The study was conducted by scientists at the University of Pretoria (UP) in 2019 and 2020 into the prevalence of Listeria monocytogenes in beef and beef products at abattoirs and retailers in the Gauteng, Mpumalanga and North West provinces.

It showed that 4.6 percent of chilled carcasses sampled at seven abattoirs in Gauteng were positive for Listeria. This means that contaminated items could enter the food chain as beef products sold at retail outlets in the province. 

The study, funded by Red Meat Research and Development South Africa, was prompted by the 2017-2018 outbreak of listeriosis with 1,065 confirmed cases and 218 deaths. It was traced to a ready-to-eat processed meat product called polony, made at a plant in Polokwane run by Enterprise Foods, which at that time was owned by Tiger Brands.

Ready-to-eat (RTE) food, including polony, were also positive for Listeria in the current study.

Supply chain assessment
“Processed foods become contaminated by contact with equipment, the handling of raw products, or from post-processing settings in which the pathogen can survive despite the routine use of disinfectants. Because of potential contamination during slaughter, carcasses can become contaminated, leading to contaminated meat and meat products,” said Dr Rebone Moerane, head of UP’s Department of Production Animal Studies, who was part of the research team.

Another study, published in the Journal of Food Safety, revealed that 8.3 percent, or 33 of 400, beef and beef products were contaminated with Listeria monocytogenes.

University of Pretoria researchers also looked at the prevalence and factors associated with Listeria in cattle, silage, feeds, and water on farms in the three provinces; in slaughtered cattle and carcasses at processing plants; and the contamination of beef products at retail. 

Samples were collected from cattle farms; carcass swabs were taken from abattoirs, and samples of raw beef and beef products, including ready-to-eat items, were collected from shops of all sizes. 

Researchers found the risk of exposure of cattle to listeriosis on farms is minimal. However, the detection of contaminated chilled carcasses sampled at Gauteng abattoirs is troubling, as are the findings at retail outlets, they said.

Get ahead of another outbreak
The prevalence of Listeria was 6 percent, 8.3 percent, and 9.3 percent in beef and beef products sampled in outlets in North West, Mpumalanga, and Gauteng respectively, and 4.3 percent, 11 percent and 9.3 percent for cold beef and beef products.

“Some of the contaminated products were RTE items – including polony, which is widely consumed, and biltong. This increases the risk of human exposure to the pathogen,” said Dr. Moerane. 

“It’s our hope that government and industry stakeholders will act on these findings and introduce strict control and monitoring measures at the appropriate stages in the beef production system. It’s vital that we use the outcomes of this study to get ahead of another potential outbreak of listeriosis.”

In most cases, Listeria monocytogenes isolates responded to penicillin, ampicillin and sulfamethoxazole-trimethoprim, which are important antimicrobials used to treat listeriosis.

Scientists recommended that government and industry implement stringent food safety measures at abattoirs and processing plants to reduce contamination and lower the possibility of another listeriosis outbreak. 

They also suggested follow-up studies of moist biltong, which is widely consumed in the country, to determine its ability to support the growth of Listeria and assess the risk posed to consumers. 

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On Sept. 5, 2023, the firm was notified by the South Carolina Department of Health and Environmental Control (SCDHEC) that their Not Fried Chicken ice cream treat tested positive for Listeria monocytogenes. The firm also recalled their Life Is Peachy Ice Cream treats because both products were manufactured in the same room.

These products were packaged in lamented buckets and plastic wrap and shipped to Georgia, Illinois, Maryland, North Carolina, New York, South Carolina and Texas distribution centers. The product was also shipped online directly to consumers located in all fifty states plus the District of Columbia.

Recalled products:

As of the posting of this recall, no illnesses have been reported to date.

Consumers who have purchased these products are urged not to consume them and to return the products to the place of purchase for a full refund or they may discard the product. 

About Listeria infections

Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled products and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News, click here.)

Nineteen sick people are aged 63 to 93, including 13 men and six women. Patients have been reported from 10 different regions.

