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South Africa Has the World’s Largest Listeria Outbreak According to WHO

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The Cause Unknown after a Year

South Africa is encountering the worst case of listeriosis ever reported, according to WHO (World Health Organization). Currently, there are 727 laboratory-confirmed cases with 67 death reported. The number of cases and the death toll increased significantly since last December when South Africa had 577 cases and 36 deaths.
South Africa Health Minister Aaron Motsoaledi said “When we view statistics of affected people, we note that of all the vulnerable groups, neonates [newborn babies within first 28 days of life] are the worst affected if we analyze it by age group from birth to 93 years. In this case, neonates alone account for close to 40 percent of the cases,” The minister continued: “Of note is that of all the neonates that get affected, 96 percent had an early-onset disease, that is, from birth to six days after birth. It is clear that these neonates are simply vulnerable due to their pregnant mothers. They are infected by their mothers at birth.”
According to WHO the most distressing element of this outbreak is that 40% of the dead are babies less than four weeks old, mostly infected from their mothers.
The infected people come from diverse socio-economic backgrounds, as determined by the use of both public and private hospitals.
The source of the infection is yet unknown. The long incubation period for the disease symptoms makes it difficult to identify the food source.  “Even if a food source is identified, we can expect to have cases reported for several weeks to come,” said Lindmeier (WHO media Officer). “This is making the investigation into the source of the outbreak particularly complex.”

Listeria Stains

In a press release South Africa Ministry of Health reported that from 1st of January 2017 to 3rd of January 2018, 337 isolates from the outbreak had been sequenced. Of them 73% were clinical isolates, 22% were food isolates, and 5% were environmental isolates.
The minister Motsoaledi said that “…out of the total of 727 laboratory confirmed cases which we know about, we are only able to trace 134 actual patients, which is only 18%. This means that we still have a long way to go in searching. Out of the 134 traced patients, 61 had passed on,”
He further said that 91% of the isolates were the ST6 type and are very closely related to each other, representing a single strain of Listeria monocytogenes.  The ST6 isolates were found in samples from all the 9 South Africa providences.  This supports the hypothesis that there is a single source of the food contamination.  It implies that it is a widely consumed food produced at a single facility. “Most likely a food product on the market or a series of food products produced in the same manufacturing environment,” says Dr. Lucia Anelich‚ a prominent South African food microbiologist and food safety expert.
The mortality rate of listeriosis is very high (20-30%) when compared to other food pathogens such as Salmonella and E. coli, with a mortality rate of 1-2%.
The isolated Listeria strain was not drug-resistant. Therefore, the deaths due to this outbreak were due to delays in diagnosis and treatment.

Potential Source of the Outbreak

Listeriosis most often results from foods such as unpasteurized (raw) milk and dairy products; soft cheese made with unpasteurized milk‚ such as feta‚ brie and camembert; refrigerated smoked seafood, ready-to-eat meats, raw vegetables, and pre-packed salads.
However, in this case, the minister of Health Motsoaledi said that a piece of chicken obtained from a patient’s home contained Listeria monocytogenes. The source of this chicken was traced back to the store and then to Soverein Foods slaughterhouse.
Whole Genome Sequencing was performed on the strains of Listeria monocytogenes isolated from the Soverein Foods environment and food samples. None of the isolates was the outbreak strain of ST6. Regardless, some of the obtained strains had the potential of causing the disease.
As a result of the data obtained from the slaughterhouse cannot be conclusively identified as the source of the outbreak. Regardless, the Department of Health closed the poultry slaughterhouse. The company was delisted from the Johannesburg stock exchange in November. Yet, since in the latest inspection found no Listeria, the plant was allowed to be reopened.   According to Reuters  Sovereign Foods head of production, Blaine van Rensburg, said: “Despite being declared clean and free of the Listeria bacterium, we are further strengthening steps to render products safer than they already are,”

Action Taken by Health Department

Since December 5, 2017, the Department of Health amended the list of notifiable diseases to include Listeriosis, requiring clinics to notify the government of any case of listeriosis.
The food industry was requested by the Director-General of the National Department of Health to formally submit details of Listeria -positive food items, environmental swabs and Listeria isolates to the authorities.
It is very troublesome that after a whole year the outbreak is still continuing without any resolution forthcoming.
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Trending now in food Safety- New page to the BioExpert site

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The Trending Page

We have just added a new exciting page on our website. The purpose of this additional page is to introduce and discuss current trends in food safety, intriguing articles, and bring to the attention of the food safety community any new topic that might be of interest.  Any registered user will be able to easily publish any relevant trend or comment on any previously published trend articles. Anyone can read the content of this page.
I am hoping that all registered users will contribute to this page thereby creating a compelling new relevant body of information and pointing readers to important food safety information. By your active participation, you will be able to help your colleagues to understand the most pressing trends in food safety and determine where to focus their attention.

