ZOONOSES MONITORING. Sweden IN 2016 TRENDS AND SOURCES OF ZOONOSES AND ZOONOTIC AGENTS IN FOODSTUFFS, ANIMALS AND FEEDINGSTUFFS

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1 ZOONOSES MONITORING Sweden TRENDS AND SOURCES OF ZOONOSES AND ZOOIC AGENTS IN FOODSTUFFS, ANIMALS AND FEEDINGSTUFFS including information on foodborne outbreak, antimicrobial reitance in zoonotic and indicator bacteria and ome pathogenic microbiological ag IN 6 Sweden - 6

2 Sweden - 6 Report on trend and ource of zoonoe PREFACE Thi report i ubmitted to the European Commiion in accordance with Article 9 of Council Directive /99/ EC*. The information ha alo been forwarded to the European Food Safety Authority (EFSA). The report contain information on trend and ource of zoonoe and zoonotic ag in Sweden during the year 6. The information cover the occurrence of thee dieae and ag in, foodtuff and in ome cae alo in feedingtuff. In addition the report include data on antimicrobial reitance in ome zoonotic ag and indicator bacteria a well a information on epidemiological invetigation of foodborne outbreak. Complemary data on uceptible population in the country i alo given. The information given cover both zoonoe that are important for the public health in the whole European Union a well a zoonoe, which are relevant on the bai of the national epidemiological ituation. The report decribe the monitoring ytem in place and the previon and control trategie applied in the country. For ome zoonoe thi monitoring i baed on legal requirem laid down by the European Union legilation, while for the other zoonoe national approache are applied. The report pre the reult of the examination carried out in the reporting year. A national evaluation of the epidemiological ituation, with pecial reference to trend and ource of zoonotic infection, i given. Whenever poible, the relevance of finding in foodtuff and to zoonoe cae in human i evaluated. The information covered by thi report i ued in the annual European Union Summary Report on zoonoe and antimicrobial reitance that are publihed each year by EFSA. * Directive / 99/ EC of the European Parliam and of the Council of December on the monitoring of zoonoe and zoonotic ag, amending Deciion 9/ / EEC and repealing Council Directive 9/ 7/ EEC, OJ L, 7.., p. Sweden - 6

3 Lit of Cont TEXTFORMS ANTIMICROBIAL RESISTANCE INFORMATION ON SPECIFIC ZOONOSES AND ZOOIC AGENTS. SALMONELLOSIS.. in... Antimicrobial reitance in All. CAMPYLOBACTERIOSIS.. Campylobacter in... Antimicrobial reitance in C. jejuni Gallu gallu (fowl). ESCHERICHIA COLI, NON-PATHOGENIC 5.. Echerichia coli, non-pathogenic in foodtuff 6... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Meat from broiler (Gallu gallu) 6.. Echerichia coli, non-pathogenic in 7... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Gallu gallu (fowl) 7... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Turkey 8. ENTEROCOCCUS, NON-PATHOGENIC.. Enterococcu, non-pathogenic in... Antimicrobial reitance in Enterococcu pp., unpecified Turkey.5 STAPHYLOCOCCUS AUREUS METICILLIN RESISTANT (MRSA) INFECTION.5. Staphylococcu in.5.. Antimicrobial reitance in S. aureu, meticillin reitant (MRSA) All FOODBORNE OUTBREAKS. Outbreak.. Foodborne outbreak ANIMAL POPULATION TABLES 5 DISEASE STATUS TABLES FOR BRUCELLA 6 Bovine brucelloi in countrie and region that do not receive Community co-financing for eradication programme 6 Ovine or Caprine brucelloi in countrie and region that do not receive Community co-financing for eradication programme DISEASE STATUS TABLES FOR MYCOBACTERIUM Bovine tuberculoi in countrie and region that do not receive Community co-financing for eradication programme 8 Tuberculoi in farmed deer 8 PREVALENCE TABLES 9 BRUCELLA 9 9 CAMPYLOBACTER food COXIELLA CYSTICERCUS ECHINOCOCCUS ESCHERICHIA COLI 6 6 food 7 FRANCISELLA 8 8 LISTERIA 9 food 9 LYSSAVIRUS MYCOBACTERIUM SALMONELLA food 5 feed TRICHINELLA 6 6 FOODBORNE OUTBREAKS TABLES 7 AMR TABLES FOR CAMPYLOBACTER 5 Campylobacter jejuni 5 Gallu gallu (fowl) - broiler - Slaughterhoue - Monitoring - active - Official ampling - AMR MON 5 5 AMR TABLES FOR SALMONELLA 55,5,:-:,5 55 Bird - wild - Natural habitat - Monitoring - paive - Official ampling - OTHER AMR MON Aarhu 56 Cattle (bovine ) - unpecified - Farm - Surveillance - Official ampling - OTHER AMR MON Agona 57 Dog - pet - Veterinary clinic - Clinical invetigation - Official ampling - OTHER AMR MON 57 Urine 57 Cerro 58 Gallu gallu (fowl) - laying hen - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON Dublin 59 Cattle (bovine ) - unpecified - Farm - Surveillance - Official ampling - OTHER AMR MON Cattle (bovine ) - unpecified - Slaughterhoue - Surveillance - Official ampling - OTHER AMR MON 6 6 Dueeldorf 6 Cattle (bovine ) - unpecified - Slaughterhoue - Surveillance - Official ampling - OTHER AMR MON 6 6 erica, ubpecie diarizonae 6 Sheep - Farm - Monitoring - active - Official ampling - OTHER AMR MON 6 6 Enteritidi 6 Hedgehog - wild - Natural habitat - Monitoring - paive - Official ampling - OTHER AMR MON 6 6 Fulica 6 Hedgehog - wild - Natural habitat - Monitoring - paive - Official ampling - OTHER AMR MON 6 6 Indiana 65 Dog - pet - Veterinary clinic - Clinical invetigation - Official ampling - OTHER AMR MON 65 Urine 65 Livingtone Gallu gallu (fowl) - laying hen - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON Mbandaka Dog - pet - Veterinary clinic - Clinical invetigation - Official ampling - OTHER AMR MON Gallu gallu (fowl) - broiler - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON Newport

