Surveillance and outbreak report Open Access
Like 0


Trichinellosis is a rare parasitic zoonosis caused by following ingestion of raw or undercooked meat containing larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients’ muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.


Article metrics loading...

Loading full text...

Full text loading...



  1. Devleesschauwer B, Praet N, Speybroeck N, Torgerson PR, Haagsma JA, De Smet K, et al. The low global burden of trichinellosis: evidence and implications. Int J Parasitol. 2015;45(2-3):95-9.  https://doi.org/10.1016/j.ijpara.2014.05.006  PMID: 24953055 
  2. Duscher GG, Leschnik M, Fuehrer HP, Joachim A. Wildlife reservoirs for vector-borne canine, feline and zoonotic infections in Austria. Int J Parasitol Parasites Wildl. 2014;4(1):88-96. eCollection 2015.  https://doi.org/10.1016/j.ijppaw.2014.12.001  PMID: 25830102 
  3. Gottstein B, Pozio E, Nöckler K. Epidemiology, diagnosis, treatment, and control of trichinellosis. Clin Microbiol Rev. 2009;22(1):127-45.  https://doi.org/10.1128/CMR.00026-08  PMID: 19136437 
  4. Pozio E. Searching for Trichinella: not all pigs are created equal. Trends Parasitol. 2014;30(1):4-11.  https://doi.org/10.1016/j.pt.2013.11.001  PMID: 24314577 
  5. Touloudi A, Valiakos G, Athanasiou LV, Birtsas P, Giannakopoulos A, Papaspyropoulos K, et al. A serosurvey for selected pathogens in Greek European wild boar. Vet Rec Open. 2015;2(2):e000077.  https://doi.org/10.1136/vetreco-2014-000077  PMID: 26392908 
  6. Ancelle T, De Bruyne A, Poisson D, Dupouy-Camet J. Outbreak of trichinellosis due to consumption of bear meat from Canada, France, September 2005. Euro Surveill. 2005;10(10):E051013.3. PMID: 16790882 
  7. Fichi G, Stefanelli S, Pagani A, Luchi S, De Gennaro M, Gómez-Morales MA, et al. Trichinellosis outbreak caused by meat from a wild boar hunted in an Italian region considered to be at negligible risk for Trichinella. Zoonoses Public Health. 2015;62(4):285-91.  https://doi.org/10.1111/zph.12148  PMID: 25103623 
  8. Holzbauer SM, Agger WA, Hall RL, Johnson GM, Schmitt D, Garvey A, et al. Outbreak of Trichinella spiralis infections associated with a wild boar hunted at a game farm in Iowa. Clin Infect Dis. 2014;59(12):1750-6.  https://doi.org/10.1093/cid/ciu713  PMID: 25214511 
  9. Murrell KD, Bruschi F. Clinical trichinellosis. Prog Clin Parasitol. 1994;4:117-50. PMID: 7948934 
  10. Pozio E. Trichinella spp. imported with live animals and meat. Vet Parasitol. 2015;213(1-2):46-55.  https://doi.org/10.1016/j.vetpar.2015.02.017  PMID: 25754352 
  11. United States Centers for Disease Control and Prevention (CDC). Prevention & Control. Parasites - Trichinellosis (also known as Trichinosis). 13 Dec 13 2013. Atlanta, GA: CDC. [Accessed 21 Nov 2015]. Available from: http://www.cdc.gov/parasites/trichinellosis/prevent.html
  12. Fabre MV, Beiting DP, Bliss SK, Appleton JA. Immunity to Trichinella spiralis muscle infection. Vet Parasitol. 2009;159(3-4):245-8.  https://doi.org/10.1016/j.vetpar.2008.10.051  PMID: 19070961 
  13. Wang CH, Bell RG. Trichinella spiralis: newborn larval migration route in rats reexamined. Exp Parasitol. 1986;61(1):76-85.  https://doi.org/10.1016/0014-4894(86)90137-2  PMID: 3943594 
  14. Kociecka W. Trichinellosis: human disease, diagnosis and treatment. Vet Parasitol. 2000;93(3-4):365-83.  https://doi.org/10.1016/S0304-4017(00)00352-6  PMID: 11099848 
  15. Neghina R, Neghina AM, Marincu I, Iacobiciu I. Reviews on trichinellosis (II): neurological involvement. Foodborne Pathog Dis. 2011;8(5):579-85.  https://doi.org/10.1089/fpd.2010.0733  PMID: 21186993 
