outbreak investigation questionnaire fwd -...

Food- and waterborne disease outbreak investigation questionnaire tool

Repository of questions to support the investigation

of outbreaks

Suggested citation: European Centre for Disease Prevention and Control. Food- and water-borne disease outbreak investigation questionnaire tool – Repository of questions to support the investigation of outbreaks [Oct 2016], Stockholm, 2016.

© European Centre for Disease Prevention and Control, Stockholm, 2016

Table of Contents1 General and demographical questions (h-1)................................................................................4

Questions to be pre-filled (h-2)....................................................................................................4Demographics (h-4).....................................................................................................................5

2 Disease-related questions (h-5)...................................................................................................6Episode of illness (h-6).................................................................................................................6Patient history (h-7).....................................................................................................................7Contact with other cases (h-8).....................................................................................................8Possible source/vehicle of infection (h-9).....................................................................................9

3 Travel-related questions (h-11)..................................................................................................114 Food habits, allergies and diet (h-12).........................................................................................135 Shopping (h-13)..........................................................................................................................146 Restaurants and other places to eat out (h-14).........................................................................167 Vegetables and vegetable products (h-15)................................................................................18

Lettuces and mixed salads (h-16)..............................................................................................18Other vegetables (h-17).............................................................................................................19Legumes/pulses/meat substitutes (h-18)...................................................................................20Vegetable juice (h-19)................................................................................................................20Sprouts, shoots and seedlings (h-20).........................................................................................21Herbs and spices (h-21).............................................................................................................21Mushrooms (h-22)......................................................................................................................22

8 Fruits and fruit products (h-23)..................................................................................................23Fruits (except berries) (h-24).....................................................................................................23Berries (h-25).............................................................................................................................23Fruit products (h-27)..................................................................................................................24Fruit juice and smoothies (h-28)................................................................................................24

9 Nuts and seeds (h-29)................................................................................................................2510 “Superfoods” (h-30)...................................................................................................................2611 Meat and meat products (h-31)..................................................................................................26

Sausages (h-32).........................................................................................................................26Beef (h-33).................................................................................................................................27Pork (h-34).................................................................................................................................28Mutton/lamb (h-35)....................................................................................................................28Poultry (h-36).............................................................................................................................29Game meat (h-37)......................................................................................................................30Other meats (h-38).....................................................................................................................30Other meat products (h-39).......................................................................................................30

12 Fish and shellfish (h-40).............................................................................................................32Fish (h-41)..................................................................................................................................32

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Shellfish (h-42)...........................................................................................................................3313 Milk and dairy products (h-43)...................................................................................................35

Milk (h-44)..................................................................................................................................35Dairy products (excluding cheeses) (h-45)................................................................................35Cheeses (h-46)...........................................................................................................................35

14 Eggs and egg products (h-47)....................................................................................................39Eggs (h-48).................................................................................................................................39Egg products (h-49)....................................................................................................................39

15 Other food products (h-50).........................................................................................................41Grain-based products (h-51)......................................................................................................41Chocolate (h-52).........................................................................................................................41Honey (products) (h-53).............................................................................................................42Sauces, dips and dressings (h-54)..............................................................................................42Vitamins and dietary supplements (h-55)..................................................................................42

16 Food products for young children (h-56)....................................................................................4317 Water and water-based beverages (h-57)..................................................................................45

Water-based beverages (h-58)...................................................................................................45Water contact (h-59)..................................................................................................................46

18 Contact with animals (h-60).......................................................................................................4719 Food diary (h-61)........................................................................................................................4920 Closure questions (h-62)............................................................................................................53

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1 General and demographical questions (h-1)

Questions to be pre-filled (h-2)

1.1 Outbreak ID (0001):

1.2 Start outbreak investigation date(0002): On __ /__ / __ (dd/mm/year)

1.3 Disease(0003):

1.4 (Suspected) pathogen(0004):

1.5 Country investigating the outbreak(0005):

1.6 National case number/ID(0006):

1.6 Laboratory ID(0007):

1.7 Name of the case (0008):

1.8 Interviewed by (0009):

1.9 Date of completing the questionnaire (0010): __ /__ / __ (dd/mm/year)

1.10 Did the case die? (0011)

Yes, on __ /__ / __ (dd/mm/year) No

1.11 The Reference period [T] to be applied along the questionnaire is ___

Start of the interview (h-3)

Interviewer: Hello, my name is [name] and I’m calling from the [institute]. I’m calling because there have been several cases of [disease] in our community and we are working to identify the source of infection, so we can prevent additional illness in the community. We suspect that food is the source of this outbreak and we understand that you are one of the people who is potentially linked to this outbreak. To help us in the investigation of this outbreak, I would like to ask you some questions about your illness and the foods that you ate before becoming ill. This will take about [duration] minutes. Your participation is voluntary, your personal information will be treated strictly confidentially and will be destroyed or anonymised after the investigation is completed. Your name or any other identifying information will not appear in any report from this study.

Thank you very much in advance.

Self-administrated: Dear Sir/Madam, you are receiving this email because there have been several cases of [disease] in our community and we are working to identify the source of infection, so we can prevent additional illness in the community. We suspect that food is the source of this outbreak and we understand that you are one of the people who is potentially linked to this outbreak. To help us in the investigation of this outbreak, we would like to ask you some questions about your illness and the foods that you ate before becoming ill. This will take about [duration] minutes. Your participation

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is voluntary, your personal information will be treated strictly confidentially and will be destroyed or anonymised after the investigation is completed. Your name or any other identifying information will not appear in any report from this study.

Thank you very much in advance.

1.12 Are you willing to continue with my questions? (0012)

Yes Yes, but self-administered: _______________ (email address) No Need more information, specify

1.13 Can we continue right now, or should I call you back at a later time or date? (0013)

1.13.1 If now is not a good time, when would be a convenient time for me to call you back? ______

1.13.2 If you do not want to participate, may I ask the reasons why?

Demographics (h-4)

1.1 The questionnaire is completed by (0014): (0014 1) the case (0014 2) parent (0014 3) spouse (0014 4) someone else, specify

Interviewer and self-administrated : If you are not the case, please answer all questions, as far as possible from the case's point of view.

1.2 Gender (0015): (0015 1) Male (0015 2) Female

1.3 Age (0016a): __ years (or months when aged <2 yrs(0016b))

1.4 Date of birth (0017): __ /__ / __ (dd/mm/year)

1.5 Address:

1.6 Postal code:

1.7 City (0020):

1.8 Country of residence (0021):

1.9 Phone number on which you can be joined: (home) (mobile)

1.10 Do you have a professional activity? (0024)

Yes, specify your profession and where is your work place located (0024 1) No (0024 0)

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1.11 Outside your household, are you in any way involved in the production, preparation or serving of food? (0026)

Yes, specify (0026a) No (0026b)

6

2 Disease-related questions (h-5)

Episode of illness (h-6)

Interviewer: We will continue this interview with questions about your recent gastrointestinal illness.

Self-administrated: The next questions are about your recent gastrointestinal illness.

