H5N1

UK: Hancock pledges hospital food overhaul after listeria deaths

Via The Guardian: Hancock pledges hospital food overhaul after listeria deaths. Excerpt:

Health secretary Matt Hancock has ordered a “root and branch” review of NHS food after two more patient deaths were linked last week to a listeria outbreak. The new deaths bring the number of suspected fatalities to five and doctors have warned that further cases could occur.  

Hancock said he was “incredibly concerned” after it emerged the patients were suspected of dying as a result of eating pre-packaged sandwiches and salads linked by the same supplier, The Good Food Chain. 

The affected products have since been withdrawn from hospitals and Public Health England said evidence suggested all the deaths had occurred before the items were removed from circulation on 25 May. 

“We need a radical new approach to the food that is served in our NHS,” added Hancock. “Our NHS should be at the forefront of supporting people to make healthy choices.”  

A Public Health England official said investigations into the outbreak were taking place and were being conducted in partnership with the Food Standards Agency. Listeria is caused by the bacterium Listeria monocytogenes and can trigger very severe disease in humans. It usually affects people whose immune systems have been weakened – such as the elderly, pregnant women or patients taking immuno-suppressant drugs. The disease is caught by eating contaminated food.  

The first three deaths were at Manchester University NHS foundation trust and Aintree University Hospital NHS foundation trust in Liverpool. One of the two new cases is understood to have died after these three cases. However, the other patient died before the three succumbed. Doctors have only just discovered the death was linked to the same strain of the bacterium. 

“These two cases had already been reported to Public Health England but were re-analysed using whole genome sequence data,” said Dr Catherine Rees, associate professor in microbiology at Nottingham University. “This showed that the listeria isolated from these patients were highly likely to have come from the same source.”

The trusts where the latest two victims were receiving treatment have not yet been named, although PHE said there are now seven trusts across the country dealing with listeria cases. The first case showed symptoms on 25 April and sandwiches and salads were withdrawn on 25 May. It is understood that some of the products were sold at hospitals, while others were given to patients.

“Pre-packed sandwiches are recurrently incriminated in the UK in listeriosis episodes,” added Professor Jose Vazquez-Boland of Edinburgh University. “For example, in 2017 there was an outbreak in Yorkshire and the Humber that also involved sandwiches supplied to hospitals. There is clearly a warning here that microbiological controls for listeria need to be stepped up with pre-packed sandwiches. 

“In general, foods involved in listeria infections are industrially processed foods that are kept at refrigeration temperatures and are consumed without previous cooking.”  

The Good Food Chain, which supplied 43 NHS trusts across the UK, voluntarily ceased production. The company was supplied with meats from North Country Cooked Meat. Some of these have since tested positive for the outbreak strain of Listeria monocytogenes and the company has also stopped production. 

“Since the source has been traced, there should be no more exposure, but the bacterium’s long incubation period means that the risk of new cases coming to light cannot be ruled out yet,” added Rees.

ECDC: CDTR, week 36

ECDC has published Communicable disease threats report, 2-8 September 2018, week 36. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 2-8 September 2018 and includes updates on poliomyelitis, Middle East respiratory syndrome coronavirus (MERS-CoV), influenza A(H5N6), listeriosis, West Nile virus, Ebola virus disease and cholera.

ECDC listeria surveillance: New EU-wide study reveals that most outbreaks remain undetected

ECDc has published Listeria surveillance: new EU-wide study reveals that most outbreaks remain undetected. 

More than half of the severe listeriosis cases in the European Union belong to clusters, many of which are not being picked up fast enough by the current surveillance system, suggests a new article published in Eurosurveillance. 

The large-scale study looked into listeriosis epidemiology through whole genome sequencing and found that this method, when implemented at EU-level, could lead to faster detection of multi-country outbreaks, saving up to 5 months of the investigations.  

The study, coordinated by the European Centre for Disease Prevention and Control (ECDC), analysed 2 726 human Listeria monocytogenes isolates from 27 countries between 2010 and 2015. It found that slightly under 50% of the cases are isolated whereas the remaining half of cases is clustered together. Around one third of the cases that were identified as part of a cluster affected more than one country, often lasting for several years. 

