Listeria Attorney

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NICD updated this Listeria Outbreak at the end of July.  Of note, the numbers of ill have continued to drop following the recall of Tiger Brands Enterprise Foods polony in March. However, it appears that some of the “recalled” product is still being consumed.  NICD’s partial report is below.

1,060 laboratory-confirmed cases have been reported from 01 January 2017 to 17 July 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 with no new cases of listeriosis reported during the week prior to release of this sitrep (Figure 1). Neonates ≤28 days of age are the most affected age group (42%, 443/1 060), followed by adults aged 15 – 49 years of age (32%, 334/1 060) – Figure 2. Most cases have been reported from Gauteng Province (58%, 614/1 060), followed by Western Cape (13%, 136/1 060) and KwaZulu-Natal (8%, 83/1 060) provinces (Table 1). Final outcome (i.e. death or discharge) is known for 76% (806/1 060) of total cases to date; 27% (216/806) with known outcome died.

Following a recall of the implicated products, the number of cases has steadily decreased. However, it is anticipated that cases could still be reported for the following reasons:

  • The incubation period of listeriosis can be up to 70 days.
  • The implicated products have a long shelf life and it is possible that despite the recall some products have not been removed from retail or consumer’s homes.
  • Cross-contamination at retail and in the home can occur.

Post recall (05 March 2018 to date), all new cases of laboratory-confirmed listeriosis are contacted by IMT members, and a comprehensive food history is obtained. Exposure to food products implicated in the listeria outbreak is determined.

Of 87 post-recall cases, 65 have been interviewed to date.

Of those interviewed, 38/65 (58%) of ill people or their proxy reported consuming polony prior to their illness onset; brands manufactured by Tiger Brands Enterprise Foods were most commonly reported to have been consumed where brand of polony was known.

Prior to 2017, an average of 60 to 80 laboratory-confirmed listeriosis cases per year (approximately 1 per week), were reported in South Africa. In July 2017, an increase in laboratory-confirmed cases of listeriosis was reported to National Institute for Communicable Diseases (NICD) which triggered further investigation. On 05 December 2017, the listeriosis outbreak was declared by the Minister of Health, Dr. Aaron Motsoaledi. The source of the outbreak was identified as ready-to-eat processed meat products manufactured at Tiger Brand’s Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.

1,053 cases have been reported from 01 January 2017 to 20 June 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 (Figure 1). Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age (Figure 2). Most cases have been reported from Gauteng Province (58%, 613/1 053), followed by Western Cape (13%, 132/1 053) and KwaZulu-Natal (8%, 81/1 053) provinces (Table 1).

Prior to 2017, an average of 60 to 80 laboratory-confirmed listeriosis cases per year (approximately 1 per week), were reported in South Africa. In July 2017, an increase in laboratory-confirmed cases of listeriosis was reported to National Institute for Communicable Diseases (NICD) which was followed by investigations into the reported increase. On 05 December 2017, the listeriosis outbreak was declared by the Minister of Health, Dr. Aaron Motsoaledi. The source of the outbreak was identified as ready-to-eat processed meat products manufactured at Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.

1034 sick with 204 dead as of two weeks ago – this week 1038 sick with 208 dead.

NICD Listeria Situation Report Update:  1038 cases have been reported from 01 January 2017 to 22 May 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 (Figure 1). Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age (Figure 2). Most cases have been reported from Gauteng Province (58 %, 607/1038), followed by Western Cape (13%, 130/1038) and KwaZulu-Natal (7%, 76/1038) provinces (Table 1).

  • The number of reported cases per week has decreased since the implicated products were recalled on 04 March 2018 with a total of 64 cases reported since 5 March 2018 (average 6.4 cases/week), whereas 249 cases were reported for the 10-week period prior to the recall (average 24.9 cases/week).
  • Prior to 2017, an average of 60 to 80 laboratory-confirmed listeriosis cases per year (approximately 1 per week), were reported in South Africa. In July 2017, an increase in laboratory-confirmed cases of listeriosis was reported to National Institute for Communicable Diseases (NICD) which was followed by investigations into the reported increase. On 05 December 2017, the listeriosis outbreak was declared by the Minister of Health, Dr. Aaron Motsoaledi. The source of the outbreak was identified as ready-to-eat processed meat products manufactured at Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.

