L isteriosis is a severe, mainly foodborne, human infection associated with higher casefatality and hospitalization rates than other bacterial gastrointestinal pathogens (1). The causative agent, Listeria monocytogenes, occurs ubiquitously in the environment and disseminates into the food production chain. Patients develop either self-limiting noninvasive gastroenteritis or invasive listeriosis (2,3). Listeriosis adversely affects older and immunocompromised persons, as well as pregnant women, causing a severe invasive form of the disease that leads to sepsis, meningitis, and encephalitis, as well as neonatal infections and miscarriage (4). Case-fatality rates of invasive listeriosis are ≈30% for neurolisteriosis and even higher in septic patients (5). In Europe and North America, invasive listeriosis affects 0.3-0.6 persons/100,000 population/year (6,7). L. monocytogenes forms hard-to-remove biofilms in food-processing plants, can acquire tolerance to sanitizers, and multiplies even at temperatures used for refrigeration (8). These properties complicate efficient prevention of L. monocytogenes contaminations in different types of ready-to-eat products, including dairy, meat, and fish, and in fruits and vegetables, all of which have been vehicles for listeriosis outbreaks in the past (9-12).
Kleta (2020) Backtracking and forward checking of human listeriosis clusters identified a multiclonal outbreak linked to Listeriamonocytogenes in meat products of a single producer,
Objectives: Invasive listeriosis is a severe foodborne infection caused by Listeria (L.) monocytogenes. The aim of this investigation was to verify and describe a molecular cluster of listeriosis patients and identify factors leading to this outbreak. Methods: Whole genome sequencing and core genome multilocus sequence typing were used for subtyping L. monocytogenes isolates from listeriosis cases and food samples in Germany. Patient interviews and investigational tracing of foodstuffs offered in health-care facilities (HCF), where some of the cases occurred, were conducted. Results: We identified a German-wide listeriosis outbreak with 39 genetically related cases occurring between 2014 and 2019. Three patients died as a result of listeriosis. After identification of HCF in different regions of Germany for at least 13 cases as places of exposure, investigational tracing of food supplies in six prioritized HCF revealed meat products from one company (X) as a commonality. Subsequently the outbreak strain was analysed in six isolates from ready-to-eat meat products and one isolate from the production environment of company X. No further Sigma1 cases were detected after recall of the meat products from the market and closure of company X (as of August 2020). Conclusions: Interdisciplinary efforts including whole genome sequencing, epidemiological investigations in patients and investigational tracing of foods were essential to identify the source of infections, and thereby prevent further illnesses and deaths. This outbreak underlines the vulnerability of hospitalized patients for foodborne diseases, such as listeriosis. Food producers and HCF should minimize the risk of microbiological hazards when producing, selecting and preparing food for patients.
L isteria monocytogenes infections are primarily foodborne and cause gastrointestinal disease or invasive syndromes among infected persons (1). Because L. monocytogenes is an intracellular pathogen and because invasive listeriosis is the primary manifestation in diagnosed listeriosis, persons with defi cient cell-mediated immunity are at increased risk for its symptoms, including sepsis and meningitis. In addition, infection during pregnancy can lead to chorioamnionitis and fetal infection that can result in miscarriage and stillbirth even 2 months after the mother is exposed. One study found that 44% of patients with non-pregnancyassociated (NPA) listeriosis in Germany had received immunosuppressive therapy ≤3 months before illness onset and another 28% had a coexistent immunocompromising illness, such as diabetes (2). Testing for bacteria in blood cultures or cerebrospinal fl uid (CSF) is recommended for diagnosis.Listeria is ubiquitous in the environment and can produce biofi lms in the food production environment and thus contaminate ready-to-eat (RTE) products, which are typically consumed raw or without further processing. Listeria species grow during shelf life, even at low temperatures, and multiply to concentration levels that make invasive listeriosis and outbreaks more likely. For these reasons, it is suspected that L. monocytogenes exposure is very common but the disease rare. However, in recent years several large outbreaks have been reported in Germany (3-7). The StudyWe analyzed mandatory notifi cation data about invasive listeriosis cases in Germany during 2010-2019 to describe time trends, case-fatality rates, demographic