However, only two listeriosis outbreaks were reported in the EU in 2016 and five in 2015, which suggests that many of them have gone undetected.  

The authors determined that the use of whole genome sequencing to characterise listeriosis cases at EU-level could speed up the detection of clusters by up to five months, when compared to epidemiological investigation at country level. A more timely detection of clusters would potentially limit the occurrence of further cases from the same, common food source. 

“This study is a milestone on the way to tackling listeriosis in Europe. With this new collaborative effort with the Member States, we have revealed the related nature of many cases of severe listeriosis. We are now strengthening routine surveillance by introducing the collection and analysis of whole genome sequencing data from all reported human listeriosis cases”, says ECDC’s Chief Scientist Mike Catchpole.  

Listeriosis is a relatively rare but potentially severe food-borne disease that has been reported in increasing numbers in the EU/EEA countries since 2008. In 2016, 2 536 cases were reported, including 247 deaths. “Improving our surveillance on Listeria cases will save lives, particularly among vulnerable population groups such as the elderly and also pregnant women, who may pass on the bacteria to the fetus if they consume contaminated food”, Mike Catchpole points out. 

The study also defines the most appropriate typing methods for earlier detection and investigation of dispersed cross-border clusters and outbreaks of Listeria monocytogenes.

WHO: Listeriosis – South Africa

WHO has published Listeriosis – South Africa. Excerpt:

In South Africa, the current outbreak of listeriosis, a serious foodborne disease, that has affected the country since early 2017 is showing a downward trend after the food source was identified in early March 2018 (see previous DON), but additional cases are expected. 

Between 1 January 2017 through 24 April 2018, 1024 laboratory-confirmed listeriosis cases have been reported to the National Institute for Communicable Diseases (NICD) from all provinces. The majority of cases have come from three provinces: 601 (59%) from Gauteng, 128 (13%) from Western Cape and 73 (7%) from KwaZulu-Natal provinces, with the remaining cases coming from the other provinces in South Africa. 

The outcome of illness is known for 700 patients, of whom 200 (28.6%) of them died; this case fatality rate is comparable to other recorded listeriosis outbreaks worldwide. Most of the cases are persons who have higher risks for a severe disease outcome, such as neonates, pregnant women, the elderly and immunocompromised persons. In this outbreak, 42% of the cases are neonates who were infected during pregnancy or delivery.  

Whole genome sequencing was performed on 521 isolates from patients. Eighty five percent of the strains belonged to Listeria monocytogenes Sequence Type 6 (ST6) and 15% (83/521) representing 19 other sequence types (ST1, ST54, ST876, ST2, ST5, ST204, ST219, ST224, ST71, ST101, ST121, ST155, ST3, ST403, ST515, ST7, ST8 and ST88). 

The same ST6 sequence type was identified in a widely consumed ready-to-eat processed meat product called “Polony”. The same strain was also found in the processing environment of the manufacturer of the implicated product. On 4 March 2018, the Ministry of Health announced that this product was believed to be the source of the outbreak and initiated a country wide recall of the implicated products. Since the recall, the number of cases has dropped significantly.

ECDC: CDTR, week 15

ECDC has published Communicable disease threats report, 8-14 April 2018, week 15. The summary:

The ECDC Communicable Disease Threats Report (CDTR) is a weekly bulletin for epidemiologists and health professionals on active public health threats. This issue covers the period 8-14 April 2018 and includes updates on measles, dengue, rubella, influenza, listeria and yellow fever.

WHO: Listeriosis – Australia

WHO has published Listeriosis – Australia. Excerpt:

On 2 March 2018, the Australian National Focal Point (NFP) notified WHO of an outbreak of Listeria monocytogenes infection (listeriosis) associated with the consumption of rockmelons (cantaloupe) from a single grower.  

From 17 January 2018 through to 6 April 2018, 20 outbreak cases (19 confirmed and 1 probable) of listeriosis were reported. All of the cases were hospitalized and there have been seven deaths and one miscarriage associated with the outbreak. All of the outbreak cases have had illness onset since 17 January 2018. 

Public health response 

Epidemiological investigations suggested that the source of the outbreak was rockmelon (cantaloupe melons) from a single grower in Australia. Epidemiological and environmental investigations were undertaken, which led to the recall of rockmelons produced by the single grower on 27 February 2018.  