2.1 When did you have the first symptoms? (0027)

(0027 1) Did not have any symptoms (0027 2) My symptoms started with _______________ on __ /__ / __ (dd/mm/year) or around ________ (0027a)

2.2 Time of illness onset (0028): ______ or unknown

2.3 How long did your illness last? (0029) __ days

2.4 Did you recover or are you still ill? (0029a) Recovered Still ill

2.5 Did you have the following symptoms? (Yes (Y)/No (N)/unknown (?)) (0030)

Y/N/? Onset date Comments

Diarrhoea (0031)

If yes, what was the maximum number of stools in a 24-hour period: ____ (0031a)Did you notice any particularity in the aspect of the diarrhoea? ____ (0031b)

Light (coloured) stools (0033)Nausea (0034)Vomiting (0035)Abdominal pain/cramps (0036)Fever (>38 ̊C) (0037) If yes, how many degrees? __ ̊C (0037a)Chills (0038)Body aches (0039)Joint pain (0040)Muscle aches (0041)Unusual fatigue/tiredness (0042)Constipation (0043)Flatulence (0044)Headache (0045)Jaundice/yellow eyes (0047)Dark urine (0048)Eye problems (0049)Weakness (0050)Difficulty swallowing (Dysphagia) (0051)Painful urination (Dysuria) (0052)Weakness or impaired movement (Paresis of limb(s)) (0053)Loss of muscle function (Paralysis of limb(s)) (0054)Bacteraemia/sepsis (0056)Pneumonia (1099)Loss of appetite (0057)

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Dizziness (0058)Other symptoms (0059) If yes, which (0059a)

2.6 Have you consulted a healthcare professional (e.g. doctor or nurse) for any of these symptoms? (0061)

(0061_1) Yes (0061_0) No

2.6.1 If yes, on which date did you first consult? __ /__ / __ (dd/mm/year) (0061a)

2.7 Did you attend the emergency department for this illness? (0062)

(0062 1) Yes (0062 0) No

2.8 Were you admitted to hospital due to the illness? (0063)

(0063 1) Yes (0063 0) No

If yes,

2.8.1 What was/is the name of the hospital? (0063a)

2.8.2 When were you admitted? __ /__ / __ (dd/mm/year) (0063b)

2.8.3 Are you still in the hospital?

Yes No, specify when you were discharged? __ /__ / __ (dd/mm/year) (0063c)

2.9 Was a stool sample taken? (0064)

(0064 1) Yes (0064 0) No (0064 1) Don’t know

2.9.1 If yes, what was/ere the pathogen(s) identified?

2.10 Was a blood sample taken? (0065)

(0065 1) Yes (0065 0) No (0065 1) Don’t know

2.10.1 If yes, what was/ere the pathogen(s) identified?

2.11 Is there anything specific you experienced during the course of illness and that you would like to share with us? (0066)

Patient history (h-7)

2.12 Have you been vaccinated against [disease]? (0067)

(0067 1) Yes8

(0067 0) No (0067 9) Don’t know

If yes,

2.12.1 When were you vaccinated? (0067a) 2.12.2 How many doses of vaccine did you receive? (0067b) 2.12.3 What type of vaccine did you receive? (0067c)

2.13 Do you have a chronic disease (e.g. Crohn’s disease, immune disorder, diabetes)? (0069)

(0069 1) Yes, specify (0069 0) No

2.14 Did you take any of the below-mentioned medications in the three months preceding this infection? (0070)

(0070 1) Yes, antacids, specify (0070a)

(0070 2) Yes, antibiotics, specify (0070b)

(0070 3) Yes, immunosuppressors (including chemotherapy), specify (0070c)

(0070 0) No (0070 9) Don’t know

2.15 Were you hospitalised or resident in a hospice, nursing home or similar in the [T] before you became ill? (0071)

(0071 1) Yes (0071 0) No

If yes,

2.15.1 Where was it? (0071a)

2.15.2 When was it? From __ /__ / __ (0071b) until __ /__ / __ (dd/mm/year) (0071c)

Contact with other cases (h-8)

Interviewer: To get a view of other possible cases in your social circles, I will now ask you some questions about your household and social contacts.

Self-administrated: To get a view of other possible cases in your social circles, the following questions will be about your household and social contacts.

2.16 How many persons, including you, live in your household? (0072)

___ persons, among which __ adults, __ children aged 2-16 years, ___ children aged under 2 years old.

2.17 Has anyone in your household had similar symptoms? (0073)

(0073 1) Yes (0073 0) No (0073 9) Don’t know/Don’t remember

If yes, how many persons became ill (excluding yourself) (0074)

2.17.1 The same week __ persons (0074a)

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2.17.2 The week before __ persons (0074b)

2.17.3 The week after __ persons (0074c)

2.18 Excluding your household, are you aware of having had contact with someone with similar symptoms within one week before onset of symptoms? (0075)

(0075 1) Yes (0075 0) No/Don’t know/Don’t remember

2.19 If you had contact with other cases, could you provide the following details? (0076)

Nr. Name of contact

Relation to contact

Age, sex

Date of symptoms Symptoms

1 (0076a)2 (0076b)3 (0076c)

2.20 If there were other people who have been ill at the same time as you, did you share meals or events with him/her/them? (0077)


2.20.1 If yes, what was shared? (0077a)

2.21 Have you had contact with children attending daycare during the [T] before the start of your symptoms? (0078)

(0078 1) Yes, specify (0078 0) No (0078 9) Don’t know/Don’t remember

If yes,

2.21.1 What is the name and address of the daycare facility? (0078b)

2.21.2 Are you aware of any related illness in the daycare facility? (0078c)

(0078c 1) Yes, specify (0078c 0) No

2.22 Do you have any other information about contact with other ill people that could be relevant? (0079)

Possible source/vehicle of infection (h-9)

2.23 According to you, what is the cause of your illness? (0080)

2.24 Did you consume food or drinks that in your opinion smelled or tasted like it could have been spoiled? (0081)

(0081 1) Yes10

(0081 0) No

2.24.1 If yes, what food/drink was it, when was it and where was it? (0081a)

2.25 Did you consume food or drinks that had gone over the expiration date? (0082)

(0082 1) Yes (0082 0) No

2.25.1 If yes, what food/drink was it, when was it and where was it? (0082a)

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3 Travel-related questions (h-11)

Interviewer and self-administrated: The following questions are about your possible travel within [country] as well as abroad and also about food items you or someone you know may have brought from abroad.

3.1 Did you spend one or more nights outside your home (e.g. visiting family or business), but within [country] in the [T] before you became ill? (0084)

(0084 1) Yes (0084 0) No

If yes, specify

Nr.City(-ies) where you stayed the night or had a meal

Name of the restaurant/place where you had a meal

Date Transport mode to that city

1234

3.2 Did you visit a foreign country in the [T] before you became ill? (0085)

(0085 1) Yes (0085 0) No

If yes, specify

Nr.

