On December 1, 2017, PulseNet, CDC’s molecular subtyping network for foodborne disease surveillance, identified a cluster of three Listeria monocytogenes clinical isolates with indistinguishable pulsed-field gel electrophoresis (PFGE) pattern combinations. These isolates were closely related to one another by whole-genome multilocus sequence typing within three allele differences (range = 0–3 alleles), indicating that the infections were likely from the same source. CDC, the Food and Drug Administration (FDA), and state and local health departments initiated a multistate investigation. An outbreak case of listeriosis was defined as an infection with L. monocytogenes, with an isolate that was indistinguishable by PFGE and closely related by whole-genome multilocus sequence typing to the outbreak strain isolated during October–December 2017.

The cases corresponding to the three isolates were identified in Illinois, Iowa, and Michigan. Isolation dates ranged from October 15, 2017, to October 29, 2017. Patients ranged in age from 55 to 71 years (median = 69 years), and all three patients were male. All patients were hospitalized for listeriosis; no deaths were reported. PulseNet was queried routinely for new isolate matches during the investigation, and no additional cases were identified.

Interviews were conducted with all three patients or their surrogates using the standard Listeria Initiative questionnaire (1), which asks about a variety of foods consumed in the month preceding illness onset. Grocery store receipts were collected for the patient in Michigan. Review of reported exposures indicated that all three patients had consumed prepackaged caramel apples purchased from retail establishments in the month preceding illness onset. A case-case analysis was performed comparing exposure frequencies for all food items included in the Listeria Initiative questionnaire for the three outbreak-associated cases with exposure frequencies for 186 sporadic cases of listeriosis from the same states reported to CDC since 2006. Caramel apple consumption was significantly higher among patients included in the outbreak, compared with that among patients with sporadic illnesses (odds ratio = 21.7; 95% confidence interval = 2.3–infinity). None of the interviewed patients had leftover caramel apples in their home for testing.

State and local officials collected records at two of the three retail locations where caramel apples had been purchased. All three retailers sold the same brand of caramel apples (brand A). The product was packaged in a plastic clamshell containing three caramel apples, each on a stick. Caramel apples were seasonal products that were only available for a short period in the fall at two of the retail locations. However, the retail location where the Illinois patient purchased caramel apples had the product in stock at the time of the investigation. Eight packages of caramel apples were collected for testing by the Illinois Department of Public Health, but L. monocytogenes was not detected in any samples. It was not known whether the tested caramel apples were from the same lots as those consumed by the ill persons in this outbreak.

During an inspection at the caramel apple production facility, FDA reviewed records and practices and collected environmental samples for testing. No significant food safety concerns were observed. None of the environmental swabs yielded L. monocytogenes. Environmental swabs collected at a single whole apple supplier yielded L. monocytogenes, but it was not the outbreak strain. Traceback activities did not implicate a specific lot or supplier of whole apples used in brand A caramel apple production during the period of interest.

No additional outbreak-associated illnesses were identified during the investigation. In light of the limited shelf life of the product (reported by the production facility to be 15 days), it was unlikely that caramel apples consumed by ill persons in this outbreak would have still been available for purchase or in persons’ homes at the time of the investigation. Because there was no evidence to suggest an ongoing risk to the public, no public warning was issued by federal or state agencies.

Although the outbreak strain of L. monocytogenes was not isolated from caramel apples or their production environment, the epidemiologic evidence indicated that caramel apples were the suspected vehicle in this outbreak. All outbreak-associated ill persons consumed a specific brand of a relatively uncommon food product in the month before their illness onset, and all were infected with indistinguishable L. monocytogenes strains. Caramel apples were previously implicated in a large multistate outbreak of listeriosis during 2014–2015, caused by contamination of whole apples (2). Ready-to-eat food processors, including those that make caramel apples, could consider the introduction and persistence of L. monocytogenes in food production environments as a potential hazard and mitigate that risk through appropriate environmental monitoring and preventive controls (3). Further research into the control of L. monocytogenes in fresh produce, including fresh apples, might help identify prevention strategies to reduce or eliminate the pathogen in some ready-to-eat foods.

Routine samples of the Green Cedar Ackawi cheese collected and tested by the U.S. Food and Drug Administration and the Michigan Department of Agriculture and Rural Development tested positive for the presence of Listeria monocytogenes.