distribution, clinical and diagnostic characteristics, and geographic trends (Appendix, https://wwwnc. cdc.gov/EID/article/27/9/21-0068-App1.pdf). In total, 5,576 listeriosis cases were reported during the 10year study period; 5,064 (91%) of those were NPA and 486 (9%) were pregnancy associated, 241 in mothers and 245 in newborns. Information on disease manifestation was not transmitted for 26 cases. The lowest annual incidence was in 2011 (0.41/100,000 residents) and the highest in 2017 (0.93/100,000 residents); the average for 2010-2019 was 0.69/100,000 residents. We observed a steady increase in cases during 2011-2017, but incidence in 2019 was lower than in previous years. Exceptionally high numbers were reported in the third quarters of 2016, 2017, and 2018 (Figure 1).Among the 5,064 NPA listeriosis case-patients, 2,032 (40%) were female and 3,855 (76%) were >65 years of age (Table 1). Listeriosis among adolescents and children other than newborns is rare (37 cases). Incidence in adults 18-44 years of age is <0.1/100,000 residents, in contrast with incidence among adults ≥85 years of age: 3.99/100,000 residents for men and 2.08/100,000 residents for women. Annual median age of case-patients increased steadily from 72 years of age in 2010 to 77 years of age in 2019.Sources for testing samples included CSF (657, 13%), blood (4,097, 81%), and material from other usually steril...
Invasive listeriosis, caused by Listeria (L.) monocytogenes , is a severe foodborne infection, especially for immunocompromised individuals. The aim of our investigation was the identification and analysis of listeriosis outbreaks in Germany with smoked and graved salmon products as the most likely source of infection using whole-genome sequencing (WGS) and patient interviews. In a national surveillance programme, WGS was used for subtyping and core genome multi locus sequence typing (cgMLST) for cluster detection of L. monocytogenes isolates from listeriosis cases as well as food and environmental samples in Germany. Patient interviews were conducted to complement the molecular typing. We identified 22 independent listeriosis outbreaks occurring between 2010 and 2021 that were most likely associated with the consumption of smoked and graved salmon products. In Germany, 228 cases were identified, of 50 deaths (22%) reported 17 were confirmed to have died from listeriosis. Many of these 22 outbreaks were cross-border outbreaks with further cases in other countries. This report shows that smoked and graved salmon products contaminated with L. monocytogenes pose a serious risk for listeriosis infection in Germany. Interdisciplinary efforts including WGS and epidemiological investigations were essential to identifying the source of infection. Uncooked salmon products are high-risk foods frequently contaminated with L. monocytogenes . In order to minimize the risk of infection for consumers, food producers need to improve hygiene measures and reduce the entry of pathogens into food processing. Furthermore, susceptible individuals should be better informed of the risk of acquiring listeriosis from consuming smoked and graved salmon products.
Europe received an increased number of migrants in 2015. Housing in inadequate mass accommodations (MA) made migrants prone to infectious disease outbreaks. In order to enhance awareness for infectious diseases (ID) and to detect clusters early, we developed and evaluated a syndromic surveillance system in three MA with medical centres in Berlin, Germany. Healthcare workers transferred daily data on 14 syndromes to the German public health institute (Robert Koch-Institute). Clusters of ID syndromes and single cases of outbreak-prone diseases produced a signal according to a simple aberration-detection algorithm that computes a statistical threshold above which a case count is considered unusually high. Between May 2016–April 2017, 9,364 syndromes were reported; 2,717 (29%) were ID, of those 2,017 (74%) were respiratory infections, 262 (10%) skin parasites, 181 (7%) gastrointestinal infections. The system produced 204 signals, no major outbreak was detected. The surveillance reinforced awareness for public health aspects of ID. It provided real-time data on migrants' health and stressed the burden of non-communicable diseases. The tool is available online and was evaluated as being feasible and flexible. It complements traditional notification systems. We recommend its usage especially when laboratory testing is not available and real-time data are needed.
We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case–control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.
Listeriosis is a severe infectious disease in humans and characterized by an exceptionally high case fatality rate. The disease is transmitted through consumption of food contaminated by the bacterium Listeria monocytogenes .
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