  16. Compton SJ, Celum CL, Lee C, Thompson D, Sumi SM, Fritsche TR, et al. Trichinosis with ventilatory failure and persistent myocarditis. Clin Infect Dis. 1993;16(4):500-4.  https://doi.org/10.1093/clind/16.4.500  PMID: 8513055 
  17. Lazarević AM, Nesković AN, Goronja M, Golubovic S, Komić J, Bojić M, et al. Low incidence of cardiac abnormalities in treated trichinosis: a prospective study of 62 patients from a single-source outbreak. Am J Med. 1999;107(1):18-23.  https://doi.org/10.1016/S0002-9343(99)00161-8  PMID: 10403348 
  18. Neghina R, Neghina AM, Marincu I. Reviews on trichinellosis (III): cardiovascular involvement. Foodborne Pathog Dis. 2011;8(8):853-60.  https://doi.org/10.1089/fpd.2010.0815  PMID: 21438766 
  19. Pozio E. Trichinellosis in the European union: epidemiology, ecology and economic impact. Parasitol Today. 1998;14(1):35-8.  https://doi.org/10.1016/S0169-4758(97)01165-4  PMID: 17040688 
  20. Council of the European Communities. Council Directive 92/45/EEC of 16 June 1992, on public health and animal health problems relating to the killing of wild game and the placing on the market of wild-game meat. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 14. 9 . 92:L 268. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1426636760883&uri=CELEX:31992L0045
  21. European Commission. Commission implementing regulation (EU) 2015/1375 of 10 August 2015 laying down specific rules on official controls for Trichinella in meat. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 11.8.2015:L 212. Available from: http://eur-lex.europa.eu/legal-content/EN/TXT/?qid=1448152892014&uri=CELEX:32015R1375
  22. European Centre for Disease Prevention and Control (ECDC). Annual epidemiological report 2014 – food- and waterborne diseases and zoonoses. Stockholm: ECDC; 2014. Available from: http://ecdc.europa.eu/en/publications/Publications/food-waterborne-diseases-annual-epidemiological-report-2014.pdf
  23. European Centre for Disease Prevention and Control (ECDC). Surveillance atlas of infectious diseases. Trichinellosis - Confirmed cases - Reported cases. Data by country and year (2014). Stockholm: ECDC. [Accessed 14 Sep 2016]. Available from: http://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=53&Indicator=118822&GeoResolution=2&TimeResolution=Year&StartTime=2007&EndTime=2014&CurrentTime=2014&Distribution=118831&DistributionRepresentation=B&TimeSeries=118822&TimeSeriesRepresentation=T
  24. Famerée L, Cotteleer C, Van Den Abbeele O. [Trichinosis in Belgium. Apropos of a familial epidemic following consumption of wild boar meat]. Rev Med Liege. 1979;34(10):464-73. French. PMID: 575573 
  25. Schynts F, van der Giessen J, Tixhon S, Pozio E, Dorny P, de Borchgrave J. First isolation of Trichinella britovi from a wild boar (Sus scrofa) in Belgium. Vet Parasitol. 2006;135(2):191-4.  https://doi.org/10.1016/j.vetpar.2005.09.002  PMID: 16202536 
  26. Vercammen F, Vervaeke M, Dorny P, Brandt J, Brochier B, Geerts S, et al. Survey for Trichinella spp. in red foxes (Vulpes vulpes) in Belgium. Vet Parasitol. 2002;103(1-2):83-8.  https://doi.org/10.1016/S0304-4017(01)00579-9  PMID: 11751003 
  27. ProMED-mail. Trichinellosis - Belgium: ex Spain, wild boar meat, request for information. Archive Number: 20141206.3015631. 6 Dec 2014. Available from: http://www.promedmail.org/