  • 1 034 cases have been reported from 01 January 2017 to 16 May 2018. The number of new cases reported each week has decreased since the implicated products were recalled on 04 March 2018 (Figure 1). Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age (Figure 2). Most cases have been reported from Gauteng Province (59%, 606/1 034), followed by Western Cape (13%, 130/1 034) and KwaZulu-Natal (7%, 75/1 034) provinces (Table 1).

  • All clinical isolates received at NICD are undergoing whole genome sequencing (WGS). A total of 543 clinical isolates have undergone WGS to date (Figure 1); 92% (499/541) belong to the sequence type 6 (ST6) outbreak strain, and the remainder belong to thirteen different sequence types.
  • Listeriosis outbreak situation report draft _21May2018_final
According to the most recent update from NICD, the source of the outbreak continues to be identified as ready-to-eat processed meat products manufactured at Enterprise Foods’ Polokwane production facility. A recall of affected products was initiated on 04 March 2018.
Because of the recall the number of cases of listeriosis diagnosed each week has decreased, with three additional cases reported since the last situation report. In total, 1,027 cases have been reported from 01 January 2017 to 02 May 2018, with 58 cases reported for the 8-week period since 5 March 2018. During the eight weeks prior to 5 March 2018, 200 cases of listeria were reported.
1,027 cases have been reported from 01 January 2017 to 02 May 2018. The number of reported cases has decreased since the implicated products were recalled on 04 March 2018 (Figure 1). Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age (Figure 2). Most cases have been reported from Gauteng Province (59%, 603/1 027), followed by Western Cape (13%, 128/1 027) and KwaZulu- Natal (7%, 74/1 027) provinces (Table 1). There have been 201 deaths.
Following a recall of implicated products, the number of cases went down. However, it is anticipated that cases could still be reported for the following reasons:
1. The incubation period of listeriosis can be up to 70 days.
2. The implicated products have a long shelf life and it is possibly that despite the recall some products have not been removed from retail or consumer’s homes.
3. Cross-contamination at retail and in the home can occur.

Earlier this week the National Institute of Communicable Diseases (NICD) reported that 1019 Listeria illnesses with 199 deaths have been linked to Tiger Brands Enterprise polony.  Today, Tiger Brands provided to the public – through an announcement to its shareholders that it had confirmed the NICD’s findings the a specific type of Listeria – Listeria monocytogenes ST6 type – was found.

To Tiger Brands’ credit, it has been transparent with its test results.  Its transparency support of the NICD findings is hopeful for its customers that suffered as a result of the Listeria-tainted product.  Tiger Brands should be commended for its willingness to provide the results in a public forum.

Here is the Tiger Brands’ announcement in full:

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.

The NICD published its most recent report on the deadly Listeria outbreak. Fortunately, it is winding down at the polony was pulled from shelves.  However, the NICD warns that not all polony has been recalled, and due to the long incubation period for Listeria, case could still be counted for some time.

It was a wide-spread outbreak.

The outbreak greatest impact was on babies less that 28 days of age and people in the 15 – 49 years of age.

Listeriosis outbreak situation report_22April 2018_fordistribution

According to the NICD, Aas of 26 March 2018, a total of 982 laboratory-confirmed listeriosis cases have been reported to NICD since 01 January 2017 (Figure 1). Most cases have been reported from Gauteng Province (59%, 576/982) followed by Western Cape (12%, 121/982) and KwaZulu-Natal (7%, 71/982) provinces. Cases have been diagnosed in both public (65%, 634/982) and private (35%, 348/982) healthcare sectors.Listeria monocytogenes was most commonly isolated/detected on blood culture (72%, 711/982), followed by CSF (21%, 207/982). Where age was reported (n=943), ages range from birth to 93 years (median 22 years) and 41% (404/982) are neonates aged ≤28 days (Figure 2). Of neonatal cases, 96% (389/404) had early-onset disease (birth to ≤6 days). Females account for 56% (531/950) of cases where gender is reported. Final outcome data is available for 70% (687/982) of cases, of which 28% (189/687) died.