4 Bird - wild - Natural habitat - Monitoring - paive - Official ampling - OTHER AMR MON Typhimurium Meat from pig - carcae - Slaughterhoue - Control and eradication programme - Official ampling - OTHER AMR MON Breeding pig Fattening pig 7 Bird - wild - Natural habitat - Monitoring - paive - Official ampling - OTHER AMR MON 7 7 Cat - pet - Veterinary clinic - Clinical invetigation - Official ampling - OTHER AMR MON 7 Pig - breeding - Slaughterhoue - Control and eradication programme - Official ampling - OTHER AMR MON 7 Cattle (bovine ) - unpecified - Farm - Surveillance - Official ampling - OTHER AMR MON Cattle (bovine ) - unpecified - Farm - Surveillance - Official ampling - OTHER AMR MON 76 A new MLVA type Cattle (bovine ) - unpecified - Slaughterhoue - Surveillance - Official ampling - OTHER AMR MON Pig - fattening pig - Slaughterhoue - Control and eradication programme - Official ampling - OTHER AMR MON Dog - pet - Veterinary clinic - Clinical invetigation - Official ampling - OTHER AMR MON 8 8 Gallu gallu (fowl) - broiler - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON Gallu gallu (fowl) - par breeding flock for broiler production line - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON 8 8 Geee - meat production flock - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON 8 8 Gallu gallu (fowl) - laying hen - Farm - Control and eradication programme - Official and indutry ampling - OTHER AMR MON 8 8 AMR TABLES FOR ESCHERICHIA COLI 85 Echerichia coli, non-pathogenic, unpecified 85 Meat from broiler (Gallu gallu) - freh - Retail - Monitoring - Official ampling - ESBL MON pnl Meat from broiler (Gallu gallu) - freh - Retail - Monitoring - Official ampling - ESBL MON Meat from broiler (Gallu gallu) - freh - Retail - Monitoring - Official ampling - ESBL MON pnl Meat from broiler (Gallu gallu) - freh - Retail - Monitoring - Official ampling - ESBL MON Gallu gallu (fowl) - broiler - Slaughterhoue - Monitoring - Official ampling - AMR MON pnl Gallu gallu (fowl) - broiler - Slaughterhoue - Monitoring - Official ampling - AMR MON 9 9 Gallu gallu (fowl) - broiler - Slaughterhoue - Monitoring - Official ampling - ESBL MON pnl 9 9 Gallu gallu (fowl) - broiler - Slaughterhoue - Monitoring - Official ampling - ESBL MON 9 9 Turkey - fattening flock - Slaughterhoue - Monitoring - Official ampling - AMR MON 9 9 Turkey - fattening flock - Slaughterhoue - Monitoring - Official ampling - ESBL MON pnl 9 9 Turkey - fattening flock - Slaughterhoue - Monitoring - Official ampling - ESBL MON OTHER AMR TABLES 96 Enterococcu, non-pathogenic - E. faecali 96 Turkey - fattening flock - Slaughterhoue - Monitoring - Official ampling - OTHER AMR MON Enterococcu, non-pathogenic - E. faecium 97 Turkey - fattening flock - Slaughterhoue - Monitoring - Official ampling - OTHER AMR MON Methicillin reitant Staphylococcu aureu (MRSA) 98 Cat - pet - Veterinary clinic - Clinical invetigation - applicable - OTHER AMR MON Dog - pet - Veterinary clinic - Clinical invetigation - applicable - OTHER AMR MON Soliped, dometic - hore - Veterinary clinic - Clinical invetigation - applicable - OTHER AMR MON Goat - Zoo - Clinical invetigation - applicable - OTHER AMR MON Hedgehog - wild - Natural habitat - Clinical invetigation - applicable - OTHER AMR MON ESBL LATEST TRANSMISSIONS

5 ANTIMICROBIAL RESISTANCE INFORMATION ON SPECIFIC ZOONOSES AND ZOOIC AGENTS. SALMONELLOSIS.. in... Antimicrobial reitance in All Decription of ampling deign Salmonelloi in i a notifiable dieae in Sweden and from each notified incid are confirmed at SVA. Data preed are from uceptibility teting of thee. The ummary for each year include one iolate of each erovar from each warm-blooded pecie in notified incid. An exception i from cat and wildlife from which a ubet of i elected by convenience. Iolate from incid previouly notified and till under retriction are included in the yearly tatitic. Alo included are obtained in the almonella urveillance programme from ample collected at laughter (carca wab, neck kin and lymph node). Stratification procedure per population and food categorie See above. Randomiation procedure per population and food categorie See above. Sampling trategy ued in monitoring Frequency of the ampling relevant Type of pecimen taken Several differ type depending on context (clinical ubmiion, control programme). Method of ampling (decription of ampling technique) Several differ type depending on context (clinical ubmiion, control programme). Procedure for the election of for antimicrobial teting Salmonelloi in i a notifiable dieae in Sweden and one iolate from each notified incid mut be confirmed at SVA. Data on antimicrobial reitance preed in the zoonoi report include one iolate of each erovar, and when appropriate from each phage-type. Thee are from cattle, pig and poultry in incid notified during 6 and in incid previouly notified and till under retriction in 6. Iolate are alo included that were obtained in 6 in the urveillance programme from ample collected at laughter (carca wab, neck kin and lymph node). Method ued for collecting data Data for each ubmitted ample i tored in a data bae. Laboratory methodology ued for idification of the microbial Sweden - 6

