Listeria monocytogenes. Tom Duszynski, MPH, REHS Director of Surveillance and Inves>ga>on

Transcription

1 Listeria monocytogenes Tom Duszynski, MPH, REHS Director of Surveillance and Inves>ga>on

2 References Scallan, E., Hoekstra R.M., Angulo F.J., Tauxe R.V., Widdowson M.A., Roy S.L., et al. Foodborne illness acquired in the United States- - - major pathogens. Emerg Infect Dis 2011; 17(1): Retrieved from hyp:// on December 27, 2011 Retrieved from hyp:// jensen- farms/index.html on December 27, 2011

3 Listeria monocytogenes Bacterium Listeria monocytogenes, is an important public health problem in the United States. The disease primarily affects older adults, pregnant women, newborns, and adults with weakened immune systems. Rarely, persons without these risk factors can also be affected.

4 Listeria monocytogenes Listeria monocytogenes, a gram- posi>ve rod- shaped bacterium, commonly found in soil and water. Animals can carry the bacterium without appearing ill and can contaminate foods of animal origin, such as meats and dairy products. Most human infec>ons follow consump>on of contaminated food. Rare cases of nosocomial transmission have been reported.

5 Where it can be found The bacterium has been found in a variety of raw foods, such as uncooked meats and vegetables Foods that become contaminated a^er cooking or processing, such as so^ cheeses, processed meats such as hot dogs and deli meat (both products in factory- sealed packages and products sold at deli counters), and smoked seafood.

6 Where it can be found Unpasteurized (raw) milk and cheeses and other foods made from unpasteurized milk are par>cularly likely to contain the bacterium. Listeria is killed by pasteuriza>on and cooking; however, in some ready- to- eat foods, such as hot dogs and deli meats, contamina>on may occur a^er factory cooking but before packaging. Unlike most bacteria, Listeria can grow and mul>ply in some foods in the refrigerator.

7 Who Gets Listeriosis? Pregnant women are about 20 >mes more likely than other healthy adults to get listeriosis. About one in six (17%) cases of listeriosis occurs during pregnancy. Newborn babies suffer the most serious effects of infec>on in pregnancy. Persons with weakened immune systems from transplants or certain diseases, therapies, or medica>ons.

8 Who Gets Listeriosis? Persons with cancer, diabetes, alcoholism, liver or kidney disease. Persons with AIDS are almost 300 >mes more likely to get listeriosis than people with normal immune systems. Older adults Healthy children and adults occasionally get infected with Listeria, but they rarely become seriously ill.

9 Patients with non-pregnancy-associated listeriosis, by age group and sex, Listeria Initiative, 2009 (n=421).

10 Challenges of recogni>on Incuba>on Period for Listerosis is 3-70 days with a median incuba>on of 3 weeks Signs and Symptoms mimic many other infec>ons The bacteria can stay in the body a long >me before making a person sick, allowing more people to be infected

11 Signs and Symptoms A person with listeriosis usually has fever and muscle aches, some>mes preceded by diarrhea or other gastrointes>nal symptoms. Almost everyone who is diagnosed with listeriosis has "invasive" infec>on, in which the bacteria spread beyond the gastrointes>nal tract. The symptoms vary with the infected person

12 Signs and Symptoms Symptoms, in addi>on to fever and muscle aches, can include headache, s>ff neck, confusion, loss of balance, and convulsions. Pregnant women typically experience only a mild, flu- like illness. Infec>ons can lead to miscarriage, s>llbirth, premature delivery, or life- threatening infec>on of the newborn.

13 Surveillance Listeriosis (infec>on with Listeria monocytogenes) was added to the list of na>onally no>fiable diseases in To improve surveillance, the Council of State and Territorial Epidemiologists has recommended that all L. monocytogenes isolates be forwarded to state public health laboratories for subtyping

14 Sta>s>cs Listeria monocytogenes is es>mated to cause nearly 1,600 illnesses (Listeriosis) each year in the United States, with more than 1,400 hospitaliza>ons and 250 deaths Compared to , the incidence of listeriosis had declined by about 38% by 2003.

15 Sta>s>cs On average from , 2.4 outbreaks per year were reported to CDC. Before 2011, the largest outbreak occurred in 2002, when 54 illnesses, 8 deaths, and 3 fetal deaths in 9 states were found to be associated with consump>on of contaminated turkey deli meat.