The recall of polony has turned the tide on illnesses.

But, what about the victims, where are their stories?

I am just not sure about this.  Should a grower responsible for illnesses and deaths and the devastation of the Australian rockmelon industry be allowed to start production of rockmelon months after an outbreak?

NWS Food Safety Authority announced yesterday the likely cause of 19 Listeria illnesses with sixth deaths.

What is Listeria and how do rockmelons become contaminated?

While rockmelons are grown off the ground on top of plastic sheeting, the fruit is grown in the open farm environment and subject to rain, wind and other natural contamination pathways. Listeria species, including Listeria monocytogenes, are soil bacteria that are naturally found in the environment, including farm paddocks. It is not unusual to find Listeria on the surfaces of any raw fruit and vegetable. Rockmelon skin is rough and irregular which allows more soil and bacteria like Listeria to be trapped.

How did this outbreak happen?

To reduce the risk of contamination farms usually wash and sanitise rockmelons. The investigation found that the contamination is likely to have occurred due to adverse weather (localised storm over the farm and subsequent dust storms during the season) increasing the levels of Listeria on the fruit prior to harvest. On this occasion and despite following industry best practice, the washing and sanitising at Rombola Family Farms was not able to remove all the trapped bacteria from the rockmelon surfaces, resulting in a low level of Listeria being present.

Inspections by the NSW Food Authority found there was also an opportunity for the introduction of Listeria after washing through contact with surfaces or equipment that may have had traces of Listeria monocytogenes. This includes dust blown from fans used to dry the fruit after washing, and from porous material on packing tables that was not able to be effectively cleaned at the time.

While Listeria monocytogenes is not an issue for healthy consumers, it poses a serious health risk for those vulnerable to infection, such as individuals who are immunocompromised or pregnant.

What are the results of the investigation?

The NSW Food Authority has completed extensive microbiological swabbing of the packing shed environment and equipment for Listeria. Listeria species and Listeria monocytogenes was found on the packing shed floor during the investigation, which is not surprising as Listeria are often found in soil.

Melons from boxed product at Flemington Markets tested positive for Listeria monocytogenes and a trade level recall was initiated on
28 February. That same day the NSW Food Authority issued a media release advising consumers to discard any rockmelon they may have purchased.

Melons obtained at retail, wholesale, and a swab of melons at the packing shed tested positive for Listeria monocytogenes. The genetic sequence of these Listeria isolates was an exact match with clinical cases. No rockmelons or swabs from other farms tested positive for Listeria monocytogenes.

During the investigation there was an allegation of raw organic fertiliser use on the rockmelon crop which was found to be incorrect. There is no reason to believe this played a role in the outbreak.

Why is the NSW Food Authority allowing the farm to pack rockmelons?

The production of rockmelons on the farm and packing shed environment has been investigated. During March 2018, further rockmelon packing trials and swabbing verified effective washing and sanitising is in place. The company has fully cooperated with the NSW Food Authority and has made significant line modifications to improve cleaning. They have also increased cleaning and sanitising of the packing line environment and increased the sanitiser concentration during the washing of melons. The company and the NSW Food Authority will continue to monitor the situation through inspections and product sampling. The NSW Food Authority is currently satisfied that the company has adequate steps in place to minimise the risk of foodborne illness, noting that immunocompromised people should avoid rockmelons.  No melons from the farm will be released for sale prior to testing for Listeria.

Will it happen again?