City(-ies) where you stayed the night or had a meal

Country name

Name of the restaurant/place where you had a meal

DateTransport mode to that city

1234

3.3 Did you have a meal during the transportation (e.g. in the plane, train)? (0099)

(0099 1) Yes, specify (0099 0) No

3.4 Did you seek medical advice regarding your trip abroad prior to departure? (0106)

(0106 1) Yes (0106 0) No

If yes,

3.4.1 Where did you get advice? (0106a)3.4.2 Which vaccine was recommended? (0106b)3.4.3 Which vaccine did you take in relation to this travel? (0106c)

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3.5 Did you always and exclusively eat from the services of your hotel or resort (including the potential different restaurants in the compound of the hotel)? (0107)

(0107 1) Yes (0107 0) No

3.5.1 If yes, in which restaurants within the hotel or resort did you have your meals? (0107c)

3.5.2 If no, which meals did you take outside the hotel or resort and where was it? (0107d)

3.6 Did you bring food back from your travels and consumed it? (0111)

(0111 1) Yes (0111 0) No

3.6.1 If yes, what type of food was it? (0111a)

3.6.2 When did you consume it? (0111b)

3.7 Have you received and consumed food from other countries that someone else brought back? (0112)

(0112 1) Yes (0112 0) No (0112 9) Don’t know

If yes,

3.7.1 Which product(s) was it? (0112a)

3.7.2 When did you consume the product(s)? (0112b)

3.8 Has anyone in your household been abroad in the [T] before you became ill? (0113)

(0113 1) Yes (0113 0) No (0113 9) Don’t know

If yes,

3.8.1 In which country did she/he go?: (0114)

3.8.2 When was it? From __ /__ / __ (0115a) until __ /__ / __ (dd/mm/year) (0115b)

3.8.3 Did the person become ill with the same symptoms as you, abroad or shortly after returning? (0116)

(0116 1) Yes (0116 0) No (0116 9) Don’t know

3.9 Do you have other information about travels or food from abroad which could be relevant? (0117)

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4 Food habits, allergies and diet (h-12)

Interviewer: In order to exclude food items from the list of suspected vehicles of infection, I would like to know whether there are food items you don’t eat or if you follow a specific diet.

Self-administrated: In order to exclude food items from the list of suspected vehicles of infection, could you indicate whether there are food items you don’t eat or if you follow a specific diet.

4.1 Do you have any food allergies/intolerances or follow special diet for medical, weight loss, religious, or any other reason? (Check all that apply) (0118)

Food allergies/intolerances (0119)

Lactose or milk-protein (0120)

Gluten/wheat (0121)

Nuts (e.g. Peanuts, hazelnuts), specify (0122)

Shellfish, specify (0127)

Fish, specify (0128)

Eggs (0129)

Soya (0130)

Other, specify (0131)

Vegan (no meat, no fish, no eggs, no dairy, no honey) (0132)

Vegetarian (0133), specify No meat (0133a) No fish (0133b)

No eggs (0133c)

No dairy (0133d)

No pork or pork products (0136)

No beef or beef products (0137)

Halal (0138)

Kosher (0139)

Medical diet, specify (0140)

Weight loss diet, specify (0141)


No food allergies/intolerances/specific diets (0118 0)

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5 Shopping (h-13)

Interviewer: We would like to know how the food causing the outbreak is distributed. Therefore, I will ask you now where you usually do your grocery shopping.

Self-administrated: We would like to know how the food causing the outbreak is distributed. Therefore, could you indicate where you usually do your grocery shopping.

5.1 In which of the following stores do you normally buy food? (Check all that apply) (0143)

(0143 1) Market, specify (0143 2) Bakery, specify (0143 3) Butcher, specify (0143 4) Greengrocer, specify (0143 5) Deli shop, specify (0143 6) Cheese shop, specify (0143 7) Fish shop, specify (0143 8) Directly at the farm, specify (0143 9) Ethnic supermarket, e.g. Asian store, specify (0143 10) Supermarket [name] (0143 11) Supermarket [name]

5.2 In which of the following stores do you normally buy meat and meat products? (Check all that apply) (0144)

(0144 1) Butcher, specify (0144 2) Market, specify (0144 3) Deli shop, specify (0144 4) Directly at the farm, specify (0144 5) Supermarket, specify (0144 6) Other, specify (0144 7) Not applicable (Do not eat meat)

5.3 In which of the following stores do you normally buy milk and dairy products? (Check all that apply) (0145)

(0145 1) Market, specify (0145 2) Deli shop, specify (0145 3) Cheese shop, specify (0145 4) Directly at the farm, specify (0145 5) Supermarket, specify (0145 6) Other, specify (0145 7) Not applicable (Do not eat dairy)

5.4 In which of the following stores do you normally buy vegetables and fruit? (Check all that apply) (0146)

(0146 1) Greengrocer, specify (0146 2) Market, specify (0146 3) Deli shop, specify (0146 4) Directly at the farm, specify (0146 5) Supermarket, specify (0146 6) Other, specify

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5.5 In which of the following stores do you normally buy fish and shellfish? (Check all that apply) (0147)

(0147 1) Fish shop, specify (0147 2) Market, specify (0147 3) Deli shop, specify (0147 4) Supermarket, specify (0147 5) Other, specify (0147 6) Not applicable (Do not eat fish or shellfish)

5.6 Do you have a shopper/loyalty card for the shop(s) where you buy your groceries? (0151)

(0151 1) Yes (0151 0) No

If yes,

5.7.1 Specify for which shop(s) (0151c)

5.7.2 Would you agree that we contact the store(s) to get your shopping records? (0151d)

Yes, loyalty card number: _________ No

5.7 How do you usually pay for your food purchases? (0150)

(0150 1) Cash (0150 2) Debit/credit card (0150 4) Cheque (0150 5) Other, specify

5.8 Apart from your loyalty card (if any), what other kind of purchase record would you be willing to share with us? (if a record is available, provide instructions on how to transmit the record to you) (0152)

(0152 1) Receipts from the store, specify (0152 2) Statement from the bank/card company, specify (0152 7) Other, specify (0152a)

(0152 0) No records available

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6 Restaurants and other places to eat out (h-14)

Interviewer: As food is not only bought in shops, but also in restaurants and other places, I will now ask you about food bought or eaten at other places than the shops you mentioned in the previous part.

Self-administrated: As food is not only bought in shops, but also in restaurants and other places, the following questions are about food bought or eaten at other places than the shops you mentioned in the previous part.

6.1 Did you attend any gatherings, events or celebrations in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?))(0154)

Y/N/?What event was it?

Where was the event?

When was it?

What did you eat?

Sporting event/Festival (e.g. music) (0155)Conference/fair/exhibition (0156)Private gathering (e.g. wedding, barbecue) (0159)Other (0162)

6.1.1 If yes on one of the above items, are you aware of any related illness among other guests? (0163)

Yes, specify (0163a)

No

6.2 Did you eat outside your home or eat a takeaway meal in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0164)

Y/N/?Where did you eat or bought your takeaway meal?

When was it?

What did you eat?

Canteen (work, school, hospital, nursing home, retirement centre) (0168)Food on aeroplane, train, ferry, etc. (0171)Gas stations (0172)Street vendors/food trucks (0173)Shopping mall food courts (0174)Coffee or tea shops (0175)Sandwich shop, bakery or deli (0176)Cafeteria/pub (0177)Kebab/falafel bar (0178)Burger restaurant (0179)Fast-food restaurant/snack bar (0180)Pizzeria (0181)Asian restaurant (0182)Hotel (0184)Takeaway (including when home delivered) (0185)Other(0186), specify____

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6.2.1 If yes on one of the above items, are you aware of any related illness in other guests? (0187)

(0187 1) Yes, specify (0187a)

(0187 0) No

6.3 Did you eat ready-to-eat food from the cooling/freezing department from the supermarket in the [T] before you became ill? (0188)


If yes,

6.3.1. What type of food was it? (0188a)

6.3.2 Where did you buy it? (0188b)

6.3.3 When was it? (0188c)

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7 Vegetables and vegetable products (h-15)

Interviewer: I will now continue with questions about food items you may have eaten in the [T]. I will start with the questions about vegetables.

