Interviews were conducted with two people: both report shopping at international markets that stock mostly Arabic and Middle Eastern foods and ingredients, and ate items containing tahini. Interviews are pending on the remaining ill people. Two have traveled to Syria and have not been reachable by public health officials.

Ill people range from less than one to 57 years old, with a median age of 19.5 years. Illness onset dates are from Nov. 19, 2020 to Sept. 5, 2021.

Canada has eight confirmed cases: five of Salmonella Mbandaka, two of Salmonella Havana and one of Salmonella Orion from 2019 to 2021.

Salmonella Mbandaka cases have dates of illness onset between November 2019 and July 2021. The Salmonella Havana cases have onset dates in April and June 2019. The Salmonella Orion patient fell ill in May 2021. Canada also has one patient with an infection of Salmonella Tennessee with a date of onset in May 2021, who reported consuming pistachio halva.

Wider outbreak
In Europe, 121 people have been affected since January 2019 in five countries with the most recent patient reported in mid-September 2021. There was a notable rise of infections in March this year.

Six different types of Salmonella are behind illnesses in Germany, Sweden, Norway, Denmark, and the Netherlands. The most common is Salmonella Havana followed by Salmonella Mbandaka, Salmonella Orion, Salmonella Kintambo, Salmonella Senftenberg, and Salmonella Amsterdam.

Almost half of those sick are children younger than 10 years of age. Of 52 confirmed cases with available information, 22 were hospitalized including 12 children.

Germany has 72 cases, Sweden has 37, Denmark has nine, Norway has five and Netherlands has two.

Sesame-based products were sealed and ready to be consumed, which suggests contamination occurred before they reached the EU, said the European Food Safety Authority (EFSA) and European Centre for Disease Prevention and Control (ECDC).

Patient interviews in four countries of eight people revealed consumption of sesame-based products such as halva or tahini prior to illness.

Contaminated products available for 2 years
Since November 2019, 14 batches of sesame-based products originating from Syria, tested positive for one or multiple Salmonella outbreak strains.

Occurrence of infected people and findings of positive food samples since 2019 indicate contaminated sesame-based products have been on the EU market for more than two years, said EFSA and ECDC.

Control measures such as withdrawals, recalls, and destroying implicated batches of sesame-based products have been taking place since August 2020 by food safety authorities in Germany, Sweden, Norway, and Finland. However, it has not prevented occurrence of illnesses up to September 2021, possibly due to the long shelf life of products.

There remains a risk for new Salmonella infections linked to imported sesame-based products from Syria as there is limited information on product manufacturing, including growing, harvesting, and distribution, said EFSA and ECDC.

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