Outbreak of Listeriosis in South Africa Associated with Processed Meat
Thomas J, Govender N, McCarthy KM, Erasmus LK, Doyle TJ, Allam M, Ismail A, Ramalwa N, Sekwadi P, Ntshoe G, Shonhiwa A, Essel V, Tau N, Smouse S, Ngomane HM, Disenyeng B, Page NA, Govender NP, Duse AG, Stewart R, Thomas T, Mahoney D, Tourdjman M, Disson O, Thouvenot P, Maury MM, Leclercq A, Lecuit M, Smith AM, Blumberg LH
The New England journal of medicine · 151 citations
Review labels
Neutral facts our review recorded about how this study was done. They describe method, never whether we like the result.
How it was studied
- Design
- Case-control study (indexed by PubMed)
- Studied in
- People
- Main outcome
- Clinical events such as disease or death
- Intake measured by
- Not stated
Who paid for it
- Funding
- Independent funding
- Government
- Agence Nationale de la Recherche
- Government
- Institut National de la Santé et de la Recherche Médicale
- Government
- National Health Laboratory Service
- Government
- National Institutes of Health
- Government
- Intramural CDC HHS
- Grants
- Agence Nationale de la Recherche (ANR-16-CONV-0005); National Institutes of Health (CC999999)
Based on 5 listed funder(s).
Publication
- Published
- 2020-02-12 · N Engl J Med · vol. 382 · issue 7 · pp. 632–643
- Publisher
- Massachusetts Medical Society
- Cited
- 255 citations · more than 100% of similar papers · 20.9× the field average
- Impact
- Top 10% most cited in its field
- References
- 34 works
- Access
- Free to read
- Research areas
- Listeria monocytogenes in Food Safety · Food Safety and Hygiene · Salmonella and Campylobacter epidemiology
- Keywords
- Outbreak, Geography, Listeria monocytogenes, Virology, Socioeconomics, Medicine, Biology, Economics, Genetics
- MeSH
- humans, listeria monocytogenes, hiv-1, pregnancy complications, infectious, hiv infections, bacterial typing techniques, case-control studies, disease outbreaks, sex distribution, pregnancy, meat products, adolescent, adult, aged, middle aged, infant, newborn, south africa, female, male, young adult, foodborne diseases, product recalls and withdrawals, listeriosis, whole genome sequencing
30 authors
From ZA, US, FR
- Juno Thomas
- Nevashan Govender
- Kerrigan McCarthyNational Health Laboratory Service; University of the Witwatersrand
- Linda Erasmus
- Timothy J. DoyleCenter for Global Health
- Mushal Allam
Abstract
Background
An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.
Methods
We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type Listeria monocytogenes isolates. A case was defined as laboratory-confirmed L. monocytogenes infection during the period from June 11, 2017, to April 7, 2018.
Results
A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of L. monocytogenes ST6 infections.
Conclusions
This investigation showed that in a middle-income country with a high prevalence of HIV infection, L. monocytogenes caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.
Abstract via Europe PMC. Copyright remains with the authors or publisher.
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