Wednesday, September 5, 2018

PRO/AH/EDR> Listeriosis - South Africa (15): fatal, ST6, end of outbreak

LISTERIOSIS - SOUTH AFRICA (15): FATAL, ST6, END OF OUTBREAK
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[1]
Date: Mon 3 Sep 2018 17:17 SAST
Source: Business Live [edited]
<https://www.businesslive.co.za/bd/national/2018-09-03-listeriosis-outbreak-officially-over-says-aaron-motsoaledi/>


The government has declared the end of the listeriosis outbreak, the
world's deadliest on record, and has withdrawn advice against
consuming ready-to-eat processed meat products.

And the Enterprise factory in Limpopo, identified as the source of the
outbreak, could reopen in October [2018], health minister Aaron
Motsoaledi said in Johannesburg on [Mon 3 Sep 2018].

The listeriosis outbreak has been costly for Tiger Brands, with
recall-related costs amounting to Rand 365 million [about 23.9
million] for the initial insurance claims, spokesperson Nevashnee
Naicker said. The packaged goods company lost a further Rand 50
million [about USD 3.27 million] a month as operations ceased.

The National Institute for Communicable Diseases also identified
_Listeria_ at RCL's Rainbow Foods, resulting in a recall of all
ready-to-eat processed meat products from the facility.

The country has destroyed more than 5800 tons of recalled meat since
the beginning of March [2018], when it linked the products to the
outbreak and named a plant owned by Tiger Brands as the source of the
crisis.

More than 200 people died from listeriosis between January 2017 and
[26 Jul 2018] and 1060 cases of the illness were identified, according
to the National Institute for Communicable Diseases. No new cases
caused by the outbreak strain have been identified since the 1st week
of June [2018] and incidences have dropped to pre-outbreak levels,
Motsoaledi said, adding the outbreak has been declared over. It is
still unclear how the bacteria strain entered the affected factory,
Motsoaledi said.

"Today's announcement means that ready-to-eat processed meat can now
be safely consumed, as before the outbreak," he said. South Africans
are now free to eat "kotas", a popular township meal made of a quarter
loaf of bread stuffed with chips, cheese, and cold meat.

[Byline: Penelope Mashego]

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Communicated by:
ProMED-mail
<promed@promedmail.org>

******
[2]
Date: August 2018
Source: National Institute for Communicable Diseases (NICD) [edited]
<http://www.nicd.ac.za/wp-content/uploads/2018/08/An-update-on-the-outbreak-of-Listeria-monocytogenes-South-Africa.pdf>


An update on the outbreak of _Listeria monocytogenes_, South Africa
-------------------------------------------------------------------
As of 14 Aug 2018, a total of 1064 laboratory-confirmed listeriosis
cases has been reported to NICD since [1 Jan 2017 (Figure 3 [all
figures are available at the source URL above]). Most cases have been
reported from Gauteng Province (58 percent, 612/1064) followed by
Western Cape (13 percent, 139/1064) and KwaZulu-Natal (8 percent,
84/1064) provinces. Cases have been diagnosed in both public (64
percent, 683/1064) and private (36 percent, 381/1064) healthcare
sectors. Outcome is known for 828/1064 (78 percent) patients, of whom
218 (26 percent) have died (Figure 4).

Females account for 56 percent (576/1039) of cases where gender is
reported. Where age was reported (n=1043), ages range from birth to 93
years (median 19 years) - Figure 5. Neonates aged 28 days and less
account for 43 percent (444/1043) of cases. Of neonatal cases, 95
percent (424/444) had early-onset disease (birth to 6 days or less).

Although outbreak-related cases have declined sharply, sporadic cases
(that is, not epidemiologically linked) continue to be reported, as
expected. Therefore, healthcare workers are encouraged to continue
providing risk reduction guidance to persons at high risk for
developing listeriosis (pregnant women, neonates 28 days of age and
younger, persons older than 65 years of age, and persons with
immunosuppression (due to HIV infection, cancer, diabetes, chronic
renal disease, chronic liver disease, transplantation and
immunosuppressive therapy). Such guidance includes advice on food
hygiene (the World Health Organization's 5 keys to safer food
[<http://www.who.int/foodsafety/publications/5keysmanual/en/>] is a
useful resource for generic food hygiene advice) and avoidance of
at-risk food.

