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Organizations are concerned about the risks associated with products and services that may contain potentially malicious functionality, are counterfeit, or are vulnerable due to poor manufacturing and development practices within the supply chain. These risks are associated with an enterprise’s decreased visibility into, and understanding of, how the technology they acquire is developed, integrated, and deployed, or the processes, procedures, standards, and practices used to ensure the security, resilience, reliability, safety, integrity, and quality of the products and services. This publication provides guidance to organizations on identifying, assessing, and mitigating cybersecurity risks throughout the supply chain at all levels of their organizations. The publication integrates cybersecurity supply chain risk management (C-SCRM) into risk management activities by applying a multilevel, C-SCRM-specific approach, including guidance on development of C-SCRM strategy implementation plans, C-SCRM policies, C-SCRM plans, and risk assessments for products and services

Three days after the end of a bout of diarrhoea of 3 days' duration, a 19-year-old patient developed severe nocturnal thoracic pain unresponsive to isosorbitol dinitrate. There were no abnormal findings on physical examination, except a sweaty skin. SGOT (38 U/l), creatinine kinase (291 U/l, CK-MB 29 U/l) and lactate dehydrogenase (246 U/l) were all elevated. The ECG showed ST segment elevations in leads I, II, III, aVF and V1-V6 as well as negative terminal T waves in I, II, aVL, AVF and V3-V6, changes suggesting peri- and myocarditis. The Widal test gave a raised antibody titre (1:800) against Yersinia enterocolitica serotype O:3. Seven days later the immunoblot test demonstrated antibodies against the same organism, which was finally isolated from stool after 11 days. Treatment consisted of ciprofloxacin (500 mg twice daily for 14 days). All symptoms, as well as the biochemical and ECG abnormalities, quickly improved. The patient was discharged free of symptoms after 34 days.

Mitte August 2005 ereignete sich in Hamburg bei Besuchern einer Firmenkantine ein Gastroenteritis-Ausbruch mit 241 Erkrankungsfallen. In Stuhlproben von 16 Erkrankten, darunter 6 Kuchenmitarbeitern, wurden Noroviren (Genogruppe I) nachgewiesen. In keiner der Lebensmittelproben ergab sich ein Nachweis bakterieller oder virale Enteritiserreger. Eine Kohortenstudie mit 162 Kantinenbesuchern, von denen 69 (42,6%) die Falldefinition erfullten, erbrachte einen signifikanten Zusammenhang zwischen dem Verzehr von Brombeerjogurt (RR 6,9; 95%-CI 3,36–14,16) bei gleichzeitigem protektivem Effekt der Entscheidung fur den Alternativnachtisch Eiskonfekt (RR 0,19; 95%-CI 0,08–0,45). Die Susspeise, die in der Groskuche selbst aus tiefgekuhlten Brombeeren und Jogurt aus industrieller Produktion zubereitet wurde, ist damit die wahrscheinlichste Quelle des Ausbruchs gewesen. Im Groskuchenbereich sollten tiefgekuhlte Beerenfruchte in die HACCP-Konzepte einbezogen werden.

An outbreak of acute gastroenteritis occurred in Hamburg among guests of a canteen in August 2005. A total of 241 persons were found ill. In stool samples of 16 of them Norovirus Genogroup I was identified. Neither bacterial nor viral pathogens could be detected in food samples. Among 162 guests enrolled in a cohort study, 69 (42.6 %) met the case definition. A desert dish made from blackberries and yoghurt showed a significant association with the disease (RR 6.9; 95% CI 3.36-14.16). In addition, a protective effect of the decision for the alternative desert dish ice cream was observed (RR 0.9; 95% CI 0.08-0.45). The desert, which was prepared in the canteen kitchen from yoghurt and frozen blackberries, was the most likely source of the outbreak. Frozen berries should be included in the HACCP concepts for canteen kitchens.

Three days after the end of a bout of diarrhoea of 3 days' duration, a 19-year-old patient developed severe nocturnal thoracic pain unresponsive to isosorbitol dinitrate. There were no abnormal findings on physical examination, except a sweaty skin. SGOT (38 U/l), creatinine kinase (291 U/l, CK-MB 29 U/l) and lactate dehydrogenase (246 U/l) were all elevated. The ECG showed ST segment elevations in leads I, II, III, aVF and V1-V6 as well as negative terminal T waves in I, II, aVL, AVF and V3-V6, changes suggesting peri- and myocarditis. The Widal test gave a raised antibody titre (1:800) against Yersinia enterocolitica serotype O:3. Seven days later the immunoblot test demonstrated antibodies against the same organism, which was finally isolated from stool after 11 days. Treatment consisted of ciprofloxacin (500 mg twice daily for 14 days). All symptoms, as well as the biochemical and ECG abnormalities, quickly improved. The patient was discharged free of symptoms after 34 days.