What Could be Covered

Examples of interesting topics:
  • The ever-shifting regulatory environment and trying to keep up with the FSMA regulations
  • The globalization of food safety with the FSMA Foreign Supplier Verification Program
  • New food safety regulations around the world
  • Impact of natural and organic food on food safety
  • Recalls and the reasons for frequent recalls
  • Allergens and their impact on recalls
  • Labeling issues as a reason for recalls
  • Advanced system for pathogen testing
  • Impact of technology on the industry
  • Important actions by FDA, USDA, and FSIS that impact the food industry

How to Add a New Trend to the Page?

After signing in to the BioExpert site observe a new tab called “Trending.”

Entering the Site as a Guest

A guest entering the site and clicking on “Trending” will bring you to the following page:
In this screen, you can:
  • Read all the trending entries (just scroll down the page)
  • Login to the site if you are a registered user
  • Register to the site by clicking the green “Register” button
  • Submit your name and Email to receive updates from this page.
To contribute to the page one needs to be a registered user.

Registered Users

As a registered user, you are encouraged to contribute to this page by adding important trend that you would like to share.  By entering the trending page, you will see on top of the page:
By clicking on “Enter conversation Title…” you will see:
Simply type (or paste) the title of your conversation, and write (or paste) a short text in the “add text” box. If the text refers to a website add: “ @ “ and the site location. You can also add an image to the posting by clicking on the image button.
Optionally a category for the posting can be added:

Email Notification

Registered users will not receive routine updates from the trending page. If you wish to receive updates, please sign for it by filling the information in the “Trending Email Sign up.”    
   

The success of this page depends upon YOU

We rely on our registered users to help us and help the food safety community by bringing to everyone’s attention trends that are important to all of us. 
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E. coli in Romaine Lettuce-Impact of No Recall and Potential Solution

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The E. coli Outbreak

Earlier we reported that an E. coli O157:H7 outbreak in the US was suspected of being related to an outbreak in Canada that had been linked to romaine lettuce.  From November 15 to December 17 illnesses in 13 states were reported. Five people have been hospitalized, two have developed hemolytic uremic syndrome (HUS), and one person died.
The Canadian Health Authorities reported on 41 cases of illnesses in 5 Eastern states (Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13)) attributed to E. coli O157:H7 in romaine lettuce. Seventeen individuals have been hospitalized. One individual died. 
As a result of their investigation, the Canadian Health authorities recommended the people in the Eastern provinces to refrain from eating romaine lettuce.
The CDC reported that the E. coli causing the illnesses in both countries was genetically closely related. This closeness implies that the illnesses are sharing a common source of infection. However, the CDC has not yet identified the source of the US infection.
In the U.S. there is no recall of romaine lettuce or a recommendation to stop its consumption. In a statement Brittany Behm, MPH, a CDC spokeswoman said in an email that “there is not enough epidemiologic or traceback evidence at this time to indicate a specific source of illnesses in the United States. Therefore, CDC cannot recommend that U.S. residents avoid a particular food.”   The CDC believes that the evidence collected to date does not have sufficient convincing information linking the lettuce to the illnesses. “We strive to be fast and right. … We wish we knew more and we’re working hard to get there. But we don’t have enough evidence yet,” said Wiliams, chief of the CDC’s Outbreak Response and Prevention Branch.  He also said that there was no guarantee that in the future, the CDC and FDA would be able to identify the exact source of the outbreak.    

Consumer Report Recommendation

The consumer Report magazine has taken an extreme step advising the public to stop the consumption of any romaine lettuce until there is a clarification of the situation.
“Even though we can’t say with 100 percent certainty that romaine lettuce is the cause of the E. coli outbreak in the U.S., a greater degree of caution is appropriate given that lettuce is almost always consumed raw,” said James Rogers, the Consumer Report’s director of food safety and research.
Jean Halloran, the director of food policy initiatives at Consumers Union, said:” Better to avoid romaine lettuce for now.”  “Given the size of the outbreak and the severity of the risk, which is worse for elderly people and children, the magazine felt it was the right decision,”.
Bill Marler, a Seattle-based attorney specializing in food safety cases noted that “Identifying the source of a foodborne illness outbreak can be a delicate balance between warning consumers of public health risks and unduly tainting industries or specific businesses without sufficient evidence.” However, he supports the Consumer Report decision to advise people not to consume romaine lettuce.
The consumer Report recommendation was intensely covered by the many TV outlets and in many of the papers.