Self-administrated: We now continue with questions about food items you may have eaten in the [T], starting with the questions about vegetables.

Lettuces and mixed salads (h-16)

7.1 Did you eat any of the following lettuces in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?))(0189)

Y/N/?Where did you buy/eat it? (Name and location of the shop/place)

How was it packaged/presented? (e.g. whole, ready-to-eat, bagged)

How was it prepared/eaten? (e.g. washed)

Lamb’s lettuces (0190)Lettuces (e.g. Lollo rosso) (0191)Crisp lettuce (e.g. Iceberg) (0192)Romaine lettuce (0193)Escarole (0194)Curly endives (0195)Radicchio (0196)Wild chicories (0197)Land cresses (0198)Roman rocket (e.g. rucola) (0199)Red mustard leaves (0200)Baby leaf escaroles, baby leaf spinaches (0201)Spinach-type leaves (0202)Grape leaves (0203)Watercress (0204)Witloofs (0205)Fern (0206)Brussels sprouts (0207)Head cabbages (0208)Chinese

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cabbages (0209)Kales (0210)Other lettuce (0211), specify _____

7.2 Did you eat a mixed salad in the [T] before you became ill? (0212)


If yes:7.2.1 What type of mixed salad did you eat? (0213)

Home-made (0214)

Ready-to-eat pre-packaged (0216)

From a buffet or salad bar (0217)


7.2.2 If not home-made, where did you buy this mixed salad? (0220)

7.2.3 What ingredients were in the mixed salad you ate? (0221)

Vegetables (0222), specify Chicken (0223)

Pork (0224)

Beef (0225)

Tuna (0226)

Salmon (0227)

Other fish, specify (0228)

Shellfish (0229), specify Herbs (e.g. coriander, chives) (0229), specify Sprouts (0230), specify Seeds (0231), specify Nuts (0232), specify Other, specify (0233)

7.2.4 What type of dressing was on the mixed salad? (0234)

No dressing (0234a)

French dressing (0234b)

Ceasar dressing (0234c)

Blue cheese dressing (0234d)

Mayonnaise (0234e)

Other (0234f), specify

Other vegetables (h-17)

7.3 Did you eat any of the following vegetables in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?))(0235)


How was it packaged/presented? (e.g. whole, sliced, ready-to-eat, bagged, canned, fresh)

How was it prepared/eaten? (e.g. raw, peeled)

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Tomatoes (0249)Sun-dried/semi-dried tomatoes (0252)Carrots (0258)

Cucumbers (0255)Baby corn/maize (0256)Garlic (0246)Onions (0247)Spring onions (0248)Sweet peppers (0253)Chili peppers (0254)Broccoli (0236)Cauliflowers (0237)Asparagus (0238)Celery (0239)Florence fennels bulb (0240)Globe artichokes (0241)Leeks (0242)Beetroots (0257)Bamboo shoots (0244)Palm hearts (0245)Horseradish roots (0259)Radishes (0260)Fermented vegetable such as sauerkraut (0261)Pickled vegetable (0262)Other vegetables(0263), specify____

Legumes/pulses/meat substitutes (h-18)

7.4 Did you eat any of the following legumes/meat substitute products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0264)


How was it packaged/presented? (e.g. dried, canned)

How was it prepared/eaten?

Azuki beans (0265)Broad beans (0266)Runner beans (0267)Mung beans (0268)Rice beans (0269)

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Soyabeans (0270)Garden peas (0271)Asparagus peas (0272)Chickpeas (0273)Lentils (0274)Lupins (0275)Tofu/bean curd (0276)Hummus (0277)Veggie burger (0278)Soya meat (0279)Other legumes/meat substitute products (0280), specify____

Vegetable juice (h-19)

7.5 Did you drink vegetable juice in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0281)

Y/N/?Where did you buy/drink it? (Name and location of the shop/place)

How was it packaged/presented? (e.g. homemade, ready-to-drink)

What was the brand and flavour/composition?

Self-made vegetable juice (0282)Fresh ready-to-drink vegetable juice (0283)Long-life ready-to-drink vegetable juice (0284)

Sprouts, shoots and seedlings (h-20)

7.6 Did you eat any of the following sprouts, shoots or seedlings in the [T] before you became ill? Also think about sprouts on a salad, a sandwich or a soup. (Yes (Y)/No (N)/unknown (?)) (0285)

Y/N/?Where did you buy/eat them? (Name and location of the shop/place)

How was it packaged/presented?

How were they eaten?

Cresses (0286)Alfalfa sprouts (0287)Beetroot sprouts (0288)Mung bean sprouts (0289)Radish sprouts (0290)Soybeans

22

sprouts (0291)Lentil sprouts (0292)Broccoli sprouts (0293)Wheatgrass (0294)Mixed sprouts(0295), specify (0295d)Other sprouts, shoots or seedlings(0296),specify___

Herbs and spices (h-21)

7.7 Did you eat or drink any of the following herbs in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0297)

Y/N/?Where did you buy/eat/drink it? (Name and location of the shop/place)

How was it packaged/presented? (e.g. plant, dried, frozen)

How was it prepared/eaten? (e.g. raw, cooked)

Parsley (0298)Chive (0299)Chervil (0300)Basil (0302)Coriander (0303)Mint (0304)Lemongrass (0305)Dill (0306)Oregano (0307)Tarragon (0308)Thyme (0309)Rosemary (0310)Laurel (0311)Marjoram (0312)Sage (0313)Tea with fresh herbs (e.g. mint) (0314), specify___Herbal tea (bag/leaves) (0315), specify____Mixed herbs(0316), specify____Other herbs(0317), specify____

7.8 Did you eat any of the following spices in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0318)


How was it packaged/presented? (e.g. grinded)

How was it eaten?

Pepper (black, green, white) (0319) Cumin (0320)Paprika (0321)Fennel (0322)

23

Cloves (0323)Cinnamon (0324)Nutmeg (0325)Anise (0326)Ginger (0327)Mixed spices(0328), specify___Other spices(0329), specify___

Mushrooms (h-22)

7.9 Did you eat any of the following mushrooms in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0330)


What variety of mushroom was it?