While rockmelons from Rombola are washed, sanitised and packed under hygienic conditions there is no absolute guarantee that any fresh produce item will be free from Listeria. The NSW Food Authority recommends that any farm produce eaten raw should be thoroughly washed before consumption. Consumers who are immunocompromised or pregnant are also advised to avoid high risk foods, including rockmelons.

What happens next?

The NSW Food Authority will continue to work with the industry and food regulatory agencies to share lessons learnt from this outbreak. This includes interstate businesses and food safety agencies so the industry as a whole can move forward with confidence in the future.

Summary of Key Findings:

  • Of the 439 clinical isolates from case-patients sequenced to date, 92% belong to sequence type 6 (ST6) and are highly genetically related. This confirms that this single strain is causing the outbreak and is responsible for disease in the vast majority of patients with listeriosis.
  • As 86% of patients interviewed reported eating polony in the month before falling ill with listeriosis, ready-to-eat processed meat products became the focus of investigations.
  • The outbreak strain isolates from patients and from the Enterprise Foods’ Polokwane production facility (notably, the post-cooking area and the final product clips and casing) differ by only ≤7 single base pairs out of 3 million. This extremely high level of genetic relatedness (99.99% similarity) means there can be no doubt that these L. monocytogenes ST6 strains are all linked, and that there is certainty that products manufactured at Enterprise Polokwane are the source of the outbreak. This is much like paternity confirmation by DNA testing.
  • Seven samples of ready-to-eat processed meat products taken on 15 February 2018 tested positive for L. monocytogenes ST6 (outbreak strain). This means that the outbreak strain has been found inside the ready-to-eat processed meat products manufactured at Enterprise Foods’ Polokwane production facility, dispelling claims made to the contrary.

Issued by the National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS)

Date of release: 02 April 2018

The National Institute for Communicable Diseases (NICD) is concerned about recent developments and statements supposedly released as facts into the public domain about the listeriosis outbreak.

We are particularly worried about the confusion that emanated from statements made at the meeting called by the Parliamentary Portfolio Committee on Agriculture on 28 March 2018.

Of major concern are the claims that the primary source of the outbreak is still unknown, and that the Minister of Health has backed down on his previous announcement that the source had been identified, both of which we refute. The statements the Minister of Health has made have emanated from epidemiologic and scientific investigations conducted by the NICD. The implication that the NICD has misled the Minister of Health and the public is rejected. Furthermore, we condemn the statement made that the government prematurely scapegoated ‘Enterprise and Rainbow’ without sufficient evidence. We contend that this evidence has been amply provided by the NICD.*

We do not regard these claims as a small matter, because the NICD is not just a routine diagnostic laboratory with an impact localised to South Africa. The NICD’s work goes far beyond the borders of our country and has an international impact. In outbreaks of this nature, the NICD is obligated by the International Health Regulations to report findings through the National Department of Health to the World Health Organization, and cannot afford to, and does not mislead.

To serve its purpose, the NICD has specialised laboratories and public health and epidemiologic expertise. This expertise leads it to serve as a reference centre, not only for the public and private sectors in South Africa, but across Africa. It shares information and works together with the World Health Organization (WHO) and eminent international institutions (including the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) of the USA, the European Centre for Disease Control (ECDC) and Public Health England). The NICD is the co-ordinator of the prestigious PulseNet Africa network, within PulseNet International. PulseNet is a global network of laboratories dedicated to tracking foodborne infections (including listeriosis) world-wide, all of whose laboratories, including the NICD, utilise internationally-recognised standardised genotyping methods and share information in real-time.

Therefore, the work of the NICD is scientifically sound and evidence-based. For those who still have lingering doubts, this is how we arrived at the conclusions announced by the Minister of Health on 04 March 2018.