Six people with listeriosis have died. However, it is unclear what role the infection played in their death because most patients had other severe underlying diseases.

People have been sick with the same type of Listeria since autumn 2022, but 15 cases occurred from the end of May this year, said Folkhälsomyndigheten (the Public Health Agency of Sweden).

Of cases with available information, 14 reported eating vacuum-packed salmon from one of two brands before falling sick. Both these brands are produced by Leröy Seafood, and Listeria was detected in products and environmental samples in the firm’s facility.

In most cases, samples have only been analyzed qualitatively so it is unclear if Listeria was above the limit of 100 CFU/g, according to Livsmedelsverket (the Swedish Food Agency).

“For Leröy Smögen Seafood, safe and secure food is our priority, and we take this incident very seriously. We are doing everything we can to ensure this does not happen again. We have a good cooperation and dialogue with the Swedish Food Agency,” said a company statement.

Finding the source of infections
Further analysis of samples from food, the environment, and human cases found the same type of Listeria, which points to the salmon products being the likely source of infection. The company has increased sampling and is carrying out further clean-up measures at the facility.

In early August, the retailer Axfood recalled a batch of Falkenberg Seafood cold smoked salmon 200-grams after low levels of Listeria were found.

The product was available for sale in the majority of Axfood’s stores. Listeria was detected during the retailer’s internal checks.

“The production has not been stopped, but all batches are currently analyzed for the presence of Listeria before release on the market. The company must take action following its HACCP-based procedures. They must also investigate the cause of contaminated products with Listeria monocytogenes and take measures to prevent such contamination. This may involve changes to HACCP-based procedures or other measures,” said Mats Lindblad from Livsmedelsverket.

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The recalled products were sold at the Ice Cream House in Brooklyn, NY, and through retail supermarkets in New York, New Jersey, and Ohio, according to the company’s recall notice posted by the Food and Drug Administration this afternoon.

This recall is related to the soft serve On The Go cups previously recalled by Real Kosher Ice Cream Inc., where two cases of illnesses have been reported in this outbreak in New York and Pennsylvania. Both individuals were hospitalized, but no deaths have been reported to date. 

Consumers can use the following information to identify the recalled products:

The company has ceased producing and distributing the products as the investigation is ongoing. 

The newly recalled products include all Ice Cream House branded items currently on the market. This includes all dairy and non-dairy (Parve) products, like ice creams, cakes, logs, and novelty items with the “Ice Cream House” logo. Products are packed in clamshells or cake trays with plastic dome covers in various sizes and styles and have an Ice Cream House label, as seen above. Recalled products are not labeled with lot or date codes.

Products involved in the recall should be discarded or returned to the original point of purchase for a full refund or replacement.

“Ice Cream has a long shelf life and may still be in the freezers of consumers. Consumers should check their freezers and throw away the recalled ice cream products or return it to the place of purchase,” according to the recall notice.

Anyone with questions or concerns can email the company at: [email protected] or call 845-445-7644.

About Listeria infections

Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalledproducts and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News,click here)

Some main points:

Estimate the loss of 204 that died was at least $240,000,000 US

Hospitalization costs were at least $10,400,000 US

Loss to businesses was at least $15,000,000 US

This does not even account for future medical expenses and/or lost productivity to those that survived and who have life-altering complications. 

And, what about the emotional cost of the survivors?

Here is the abstract:

Periodic outbreaks of foodborne pathogens have resulted in food safety concerns, due to health implications and cost consequences. Occurrence of Listeria monocytogenes in foods and listeriosis have been reported in developed countries; however, documentation of listeriosis in South Africa is limited. In 2017–2018, Listeria was reported on polony (processed deli meat) and listeriosis was observed in South Africa (L. monocytogenes sequence type 6 (ST-6) was identified as the causal agent for listeriosis). Due to its potential effects, we conducted cost estimates to assess the implications of listeriosis outbreak with respect to illnesses, hospitalizations and deaths, and productivity losses. Cost estimates were computed on publicly available data by using USDA-ERS cost computation model for Listeria. Listeriosis had significant impacts, as mortality of 204 individuals with confirmed listeriosis cases was reported, with infants having the highest percent of fatalities (42%). The cost valuation of fatality cases was over US$ 260 million. Hospitalization costs associated with one-month recovery from listeriosis were estimated at US$ 10.4 million. Productivity losses attributed to listeriosis for humans and export value losses for food processors were in excess of US$ 15 million. Increase of food safety measures in South Africa could reduce foodborne disease outbreaks. Pre-emptive pathogen detection, sanitary procedures and bacterial inactivation can enhance control of L. monocytogenes in food processing environments.