Fresh mushrooms (0331)Dried mushrooms (0333)Canned mushrooms (0334)Other mushrooms(0335), specify___

24

8 Fruits and fruit products (h-23)

Fruits (except berries) (h-24)

8.1 Did you eat any of the following fruits in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0336)


What was the variety? (when applicable)

How was it packaged/presented? (e.g. whole, pre-cut, frozen, dried)


Apples (0337)Pears (0338)Banana (0339)Oranges (0340)Mandarins (0341)Lemons and limes (0342)Grapefruit (0343)Peaches (0344)Nectarines (0345)Kiwi (0346)Apricots (0347)Plums (0348)Grapes/raisins (0349)Cherries (0350)Melon (0351)

Watermelon (0352)Cantaloupe (0353)Other melon(0354), specify___

Pomegranate (0355)Mango (0356)Avocado (0357)Figs (0358)Mango (0359)Kumquats (0360)Carambolas (0361)Kaki (0362)Litchis (0363)Passion fruits (0364)Papaya (0365)Cherimoya (0366)Guava (0367)Pineapple (0368)Coconut (0369)Rhubarb (0243)Dates (0371)Other fruits (0372), specify___

Berries (h-25)

8.2 Did you eat any of the following berries in the [T] before you became ill? Also as a topping on cereals, yoghurts or desserts. (Yes (Y)/No (N)/unknown (?)) (0373)

25


How was it packaged/presented? (e.g. fresh, frozen, dried)


Strawberries (0374)Raspberries (0375)Blueberries (0376)Blackberries (0377)Cranberries (0378)Blackcurrants (0379)Redcurrants (0380)Mulberries (0381)Mixed berries(0382), composed of____Other berries (0383), specify_____

Fruit products (h-27)

8.3 Did you eat any of the following fruit products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0384)


How was it packaged/presented? (e.g. homemade, ready-to-eat)


Compote (0385)Jam or marmalade (0386)Fruit salad (0387)Fruit sauce (e.g. with pancakes, yoghurt) (0388)Pastry containing fruit (0389)Sorbet ice (0390)Other fruit products (0391), specify___

Fruit juice and smoothies (h-28)

8.4 Did you drink any of the following fruit juices and smoothies in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0392)


How was it packaged/presented? (e.g. homemade, ready-to-drink)


Orange juice 26

(0393)Apple juice (0394)Coconut milk (0396)Smoothie (0399)Other fruit juices (0400)

27

9 Nuts and seeds (h-29)

9.1 Did you eat any of the following nuts in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0401)


How was it packaged/presented? (e.g. bagged, fresh, grinded)

How were they eaten? (e.g. raw, roasted)

Peanuts (0402)Almonds (0403)Pistachios (0404)Cashew nuts (0405)Chestnuts (0406)Hazelnuts (0407)Brazil nuts (0408)Pecans (0409)Walnuts (0410)Macadamias (0411)Pine nuts kernels (0412)Candied or sugar coated nuts (0413)Other nuts (0414), please specify ____

9.2 Did you eat any of the following seeds in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0415)


What was the brand?

How were they eaten? (e.g. raw, cooked)

Linseeds/flax seeds (0416)Pumpkin seeds (0417)Sesame seeds (0418)Poppy seeds (0419)Sunflower seeds (0420)Hemp seeds (0421)Chia seeds (0422)Rapeseeds (0423)Other seeds(0424), specify____

9.3 Did you eat nut- or seed-based spreads in the [T] before you became ill? (0425)

Y/N/? Where did you buy/eat it? (Name and location of the shop/place)

What was the brand?

Peanut butter (0426)Almond paste (0427)Sesame paste

28

(tahini/halawa/halva) (0428)Chestnut puree (0429)Chocolate spread including nuts (0430)Other pastes (0431), specify____

10 “Superfoods” (h-30)

10.1 Did you eat any of the following “superfoods” in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0432)

Y/N/?

Where did you buy/eat/drink them? (Name and location of the shop/place)


What was the brand?

How was it prepared/eaten/drunk? (e.g. raw, cooked)

Wheatgrass (0290)Chia seeds (0434)Gojiberry (0435)Maca roots/powder (0436)Açai berries (0437) Aloe vera (0438)Raw organic cacao/chocolate (0439)Spirulina (blue-green algae) (0440)Chlorella (0441)Marine phytoplankton (0442)Sea lettuce (seaweed) (0443)Other algae (0444), specify___Other superfoods (0445), specify____

11 Meat and meat products (h-31)

Sausages (h-32)

11.1 Did you eat any of the following sausages in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) Also think about sliced sausages on pizzas for instance. (0446)

Y/N/?

Where did you buy/eat it? (Name and location of the shop/place)


From what meat was it made of and was the meat organic?


Fresh raw 29

sausages (0447)Italian sausage (0448)Breakfast-type sausage (0449)Chipolata (0450)Bratwurst (0451)

Ready-to-eat sausages made of raw meat (0452)

Mettwurst (0453)Teewurst (0454)Kolbasz (0455)

Preserved/ripened sausages (0456)

Salami (0457)Pepperoni/

chorizo (0458)Cooked sausages (0459)

Spreadable liver-type sausage (0460)Polish-type sausage (0461)Mortadella

(0462)Bologna (0463)Blood sausage/black pudding (0464)Head cheese (0465)Knackwurst (0466)Thuringian sausage (0467)Weisswurst (0468)Frankfurter/Wiener sausage (0469)Beerwurst (0470)Bockwurst (0471)Cervelat (0472)

Other sausage (0473), specify____

Beef (h-33)

11.2 Did you eat any of the following beef in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0474)

Y/N/?



Was the meat organic?


Ground beef steak (0475)Rib eye (0476)Tenderloin (0477)Sirloin (0478)Steak tartare (0479)

30

Minced beef (0480) Hamburger (0481)Meat balls (0482)Beef/veal liver (0483) Other offal(0484), specify____Veal (0485) Beef/veal kebab (0486)Sliced/diced beef (0487)Roast beef (0488)Carpaccio (0489)Corned beef (0490)Other beef (0491), specify____

Pork (h-34)

11.3 Did you eat any of the following pork meat in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0492)





Pork minced meat (0493) Mixed minced meat (0494), specify____Pork meat loaf balls (0495)Pork meat balls (0496)Tenderloin (0497)Sirloin (0498)Pork chop (0499)Spare ribs (0500)Pig head (0501)Pig tongue (0502)Pig heart (0503)Pig stomach (0504)Pig kidney (0505)Pig liver (0506)Other offal (0507), specify____Bacon (0508)Fresh ham (0509a)Dry-cured

31

ham (e.g. Prosciutto di Parma) (0509b)Wet-cured ham (0509c)Dried sausage (0582)Pancetta (0510)Tiroler speck (0511)Corned pork meat (0512)Kebab including pork (0513)Cured pork fat (0514)Pastrami (0515)Porchetta (0516)Pork liver pate (0517)Goulash with pork (0518)Meat stew with pork (0519)Meat terrine with pork (0520)Other pork(0521), specify____

Mutton/lamb (h-35)

11.4 Did you eat any of the following mutton/lamb meat products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0522)





Lamb chop (0523)Lamb ribs (0524)Offal (0525), specify (0525d)Lamb kebab (0526)Sliced/diced meat (0527)Other lamb/mutton meat (0528), specify____

Poultry (h-36)

11.5 Did you eat any of the following chicken meat products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0529)





Whole chicken (0530)Chicken wing (0531)

32

Drumstick (0532)Escalope (0533)Chicken thigh (0534)Chicken breast (0535)Chicken fillets (0536)Chicken kebab (0537)Minced chicken (0538)Smoked chicken (0539)Sliced/diced chicken meat (0540)Chicken giblets (0541), specify (0541d)Other chicken meat (0542), specify____

11.6 Did you eat any of the following turkey meat products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0543)





Whole turkey (0544)Turkey wing (0545)Turkey leg (0546)Turkey thigh (0547)Turkey breast (0548)Turkey kebab (0549)Minced turkey (0550)Sliced/diced turkey meat (0551)Turkey skewer (0552)Turkey giblets (0553), specify____Other turkey meat (0554), specify____

11.7 Did you eat any of the following other poultry/fowl meat products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0555)





Goose (0556)Foie gras (0557)Duck breast (0558)Other duck meat (0556), specify___Pigeon (0560) Quail (0561)

33

Pheasant (0562)Galantine/Ballottine/Roulade/Roll (0563)Other(0564), specify___

Game meat (h-37)

11.8 Did you eat any of the following game meat in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0565)



Was the meat organic or from wild animal?


