Country Ham vs. Deli Ham vs. Country Ham Sliced

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1 Virginia Katherine G McCombs, MPH Foodborne Disease Epidemiology Program Coordinator Virginia Department of Health And Lauren Turner, PhD Foodborne and Advanced Pathogen Characterization Lead Scientist Division of Consolidated Laboratory Services Department of General Services

2

3 Country Ham vs Deli Ham vs Country Ham Sliced

4

5 Number of Listeriosis Cases Reported Listeriosis Cases by Year Virginia, Year

6 Patient Information Patient 1 (2017) 7/8/ years of age underlying illnesses hospitalized for illness survived illness died in July 2018 Patient 2 (2018) 6/14/ years of age underlying illnesses living in an ALF Died in June 2018 from the illness Patient 3 (2018) 6/19/ years of age underlying illness and dementia survived died in August 2018

7 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1

8 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 4/28/18: P2 to ALF

9 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 4/28/18: P2 to ALF

10 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 4/28/18: P2 to ALF 6/18: P2 Dies

11 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 4/28/18: P2 to ALF 6/18: P2 Dies

12 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2

13 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2

14 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2 7/2: DCLS informs of cluster

15 Requirement for submission of Listeria monocytogenes to DCLS

16 DCLS Laboratory Testing Algorithm for Listeria monocytogenes Lab Team Day 0 Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7/8 Micro Test Isolate Receipt and subculture Purity check Confirmatory Identification Day 1: Purity check Pass for Molecular Day 2-4 Pathogen Confirmatory Identification PFGE Test Plug Preparation Restriction Digestion Gel Analysis WGS Test DNA extraction Library Preparation/MiSeq Run Data Review and Analysis: Run Metrics Worksheets Day 2-4 Molecular Subtyping by PFGE BioNumerics Reporting to VDH/CDC

17 1807VAGX6-1: Virginia Testing Timeline July July VDH Epidemiologist Notification Format July

18 1807VAGX6-1: August 13, 2018 wgmlst (<All Characters>) WGS_id KeyNCBI_ACCESSION SRR_ID WGST Modified cdc_id Outbreak Mcdc_id date Mcdc_id M WGS_id SourceType SourceSite WGS_id WGS_id Key NCBI_ACCESSION SRR_ID WGST TypeDetails PulseNet_UploadDate IsolatDate NS WGST NS WGST NS ReceivedDate UploadDate PFGE-AscI-pattern Mcdc_id Outbreak Outbreak Outbreak WGS_id PFGE-AscI-status PFGE-ApaI-pattern SourceType SourceSite SourceSite SourceSite N WGST PFGE-ApaI-status Genus Species Lineage Serotype TypeDetails PulseNet_UploadDate IsolatDate TP IsolatDate TP IsolatDate TP ANICoverage MLST SequencerRun comments Exposure LabID ListMember NARMS-EB NCBISubmissi OtherStateIsol PatientAgeDay PatientAgeMon PatientAgeYea PatientSex PFGE-ApaI-file PFGE-ApaI-run PFGE-AscI-file PFGE-AscI-run PFGE-SmaI-file PFGE-SmaI-pa PFGE-SmaI-ru PFGE-SmaI-sta SourceCity SourceCountry SourceCounty SourceState ReceivedD UploadDa loci Outbrea ST 100 FSIS Pork FSIS USDA_ LMO LMO LMO VAGX VAGX6-1 FSIS Pork Pork PNUSAL VA R LMO10 VA R L VAGX L L-6276 PNUSAL Blood PNUSAL VA R LMO LMO LMO L VAGX VAGX6-1 PNUSAL Blood Blood Blood LMO10 Blood not typed VA 1807VAG PNUSAL VA R LMO10 VA R L VAGX L L-6221 PNUSAL Blood PNUSAL VA R LMO LMO LMO L VAGX VAGX6-1 PNUSAL Blood Blood Blood LMO10 Blood not typed VA 1807VAG FSIS Pork FSIS USDA_ LMO LMO LMO10 - GX6A VAGX VAGX6-1 FSIS GX6A Pork Pork PNUSAL VA R LMO10 VA R L VAGX L L-6294 PNUSAL Blood PNUSAL VA R LMO LMO LMO10 - GX6A L VAGX VAGX6-1 PNUSAL GX6A Blood Blood Blood LMO10 Blood not typed VA GX6A VAG 4[1,7] FSIS USDA_ LMO10 USDA_ VAGX6-1 FSIS USDA_ LMO10 USDA_ VAGX6-1 FSIS USDA_ LMO10 USDA_ VAGX6-1 FSIS Pork FSIS USDA_ LMO LMO LMO VAGX VAGX6-1 FSIS Pork Pork Pork LMO10 Pork not typed NC 1807VAG Pork LMO10 Pork not typed NC GX6A VAG Pork LMO10 Pork not typed NC 1807VAG Updated:

