Outbreak of Listeriosis in South Africa Associated with Processed Meat

Details

• Alternative Title:
  N Engl J Med
• Personal Author:
  Thomas, J. ; Govender, N. ; McCarthy, K.M. ; Erasmus, L.K. ; Doyle, T.J. ; Allam, M. ; Ismail, A ; Ramalwa, N. ; Sekwadi, P. ; Ntshoe, G. ; Shonhiwa, A. ; Essel, V. ; Tau, N. ; Smouse, S. ; Ngomane, H.M. ; Disenyeng, B. ; Page, N.A. ; Govender, N.P. ; Duse, A.G. ; Stewar, R. ; Thomas, T. ; Mahoney, D. ; Tourdjman, M. ; Disson, O. ; Thouvenot, P. ; Maury, M.M. ; Leclercq, A. ; Lecuit, M. ; Smith, A.M. ; Blumberg, L.H.
• Description:
  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.
  
  
• Subjects:
  Adolescent Adult Aged Bacterial Typing Techniques Case-Control Studies Disease Outbreaks Female Foodborne Diseases HIV-1 HIV Infections Humans Infant, Newborn Listeria Monocytogenes Listeriosis Male Meat Products Middle Aged Pregnancy Pregnancy Complications, Infectious Product Recalls And Withdrawals Sex Distribution South Africa Whole Genome Sequencing Young Adult

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• Source:
  N Engl J Med. 382(7):632-643
• Pubmed ID:
  32053299
• Pubmed Central ID:
  PMC7301195
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  382
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9ffadbb4c3e18ca9eb34484768f22fafae387c530951292c8d636a8ff9b0889b
• Download URL:
  https://stacks.cdc.gov/view/cdc/89525/cdc_89525_DS1.pdf
• File Type:
  [PDF - 868.82 KB ]