“To Recall or Not” and Their Consequences

The Office of Inspector General (OIG) of the U.S. Department of Health and Human Services issued a recent report concluding that the current recall process used by the FDA can be too slow putting consumers at risk.  In response to the report, the FDA is planning to announce a new strategic plan in place to outline actions to improve the recall management. A faster process if clearly needed.
With the requirement to definitively decide the source of the outbreak, the investigation sometimes takes a very long time, and meanwhile, the products are being consumed, and people get ill.
The heavily publicized recommendation by the Consumer Report will certainly cause many good lettuces to be disposed of. Growers of perfectly health romaine lettuce will suffer. Currently, all romaine lettuce is presumed guilty of contamination.  A better system should be put in place to make the identification of contaminated produce easier.
On Jan. 6, the United Fresh Produce Association e-mailed members, stressing that the last U.S. case was reported Dec. 8; the last case in Canada was Dec. 12. “This fact makes it very unlikely — even if the outbreak is tied to romaine —that any affected product remains in marketing channels,” therefore in their opinion the outbreak is over.
However, Bill Marler wrote “I certainly understand that many romaine lettuce growers would like the CDC to call the “outbreak over” since lettuce is perishable. Since neither Canada nor the US has been able to confirm where the contamination occurred – on the farm, in processing, in transit – I think I agree with the Canadian and Consumer Reports approach – “When in doubt, throw it out.”

Is Blockchain the Solution

As reported earlier Blockchain is a decentralized, shared log of data maintained on a network of computers. It is an exciting new technology that can revolutionize food safety and offer much faster traceability of food products including produce.
According to Fortune magazine Viant and the World Wild Fund for Nature, using blockchain technology, provided a way to verify the fish journey from the ocean to the plate. The Tuna fish is tagged with a QR code (two-dimensional barcode) supplied by Viant. The fish is logged into the blockchain system, and its progress is monitored throughout the chain.
It is conceivable that in the future lettuce can be tagged with a QR barcode and be followed to the markets. As a result, any outbreak will be easier to trace back to the farm of origin.
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T. Marzetti Buttermilk biscuits sold across the US recalled due to Listeria concerns

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The FDA announced that T. Marzetti Company voluntarily recalled a variety of frozen biscuits due to the potential contamination with Listeria monocytogenes, as a precautionary measure.
 
Twenty-three frozen 12 or 20 count biscuits packs of T. Marzetti biscuit products are being recalled, including: Southern Home Old Fashioned Buttermilk Style Biscuits, Marshall’s and Shur Fine Old Fashioned Southern Style Biscuits, Shur Fine Old Fashioned, Buttermilk Biscuits, Valu Time, Food Club, SE Grocers, Lowes Foods, Laura Lynn, and Southern Home Southern Style Biscuits; Valu Time Buttermilk Style Biscuits, Food Lion Homestyle Buttermilk Biscuits, Food Club, SE Grocers, Piggly Wiggly, Lowes Foods, Premium Pick 5, Morning Fresh Farms, Laura Lynn, and Southern Home Buttermilk Biscuits, and Piggly Wiggly Homestyle Biscuits.
The products were distributed in the following states: Alabama, Florida, Georgia, Indiana, Kentucky, Louisiana, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. Food Safety News reports that Marshall’s Old Fashioned Southern Style Biscuits have also been recalled in California.
The frozen biscuits are not ready-to-eat products and need to be baked before consumption.  Typically the baking instructions call the baking of the product at 4000F for 20 minutes. The internal biscuit temperature should reach 2000F (930C) enough to kill the organism if present. However, since undercooking can occur, there might be a slight risk, and as a result, Marzetti had decided to recall the product.
Interestingly, this recall was intensely covered by the general media, including many TV stations and newspapers, disproportionate to the risk it poses.
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Listeria Recalls in the News: due to Raw Apples and Smoked Salmon Fish