The following product has been recalled:

Green Cedar Ackawi cheese in small clear plastic shrink wrapped packaging (see images below) bearing a “sell by” date of March 26, 2019 or later. The “sell by” date is on a white sticker on the back of the product.

Consumption of food contaminated with listeria monocytogenescan cause listeriosis, a serious and sometimes fatal infection that primarily affects young children, older adults, and persons with weakened immune systems. Less commonly, persons outside these risk groups may be affected. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeriosis can cause miscarriages and stillbirths among pregnant women.

This issue was discovered on November 9, 2018 during a routine inspection by the Michigan Department of Agriculture & Rural Development, Food & Dairy Division (MDARD) and by the Federal Food and Drug Administration (FDA).

This product was distributed at retail locations East Dearborn and Dearborn Heights Michigan. There have been no reports of adverse health impacts or reactions related to the consumption of this product to date.

Consumers who have purchased these products are urged not to consume them.

By 8 October 2018, 12 cases including four deaths had been reported in the affected countries.

In August 2017, Denmark reported the first cluster of cases linked to the consumption of ready-to-eat smoked salmon produced in Poland. Control measures were implemented and other EU Member States and competent authorities were informed.

In October 2017 France reported the detection of the same strain of Listeria in marinated salmon originating from the same Polish processing company as identified in the Danish outbreak investigation.

The most recent case linked to the outbreak was notified in Germany in May 2018.

Due to the lack of whole genome sequencing data from the environmental and food samples taken at the Polish processing plant, it is not possible at present to confirm whether the contamination occurred in the suspected plant. Moreover, until information on the Norwegian primary producers of the salmon used in the contaminated batches has been reported and assessed, the possibility of contamination at primary production level cannot be excluded.

The identification of the same Listeria strain in a salmon product in France and a new human case in Germany suggest that the source of contamination may still be active and that contaminated products have been distributed to other EU countries than Denmark. Pregnant women, the elderly and immunocompromised people are at higher risk of contracting listeriosis.

Johnston County Hams, a Smithfield, N.C. establishment, is recalling approximately 89,096 pounds of ready-to-eat ham products that may be adulterated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ready-to-eat deli-loaf ham items were produced from April 3, 2017 to Oct. 2, 2018. The following products are subject to recall:

  • Varying weights of 7 to 8-lbs. plastic-wrapped “JOHNSTON COUNTY HAMS, INC. COUNTRY STYLE FULLY COOKED BONELESS DELI HAM.”
  • Varying weights of 7 to 8-lbs. plastic-wrapped “Ole Fashioned Sugar Cured The Old Dominion Brand Hams Premium Fully Cooked Country Ham” with Sell-By dates from 4/10/2018 to 9/27/2019.
  • Varying weights of 7 to 8-lbs. plastic-wrapped “Padow’s Hams & Deli, Inc. FULLY COOKED COUNTRY HAM BONELESS Glazed with Brown Sugar.”
  • Varying weights of 7 to 8-lbs. plastic-wrapped “Premium Fully Cooked Country Ham LESS SALT Distributed By: Valley Country Hams LLC” with Sell-By dates from 4/10/2018 to 9/27/2019.
  • Varying weights of 7 to 8-lbs. plastic-wrapped “GOODNIGHT BROTHERS COUNTRY HAM Boneless Fully Cooked.”

The products subject to recall bear establishment number “EST. M2646” inside the USDA mark of inspection. These items were shipped to distributors in Maryland, North Carolina, New York, South Carolina and Virginia.

On September 27, 2018, FSIS was notified that a person ill with listeriosis reported consuming a ham product produced at Johnston County Hams. Working in conjunction with the Centers for Disease Control and Prevention and state public health and agriculture partners, FSIS determined that there is a link between the Listeria monocytogenes illnesses and ham products produced at Johnston County Hams. The epidemiologic investigation identified a total of four listeriosis confirmed illnesses, including one death, between July 8, 2017 and August 11, 2018. FSIS collected two deli ham product samples from the Johnston County Hams, Inc. facility in 2016 and in early 2018. Whole genome sequencing results showed that Listeria monocytogenes identified in deli ham both years was closely related genetically to Listeria monocytogenes from ill people. FSIS is continuing to work with federal and state public health partners to determine if there are additional illnesses linked to these products and will provide updated information should it become available.