6 wa iolated and idified at the Dept. of Microbiology, SVA or at regional laboratorie in accordance with tandard procedure. All ample within official control programme are cultured according to the procedure detailed by the MSRV (ISO-EN 6579:/ Amd :7). Confirmatory idification and erotyping wa performed according to the procedure of Kaufmann and White. Laboratory ued for detection for reitance Antimicrobial included in monitoring Antimicrobial uceptibility wa teted by a dilution method uing cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard (CLSI, ) uing VetMIC panel produced by SVA were ued. Tet were performed at the National Veterinary Intitute. Antimicrobial teted: ampicillin, cefotaxime, ceftazidime, chloramphemicol, ciprofloxacin, colitin, florfenicol, gamicin, kanamycin, nalidixic acid, treptomycin, ulphamethoxazole, tetracycline, trimethoprim. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information i rare in in Sweden, and few incid involve antibiotic-reitant train. Strain with ESBL reitance have never been found in from in Sweden, and reitance to fluoroquinolone i rare. Iolate from human invaive infection are markedly more reitant, which make in Sweden an unlikely ource for thee infection. In 6, altogether, 77 were teted for AMR of which 56 were S. Typhimurium. The majority of (86%) were uceptible to all antibiotic teted, but eleven were reitant to at leat one ubtance and four (5%) were multireitant. In the ubet of S. Typhimurium reitance wa overall low but ha varied over the year due to occurrence of multireitant train in individual year. One iolate of S. Mbandaka from poultry wa phenotypically reitant to colitin (MIC mg/l) but wa negative for the mcr- and mcr- gene on teting with PCR. No iolate wa reitant to extended pectrum cephaloporin. All the four multireitant were S. Typhimurium, of which two were from dog and two from cattle. The two from cattle were reitant to ampicillin, treptomycin, ulphonamide and trimethoprim. One of the from dog wa reitant to ampicillin, treptomycin, ulphonamide and tetracycline and the other wa reitant to quinolone (ciprofloxacin and nalidixic aci, treptomycin and ulphonamide.. CAMPYLOBACTERIOSIS.. Campylobacter in... Antimicrobial reitance in C. jejuni Gallu gallu (fowl) Decription of ampling deign Iolate reported are from the Swedih broiler Campylobacter programme. The programme include even abattoir and cover 99% of laughtered broiler. All flock in the programme are ampled at laughter. The programme i financed by the Swedih Board of Agriculture and the Poultry Meat Aociation. Stratification procedure per population and food categorie All flock of broiler were ampled. Each ample i from a unique flock but not neecarily from a unique production ite. Randomiation procedure per population and food categorie Ten bird from each laughtered flock are randomly ampled at laughter. Sweden - 6

7 Sampling trategy ued in monitoring Frequency of the ampling From every flock of brolier laughtered in 6, the caecum of ten bird i taken and pooled to form one compoite ample. Type of pecimen taken Caecum ample Method of ampling (decription of ampling technique) From every flock, the caecum of ten bird i taken at laughter by laughterhoue peronnel and pooled to form one compoite ample. Procedure for the election of for antimicrobial teting In January 7, 7 were randomly elected from the Campylobacter jejuni recovered in the Campylobacter programme during 6 (n=6). Method ued for collecting data Reult of antimicrobial uceptibility teting and information on the origin of from ubmiion form were tored in a databae at SVA. For ummary tatitic, the relevant data were extracted from the databae. Laboratory methodology ued for idification of the microbial ISO/DIS 7: part and. Iolation wa performed at the National Veterinary Intitute. Laboratory ued for detection for reitance Antimicrobial included in monitoring Antimicrobial uceptibility wa teted uing dilution method in cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard according to the CLSI tandard M5-rd ed. for fatidiou bacteria uing VetMIC panel produced by the National Veterinary Intitute. Antimicrobial teted are thoe advied by EFSA (ciprofloxacin, nalidixic acid, erythromycin, tetracycline, gamicin, treptomycin). Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information Of the 7 teted, 7 (75%) were uceptible to all ix antibiotic. Reitance to tetracycline (6%) only wa the mot common phenotype and thi i new for 6. Reitance to fluoroquinolone only (ciprofloxacin and nalidixic aci wa the econd mot common phenotype (%). Seven (%) were reitant to both fluoroquinolone and tetracycline. All were uceptible to erythromycin and gamicin. In comparion to previou year, quinolone reitance increaed notably in but ha declined ince then and in 6 there i a light increae again. The reaon for the quinolone and tetracycline reitance are not known but election through ue of antibiotic i unlikely ince antibiotic are mot rarely are ued in broiler production in Sweden.. ESCHERICHIA COLI, NON-PATHOGENIC Sweden - 6 5

