Fatal emetic Bacillus cereus outbreak associated with consumption of pre-cooked tortellini, Germany, August to September 2024

In September 2024, the competent food control authority was informed that two people had fallen ill after visiting a restaurant and one of them died shortly after. As other people had already reported serious symptoms and hospitalisation after visiting the venue in question, a food-related outbreak had to be assumed. The investigations clarified that the outbreak was most likely triggered by pre-cooked tortellini with meat filling. High bacterial levels of emetic toxin-producing bacteria of the Bacillus cereus group were detected in food and environmental samples from the restaurant as well as in the stool of one affected hospitalised person. In addition, emetic toxin cereulide was detected in the remains of pre-cooked tortellini, food residues of an aluminium tray from a takeaway meal and in stool samples. The connections between the individual findings were demonstrated with the help of next-generation sequencing, which confirmed a genetic relationship between the corresponding isolates from food, environmental and human samples. The outbreak has been linked to at least eleven human cases, with one of these being fatal.