16 How do I know if I have Listeriosis? If you develop fever and chills while pregnant or if you are very sick with fever and muscle aches or s>ff neck, consult your doctor immediately. A blood or spinal fluid test (to look for the bacteria) will show if you have listeriosis.

17 Diagnosis & Tes>ng Diagnosis is confirmed only a^er isola>on of Listeria monocytogenes from a normally sterile site, such as blood, or from amnio>c fluid or the placenta in the semng of pregnancy.

18 Treatment & Outcomes Listeriosis is treated with an>bio>cs. A person in a high- risk category who experiences flu- like symptoms within 2 months of ea>ng contaminated food should seek medical care Even with prompt treatment, some listeriosis cases result in death. This is par>cularly likely in older adults and in persons with other serious medical problems.

19 The 2011 Outbreak

20 Listerosis and Cantaloupes In 2011, cantaloupes contaminated with the bacteria Listeria monocytogenes caused the deadliest foodborne disease outbreak in the United States in nearly 90 years.

21 Outbreak Inves>ga>on September 2 Listeria 'spike' reported in Colorado Local doctors report seven cases of listeria infec>on far more than usual Outbreak defini>on: More cases of disease than expected in a given popula>on at a given >me

22 Outbreak Inves>ga>on September 2: The Colorado Department of Public Health and Environment (CDPHE) no>fies the Centers for Disease Control and Preven>on (CDC) of seven ill persons with listeriosis (Listeria infec>on) reported since 8/29/11. September 5: Cantaloupes are collected by CDPHE for Listeria tes>ng from the home of an ill person.

23 Outbreak Inves>ga>on September 6 th PulseNet defines the Outbreak strain Cases seen in the NE and Texas with the strain

24 Outbreak Inves>ga>on September 7 th - - CDC begins coordina>on of a mul>- state inves>ga>on September 8 th States with cases are asked to use supplemental ques>onnaire to learn more about possible exposure September 9 th Cantaloupes are iden>fied as a likely suspect in the outbreak.

25 Outbreak Inves>ga>on September 10: FDA and CDPHE visit Jensen Farms for an inspec>on and to collect environmental and product samples. The broker for Jensen Farms stops distribu>on of cantaloupes and tells grocery stores to remove Jensen Farms cantaloupes from shelves. September 11 th Preliminary Traceback suggests cantaloupes were produced at Jensen Farms

26 Outbreak Inves>ga>on September 12 th CDC post mul>state outbreak informa>on of Listeriosis linked to cantaloupes and issues na>onal listeria warning, saving many lives September 13 th FDA issues a statement that most ill people consumed cantaloupes September 14 th CDC posts a web update linking the listerosis cases to cantaloupes produced at Jensen Farms.

27 Outbreak Inves>ga>on September 22: FDA, along with CO state and local officials, begins an environmental assessment at Jensen Farms. September 23: Carol s Cuts of Kansas City, Kansas ini>ates a recall of cantaloupe October 6: Fruit Fresh Up of Buffalo, New York ini>ates a recall of individual packages of fresh cut cantaloupe

28 Outbreak Inves>ga>on October 18: FDA issues a warning leyer to Jensen Farms based on the presence of the outbreak strains of Listeria in environmental and cantaloupe samples taken on 9/10. October 19: FDA announces findings of its environmental assessment at Jensen Farms

29 Outbreak Inves>ga>on 146 cases, 30 deaths, and 1 miscarriage in 28 states. Onset ranged from July 31, 2011 through October 27, Ages ranged from <1 to 96 years, median age of 77 years. Most ill persons were over 60 years old. 58% of ill persons were female. Among the 144 ill persons 142 (99%) were hospitalized.

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31 Outbreak Inves>ga>on Collabora>ve inves>ga>ons by local, state, and federal public health and regulatory agencies indicated that the source of the outbreak was whole cantaloupe grown at Jensen Farms Among the 140 ill persons with available informa>on on what they ate, 131 (94%) reported consuming cantaloupe in the month before illness onset.

32 Outbreak and Lab Tes>ng Laboratory tes>ng by the Colorado Department of Public Health and Environment iden>fied Listeria monocytogenes outbreak strains on cantaloupes collected from grocery stores and from ill persons' homes. Product traceback informa>on from Colorado state officials indicated that these cantaloupes also came from Jensen Farms.

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35 Ques>ons Wash your hands Stay home if you re sick Get your vaccines Tom Duszynski,