  28. Gamble HR, Bessonov AS, Cuperlovic K, Gajadhar AA, van Knapen F, Noeckler K, et al. International Commission on Trichinellosis: recommendations on methods for the control of Trichinella in domestic and wild animals intended for human consumption. Vet Parasitol. 2000;93(3-4):393-408.  https://doi.org/10.1016/S0304-4017(00)00354-X  PMID: 11099850 
  29. Zarlenga DS, Chute MB, Martin A, Kapel CM. A multiplex PCR for unequivocal differentiation of all encapsulated and non-encapsulated genotypes of Trichinella. Int J Parasitol. 1999;29(11):1859-67.  https://doi.org/10.1016/S0020-7519(99)00107-1  PMID: 10616932 
  30. European Union Reference Laboratory for Parasites. Istituto Superiore di Sanità (ISS). Identification of Trichinella Muscle Stage Larvae at the Species Level by Multiplex PCR. Rome: ISS; 2013. Available from: http://www.iss.it/binary/crlp/cont/MI_02_WEB_SITE.pdf
  31. Deroose CM, Van Weehaeghe D, Tousseyn T, Van Rompuy AS, Vanderschueren S, Blockmans D, et al. Diffuse 18F-FDG Muscle Uptake in Trichinella spiralis Infection. Clin Nucl Med. 2016;41(1):55-6.  https://doi.org/10.1097/RLU.0000000000000933  PMID: 26252328 
  32. Cortés-Blanco M, García-Cabañas A, Guerra-Peguero F, Ramos-Aceitero JM, Herrera-Guibert D, Martínez-Navarro JF. Outbreak of trichinellosis in Cáceres, Spain, December 2001-February 2002. Euro Surveill. 2002;7(10):136-8. PMID: 12631992 
  33. Zamora MJ, Alvarez M, Olmedo J, Blanco MC, Pozio E. Trichinella pseudospiralis in the Iberian peninsula. Vet Parasitol. 2015;210(3-4):255-9.  https://doi.org/10.1016/j.vetpar.2015.04.004  PMID: 25913596 
  34. Angheben A, Mascarello M, Zavarise G, Gobbi F, Monteiro G, Marocco S, et al. Outbreak of imported trichinellosis in Verona, Italy, January 2008. Euro Surveill. 2008;13(22):18891. PMID: 18761961 
  35. Pozio E, Mesina P, Sechi F, Pira M, Liciardi M, Cossu P, et al. Human outbreak of trichinellosis in the Mediterranean island of Sardinia, Italy. Vet Parasitol. 2006;140(1-2):177-80.  https://doi.org/10.1016/j.vetpar.2006.03.012  PMID: 16621284 
  36. Gallardo MT, Mateos L, Artieda J, Wesslen L, Ruiz C, García MA, et al. Outbreak of trichinellosis in Spain and Sweden due to consumption of wild boar meat contaminated with Trichinella britovi. Euro Surveill. 2007;12(3):E070315.1. PMID: 17439785 
  37. Puljiz I, Beus A, Kuzman I, Seiwerth S. Electrocardiographic changes and myocarditis in trichinellosis: a retrospective study of 154 patients. Ann Trop Med Parasitol. 2005;99(4):403-11.  https://doi.org/10.1179/136485905X36307  PMID: 15949188 
  38. Bruschi F, Dupouy-Camet J, Kociecka W, Pozio E, Bolas-Fernandez F. Opinion on the diagnosis and treatment of human trichinellosis. Expert Opin Pharmacother. 2002;3(8):1117-30.  https://doi.org/10.1517/14656566.3.8.1117  PMID: 12150691 
  39. Fourestié V, Bougnoux ME, Ancelle T, Liance M, Roudot-Thoraval F, Naga H, et al. Randomized trial of albendazole versus tiabendazole plus flubendazole during an outbreak of human trichinellosis. Parasitol Res. 1988;75(1):36-41.  https://doi.org/10.1007/BF00931188  PMID: 3060872 
  40. Pozio E, Sacchini D, Sacchi L, Tamburrini A, Alberici F. Failure of mebendazole in the treatment of humans with Trichinella spiralis infection at the stage of encapsulating larvae. Clin Infect Dis. 2001;32(4):638-42.  https://doi.org/10.1086/318707  PMID: 11181129 
  41. Faber M, Schink S, Mayer-Scholl A, Ziesch C, Schönfelder R, Wichmann-Schauer H, et al. Outbreak of trichinellosis due to wild boar meat and evaluation of the effectiveness of post exposure prophylaxis, Germany, 2013. Clin Infect Dis. 2015;60(12):e98-104.  https://doi.org/10.1093/cid/civ199  PMID: 25770171 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error