8 .. Echerichia coli, non-pathogenic in foodtuff... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Meat from broiler (Gallu gallu) Decription of ampling deign Sample of freh broiler meat were collected throughout the year by municipal environmal departm in twelve differ citie in Sweden. In each city, a proportional number of ample in relation to the human population wa collected Stratification procedure per population and food categorie Freh broiler meat wa collected at retail by peronnel at municipal environmal departm. No tratification by country of origin wa made. Randomiation procedure per population and food categorie No formal randomiation wa made but municipal officer were intructed to at on each ampling occaion collect up to five ample meeting the incluion criteria (freh broiler meat) and to at each retail tore elect only one ample of each available brand. Sampling trategy ued in monitoring Frequency of the ampling The ampling wa conducted between January and December 6 and divided on 6 differ occaion. According to the ampling plan ample were to be collected but only 69 of thee were finally analyed becae of delayed tranportation to the laboratory reulting in a to high temperature on arrival. Of the 69 ample were of Swedih origin and 6 from abroad. Type of pecimen taken Freh broiler meat Method of ampling (decription of ampling technique) Sample were collected freh in their own package and to the laboratory by mail in refrigerated boxe. Procedure for the election of for antimicrobial teting From each ample cultured, one iolate of the relevant bacterial pecie from each elective plate ( MacConkey agar with cefotaxime ( mg/l), CHROMID CARBA agar and CHROMID OXA 8 agar) wa randomly elected for antimicrobial uceptibility teting. Method ued for collecting data Reult of antimicrobial uceptibility teting and information on the origin of, from package, were tored in a databae at the Swedih National Veterinary Intitute (SVA). For ummary tatitic, the relevant data were extracted from the databae. Laboratory methodology ued for idification of the microbial g of urface meat wa homogenized in ml BPW and incubated at 7 C overnight. From the BPW homogenate µl per agar plate wa pread on MacConkey agar with cefotaxime ( mg/l), CHROMID CARBA agar and CHROMID OXA 8 agar and incubated overnight at C for MacConkey agar and 7 C for the chromagar. One lactoe poitive colony with morphology typical for E. coli wa ub-cultured on hore-blood agar (5% v/v), after which the iolate wa teted for production of tryptophanae (indole). Only lactoe and indole poitive with typical morphology were elected for uceptibility tet and further teted for ESBL detection. Sweden - 6 6

9 Laboratory ued for detection for reitance Antimicrobial included in monitoring Antimicrobial uceptibility wa teted uing dilution method in cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard (CLSI, ). For E. coli Senititre panel (Panel and ) produced by Trek Diagnotic LTD were ued. Antimicrobial teted are thoe advied by EFSA. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information In 9 of 69 ample ESC reitant E. coli were found. Separated by origin, ESC reitant E. coli were detected in 7 (%) of the ample from broiler meat originating from Sweden and (8%) of the ample from broiler meat originating from other countrie. In 7 of the tranmiible gene conferring ESC-reitance were found but in no gene were detected by PCR. Of the 7 with tranmiible gene, 7 carried a gene in the CTX-M--group, a gene in the CIT-group and a TEM-gene. The exact gene wa determined by equencing for twelve (ix with a gene in the CTX-M--group, five with a gene in the CIT-group and the one iolate with a TEM-gene). Five of the with a gene in the CTX-M--group were confirmed to carry the gene blactx-m- and the lat of them carried the gene blactx-m-5. The five with a gene in the CIT-group were all confirmed to carry the gene blacmy-. The iolate with a TEM-gene wa confirmed to carry the gene blatem-5. Carbapenem reitant E. coli wa not detected in any ample... Echerichia coli, non-pathogenic in... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Gallu gallu (fowl) Decription of ampling deign Sample from broiler were collected at laughter within the Swedih Campylobacter programme in which whole caeca are collected from each of broiler laughtered. From thee ample, 9 were elected in January-June and 5 in Augut-November. Each ample wa from a unique flock but not alway from a unique production ite. Sample cultured were collected at eight abattoir that in 6 accounted for approximately 98% of the total volume of broiler laughtered. The number of ample from each abattoir wa roughly proportional to the annual laughter volume of the abattoir. Stratification procedure per population and food categorie See above. Randomiation procedure per population and food categorie No formal randomiation wa made in the election of ample for culture but ince all flock laughterd are ampled in the Campylobacter programme the election wa made from a cenu ample of flock. Sampling trategy ued in monitoring Frequency of the ampling Sample were collected in two period: Jannuray-June and Augut-November. Type of pecimen taken Sweden - 6 7

10 Whole caeca were ampled. Method of ampling (decription of ampling technique) From every flock, the caecum of ten bird i taken at laughter by laughterhoue peronnel. Procedure for the election of for antimicrobial teting From each ample cultured, one iolate of the relevant bacterial pecie (E. coli) wa randomly elected for antimicrobial uceptibility teting. Method ued for collecting data Reult of antimicrobial uceptibility teting and information on the origin of, collected from the laughterhoue, were tored in a databae at the Swedih National Veterinary Intitute (SVA). For ummary tatitic, the relevant data were extracted from the databae. Laboratory methodology ued for idification of the microbial Iolation wa performed at SVA. One gramme of caecum cont wa diluted in 9 ml buffered peptone water (BPW). µl of the upenion wa extracted and pread on a plate of MacConkey agar and incubated overnight at C. The remaining upenion wa incubated at 7 C overnight. From the BPW olution µl wa pread each on a plate of MacConkey agar with cefotaxime ( mg/l), CHROMID CARBA agar and CHROMID OXA 8 agar. The plate were incubated overnight at C (MacConkey agar) or 7 C (chromagar). One lactoe poitive colony with morphology typical of E. coli wa ub-cultured onto hore-blood agar (5% v/v), after which the iolate wa teted for production of tryptophanae (indole). Only lactoe and indol poitive with typical morphology were elected for uceptibility tet. Colonie growing on MacConkey agar with cefotaxime were ub-cultured on hore-blood agar (5% v/v) and further teted for ESBL/AmpC production. Laboratory ued for detection for reitance Antimicrobial included in monitoring Antimicrobial uceptibility wa teted uing dilution method in cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard (CLSI, ). For E. coli Senititre panel (Panel and ) produced by Trek Diagnotic LTD were ued. Antimicrobial teted are thoe advied by EFSA. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information Non elective culture: Echerichia coli wa iolated from 75 (8%) of 8 ample cultured. The majority of the (7%) wa uceptible to all antibiotic teted (Table.). Reitance to ulphonamide (%), ampicillin (%) and tetracycline (%) were the mot common trait. Fourteen (8%) were multireitant and all of thee had reitance to ulphonamide and ampicillin in their phenotype. Twelve of thee were reitant alo to trimethoprim. Three were reitant to cefotaxime and ceftazidime and all carried a blactx-m- gene (PCR). Since the tart of the monitoring in year, reitance to each pecific antibiotic teted ha been below 5%. Thi favorable ituation i likely due to the limited ue of antibiotic in broiler production in Sweden (ee Sale of antibiotic for ). Reitance to ulphonamide, tetracycline, ampicillin and trimethoprim ha, however, gradually increaed in rec year wherea reitance to quinolone ha decreaed again after an increae in previou year. The reaon for thee change are not known. Selective culture: ESC reitant E. coli wa iolated from (%) of ample of intetinal cont from broiler. Ninety-three had reitance gene of the CTX-M- group and gene of the CITgroup (PCR). In the remaining three, no tranferrable gene were detected. For fifteen of the the exact gene wa determined by equencing. Ten were confirmed to carry the gene blactx-m- (ESBLA) and five to carry the gene blacmy- (ESBLM). In previou year, with blacmy- have dominated among ESBL-producing E. coli from broiler even if a hift toward blactx-m- could be een already in.... Antimicrobial reitance in E.coli, non-pathogenic, unpecified Turkey Decription of ampling deign Sweden - 6 8