On 1 March 2018, the Australian NFP was notified that international distribution of the affected product had occurred. Australian authorities received information from trace forward investigations on 2 March 2018 that the rockmelons from this grower were exported to eight countries; Hong Kong Special Administrative Region (China), Japan, Kuwait, Malaysia, Oman, Qatar, Singapore, and United Arab Emirates. The Australian NFP directly advised these countries on 3 March 2018 about the export of rockmelons from Australia to their country. In parallel, a notification via the International Food Safety Authorities Network (INFOSAN) was also sent on 3 March 2018. 

Further trace forward investigations on 7 March 2018 identified that Bahrain also received an export of the rockmelons from this grower and on 8 March 2018, investigations further identified that the affected rockmelons may have been included in a consignment to the Seychelles. The Australian NFP advised the Bahrain NFP directly on 8 March 2018 and the Seychelles NFP directly on 9 March 2018. As of 8 March, trace forward activities have been concluded. 

The INFOSAN emergency contact points in the importing countries were provided with specific distribution details of the rockmelons to their respective countries by the INFOSAN emergency contact point in Australia, as they became available. 

On 4 April 2018, it was reported that more than 30 samples of melons from the grower through the supply chain, including retail and on farm, tested positive to Listeria monocytogenes. Additional testing found L. monocytogenes in the packing area. All L. monocytogenes samples had the same genetic sequence as the human cases. 

It is believed that the cause of the outbreak was a combination of environmental conditions and weather contaminating the surface of the fruit, with low levels of the bacteria persisting after the washing process. The grower continues to work closely with the relevant authorities and has returned to supply rockmelons (during the week starting 2 April) after testing cleared the property.

South Africa: Bologna blamed in worst listeria outbreak in history

Via The New York Times: Bologna Blamed in Worst Listeria Outbreak in History. Excerpt:

The world’s largest known listeria outbreak has spread throughout South Africa for 15 months, killing 189 people. Health officials believe they have identified the source: bologna. 

Since January last year, 982 confirmed cases of listeriosis had been recorded, the National Institute for Communicable Diseases in South Africa reported on Thursday. The infection, caused by food that has been contaminated with the bacterium Listeria monocytogenes, is often lethal.  

A cluster of gastroenteritis cases among toddlers in a Johannesburg hospital this January led authorities to the sandwich meat in a day care center’s refrigerator — and in turn, to a meat production facility in the northern city of Polokwane. There, officials said they detected traces of LST6, the listeria strain identified in 91 percent of the outbreak’s cases.

The South African meat processor, Enterprise Foods, issued a recall of some of its processed products in early March. Food safety experts at the World Health Organization plan to review the company’s exports to 15 countries across Africa, many of which lack reliable disease surveillance systems and diagnostic tools. Namibia recently reported one listeriosis case; its link to South Africa’s outbreak is uncertain.  

Tiger Brands, the parent company of Enterprise Foods, did not respond to requests for comment.

The highly processed meat, locally called “polony,” is known for its fluorescent artificial color. It is often consumed in low-income communities and sold by street vendors, making distribution difficult to track.  

Listeriosis has an incubation period of up to 70 days, so additional cases are expected to emerge. Because officials determined that 9 percent of the cases involved a different strain of listeria, there may be multiple outbreaks. 

Doctors in South Africa were not required to report cases of listeriosis to the Ministry of Health until last December. Patient records were vague and often lacked the contact information for follow-up, said Dr. Peter K. Ben Embarek, a food safety expert at the W.H.O.  

“Many didn’t even know to be asking patients about the meat,” said Dr. Louise Ivers, an associate global health professor at Harvard. “Surveillance is a critical but neglected piece of health systems,” Dr. Ivers said. “Without the resources and lab infrastructure, countries are left reacting: reacting to cholera, reacting to Ebola, reacting to listeria.”

WHO: Listeriosis – South Africa

WHO has published Listeriosis – South Africa. Excerpt:

In South Africa, an outbreak of listeriosis, a serious foodborne disease, has been ongoing since the start of 2017. Between 1 January 2017 through 14 March 2018, 978 laboratory-confirmed listeriosis cases have been reported to the National Institute for Communicable Diseases (NICD) from all provinces. The majority of cases have come from three provinces: 581 (59%) from Gauteng, 118 (12%) from Western Cape and 70 (7%) from KwaZulu-Natal provinces, with the remaining cases coming from the other provinces in South Africa. 