The end of the outbreak is approaching, and the activities of the
listeriosis Incident Management Team are nearing completion. The
following actions have been taken to strengthen health and
environmental systems to ensure prevention and early detection of
future outbreaks, particularly in ready-to-eat processed meat:
1. Listeriosis has been declared a notifiable medical condition under
an amendment to the National Health Act.
2. The NICD has developed a system of surveillance and investigation
of listeriosis cases including whole genome sequencing (WGS) of all
isolates from laboratory-confirmed cases. This allows timeous
identification of clusters which may represent outbreaks.
3. The NHLS has strengthened capacity to conduct food and
environmental testing for _Listeria monocytogenes_.
4. Almost 900 environmental health practitioners in all health
districts have been re-trained in inspection procedures, food safety
systems, legislative aspects of food control and tools to support
inspections including risk assessment tools and inspection
checklists.
5. All production facilities that manufacture ready-to-eat processed
meat in South Africa have been identified (n=158) and all but 9 have
been inspected by district environmental health practitioners,
supported by a core incident management team.
6. An amendment to the Regulations pertaining to the application of
the hazard analysis and critical control system (HACCP), (R908 of
2003) was published on 14 Jun 2018 requiring all producers of
ready-to-eat processed meat to be HACCP certified by externally
accredited agencies within 9 months of publication of this act.
7. Risk communication activities including the dissemination of
information pertaining to food safety, avoidance of certain foodstuffs
by persons who are at risk for listeriosis, and training of health
promoters have been conducted.

Further resources on listeriosis can be found on the NICD website at
<http://www.nicd.ac.za>, Diseases A-Z, under 'Listeriosis'.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The 2nd news report above, which is from the South African National
Institute for Communicable Diseases (NICD), says that a total of 1064
cases of the listeriosis were identified between January 2017 and 14
Aug 2018.

Over 90 percent of isolates from listeriosis cases linked to the South
African "polony" outbreak were sequence type 6 (ST6) (see ProMED-mail
post Listeriosis - South Africa (11): fatal, ST6, WHO response
http://promedmail.org/post/20180330.5718496). ST6 was also identified
in "polony", a widely consumed ready-to-eat processed meat product and
in environmental samples collected from the facility that processed
the implicated product.

Of the 645 _Listeria_ clinical isolates that have been sequence typed,
no ST6 isolates have been identified since the 1st week of June 2018
(see Figure 3 from the NICD report above at the source URL).
Considering that the implicated "polony" was recalled in early March
2018 and the incubation period of listeriosis is up to 70 days, the
1st news report above says that the South African government has
"declared the end of the listeriosis outbreak," the world's largest on
record
(<http://www.who.int/csr/don/28-march-2018-listeriosis-south-africa/en/>),
and has "withdrawn advice against consuming ready-to-eat processed
meat products." - Mod.ML

HealthMap/ProMED map of South Africa:
<http://healthmap.org/promed/p/179>]

[See Also:
Listeriosis - South Africa (14): fatal, ST6
http://promedmail.org/post/20180704.5888338
Listeriosis - South Africa (13): fatal, ST6
http://promedmail.org/post/20180517.5801104
Listeriosis - South Africa (12): fatal, ST6, WHO update
http://promedmail.org/post/20180504.5782882
Listeriosis - South Africa (11): fatal, ST6, WHO response
http://promedmail.org/post/20180330.5718496
Listeriosis - South Africa (10): fatal, more cases
http://promedmail.org/post/20180316.5691653
Listeriosis - Namibia: (OT) Vienna sausage, susp ex South Africa
http://promedmail.org/post/20180315.5687757
Listeriosis - South Africa (09): fatal, health dept. press release
http://promedmail.org/post/20180305.5666617
Listeriosis - South Africa (08): fatal, more cases, source found,
polony http://promedmail.org/post/20180305.5665592
Listeriosis - South Africa (07): fatal, more cases
http://promedmail.org/post/20180224.5648305
Listeriosis - South Africa (06): fatal, more cases
http://promedmail.org/post/20180218.5635764
Listeriosis - South Africa (05): fatal, more cases
http://promedmail.org/post/20180131.5596282
Listeriosis - South Africa (04): comment
http://promedmail.org/post/20180126.5586393
Listeriosis - South Africa (03): fatal, increasing incidence, ST6
http://promedmail.org/post/20180122.5577247
Listeriosis - South Africa (02): fatal, increasing incidence, ST6
http://promedmail.org/post/20180117.5566300
Listeriosis - South Africa: fatal, increasing incidence, ST6
http://promedmail.org/post/20180108.5545556
2017
----
Listeriosis - South Africa (04): fatal, increasing incidence
http://promedmail.org/post/20171217.5508986
Listeriosis - South Africa (03): fatal, increasing incidence,
genotyping http://promedmail.org/post/20171206.5487695
Listeriosis - South Africa (02): fatal, increasing incidence, RFI
http://promedmail.org/post/20171205.5484927
Listeriosis - South Africa: increasing incidence
http://promedmail.org/post/20171025.5402225]
.................................................sb/ml/mj/mpp
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