11 Caecal ample from healthy turkey were collected at laughter. Sampling wa performed by convenience at two abattoir in Sweden, from January to December 6. Each ample i from a unique flock but not alway from a unique production ite. In total 86 ample were collected and analyed. The turkey production in Sweden i mall and in 6 only 57 were laughtered. No pecific aem of the ample ize wa made. Stratification procedure per population and food categorie The tudy focued on turkey at laughter. Two laughterhoue participated in collection of the ample. Randomiation procedure per population and food categorie No formal randomiation wa made in the collection of the ample but each ampling day only one ample per flock of turkey wa collected by convenience by laughterhoue peronnel. Sampling trategy ued in monitoring Frequency of the ampling Sample were collected from January to December 6. Type of pecimen taken Whole caeca were ampled. Method of ampling (decription of ampling technique) Intetinal cont (caeca) from healthy turkey were ampled by convenience by laughterhoue peronnel at laughter. Each ample i from a unique flock but not alway from a unique production ite. Procedure for the election of for antimicrobial teting From each ample cultured, one iolate of the relevant bacterial pecie (E. coli) wa randomly elected for antimicrobial uceptibility teting. Method ued for collecting data Reult of antimicrobial uceptibility teting and information on the origin of from ubmiion form, collected from the laughterhoue, were tored in a databae at the Swedih National Veterinary Intitute (SVA). For ummary tatitic, the relevant data were extracted from the databae. Laboratory methodology ued for idification of the microbial Iolation wa performed at SVA. One gramme of caecum cont wa diluted in 9 ml buffered peptone water (BPW). µl of the upenion wa extracted and pread on a plate of MacConkey agar and incubated overnight at C. The remaining upenion wa incubated at 7 C overnight. From the BPW olution µl wa pread each on a plate of MacConkey agar with cefotaxime ( mg/l), CHROMID CARBA agar and CHROMID OXA 8 agar. The plate were incubated overnight at C (MacConkey agar) or 7 C (chromagar). One lactoe poitive colony with morphology typical of E. coli wa ub-cultured onto hore-blood agar (5% v/v), after which the iolate wa teted for production of tryptophanae (indole). Only lactoe and indol poitive with typical morphology were elected for uceptibility tet. Colonie growing on MacConkey agar with cefotaxime were ub-cultured on hore-blood agar (5% v/v) and further teted foresbl/ampc production. Laboratory ued for detection for reitance Antimicrobial included in monitoring Sweden - 6 9

12 Antimicrobial uceptibility wa teted uing dilution method in cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard (CLSI, ). For E. coli Senititre panel (Panel and ) produced by Trek Diagnotic LTD were ued. Antimicrobial teted are thoe advied by EFSA. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information Iolate of indicator E. coli were obtained from 85 of the 86 ample cultured and of E. coli reitant to third generation cephaloporin from ample (elective culture). The iolate reitant to third generation cephaloporin carried the gene blactx-m- (equencing). Thi i the firt time that an iolate with ESBL ha been reported from turkey in Sweden. No of E. coli reitant to carbapenem were obtained.. ENTEROCOCCUS, NON-PATHOGENIC.. Enterococcu, non-pathogenic in... Antimicrobial reitance in Enterococcu pp., unpecified Turkey Decription of ampling deign Caecal ample from healthy turkey were collected at laughter. Sampling wa performed by convenience at two abattoir in Sweden, from January to December 6. Each ample i from a unique flock but not alway from a unique production ite. In total 86 ample were collected and analyed. The turkey production in Sweden i mall and in 6 only 57 were laughtered. No pecific aem of the ample ize wa made. Stratification procedure per population and food categorie The tudy focued on turkey at laughter. Two laughterhoue participated in collection of the ample. Randomiation procedure per population and food categorie No formal randomiation wa made in the collection of the ample but each ampling day only one ample per flock of turkey wa collected by convenience by laughterhoue peronnel. Sampling trategy ued in monitoring Frequency of the ampling Sample were collected from January to December 6. Type of pecimen taken Whole caeca were ampled. Sweden - 6 Method of ampling (decription of ampling technique) Intetinal cont (caeca) from healthy turkey were ampled by convenience by laughterhoue peronnel at laughter. Each ample i from a unique flock but not alway from a unique production ite.

