilisés actuellement lors du contrôle systématique de la viande de cheval, en particulier en provenance des pays d'Europe de l'Est, où l'incidence de la trichinellose humaine et animale est élevée.s ® and horse steak bought by cases.Analysis performed by the Centre National d'Etudes Vétérinaires et Alimentaires showed a high level of contamination (900 to 2700 larvae per 100g of horse meat).Biopsy from pets both yielded larvae -one larva in 0.1g from the dog ; 11 larvae in 0.4g from the cat.Investigation of the supply and distribution channels identified a horse carcass from a batch of horses imported from the Federal Republic of Yugoslavia and slaughtered in France.A previous outbreak in the same region of France in February 1998, was linked to the consumption of horse meat imported from the same country (2).Consumption of horse meat has become the main cause of human trichinellosis in western Europe since 1975 (3).This outbreak is the eighth regional epidemic linked to the consumption of imported horse meat reported in France since 1976.It shows the limit of the protocols and methods currently used in the systematic control of horse meat, particularly when imported from countries from eastern Europe, where the incidence of human and animal trichinellosis is high.s