Rabbit (0566)Hare (0567)Deer/roe/venison (0568)Moose (0569)Reindeer (0570)Wild boar (0571)Other game meat (0572), specify____

Other meats (h-38)

11.9 Did you eat any of the following meat in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0573)





Horse meat(0574)Goat meat(0575)Ostrich meat(0576)Frog legs (0577)Other meats(0578), specify____

Other meat products (h-39)

11.10 Did you eat any of the following cold cuts products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0579)



From what meat was it made of?

Pâté (0580), specify____Smoked sausage (0581)Dried sausage (0582)Meat spread (0584)Pastrami (0585)Fresh ham (0509a)Dry-cured ham

34

(e.g. Prosciutto di Parma) (0509b)Wet-cured ham (0509c)Other pre-packed sliced deli meats (0591), specify___Pre-packed sliced poultry (0592)Other cold cuts (0593), specify___Other pre-packed sliced deli meats (0591), specify___

35

12 Fish and shellfish (h-40)

Fish (h-41)

12.1 Did you eat any of the following smoked, salted, dried or canned fish products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0594)



What was the brand?


Smoked fish (0595)Smoked salmon (0596)Smoked herring (0597)Smoked halibut (0598)Smoked mackerel (0599)Smoked pollack (0600)Smoked cod (0601)Smoked trout (0602)Other smoked fish (0603), specify____

Marinated/pickled fish (0604)

Marinated salmon (e.g. gravlax) (0605)Marinated herring (0606)Marinated anchovy (0607)Marinated catfish (0608)Other marinated fish (0609), please specify___

Salted fish (0610)Salted cod (0611)Salted herring (0612)Salted anchovy (0613)Other salted fish (0614), please specify___

Dried fish (0615)Stockfish/dried cod (0616)Other dried fish (0617), specify ___

Canned fish (0618)Canned salmon

36

(0619)Canned anchovies (0620)Canned sardines (0621)Canned tuna (0622)Other canned fish (0623), specify___

12.2 Did you eat any of the following fish and fish products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0624)


How was it packaged/presented? (e.g. fresh, frozen, canned)

What was the brand?


Fish loin/fillet/tails (0625)

Tuna (0626)Salmon (0627)Herring (0628)Cod (0629)Mackerel (0630)Pollack (0631)Mullet (0632)Sole (0633)Hake (0634)Sardine (0635)Anchovy (0636)Merou (0637)Marlin (0638)Halibut (0639)Snapper (0640)Monkfish (0641)Pangasius (0642)Sea bass (0643)Butterfish (0644)Pompano (0645)Swordfish (0646)Dentex (0647)Silverside (0649)Eels (0650)Trout (0651)Perch (e.g. perch of the Nile) (0652)Burbot (0653)Other fish (0654), specify (0654d)

Fish products (0655)Breaded fish/Fish fingers (0656)Fish burger (0657)Fish balls (0658)Sushi/sashimi/raw fish (0659), specify___Surimi (e.g. “crab” sticks) (0660)Fish paste (0661)Fish mousse (0662)

37

Fish roe (e.g. caviar) (0663), specify___Tarama (0664)Other fish products (0665), specify__

Shellfish (h-42)

12.3 Did you eat any of the following shellfish in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0666)


How was it packaged/presented? (e.g. fresh, frozen, canned)

What was the brand?


Oysters (0668)Mussels (0669)Clams (0670)Cockles (0671)Scallop (0672)Shrimps/prawns (0675)Crab (0676)Scampi (0677)Lobster (0678)Crayfish (0679)Abalone (0682)Conchs (0683)Squid (0684)Octopus (0685)Cuttlefish (0686)Urchins (0687)Other shellfish (0688), specify___

38

13 Milk and dairy products (h-43)

Milk (h-44)

13.1 Did you drink milk in the [T] before you became ill? Also consider the milk you may have put in your coffee or tea for instance. (Yes (Y)/No (N)/unknown (?)) (0689)

Y/N/?

Where did you buy/ate/drink it? (Name and location of the shop/place)


Was the milk treated? (e.g. raw, pasteurized, UHT)

What was the brand?

How was it prepared/eaten/drunk? (e.g. raw, cooked)

Cow’s milk (0690)Other milk (farm), raw/unpasteurised (0691), specify__Condensed milk (0693)Milk powder (0694)Buttermilk (0695)Traditional Nordic fermented milk (0696)Whey (0697)Chocolate milk (0698)Non-dairy milk (e.g. soya, rice, nuts) (0699)Other milk (0700), specify___

Dairy products (excluding cheeses) (h-45)

13.2 Did you eat any of the following dairy products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0703)


How was it packaged/presented? (e.g. raw, pasteurized, UHT)

What was the brand and flavour?

How was it prepared/eaten?(e.g. raw, cooked)

Cream (0704)Cream powder (0705)Whipped cream (0706)Yoghurt (0707)Drinking yoghurt (0708)Frozen yoghurt (0709)Sour cream (0710)Crème fraiche (0711)Custard (0712)Starchy pudding (0713)Butter (0714)Porridge (0715)Milkshake (0716)Ice cream (0717)Other dairy products (0722),

39

specify___

Cheeses (h-46)

13.3 Did you eat any of the following soft-ripened cheeses in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0723)

Y/N/?



Was the cheese made of raw milk?

What was the brand?

Cheese with white mould rind (0724)

Brie (0725)Camembert (0726)Chaource (0727)Chevre mould ripened (0728)Coulommiers (0729)Dunbarra (0730)Garrotxa (0731)Saint marcellin (0732)

Veined cheese with blue mould (0733)

Bavarian blue (0734)Blue castello (0735)Blue de graven (0736)Cashel blue (0737)

Other soft-ripened cheeses (0738)

Epoisses (0739)Langres (0740)Limburger (0741)Munster (0742)Taleggio (0743)Vacherin mont d’or (0744) Other soft-ripened cheeses(0745), specify___

13.4 Did you eat any of the following firm-ripened mould cheeses in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0746)




What was the brand?

Blue mould-veined cheese (0747)

Blue d’Auvergne (0748)Blue de Gex (0749)Cabrales (0750)Fourme d’Ambert (0751)Gamonedo (0752)Gorgonzola (0753)Monje picón (0754)

40

Roquefort (0755)Shropshire blue (0756)Stilton (0757)Valdeón (0758)Other blue mould-veined cheese (0759), specify___

White mould or other mould rind (0760)

Ardrahan (0761)Buche de chèvre (0762)Livarot (0763)Pont l’évèque (0764)Reblochon (0765)Other mould cheese (0766), specify___

13.5 Did you eat any of the following firm-ripened cheeses in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0767)




What was the brand?