13 Procedure for the election of for antimicrobial teting From each ample cultured, one iolate of the relevant bacterial pecie (E. faecali and E. faecium) wa randomly elected for antimicrobial uceptibility teting. Method ued for collecting data Reult of antimicrobial uceptibility teting and information on the origin of from ubmiion form, collected from the laughterhoue, were tored in a databae at the Swedih National Veterinary Intitute (SVA). For ummary tatitic, the relevant data were extracted from the databae. Laboratory methodology ued for idification of the microbial Iolation wa performed at SVA. One gramme of caecum cont wa diluted in 9 ml buffered peptone water (BPW). Subequly,. ml of the upenion wa pread on Slanetz-Bartley (SlaBa) agar and incubated at 7 C for 8 h. Two colonie, randomly choen, were ub-cultured on hore-blood agar (5% v/v; 7 C, h). Colonie with morphology conit with erococci were idified to pecie level by MALDI-TOF MS. If available, one iolate of Enterococcu faecali (RF--MCG) and one iolate of E. faecium (RF--MCG) from each ample were teted for antibiotic uceptibility. Laboratory ued for detection for reitance Antimicrobial included in monitoring Antimicrobial uceptibility wa teted by a dilution method uing cation adjuted Mueller Hinton broth (CAMBH). The tet were performed following the tandard for microdilution of the National Committee of Clinical Laboratory Standard (CLSI, ). For Enterococci VetMIC panel produced by SVA were ued. Antimicrobial teted: ampicillin, bacitracin, chloramphenicol, erythromycin, gamicin, kanamycin, linezolid, narain, treptomycin, tetracycline, vancomycin. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Additional information Thi i the firt time, erococci from turkey in Sweden were invetigated. From 86 ample cultured, a total of of Enterococcu faecali and 7 of Enterococcu faecium were obtained. In E. faecali the majority of (9%) wa reitant to at leat one antibiotic and nineteen (6%) were multireitant. Reitance to tetracycline (8%), narain (6%), erythromycin (9%) and bacitracin (7%) were the mot common trait. No reitance to vancomycin wa detected. The number of teted i mall and concluion on occurrence of reitance mut be made with caution. In E. faecium the majority of (9%) wa reitant to at leat one antibiotic and five (7%) were multireitant. Reitance to narain (79%), erythromycin (%) and tetracycline (%) were the mot common trait. No reitance to vancomycin wa detected. The number of teted i mall and concluion on occurrence of reitance mut be made with caution. The high occurrence of reitance to narain in both E. faecali and E. faecium i intereting a narain i not ued a coccidiotat for turkey. The ionophore monenin i however ued and cro reitance between the two ubtance could be an explanation. ably reitance to narain in erococci from other, where narain i not ued, i rarely found in Sweden..5 STAPHYLOCOCCUS AUREUS METICILLIN RESISTANT (MRSA) INFECTION.5. Staphylococcu in.5.. Antimicrobial reitance in S. aureu, meticillin reitant (MRSA) All Sweden - 6

14 Decription of ampling deign In Sweden MRSA in all type of i notifiable and index are to be confirmed by molecular at the National Veterinary intitute. The data reported relate to thee index. Stratification procedure per population and food categorie No tratification wa made (ee above). Randomiation procedure per population and food categorie relevant (ee above). Sampling trategy ued in monitoring Frequency of the ampling No pecific monitoring of MRSA in wa performed in 6. Reported are notified cae from clinical ubmiion and contact tracing in 6. Type of pecimen taken Differ type of ample are included (wound, notril etc). Method of ampling (decription of ampling technique) Variable depending on the clinical preation of the (ee above). Procedure for the election of for antimicrobial teting No election wa made all notified index available were included. Method ued for collecting data data from ubmiion form were recorded. Laboratory methodology ued for idification of the microbial Iolate are from differ laboratorie but were all confirmed a MRSA at the National Veterinary Intitute where Maldi-TOF wa ued for pecie idification of and PCR for detection of mec-gene. Laboratory ued for detection for reitance Antimicrobial included in monitoring The were teted for uceptibility by micro-dilution at the National Veterinary Intitute. Antimicrobial teted: ciprofloxacin, penicillin, oxacillin, cephalothin, chloramphenicol, Erythromycin (Erythromycin A), tetracycline, gamicin, fuidic acid, trimethoprim, kanamycin, cefoxitin, clindamycin. EUCAST ECOFF were ued for interpretation of MIC. Cut-off value ued in teting Epidemiological cut-off value iued by EUCAST were ued. Sweden - 6

15 Additional information There are reaon to believe that the MRSA ituation in Sweden i favourable ince few cae are notified each year. In 6 MRSA meca were reported in hore, dog and cat. In addition, MRSA mecc wa reported in hedgehog, 9 goat and heep. The cae in goat and heep (index cae reported here) relate to a group of at a zoo were one goat with dermatiti wa idified a an MRSA carrier and ubequ contact tracing. Thee were all detroyed. The ituation regarding MRSA meca in i table at a low level. A for MRSA mecc thi variant i increaingly found in and appear to be common in wild hedgehog in Sweden. Still, the total number of cae in and human i low but the epidemiology of thi variant i unclear and deerve further tudy. The few finding of MRSA in i not likely to have an important impact on the general ituation in human. Alo, the number of cae of LA-MRSA in human i low indicating that there i no large reervoir among farm in Sweden. Sweden - 6

