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Listeria monocytogenes : The Burden of Illness and the Public Health Challenge. Robert V. Tauxe, MD, MPH Foodborne and Diarrheal Diseases Branch Centers for Disease Control and Prevention, Atlanta, Georgia Food and Drug Administration, December 4, 2003.

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listeria monocytogenes the burden of illness and the public health challenge

Listeria monocytogenes: The Burden of Illness and the Public Health Challenge

Robert V. Tauxe, MD, MPH

Foodborne and Diarrheal Diseases Branch

Centers for Disease Control and Prevention, Atlanta, Georgia

Food and Drug Administration, December 4, 2003

Unpublished data in this presentation is preliminary

objectives
Background on organism and infection

Current public health burden

Trends in incidence of listeriosis

Conclusion

Unpublished data in this presentation is preliminary

Objectives
listeria monocytogenes characteristics of the organism
Listeria monocytogenesCharacteristics of the organism
  • Small rod shaped bacterium
  • Lives in soil, ubiquitous
  • Thrives in moist, cool locations
  • Grows slowly at refrigerator temperatures
  • In the animal or human, can be invasive
  • Survives inside white cells
listeria monocytogenes characteristics of the infection
Listeria monocytogenesCharacteristics of the infection
  • Perinatal infections
    • Pregnant woman may have fever, or not have a defined illness
    • Spread to the fetus
      • Sepsis
      • Miscarriage
      • Stillbirth
    • Spread to the newborn baby
      • Meningitis
listeria monocytogenes characteristics of the infection5
Listeria monocytogenesCharacteristics of the infection
  • Non-perinatal infections, compromised host
    • Malignancy
    • Organ transplant
    • Immunosuppressive medications
    • HIV/AIDS
    • Elderly
  • Can produce invasive disease
    • Sepsis
    • Meningitis
    • Encephalitis
listeria monocytogenes characteristics of the infection6
Listeria monocytogenesCharacteristics of the infection
  • Normal host
    • Most often is asymptomatic
    • Can produce diarrheal illness with fever
    • Rarely can lead to invasive disease
  • We track invasive illness
estimated annual burden of selected foodborne diseases united states 1997 estimates
Estimated annual burden of selected foodborne diseases, United States* (1997 estimates)

* Due to foodborne and other transmission routes

Mead, EID Journal, 1999

tracking listeriosis with active surveillance
Tracking listeriosis with active surveillance
  • 1985: Large outbreak in California: 142 cases, 40 fatalities, traced to Mexican style soft cheese, queso fresco
  • 1986: Active surveillance began in sentinel locations
  • Staff contact clinical laboratories to identify cases
  • 1996: Expanded to other foodborne infections as FoodNet, with support of USDA and FDA
foodnet sites 1996 2003

Year

Pop’n

(million)

1996

14.3

1997

16.1

1998

20.7

1999

25.9

2000

30.5

2001

34.1

2003

36.0

13% of U.S. population

FoodNet Sites 1996-2003
slide10
Has mortality of listeriosis changed over time? Case- fatality data from active surveillance, United States
slide11
Rate of invasive listeriosis infection in different population groups, United States*, FoodNet (1996-2000)
  • 4 per million persons in general population
    • 2 per million among White, non Hispanic
    • 2 per million among African-Americans
    • 4 per million among Asians
  • 2 per million among non-Hispanic
  • 7 per million among Hispanics
slide12
Rate of invasive listeriosis infection in different population groups, United States*, FoodNet (1996-2000)
  • Among infants
    • Incidence rate 12 fold higher among Hispanics than among non Hispanics
  • Among women of childbearing age
    • Incidence rate 11 fold higher among Hispanics than among non-Hispanics
incidence of reported cases of listeriosis in the united states 1986 2002

Hot dog outbreak;

PulseNet began subtyping

Turkey frank case,

New regulatory policies,

Industry efforts

Queso

fresco

outbreak

Deli meat

outbreak

Incidence of reported cases of listeriosis in the United States, 1986-2002*

*Data from active surveillance systems, FoodNet since1996. 2002 data are preliminary

laboratory coordination

PFGE

patterns

Participating laboratories

National database

Laboratory coordination
multistate listeriosis outbreak 1998 1999

12

Death or miscarriage

Recall

11

Survived

10

9

Number of Patients

8

7

Plant

Construction

6

5

Serotype 4b

4

3

2

1

0

6/27

8/2

9/6

10/11

11/15

12/20

1/24

2/27

4/3

Date

Multistate listeriosis outbreak,1998-1999
  • 101 cases in 22 states, 84 non-pregnant adults
  • 15 deaths (all adults), 6 miscarriages
  • Epidemiological investigation implicated eating hot dogs from Plant A
cheese associated outbreak of listeriosis north carolina 2000 2001
12 cases in North Carolina

All Hispanic

10 were in pregnant women

5 stillbirths

Epidemiological investigation: queso fresco

purchased from door-to-door vendors

homemade queso fresco made using local raw milk

Strains of serotype 4b, with a single PulseNet pattern, from patients, cheeses, and raw milk

State banned sale of raw milk, launched education program

MMWR 50:560, 2001

Cheese-associated outbreak of listeriosis, North Carolina, 2000-2001
multi state outbreak of listeriosis 2002
54 patients in 9 states

42 non-pregnant adults

8 deaths, 3 miscarriages/stillbirths

Serotype 4b

Outbreak was caused by turkey deli meat

Post-processing contamination likely

USDA-FSIS issued new microbial sampling policy

Increased environmental testing

Can base recall on environmental test results

Preliminary data

Multi-state outbreak of listeriosis, 2002
incidence of reported cases of listeriosis in the united states 1986 200218

Hot dog outbreak;

PulseNet began subtyping

Turkey frank case,

New regulatory policies,

Industry efforts

Queso

fresco

outbreak

Deli meat

outbreak

Incidence of reported cases of listeriosis in the United States, 1986-2002*

*Data from active surveillance systems,

Some data are preliminary

outbreaks of listeriosis united states 1978 2003

PulseNet begins

subtyping Listeria

Multistate outbreak

One state outbreak

Outbreaks of listeriosis, United States, 1978-2003*

* Data for 2002 and 2003 are preliminary

general conclusions from the epidemiological data
General conclusions from the epidemiological data
  • Outbreaks caused by:
    • Processed ready-to-eat meats, especially turkey and hot dogs
    • Fresh soft cheeses made with raw milk
    • Typically contaminated after initial processing
    • Locus of contamination in the processing plant
  • Sporadic cases associated with:
    • Study #1: 1988: Unreheated hot dogs, undercooked poultry
    • Study #2: 1992: Foods from a deli, soft cheeses
general conclusions from the epidemiological data22
General conclusions from the epidemiological data
  • Overall incidence has declined from 8 per million to 2.7 per million in the last decade
  • Mortality remains high at 20%
  • Risk groups include
    • Immunocompromised persons
    • Elderly
    • Pregnant women
    • Hispanic population
general conclusions from the epidemiological data23
General conclusions from the epidemiological data
  • With PulseNet, ability to detect and investigate Listeria outbreaks has improved in the past 5 years
  • Investigating outbreaks leads to immediate and longer term control measures
  • Efforts to reduce contamination are followed by declines in incidence of human illness
listeriosis control
Listeriosis control
  • National action plan
  • Reduce incidence of reported cases to below 2.5 per million per year = 700 cases per year
  • Measured through active public health surveillance of invasive cases (FoodNet)
  • Nationwide surveillance with enhanced subtyping and patient interviews for outbreak detection, investigation and control
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