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Raw Apples Recall

The FDA announced that Jack Brown Produce, Inc. of Sparta, MI had recalled Gala, Fuji, Honeycrisp and Golden Delicious apples due to the potential contamination with Listeria monocytogenes. The contaminated apples were processed and shipped by their supplier Nyblad Orchards, Inc., on December 11 through December 16, 2017.
The apples were distributed to retail stores in Michigan, Georgia, Missouri, Indiana, Ohio, and include the following varieties:
  1. Honeycrisp apples in two-pound clear plastic bags;
  2. Gala, Fuji, and Golden Delicious apples in 3-pound clear plastic bags;
  3. Fuji and Gala apples in 5-pound red-netted mesh bags; and
  4. Gala, Fuji and Honeycrisp apples that were tray-packed/individually sold.
The apples were sold under the “Apple Ridge” name. Originally only whole fresh apples are implicated in this recall.   However, on December 22, 2017, the FDA announced the recall of red/green apple slices. The recalled apples slices were distributed in Michigan, Ohio, and Wisconsin in retail stores and through distributors. The contamination was noted in a single sample that was taken from related gala apple products.
Recalled Apples were sold at ALDI stores in North Carolina, South Carolina, Ohio, Georgia, Indiana and Kentucky starting Dec. 13.
Kroger supermarket chain recalled lunchbox-size Fuji and Galas sold between Dec. 12 and Tuesday. In addition individual pieces of fruit, the recall includes Michigan-grown apples sold in 5-pound bags. The products were sold in Kroger stores in various cities in Georgia, South Carolina, Alabama, Ohio, Virginia, Michigan, Kentucky, Tennessee and West Virginia.
As a result of the Fresh-Pak Inc. recall, Meijer recalled Meijer brand packaged products due to sliced apples within the products being potentially contaminated with Listeria monocytogenes.
Routine sampling at Nyblad Orchards, Inc. facility showed the presence of Listeria monocytogenes in some of the apples. The distribution of these apples was stopped. The company said that no illnesses were reported to date.  
In the past several years there have been a number of recalls associated with raw apples and caramel apples.  There have been a few studies that investigated the potential source of Listeria monocytogenes in raw apples. Salazar et al. (Fate of Listeria monocytogenes in Fresh Apples and Caramel Apples. Salazar JKCarstens CKBathija VMNarula SSParish MTortorello ML) showed that fresh apples inoculated with Listeria monocytogenes at the steam were able to survive and grow, and apple variety did not significantly impact the results.

Smoked Salmon Fish

Initially, the FDA announced the recall of Springfield Smoked Fish of Springfield, of Massachusetts Pre-sliced Nova Salmon, distributed in Rhode Island and Connecticut through retail stores, after finding Listeria monocytogenes in the product.
The initial recall was limited to 1lb pre-sliced Nova Salmon produced on 11/24/17. No illnesses were reported to date.
The recall was expanded and currently includes product produced between May 22, 2017, and December 12, 2017. On December 12, 2017, the facility stopped production.
Most of the recalled products were sold under the Springfield Smoked Fish or Rachael’s Springfield Smoked Fish brand names. The products were distributed and sold at retail stores in Massachusetts, Connecticut, New York, Rhode Island, Colorado, Ohio, and Pennsylvania from May 2017 through December 2017. The product was also sold nationwide through online sales. 
The recalled products include Smoked Salmon – All Species, Whitefish Meat, Belly Lox, Smoked Bluefish, Smoked Sable, Kippered Salmon, Cream Cheese Spreads, and Smoked Whitefish Spread, among others. Also recalled is Boston Salads – Private Label Scallion and Veggie Cream Cheese Spreads.
The expansion is due to environmental and product testing conducted by Springfield Smoked Fish No illnesses have been reported to date. Production of the smoked salmon has been suspended during the FDA investigation of the source of the contamination.
Each year around 1,600 people eat products contaminated with Listeria monocytogenes, about 260 dies (16%). Symptoms often surface one to four weeks after contamination but could take as long as 70 days.
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Lactalis Baby Formula recalled due to Salmonella agona contamination

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Lactalis, a French dairy company, is one of the world’s largest dairy producers was ordered to recall 7,000 tons of powdered milk products due to the contamination with Salmonella agona (French Health authorities).   Twenty-six infants have become ill in France since early December. Initially, 20 children, younger than 6, became ill. This caused an initially limited recall that was expanded as more children got sick. This week 5 new cases of Salmonellosis were reported.
The recalled products were sold in Europe (France and Britain, Greece), in Africa (Morocco and Sudan), in South America (Peru and Colombia), and in Asia (Pakistan, Bangladesh, and China).The affected brands include Picot, Milumel, and Celia. None of the recalled products was sold in the USA. Lactalis believe that the outbreak of Salmonella can be traced back to its facility in Craon in northwest France and to a drying tower used to create the dry milk powder. All products produced at this facility since mid-February might be contaminated. The company had put into place new disinfection procedures together with new cleaning regiment.
The France health authority reported that all the children impacted by the recall are doing well.
Lactalis is a French privately healed company with its headquarters in Laval, in Western France. It has around 75,000 employees in 85 countries