The outcome of illness is known for 674 patients, of whom 183 (27%) of them died; this case fatality rate is comparable to other recorded listeriosis outbreaks worldwide. Most of the cases are persons who have higher risks for a severe disease outcome, such as neonates, pregnant women, the elderly and immunocompromised persons. In this outbreak, 42% of the cases are neonates who were infected during pregnancy or delivery. 

Whole genome sequencing was performed on isolates from a large subset of patients. Ninety one percent of the strains belonged to Listeria monocytogenes Sequence Type 6 (ST6). The same ST6 sequence type was identified in a widely consumed ready-to-eat processed meat product called “Polony”. The same strain was also found in the processing environment of the manufacturer of the implicated product. On 4 March 2018, the Ministry of Health, announced that this product was believed to be the source of the outbreak.  

The food processing company and three of its retailers export to 15 countries1 in the African region . All of these countries have issued recalls for the implicated products. Environmental samples from other food production companies in South Africa have also tested positive for Listeria but with strains different from the outbreak strain. These companies have also issued food recalls. Some of their products have been exported to some of the countries mentioned above.  

Nine percent of the reported cases in the present outbreak in South Africa were infected with different strains of Listeria than the predominant ST6 outbreak strain. This may indicate that more than one outbreak is ongoing. Comprehensive investigations to identify the source of infection of these cases should be conducted.

See also this Reuters report on a class action lawsuit launched against a company that makes polony

WHO supports 16 African countries to protect against listeriosis

Via WHO AFRO: WHO supports 16 African countries to protect against Listeriosis. Excerpt:

The World Health Organization has reached out to 16 African nations to provide support for preparedness and response to a listeriosis outbreak that started in South Africa in 2017 but is now threatening other countries on the continent. 

Nearly 200 South Africans have died since January 2017 as a result of contaminated ready-to-eat meat products that are widely consumed in South Africa and may also have been exported to two West African countries and 14 members of the South African Development Community (SADC).  

South African health authorities recently declared the source of the outbreak as a factory in Polokwane, South Africa. This prompted a national and international recall of the food products. However, in light of the potentially long incubation period of listeriosis and the challenges relating to large scale nationwide recall processes, further cases are likely to occur. 

Namibia has reported one confirmed case of listeriosis, a man who was admitted to hospital in early March. An investigation is ongoing to determine whether the case is connected to the outbreak in South Africa. 

WHO’s Health Emergencies programme, the Global Outbreak alert and Response Network (GOARN) and the International Food Safety Authorities Network (INFOSAN) are working with the 16 priority countries to improve their ability to prepare for, detect and respond to potential outbreaks.   

Immediate steps will include increasing awareness on listeriosis, enhancing active surveillance and laboratory diagnosis, ensuring readiness of Rapid Response Teams, and strengthening coordination and contingency planning. Experts have been deployed to South Africa, Lesotho and Swaziland to support these efforts.

South Africa expects listeria infections to increase

Via Reuters: South Africa expects listeria infections to increase. Excerpt:

South Africa’s health minister expects the infections from the worst listeria outbreak in history that has killed 180 people since January last year to increase and warned that there could also be other cases in the southern Africa region.

The government, which has been criticized for taking too long to find the cause, has linked the outbreak to a meat product known as “polony” - a cheap form of protein consumed by South Africans - made by Tiger’s Enterprise Food.  

The disease causes flu-like symptoms, nausea, diarrhea and infection of the blood stream and brain. 

“We are just at the beginning and we must expect other cases to emerge,” Health Minister Aaron Motsoaledi told reporters, without elaborating.  

Motsoaledi - who met health ministers from the southern African region - also said he also expected more cases of the outbreak to be reported in the region but did not give details.  

Namibia’s health minister said on Tuesday it had recorded its first case of listeriosis, and the victim was fighting for his life in hospital in the nation’s capital.  

Namibia and several other nations in Africa have suspended imports of processed meat from South Africa after the outbreak was linked to the factory that makes polony, a cheap sausage.