The search for the cause of the outbreak began with the isolates of Listeria monocytogenes bacteria from case-patients referred from National Health Laboratory Service (NHLS) and private sector clinical laboratories to the NICD, where they underwent confirmatory testing and whole genome sequencing (WGS). WGS is the most sensitive and specific molecular tool available to assess genetic relatedness of bacterial isolates. Of the 439 clinical isolates from case-patients sequenced to date, 92% belong to sequence type 6 (ST6) and are highly genetically related. This confirms that this single strain is causing the outbreak and is responsible for disease in the vast majority of patients with listeriosis.

At the same time, an intensive process of trying to identify the source of the outbreak was undertaken by the Departments of Health (DoH), Agriculture, Forestry and Fisheries (DAFF) and Trade and Industry (DTI), municipalities and the NICD. Epidemiological investigations included interviewing patients. As 86% of patients interviewed reported eating polony in the month before falling ill with listeriosis, ready-to-eat processed meat products became the focus of investigations. The key breakthrough came when a group of nine children attending the same crèche in Soweto developed febrile gastroenteritis in January 2018. The L. monocytogenes ST6 outbreak strain was identified in one child and in three samples of two brands of polony from the refrigerator at the crèche. This prompted further investigation of the production facilities manufacturing these polony products.

Enterprise Foods’ Polokwane production facility was visited on 2 February 2018 by a team, which included two WHO food safety experts. Extensive sampling was done. Polony production involves a number of steps: raw ingredients are mixed into an emulsion, the polony emulsion is poured into casings (the plastic wrapping) and clipped at either end of the casing, the polony is cooked in its casing, then finally it is cooled. Any Listeria that is present in the raw ingredients or emulsion should be killed during the cooking process. However, any L. monocytogenes found beyond the cooking stage poses the danger of contaminating the polony and causing disease, because polony is not usually cooked again before it is eaten. Of great concern was that the L. monocytogenes ST6 outbreak strain was found in the post-cooking processing environment, and also on the final polony products.

The whole genome sequencing (WGS) technology that identified the ST6 outbreak strain is the gold standard method for characterising which specific L. monocytogenes strain is causing an outbreak. This highly specialised test is performed at the NICD. WGS essentially shows the genetic fingerprint of the bacteria, by sequencing the chemical building blocks (nucleotides or base pairs) that make up its genome (the complete set of its DNA, including all of its genes). The L. monocytogenes genome has approximately 3 million base pairs. The outbreak strain isolates from patients and from the Enterprise Foods’ Polokwane production facility (notably, the post-cooking area and the final product clips and casing) differ by only ≤7 single base pairs out of 3 million. This extremely high level of genetic relatedness (99.99% similarity) means there can be no doubt that these L. monocytogenes ST6 strains are all linked, and that there is certainty that products manufactured at Enterprise Polokwane are the source of the outbreak. This is much like paternity confirmation by DNA testing.

From the evidence above, it is extremely misleading for anyone to claim that the primary cause of this listeriosis outbreak is unknown.

Since the first press conference held by the Minister of Health on 05 December 2017, it has been reiterated many times that L. monocytogenes is widely found in nature and can be found in water, soil, vegetation, and the faeces of some animals. Food can be contaminated from any of these sources throughout the food chain (farm, processing, packaging, retail and home food preparation). However, normal food production safety measures and water treatment procedures should deal with the risk of contamination. In addition, the WHO’s five keys to safer food should be practiced by all. These are:

• Wash hands and surfaces before, and regularly during food preparation.
•Separate raw and cooked food, and don’t mix utensils and surfaces when preparing
food
•Cook food thoroughly – all bacteria are killed above 70°C
•Keep food at safe temperatures – either simmering hot, or in the fridge
•Use safe water and safe ingredients to prepare food.

*We can report today that additional results from samples of products produced at the Enterprise Polokwane production facility and sold at the Enterprise Germiston factory shop are available. Seven samples of ready-to-eat processed meat products taken on 15 February 2018 tested positive for L. monocytogenes ST6 (outbreak strain). This means that the outbreak strain has been found inside the ready-to-eat processed meat products manufactured at Enterprise Foods’ Polokwane production facility, dispelling claims made to the contrary.