16 FOODBORNE OUTBREAKS Foodborne outbreak are incidence of two or more human cae of the ame dieae or infection where the cae are linked or are probably linked to the ame food ource. Situation, in which the oberved human cae exceed the expected number of cae and where a ame food ource i upected, i alo indicative of a foodborne outbreak.. Outbreak.. Foodborne outbreak Sytem in place for idification, epidemological invetigation and reporting of foodborne outbreak The municipal environmal and public health authoritie are reponible for detection and previon of food and waterborne dieae. Epidemiological invetigation and treatm of individual are the reponibilitie of County Medical Officer and the general practitioner. The Public Health Agency of Sweden i reponible for outbreak invetigation at the national level. The municipal authoritie are obliged to end a report on the reult of outbreak invetigation to the Swedih National Food Agency (NFA). Baed on the report received, and completed with information from The Public Health Agency of Sweden, NFA prepare a yearly report. The reporting ytem i mainly web baed. Decription of the type of outbreak covered by the reporting: The reporting ytem cover both general and houehold outbreak, and outbreak caued by toxin. The ytem alo include chemical, but if uch ag are idified they are removed from the dataet ubmitted to Efa. National evaluation of the reported outbreak in the country: Trend in number of outbreak and number of human cae involved With the curr reporting ytem it i difficult to detect any ignificant trend, becaue of difficultie in obtaining comparable data from all local authoritie. In 7, the National Food Agency i planning to launch a new web baed template for reporting of food-borne outbreak. For report from earlier year, pleae ee Additional information No additional information for 6 Sweden - 6

17 ANIMAL POPULATION TABLES Table Suceptible population Metric Population Animal pecie Category of Unit holding laughter (head) herd/flock Cattle (bovine ) Deer Duck Gallu gallu (fowl) Geee Goat Pig Reindeer Sheep Soliped, dometic Turkey Wild boar Cattle (bovine ) Cattle (bovine ) - calve (under year) Cattle (bovine ) - dairy cow and heifer Cattle (bovine ) - meat production Deer - farmed Deer - farmed - fallow deer Deer - farmed - red deer Duck Duck - meat production flock - before laughter Gallu gallu (fowl) - broiler Gallu gallu (fowl) - laying hen Gallu gallu (fowl) - laying hen - adult Geee Geee - meat production flock - before laughter Goat Pig Pig - breeding Pig - fattening pig Reindeer - emi-dometicated Sheep Sheep - over year Sheep - under year (lamb) Soliped, dometic Turkey Turkey - meat production flock Wild boar - farmed 7,6,88,9,,89 75,97 6,,87,8,9 9,657 79, 5,77 8,56,55 5,668,9, ,,68,,6,8,897 8,7,,9,97 5,69,95 5,967,8,,5,86,56,5,6,6,9 85,, 7,66 5,75 8,7 578,7 8, 8,669 8,7, 7, 96,87 7,98 76,8 55,5,67 56,5, Sweden - 6 5

18 DISEASE STATUS TABLES Table Bovine brucelloi in countrie and region that do not receive Community co-financing for eradication programme Region Metric Number of erologicall y teted under invetigatio n of upect cae Number of upended herd under invetigatio n of upect cae Number of eropoitiv e under invetigatio n of upect cae Number of poitive to BST under invetigatio n of upect cae Number of poitive in microbiolog ical teting under invetigatio n of upect cae Number of herd with tatu officially free Number of infected herd number of Number of herd teted under urveillance Number of teted under urveillance number of herd Number of infected herd teted under urveillance Number of herd teted under Number of or pool teted under Number of infected herd teted under urveillance urveillance urveillance by bulk milk by bulk milk by bulk milk Number of notified abortion whatever caue Number of iolation of Brucella infection Number of abortion due to Brucella abortu Number of teted by microbiolog y under invetigatio n of upect cae SWEDEN 7,6,88,9,, 7,6,, Sweden - 6 6

19 Table Ovine or Caprine brucelloi in countrie and region that do not receive Community co-financing for eradication programme Region Metric Number of erologicall y teted under invetigatio n of upect cae Number of upended herd under invetigatio n of upect cae Number of eropoitiv e under invetigatio n of upect cae Number of poitive in microbiolog ical teting under invetigatio n of upect cae Number of herd with tatu officially free Number of infected herd number of Number of herd teted under urveillance Number of teted under urveillance number of herd Number of infected herd teted under urveillance Number of teted by microbiolog y under invetigatio n of SWEDEN,669 59, 9,,669 upect cae Sweden - 6 7

20 DISEASE STATUS TABLES Table Bovine tuberculoi in countrie and region that do not receive Community co-financing for eradication programme Region Metric Number of herd with tatu officially free Number of infected herd number of Interval between routine tuberculin tet Number of teted with tuberculin routine teting Number of tuberculin tet carried out before the introduction into the herd Number of with upiciou leion of tuberculoi examined and ubmitted to hitopathological and bacteriological examination Number of detected poitive in bacteriological examination number of herd SWEDEN 7,6,88,9 () 7,6 Table Tuberculoi in farmed deer Region Metric Number of infected herd Number of herd with tatu free number of Interval between routine tuberculin tet Number of teted with tuberculin routine teting Number of tuberculin tet carried out before the introduction into the herd Number of with upiciou leion of tuberculoi examined and ubmitted to hitopathological and bacteriological examination Number of detected poitive in bacteriological examination number of herd SWEDEN 79, () 79 Sweden - 6 8

21 PREVALENCE TABLES Table BRUCELLA in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive Zoonoe Metric N of unit poitive Alpaca - farmed - Farm - - ample - organ/tiue - Surveillance - Official ampling - Supect ampling Bion - farmed - Farm - - ample - organ/tiue - Surveillance - Official ampling - Supect ampling Pig - unpecified - Farm - - ample - organ/tiue - Surveillance - Official ampling - Supect ampling Brucella Brucella Brucella Sweden - 6 9