Firm/semi-hard cheese (0768)

Abondance (0769)Appenzeller (0770) Ulloa (0771)Beaufort (0772) Bundnerkäse (0773) Butterkäse (0774)Cantal (0775) Carrigaline (0776) Cheshire (0777)Chimay (0778)Edam (0779)Gouda (0780)Gräddost (0781)Herrgårdost (0782)Hushållsost (0783) Ibores (0784)Jarlsberg (0785) Kasseri (0786)Lancashire (0787)Leicester (0788)Lubelski (0789)Maasdam (0790)Mimolette (0791)Morbier (0792)Nagelkaas (0793)Nisa (0794)Oltermanni

41

(0795)Ossau-iraty (0796)Passendale (0797)Piacentinu (0798)Podlaski (0799)Prästost (0800)Provolone (0801)Raclette (0802)Raschera (0803)Saint nectaire (0804)Paulin (0805)São Jorge (0806)Scamorza (0807)Toma piemontese (0808)Tomme de savoie (0809)Torta del casar (0810)Vacherin fribourgeois (0811)Västerbotten (0812)Wensleydale (0813)White stilton (0814)Other semi-hard cheese(0815), specify___

Hard cheese (0816)Aged graviera (0817)Canestrato pugliese (0818)Castelmagno (0819)Cheddar (0820)Emmental (0821)Evora (0822)Gruyère (0823)Iberico (0824)Idiazabal (0825)Kefalotyri (0826)Leyden (0827)Lincolnshire poacher (0828)Mahon (0829)Majorero (0830)Montasio (0831)Monte veronese (0832)Murcia (0833)Pecorino toscano (0834)Roncal (0835)Samsøe (0836)Schabziger (0837)Other hard cheese(0838), specify___

Extra hard cheese (0839)

Caciocavallo 42

(0840)Comté (0841)Grana padano (0842)Manchego (0843)Parmigiano reggiano (0844)Pecorino romano (0845)Ragusano (0846)San simon (0847)Sbrinz (0848)Ubriaco (0849)Zamorano (0850)Other extra hard cheese (0851), specify___

13.6 Did you eat other cheeses in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0852)




What was the brand?

Goat’s cheese(0853), specify (0853d)Sheep’s cheese(0854), specify___Cheese wedges (e.g. the laughing cow) (0855)Cheese spread (e.g. boursin) (0856)Cream cheese (0857)Cottage cheese (0858)Mascarpone (0859)Mozzarella (0860)Quark (0861)Cheese curds (0862)Ricotta (0863)Skyr (0864)Urda (0865)Boilie (0866)Burrata (0867)Feta (0868)Halloumi (0869)Other cheese(0870), specify___

14 Eggs and egg products (h-47)

Eggs (h-48)

14.1 Did you eat eggs in the [T] before you became ill? Also think about eggs on a salad or in a sandwich. (Yes (Y)/No (N)/unknown (?)) (0871)

43


How were they packaged/presented?

Were the eggs organic?

How was it prepared/eaten? (e.g. undercooked, well cooked)

Scrambled eggs (0872)Omelette (0873)Eggs sunny-side up (0874)Other fried eggs (0875)Hard-boiled eggs (0876)Soft-boiled eggs (0877)Raw eggs (0878)Poached eggs (0879)Egg white/albumen (0881)Egg powder (0882)Liquid egg (0883)Quail eggs (0884)Other eggs(0885), specify___

Egg products (h-49)

14.2 Did you eat any of the following products containing eggs in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0886)



What was the brand?

Tiramisu (0887) Chocolate mousse (0888)(Raw) dough (0889)Eggnog (0890)Pasta carbonara (0891)Mayonnaise (0892)Béarnaise/hollandaise sauce (0893)Remoulade (0894)Other products made with (raw) eggs(0895), specify___

44

15 Other food products (h-50)

Grain-based products (h-51)

15.1 Did you eat any of the following grain-based products in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0896)

Y/N/?




Breakfast grains/cereals (0896)Muesli/cereal bars (0897)Bagels/baguettes (0898)Dough or batter (raw) (0899)Pie/pastry (0900)Cheesecake (0901)Quiche (0902)Pizza (0903)Spring roll (e.g. Vietnamese spring roll) (0904)Wraps (0905)Pancakes (0906)Noodles (0907)Rice (0908)Couscous (0909)Pasta (0910)Quinoa (0433)Other grain-based products (0911), specify___

Chocolate (h-52)

15.2 Did you eat any of the following chocolate (-products) in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0917)



What was the brand and composition/filling?

Chocolate bar (0918) Candy bar with chocolate (0919)Pralines/chocolates (0920)Chocolate biscuits (0921)Chocolate spread (0922)Chocolate sauce (0923)Chocolate mousse (0888)

45

Cocoa powder (0924)Other chocolate products (0925), specify___

Honey (products) (h-53)

15.3 Did you eat any of the following honey (-products) in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0926)



What was the brand?

Honey (0927) Propolis (0928)Royal jelly (0929)Bee pollen (0930)Other honey products (0931), specify___

Sauces, dips and dressings (h-54)

15.4 Did you eat any of the following sauces or dressings in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0932)



What was the brand?

Mayonnaise (0892) Ketchup (0934)Mustard (0935)Chilli sauce (0936)Salsa sauce (0937)Sate sauce/peanut sauce (0938)Béarnaise/hollandaise sauce (0893)Tapenade (0939)Pesto (0940)Guacamole (0941)Marinades (0942)Salad dressings (0943)Other sauces, dips, dressings (0944), specify___

Vitamins and dietary supplements (h-55)

15.5 Did you use vitamins or other (dietary) supplements in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0945)

Y/N/?Where did you buy? (Name and location of the shop/place)


What was the brand and composition?

Vitamin supplements (0946)Mineral supplements (0947)Protein/amino acid

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supplements (0948)Protein/sport/recovery drinks (0949)Prebiotics/probiotics (0950)Weight loss drugs (0951)Other supplements(0952), specify___

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16 Food products for young children (h-56)

Interviewer: As babies and toddlers have their own food products, I would like to go through some ready-to-eat food products for children.

Self-administrated: As babies and toddlers have their own food products, please indicate below which ready-to-eat food products for children your child has eaten or drunk.

16.1 What did your child eat and drink in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0953)

Y/N/?Where did you buy? (Name and location of the shop/place)

How was it packaged/presented? (e.g. powder, liquid)


How was it prepared/eaten?

Milk (breastfeeding) (0954)

Not applicable Not applicable Not applicable Not applicable

Infant formula (0957)Follow-on formula (0960)Ready-to-eat meal (0964)Fruit pureeBiscuits, rusks, cookies (0968)Fruit or vegetable juices (0969)Other food (0973), specify___

If your child drinks from bottles:

16.2 What kind of water is used? (0974)

(0974 1) Bottled water, specify the brand ___ (0974 2) Boiled tap water (reaching boiling point) (0974 3) Tap water (not boiled)

16.3 Average time between preparation and consumption of a bottle? (0975) __ hours

16.4 How is the prepared bottle kept? (0976)

(0976 1) At room temperature (0976 2) In the refrigerator (0976 3) Other, specify ___

16.5 How is the bottle heated before consumption? (0977)

(0977 1) Microwave48

(0977 2) Bottle warmer (0977 3) Other, specify___

16.6 How is the bottle cleaned/disinfected? (0978)

(0978 1) Detergent (0978 2) Dishwasher (0978 3) Boiled (0978 4) Other, specify___

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17 Water and water-based beverages (h-57)

Interviewer and self-administrated: The next questions are about consumption and contact with water.

Water-based beverages (h-58)

17.1 Did you drink any of the following water and water-based beverages in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0979)



What was the brand?

