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Outbreak of Listeriosis in South Africa Associated with Processed Meat.

ABSTRACT: BACKGROUND:An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown. METHODS:We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type Listeria monocytogenes isolates. A case was defined as laboratory-confirmed L. monocytogenes infection during the period from June 11, 2017, to April 7, 2018. RESULTS:A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of L. monocytogenes ST6 infections. CONCLUSIONS:This investigation showed that in a middle-income country with a high prevalence of HIV infection, L. monocytogenes caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.

SUBMITTER: Thomas J

PROVIDER: S-EPMC7301195 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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Outbreak of Listeriosis in South Africa Associated with Processed Meat.

Thomas Juno J Govender Nevashan N McCarthy Kerrigan M KM Erasmus Linda K LK Doyle Timothy J TJ Allam Mushal M Ismail Arshad A Ramalwa Ntsieni N Sekwadi Phuti P Ntshoe Genevie G Shonhiwa Andronica A Essel Vivien V Tau Nomsa N Smouse Shannon S Ngomane Hlengiwe M HM Disenyeng Bolele B Page Nicola A NA Govender Nelesh P NP Duse Adriano G AG Stewart Rob R Thomas Teena T Mahoney Deon D Tourdjman Mathieu M Disson Olivier O Thouvenot Pierre P Maury Mylène M MM Leclercq Alexandre A Lecuit Marc M Smith Anthony M AM Blumberg Lucille H LH

The New England journal of medicine 20200201 7

<h4>Background</h4>An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.<h4>Methods</h4>We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type <i>Listeria monocytogenes</i> isolates. A case was defined as laboratory-confirmed <i>L. monocytogenes</i> infection during the period from June 11, 2017, to April 7, 2018.<h4>Results</h4>A total of 937 cases were identified, of which 465 (50%) were associated ...[more]

PMID: 32053299

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Project description:Listeria species are Gram-positive, rod-shaped, facultative anaerobic bacteria, which do not produce endospores. The genus, Listeria, currently comprises 17 characterised species of which only two (L. monocytogenes and L. ivanovii) are known to be pathogenic to humans. Food products and related processing environments are commonly contaminated with pathogenic species. Outbreaks and sporadic cases of human infections resulted in considerable economic loss. South Africa witnessed the world's largest listeriosis outbreak, characterised by a progressive increase in cases of the disease from January 2017 to July 2018. Of the 1060 laboratory-confirmed cases of listeriosis reported by the National Institute of Communicable Diseases (NICD), 216 deaths were recorded. Epidemiological investigations indicated that ready-to-eat processed meat products from a food production facility contaminated with L. monocytogenes was responsible for the outbreak. Multilocus sequence typing (MLST) revealed that a large proportion (91%) of the isolates from patients were sequence type 6 (ST6). Recent studies revealed a recurrent occurrence of small outbreaks of listeriosis with more severe side-effects in humans. This review provides a comparative analysis of a recently reported and most severe outbreak of listeriosis in South Africa, with those previously encountered in other countries worldwide. The review focuses on the transmission of the pathogen, clinical symptoms of the disease and its pathogenicity. The review also focuses on the major outbreaks of listeriosis reported in different parts of the world, sources of contamination, morbidity, and mortality rates as well as cost implications. Based on data generated during the outbreak of the disease in South Africa, listeriosis was added to the South African list of mandatory notifiable medical conditions. Surveillance systems were strengthened in the South African food chain in order to assist in preventing and facilitating early detection of both sporadic cases and outbreaks of infections caused by these pathogens in humans.

Dataset Information

Outbreak of Listeriosis in South Africa Associated with Processed Meat.

Publications

Outbreak of Listeriosis in South Africa Associated with Processed Meat.

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