22 Table CAMPYLOBACTER in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive Zoonoe Metric N of unit poitive SWEDEN Gallu gallu (fowl) - broiler - Slaughterhoue - Sweden - ample - caecum - Monitoring - active - Official ampling - Objective ampling laughte r Campylobacter jejuni thermotolerant Campylobacter, unpecified 6 5 Sweden - 6

23 Table CAMPYLOBACTER in food Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit Sample weight Sample weight unit unit teted unit poitive Zoonoe Metric N of unit poitive Cereal and meal - flour/meal or finely ground powder - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Crutacean - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Dairy product (excluding cheee) - ice-cream - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Fruit and vegetable - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Meat from bovine - meat product - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from bovine - minced meat - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from broiler (Gallu gallu) - freh - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from broiler (Gallu gallu) - meat product - Retail - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from pig - freh - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from pig - meat preparation - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Meat from wild game - bird - Unpecified - - food ample - meat - Monitoring - paive - Official ampling - Supect ampling Muhroom - Retail - - food ample - Monitoring - paive - Official ampling - Supect ampling Other proceed food product and prepared dihe - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Other proceed food product and prepared dihe - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Ready-to-eat alad - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Sauce and dreing - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Spice and herb - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Campylobacter Sweden - 6

24 Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Spice and herb - Unpecified - - food ample - Monitoring - paive - Official ampling - Supect ampling Sampling unit Sample weight Sample weight unit unit teted unit poitive Zoonoe Metric N of unit poitive Campylobacter Sweden - 6

25 Table COXIELLA in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive N of clinical affected herd Zoonoe Metric N of unit poitive All - farmed - Farm - Sweden - ample - blood - Monitoring - Official ampling - Selective ampling Cattle (bovine ) - breeding bull - Artificial inemination tation - Sweden - ample - blood - Monitoring - Official ampling - Selective ampling Cattle (bovine ) - breeding bull - Artificial inemination tation - Sweden - ample - blood - Monitoring - Official ampling - Selective ampling Cattle (bovine ) - dairy cow - Farm - Sweden - ample - milk - Clinical invetigation - Official ampling - Supect ampling Cattle (bovine ) - dairy cow - Farm - Sweden - ample - organ/tiue - Clinical invetigation - Official ampling - Supect ampling holding 6 7 Coxiella Coxiella Coxiella Coxiella burnetii Coxiella burnetii Coxiella Sweden - 6

26 Table CYSTICERCUS in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive Zoonoe Metric N of unit poitive SWEDEN Cattle (bovine ) - unpecified - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Pig - unpecified - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu 65 Cyticercu Cyticercu Sweden - 6

27 Table ECHINOCOCCUS in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive Zoonoe Metric N of unit poitive SWEDEN Cattle (bovine ) - unpecified - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Deer - farmed - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Dog - pet - Veterinary clinic - Sweden - ample - faece - Monitoring - paive - Official ampling - Supect ampling Foxe - wild - Natural habitat - Sweden - ample - organ/tiue - Survey - national urvey - Official ampling - Selective ampling Goat - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Pig - unpecified - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Reindeer - emi-dometicated - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Sheep - meat production - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Soliped, dometic - hore - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Wild boar - wild - Slaughterhoue - Sweden - ample - organ/tiue - Surveillance - Official ampling - Cenu Wolve - wild - Natural habitat - Sweden - ample - organ/tiue - Survey - national urvey - Official ampling - Selective ampling Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Echinococcu Sweden - 6

28 Table ESCHERICHIA COLI in Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit unit teted unit poitive Zoonoe Metric N of unit poitive Cattle (bovine ) - Farm - Sweden - ample - faece - Monitoring - Official ampling - Supect ampling Cattle (bovine ) - mixed herd - Farm - Sweden - ample - faece - Monitoring - Official ampling - Supect ampling Goat - Farm - Sweden - ample - faece - Monitoring - Official ampling - Supect ampling Sheep - Farm - Sweden - ample - faece - Monitoring - Official ampling - Supect ampling Sheep - mixed herd - Farm - Sweden - ample - faece - Monitoring - Official ampling - Supect ampling holding holding holding holding holding 7 5 VTEC O57 Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) VTEC O57 Verocytotoxigenic E. coli (VTEC) Sweden - 6 6

29 Table ESCHERICHIA COLI in food Area of Sampling Matrix - Sampling tage - Sampling origin - Sample type - Sampling context - Sampler - Sampling trategy Sampling unit Sample weight Sample weight unit unit teted unit poitive Zoonoe Metric N of unit poitive All foodtuff - Unpecified - - food ample - Monitoring - paive - Official ampling - pecified Fruit - Unpecified - - food ample - Monitoring - paive - Official ampling - pecified Meat from bovine - Border inpection activitie - - food ample - meat - Surveillance - Official ampling - pecified Meat from bovine - meat preparation - Unpecified - - food ample - meat - Monitoring - Official ampling - Supect ampling Meat from bovine - minced meat - Unpecified - - food ample - meat - Monitoring - Official ampling - Supect ampling Meat from heep - freh - frozen - Border inpection activitie - - food ample - meat - Surveillance - Official ampling - pecified Ready-to-eat alad - Retail - - food ample - Survey - Official ampling - Objective ampling Ready-to-eat alad - Unpecified - - food ample - Monitoring - Official ampling - Supect ampling Ready-to-eat alad - Unpecified - - food ample - Survey - Official ampling - pecified Spice and herb - Unpecified - - food ample - Monitoring - Official ampling - Supect ampling 7 5 VTEC, unpecified Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Verocytotoxigenic E. coli (VTEC) Sweden - 6 7