Toronto Public Health (TPH) is investigating a case of Listeria infection in a person who consumed food sold at the Druxy’s restaurant located in Princess Margaret Cancer Centre at 610 University Ave. Any individuals who ate non-prepackaged food such as hot and cold deli sandwiches at this restaurant from August 9 to September 26, 2018 are asked to watch for signs and symptoms of Listeria infection and seek medical attention if they have symptoms.

Common symptoms include fever, diarrhea, vomiting, nausea and cramps. Severe symptoms include headache, stiff neck, confusion, loss of balance, and convulsions, and can develop suddenly in those with a weak immune system because of a medical treatment or a medical illness, and the elderly. Symptoms usually occur within three weeks of eating foods contaminated with Listeria. There is no vaccine to prevent the Listeria infection, however it is treated with antibiotics. Healthy people may only experience mild symptoms and usually recover completely. Individuals without symptoms do not need to be tested or treated.

The Listeria infection is a serious but rare illness caused by eating food contaminated with the bacteria Listeria monocytogenes. Common foods contaminated with this bacteria include deli meats and unpasteurized dairy products. People most at risk of developing serious illness are those with weakened immune systems, the elderly and pregnant women.

TPH continues to investigate the matter. As part of this process, TPH staff have completed an extensive risk assessment, collected samples of the surfaces and food for testing, and ordered a thorough cleaning of the restaurant and the restaurant equipment. An alert has been issued to Toronto hospitals, long-term care facilities and doctors’ offices to ensure they are aware of the matter. The restaurant is currently closed and the owner is cooperating with TPH to ensure there is no further risk to the public.

Lipari Foods LLC is voluntarily recalling a brand of pre-made turkey and cheese sandwiches because of the risk of a bacterial contamination that can cause a serious, even fatal, illness.

The company recalled Premo Turkey & Cheese Wedge sandwiches produced on August 8, 2018, and distributed to stores in Illinois, Indiana, Kentucky, Maryland, Michigan, Minnesota, Ohio, Pennsylvania, Tennessee, Wisconsin, and West Virginia, according to a news release.

Testing showed potential listeria contamination. Listeria infections can very serious and sometimes fatal in young children, frail or older people, and people with weakened immune systems.

Symptoms include high fever, severe headache, stiffness, nausea, abdominal pain, and diarrhea. Listeria infection can cause miscarriages and stillbirths.

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacterium; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but Listeria bacteria are often found inside cells. Listeria also produces toxins that damage cells. Image (c) Dennis Kunkel Microscopy, Inc.

Frozen corn and possibly other frozen vegetables are the likely source of an outbreak of Listeria monocytogenes that has been affecting Austria, Denmark, Finland, Sweden, and the United Kingdom since 2015.

Experts used whole genome sequencing to identify the food source, which initially was thought to be limited to frozen corn. As of 8 June 2018, 47 cases including nine deaths had been reported.

The same strains of L. monocytogenes have been detected in frozen vegetables produced by the same Hungarian company in 2016, 2017 and 2018. This suggests that the strains have persisted in the processing plant despite the cleaning and disinfection procedures that were carried out.

The available information confirms the contamination at the Hungarian plant. However, further investigations, including thorough sampling and testing, are needed to identify the exact points of environmental contamination at the Hungarian plant. The same recommendation applies to other companies belonging to the same commercial group if environmental contamination is detected.

On 29 June 2018, the Hungarian Food Chain Safety Office banned the marketing of all frozen vegetable and frozen mixed vegetable products produced by the affected plant between August 2016 and June 2018, and ordered their immediate withdrawal and recall. This last measure is likely to significantly reduce the risk of human infections and contain the outbreak. All freezing activity at the plant has been stopped.

New cases could still emerge due to the long incubation period of listeriosis (up to 70 days); the long shelf-life of frozen corn products; and the consumption of frozen corn bought before the recalls and eaten without being cooked properly.

To reduce the risk of infection, consumers should thoroughly cook non ready-to-eat frozen vegetables, even though these products are commonly consumed without cooking (e.g. in salads and smoothies). This applies especially to consumers at highest risk of contracting listeriosis – such as the elderly, pregnant women, newborns and adults with weakened immune systems.