Bottled water (still) (0980)Bottled water (sparkling) (0981)Bottled water with flavour (0982), specify___

17.2 What kind of water do you have in your household? (0983)

(0983 1) Municipal/public/tap water (0983 2) Group water scheme (0983 3) Private well (0983 4) Other water supply, specify___

17.3 Is the drinking water treated (e.g. disinfected with chlorine or UV)? (0984)

Yes, treated with ___ (0984a)

No Don’t know/Don’t remember

17.4 Did you drink any of the following water and water-based beverages in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0985)

Y/N/? Where did you buy/drink it? (Name and location of the shop/place)

Tap water (0986)Water from a group water scheme (0987)Water from a well (0988)Water from other sources (0989)A drink containing ice cubes (0990)Tea with fresh herbs (e.g. mint) (0314), specify___Herbal tea (bag/leaves) (0315), specify___Other beverages (0991), specify___

17.5 How many glasses of tap water do you drink on average per day? Also include drinks made of tap water, such as diluted juice and infant formula. However, don’t include heated beverages such as coffee and tea. (0992)

(0992 1) less than 1 glass per day (0992 2) 1 glass per day (0992 3) 2-5 glasses per day

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(0992 4) more than 5 glasses per day (0992 9) Don’t know/Don’t remember

17.6 Did you notice anything unusual about your tap water in the [T] before you became ill? For example, unusual changes with regard to odour, colour, taste or turbidity. (0992)

Yes No Don’t know/Don’t remember

If yes, what was unusual about your tap water? (0992a)

Water contact (h-59)

17.7 Did you go swimming in the [T] before you became ill? (Yes (Y)/No (N)/unknown (?)) (0993)

Y/N/? Where did you swim?

When was it?

Did you accidentally ingested water?

In a lake/pond (0994)In a river (0995)In a stream/creek (0996)In the sea/ocean (0997)In a swimming pool (0998)In a hot tub/whirlpool (0999)Other contact with water (1000), specify___

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18 Contact with animals (h-60)

Interviewer: Animals can sometimes be the source of an outbreak. To investigate this possibility, I will end this interview with some questions about contact with animals.

Self-administrated: Animals can sometimes be the source of an outbreak. To investigate this possibility, we want to ask you some questions about contact with animals.

18.1 Did you have any contact with the following small animals in the [T] before you became ill? By contact we mean feeding or touching the animal (Yes (Y)/No (N)/unknown (?)) (1014)

Y/N/? Was it your own animal? Where

Dog (1015)Cat (1016)Hamster (1017)Mouse (1018)Rat (1019)Guinea pig (1020)Rabbit (1021)Other pet rodent (1022), specify___Bird (1023), specify___Turtle (1024)Snake (1025)Other reptiles (1026), specify___ Amphibians (1027), specify___Other pet animal (1028), specify___

18.2 Do you know if the pet/companion animal had diarrhoea or vomiting in this period? (1029)

Yes (1029a)

No (1029b)

18.2.1 If yes, which animal(s)? (1029a)

18.3 Did you have any contact with the following farm animals in the [T] before you became ill? By contact we mean feeding or touching the animal (Yes (Y)/No (N)/unknown (?)) (1030)

Y/N/? Was it your own animal?

Where was it?

When was it?

Was it your own animal?

Cows/calves (1031)Pigs (1032)Sheep (1033)Horses/ponies (1034)Donkeys (1035)Goats (1036)Chickens (1037)Geese (1038)Turkeys (1039)Other poultry (1040), specify___Other farm animals (1041), specify___

18.4 Did you have contact with any of the following other animals in the [T] before you became ill? By contact we mean feeding or touching the animal (Yes (Y)/No (N)/unknown (?)) (1042)

Y/N/? Did you feed or touch Where When 52

the animal? was it? was it?Caged wild animals in the zoo (1043), specify___Wild birds (e.g. at bird feeder) (104), specify___Bats (1045)Wild boar (1046)Deer (1047)MooseFoxes (1048)Rats (1049)Mice (1050) Rabbits (1051) Hare (1052) Hedgehogs (1053)Other (1054d), specify___

18.5 Did you handle food for animals in the [T] before you became ill? (1055)

Yes, dried pet food (1056), specify (1056a)

Yes, wet pet food (e.g. cans) (1057), specify (1057a)

Yes, raw (meat) dog/cat food, feeder mice (1058), specify (1058a)

Yes, pet treats (e.g. pet cookie, jerky, bone) (1059), specify (1059a)

Yes, bird seed, hay, nuts, etc. (1060), specify (1060a)

Yes, other animal food (1061), specify (1061a)

No (1055 0)

Don’t know (1055 9)

18.6 Did you come into contact with droppings, manure, compost or fertiliser in the [T] before you became ill? (1062)

Yes, droppings (1063), specify (1063a)

Yes, manure (1064), specify (1064a)

Yes, compost (1065), specify (1065a)

Yes, fertiliser (1066), specify (1066a)

No (1062 0)


18.7 Do you live next to a farm or a field/park/forest? (1067)

Yes, next to or on a farm (agricultural) (1068)

Yes, next to or on a farm (livestock) (1069)

Yes, next to a pasture/meadow/field (1070)

Yes, next to a park (1071)

Yes, next to a forest (1072)

No (1067 0)


18.8 Did you participate any wildlife hunting activities in the [T] before you became ill? (1068))

Yes (1068a), specify No (1068b)

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19 Food diary (h-61)

Interviewer: At this point of the interview, we have gone through the entire list of food products that we should cover. As a complement, we would like you to describe what you were eating and drinking day-by-day during the three days before you became ill. The objective is to identify any food item that may have be missing from the questionnaire. Because it is sometimes difficult to recall, you can also describe what you usually eat or drink on such days of the week.

Self-administrated: You have now gone through the entire list of food products that to covered in this investigation. As a complement, we would like you to describe what you were eating and drinking day-by-day during the three days before you became ill. The objective is to identify any food item that may have be missing from the questionnaire. Because it is sometimes difficult to recall, you can also describe what you usually eat or drink on such days of the week.

19.1 What did you eat during the three days before you became ill? (1073)

19.1.1 The day before the first signs: __ /__ /__ (dd/mm/year) (1074)

Breakfast (drinks included) (1075):

Snacks/Treats (drinks included) between breakfast and lunch (1076):

Lunch (drinks included) (1077):

Snacks/Treats (drinks included) between lunch and dinner (1078):

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Dinner (drinks included) (1079):

Snacks/Treats (drinks included) after dinner (1080):

19.1.2 Two days before the first signs: __ / __ / __ (dd/mm/year) (1081)





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19.1.3 Three days before the first signs: __ / __ / __ (dd/mm/year) (1088)





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20 Closure questions (h-62)

Interviewer: We are now at the end of the questionnaire.

Self-administrated: You are now at the end of the questionnaire.

20.1 Are there other food products you ate that are not asked or of which you don’t know what the name is? (1095)

20.2 May we contact you again if we have more questions? (1096)

No Yes, contact info (if telephone number different than the one used now): (1096a)

20.3 Is there any additional information you would like to share? (1097)

Interviewer: On behalf of the investigation team, thank you for taking the time to respond to this questionnaire.

Do you have any questions for us?

Self-administrated: On behalf of the investigation team, thank you for taking the time to respond to this questionnaire. If you have questions about the investigation, please contact […..]

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outbreak investigation questionnaire fwd -...

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