19 1807VAGX6-1: August 30, 2018 wgmlst Analysis 100 wgmlst (<All Characters>) Key NCBI_ACCESSION SRR_ID WGST Key Key Outbreak Modified cdc_id KeyM cdc_id date [1, 7] WGS_id SourceType SourceSite WGS_id Mcdc_id Mcdc_id NCBI_ACCESSION SRR_ID WGST TypeDetails PulseNet_UploadDate IsolatDate NS WGST WGS_id Key ReceivedDate UploadDate PFGE-AscI-pattern Outbreak NS WGST Outbreak NS WGST Mcdc_id PFGE-AscI-status PFGE-ApaI-pattern SourceType SourceSite SourceSite Outbreak WGS_id PFGE-ApaI-status Genus Species Lineage Serotype TypeDetails PulseNet_UploadDate IsolatDate TP IsolatDate SourceSite N WGST ANICoverage MLST SequencerRun_ comments Exposure LabID ListMember NARMS-EB NCBISubmissio OtherStateIsola PatientAgeDays PatientAgeMont PatientAgeYear PatientSex PFGE-ApaI-file PFGE-ApaI-rund PFGE-AscI-file PFGE-AscI-rund PFGE-SmaI-file PFGE-SmaI-pat PFGE-SmaI-run PFGE-SmaI-stat SourceCity SourceCountry SourceCounty SourceState ReceivedD UploadDat loci RU STTP NC MB LMO NC MB VAGX6-1 PNUSAL Blood LMO LMO10 PNUSAL NC MB VAGX6-1 LMO10 LMO Blood Blood 1807VAGX6-1 PNUSAL not typed Blood LMO10 Blood NC VA R LMO USDA_ LMO VA R VAGX L-6276 PNUSAL Blood 2018L-6276 LMO LMO10 PNUSAL VA R VAGX6-1 LMO10 LMO L Blood Blood 1807VAGX6-1 PNUSAL not typed Blood LMO10 Blood VA USDA_ VAGX6-1 FSIS Pork LMO LMO10 FSIS USDA_ VAGX6-1 LMO10 LMO Pork Pork 1807VAGX6-1 FSIS not typed Pork LMO10 Pork NC VA R LMO VA R VAGX L L-6221 PNUSAL Blood 2018L-6221 LMO LMO10 PNUSAL VA R VAGX6-1 LMO10 LMO L Blood Blood 1807VAGX6-1 PNUSAL not typed Blood LMO10 Blood VA USDA_ LMO USDA_ VAGX6-1 FSIS Pork LMO LMO10 FSIS USDA_ GX6A VAGX6-1 LMO10 LMO GX6A Pork Pork 1807VAGX6-1 FSIS not typed Pork LMO10 Pork NC GX6A VA R LMO VA R VAGX L L-6294 PNUSAL Blood 2017L-6294 LMO LMO10 PNUSAL VA R GX6A VAGX6-1 LMO10 LMO L GX6A Blood Blood 1807VAGX6-1 PNUSAL not typed Blood LMO10 Blood VA GX6A [1,7] 104 USDA_ LMO USDA_ VAGX6-1 FSIS Pork LMO LMO10 FSIS USDA_ VAGX6-1 LMO10 LMO Pork Pork 1807VAGX6-1 FSIS not typed Pork LMO10 Pork NC Updated:

20 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 7/3: Pork products match 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2 7/2: DCLS informs of cluster

21 Timeline of Listeriosis Investigation, Virginia 7/7/1 : P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 7/3: Pork products match 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2 7/2: DCLS informs of cluster 7/6: Pork product list received

22 List of Ham Products, USDA (July 6) Country Ham Whole Ham Bone-In Whole Boneless Ham Honey Cured Spiral Sliced Ham Dry Cured Bacon, in slices or slabs Mangalista Bacon Thick Cut Hickory Smoked Dry Cured Bacon Fatback, cubed, sliced, or slab Ham Chips (Small pieces for mini biscuits) Large or Split Ham Hocks Centers and Ends (Country Ham) Trimmings (Country Ham) End Slices (from butt of ham) Chunk Side Meat Country Ham Aitch Bones Iberico Ham

23 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 7/3: Pork products match 7/23: ALF Menus and supplier list 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2 7/2: DCLS informs of cluster 7/6: Pork product list received 7/26: P1 dies

24 Timeline of Listeriosis Investigation, Virginia 7/7/17: P1 6/14: P2 Illness 6/19: P3 Illness 6/29-7/3: Interviews with family of P2 7/3: Pork products match 7/23: ALF Menus and supplier list 8/24: P3 dies 4/28/18: P2 to ALF 6/18: P2 Dies 6/22: Interview at ALF for P2 7/2: DCLS informs of cluster 7/6: Pork product list received 7/26: P1 dies

25 List of Product Samples From FSIS With Name Brands Isolate Key Collection Date Sample Product Establishment Name Establishment Number Establishment Location Brands USDA_ /8/2018 Product-RTE- Other Fully Cooked, Not Sliced-Pork Whole Deli Ham Goodnight Brothers Produce Co, Inc M7431 Boone, NC Johnston County Hams Inc, Padow s Hams & Deli, Inc, Good Night Brothers Country Ham, Valley Country Hams, LLC, WayCo Ham Company, Old Dominion Brand Hams, Wholesome Foods, Inc USDA_ /12/2016 Product-RTE- Other Fully Cooked, Not Sliced-Pork Deli Ham Johnston County Hams M2646 Smithfield, NC Johnston County Hams Inc, Padow s Hams & Deli, Inc, Good Night Brothers Country Ham, Valley Country Hams, LLC, WayCo Ham Company, Old Dominion Brand Hams, Wholesome Foods, Inc USDA_ /28/2018 Product-RTE- Other Fully Cooked, Not Sliced-Pork Country Style Fully Cooked Boneless Deli Ham Johnston County Hams M2646 Smithfield, NC Johnston County Hams Inc, Padow s Hams & Deli, Inc, Good Night Brothers Country Ham, Valley Country Hams, LLC, WayCo Ham Company, Old Dominion Brand Hams, Wholesome Foods, Inc

26 Recalled Products

27 Acknowledgments VDH Kelsey Holloman, MPH Lisa Sollot, MPH Okey Utah, MPH Angie Myrick-West, MPH, CIC Lori Dixon, RN, BSN Seth Levine, MPH Christy Brennan, VDACS DCLS DCLS Microbial Reference Lab Epidemiologic Support and Molecular Detection and Characterization Group DCLS Molecular Subtyping Lab VDACS Christy Brennan

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