Results of Independent Tests carried out in respect of the presence of Listeria monocytogenes ST6 type (“LST6”) Shareholders are referred to the SENS announcement issued by the Company on 5 March 2018, relating to an order issued by the National Consumer Commission for the Company to conduct a recall of certain identified Enterprise products. In that announcement, it was stated that in a batch of one of its products tested by the Company on 14 February 2018, the presence of the ST6 strain could not be confirmed and that the relevant samples had been sent to an external laboratory for the identification of the strain. The test results were received on 15 March 2018, but these had proved inconclusive and, as a result, the samples were sent for further re-testing.

The purpose of this announcement is to update shareholders on the results of the independent laboratory re-testing which was carried out in respect of the presence of LST6 in the above samples which were manufactured at the Enterprise Polokwane processing facility. On 24 April 2018, Tiger Brands received confirmation of the presence of LST6 in these samples. As reported previously, we have been actively engaging with the Department of Health and the National Institute of Communicable Diseases on our findings and will continue to collaborate with them on the actions taken to date to actively address our findings.

The Enterprise facilities in Polokwane, Pretoria and Germiston still remain closed while remedial work continues. An arrangement has been concluded between Pork Packers (which is based in Clayville) and our pig suppliers to contract slaughter on their behalf with effect from 2 May 2018.

March 14 update:  978 Sick, 183 Deaths

According to the Minister of Public Health, Minister of Health Dr. Aaron Motsoaledi:

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

March 14, 2018 update of listeria Outbreak from the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/National Health Laboratory Service (NHLS).

A total of 978 cases has been reported since 2017. Since the last situational update (8 March 2018), 11 additional cases have been reported to the NICD.

Cases of listeriosis will continue to occur up to four weeks or longer after the recall of the implicated foodstuffs, as the incubation period for listeriosis can be as long as 21 days with a reported maximum of 70 days.

Outcome at the end of hospitalization is known for an additional 5 cases, bringing the total with known outcome to 674/978 (69%) patients. No additional deaths have been reported since the last situation update (8 March). Presently, 183/674 (27%) patients are known to have died.

Health care workers are urged to continue with vigilance for new cases as persons who have consumed implicated processed meat products over the past few weeks may continue to present with listeriosis.

As of 12 March 2018, 978 laboratory-confirmed listeriosis cases have been reported to NICD from all provinces since 01 January 2017. To date, 748 cases were reported in 2017, and 230 cases in 2018. Females account for 56% (532/948) cases where gender is reported. Where age was reported (n=946), ages range from birth to 92 years (median 19 years) and 42% (398/950) are neonates aged ≤28 days. Of neonatal cases, 96% (381/398) had early-onset disease (birth to ≤6 days). Most cases have been reported from Gauteng Province (59%, 581/981) followed by Western Cape (12%, 118/967) and KwaZulu-Natal (7%, 70/967) provinces. Cases have been diagnosed in both public (65%, 639/981) and private (35%, 342/981) healthcare sectors. Amongst 978 cases, 720 (73%) specimens that were positive for Listeria monocytogenes on blood culture, while 211 (22%) were positive on cerebrospinal fluid. 71/981 (7%) specimens were positive from a variety of other sites (stool, pus, abscess or other fluid). Four public sector patients had positive PCR test for Listeria monocytogenes, but these patients also had a positive culture.

IT has been more than a year since the first listeriosis case was reported to the National Institute of Communicable Diseases, however the source still remains unknown.

There have been 915 laboratory-confirmed cases of listeriosis and the outbreak has already claimed 172 lives.

Gauteng has the highest number of reported cases in South Africa with 59 per cent and KZN has reported seven per cent of the total cases.

Listeria is a bacterium that is naturally found in the environment. It commonly occurs in soil, water, vegetation and in the faeces of some animals.

It can contaminate a wide variety of food types, including meat and meat products, dairy products (unpasteurised and pasteurised), fresh and frozen produce (fruits, vegetables and sprouts) and ready-to-eat products. This fact, coupled with a variable incubation period that can range from six hours to 70 days, poses a major challenge in determining the source of the outbreak.