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Yersinia enterocolitica Listeria monocytogenes CMed/Epid 526, Epidemiology of Diseases Communicable from Nature PowerPoint PPT Presentation


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Yersinia enterocolitica Listeria monocytogenes CMed/Epid 526, Epidemiology of Diseases Communicable from Nature. John Kobayashi MD, MPH May 27, 2009. Learning Objectives. Describe some Yersinia enterocolitica outbreak investigations in different cultural or social settings

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Yersinia enterocolitica Listeria monocytogenes CMed/Epid 526, Epidemiology of Diseases Communicable from Nature

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Yersinia enterocoliticaListeria monocytogenesCMed/Epid 526, Epidemiology of Diseases Communicable from Nature

John Kobayashi MD, MPH

May 27, 2009


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Learning Objectives

  • Describe some Yersinia enterocolitica outbreak investigations in different cultural or social settings

  • Explain why investigating outbreaks of Listeriosis has been difficult in the past

  • Describe some epidemiologic tools which are now used to perform more effective investigations of Listeriosis and other diseases


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Yersinia enterocolitica

  • Fever, abdominal pain, diarrhea, 4-7 days after exposure

  • Older children and adults, may have right sided abdominal pain and fever (mesenteric adenitis or terminal ileitis). May be confused with appendicitis.

  • Frequent animal reservoir: pigs

  • Also found in rodents, rabbits, sheep, cattle, horses, dogs, and cats.


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Potential Sources of YE Infection

  • Contaminated food, especially raw or undercooked pork products

  • Contaminated water

  • Unpasteurized milk

  • Rarely: person to person spread, blood transfusions


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Reported and Estimated Illnesses: Foodborne pathogens--US

Mead et al (1999)


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Preliminary FoodNet Data… 2007. MMWR, April 11, 2008

Preliminary FoodNet Data… 2007. (10 sites) MMWR, April 11, 2008


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Population Based Surveillance

  • 1996-1999 – 5 FoodNet Sites: MN, OR, CA (Alameda and SF), CT (Hartford, New Haven), GA (8 counties) – 14.8 million people

  • Active laboratory and population-based surveillance for YE


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CID 2004:38 (Suppl 3) • Ray et al.


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CID 2004:38 (Suppl 3) • Ray et al.


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What are your hypotheses regarding disease transmission?


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References:

  • Topics in Minority Health: Yersinia enterocolitica Infections during the Holidays in Black Families – Georgia. MMWR Nov 16, 1990 39(45);819-820.

  • Yersinia enterocolitica Gastroenteritis Among Infants Exposed to Chitterlings – Chicago Illinois, 2002. Oct 10, 2003 52(40);956-958.


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Other investigations:


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Y. enterocolitica, Norway, 2005-6


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Grahek-Ogden, et al. “Outbreak of Yersinia enterocolitica Serogroup O:9 Infection and Processed Pork, Norway.” EID Vol 13, No. 5 May 2007, p754-756.

  • Brawn:

  • Layered pork (precooked head meat), veal, lard and spices to a mold

  • Heat to a core temp of 74 C, then 70 C for 30 minutes

  • Sold ready-to-eat


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Yersinia enterocolitica in Norway

  • Third most common cause of acute enteritis after campylobacteriosis and salmonellosis.

  • First study: Ostroff, et al. Epidemiol. Infect. 1994;112;133-41.


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Y. enterocolitica, Washington State

  • 50 YE cases Dec 15, 1981 – Feb 22, 1982,

  • Implicated food: tofu (soybean curd).

  • YE serotype O:8 from cases, tofu, and water used to make tofu

  • Tacket et al. Am J. Epidemiol. 1985 May; 121(5):705-11.


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Listeria monocytogenes

  • Gram positive rod, can be confused with “diptheroids.”

  • Grows well in refrigerator temperatures (cold enrichment possible)

  • Widespread in nature, can be found in soil, decaying vegetation, stool of mammals, raw vegetables, raw milk, fish, poultry, meats.


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Preliminary FoodNet Data… 2007. (10 sites) MMWR, April 11, 2008


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Preliminary FoodNet Data… 2007. MMWR, April 11, 2008


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Listeria monocytogenes

  • Uncommon cause of illness in the general population.

  • High risk groups, neonates, pregnant women, immunosuppressed (AIDS, cancers, transplants)

  • Bacteremia, meningitis and other CNS infections

  • Pregnancy: influenza-like illness in 3rd trimester

  • Incubation period: 11-70 days, mean: 31 days


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Alpine, Wyoming Outbreak

Alpine , WY

Cases in WA had identical PFGE pattern.

Matching was done electronically using

PulseNet.


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General Reference: Food Consumption and Disease Risk: Consumer-Pathogen Interactions. Morris Potter, ed. CRC Press, Woodhead Publishing, 2006

  • Chap 3: Globalization of the food supply and the influence of economic factors on the contamination of food with pathogens.

  • Chap 4: Trends in agricultural management and land use and the risk of foodborne disease

  • Part II: Host Factors, Chap 10: Enhance susceptibility to foodborne Infections and disease due to underlying illness and pregnancy.

  • Part III: Agent Factors Chap 17: Dose-response relationships and foodborne disease.


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