Here is what happened and why:

We are now beyond five years from the date that the NICD announced the association between Tiger Brands’ polony products and the outbreak, and the work done by all parties has only generated more evidence that the NICD’s and Tiger Brands’ conclusions are accurate. There is no evidence to the contrary.

In 2017 and 2018, the world’s largest and deadliest outbreak of listeriosis occurred in multiple provinces of South Africa (Figure 1). The outbreak was caused by contaminated polony, a ready-to-eat, processed meat product. Ready-to-eat, processed meats are a well-known vehicle for listeriosis outbreaks (Thomas et al., 2020). The Minister of Health declared that there was an outbreak of listeriosis on December 5, 2017, and, on March 4, 2018, further identified Tiger Brands’ polony products as the cause of the outbreak. The Minister of Health instructed Tiger Brands to recall all polony products the same day. See generally, Minister of Health September 3, 2018, Media Statement. The Ministry of Health based its conclusions on the investigative findings of the Joint Public Health Emergency Co-ordinating Committee, which was established for the specific purpose of identifying the cause of the outbreak and developing measures to prevent further illnesses and other outbreaks associated with processed meat products generally. Id. The relevant epidemiologic findings are set forth in the paragraphs that follow.

Figure 1. Incidence of Laboratory-Confirmed Listeriosis Cases during the Outbreak Period, According to South African Districts (Thomas et al., 2020).

Cases were reported from across the country, with most cases reported from Gauteng Province (58%). Women accounted for 55% of total cases. The ages of cases ranged from birth to 93 years. Neonates (aged £ 28 days) were the most affected age group, accounting for 43% of cases. This was followed by adults of 15 to 49 years of age, accounting for 32% of cases. The disease outcome was known for 806/1,060 (76%) of cases; 27% (216/806) had the known outcome “died” (Smith et al., 2019).

Listeriosis is a serious foodborne infection with a case-fatality rate (“death rate”) of 20-30% (Thomas et al., 2020). People primarily affected by listeriosis have impaired cell-mediated immunity. This includes those who are pregnant, elderly, or immunocompromised from conditions such as HIV, chronic disease, or immunosuppressive therapy (Thomas et al., 2020). The specific outbreak strain associated with the outbreak was Lm ST6. There are two ways that listeriosis can manifest: febrile gastroenteritis and invasive listeriosis (Coulombier). Invasive listeriosis is characterized by bacteraemia, meningitis, pneumonia, endocarditis, and sepsis (Smith et al., 2019).

A total of 1,060 cases were reported during the period of January 11, 2017, to July 17, 2018 (Figure 2)[1]. The outbreak period was defined as a duration of time during which case numbers exceeded and remained above a weekly threshold of five cases per epidemiological week (Thomas et al., 2020). At the peak of the outbreak (mid-November 2017), 41 listeriosis cases were reported in a single week. Prior to this outbreak, listeriosis was not a reportable disease in South Africa; therefore, information is not available on the prevalence, epidemiology, and description of clusters/outbreaks on listeriosis. Due to the lack of surveillance data, the baseline number of listeriosis cases was estimated from counts of listeriosis cases in 2016.

It is known that in 2015 and 2016, clusters of listeriosis occurred in South Africa. The 2015 listeriosis cluster involved 7 cases total, and the predominant strain was Lm ST6. However, researchers did not have sufficient epidemiologic evidence to connect the 2015 cluster to any specific food product (Shuping et al., 2015). For the 2016 cluster, retrospective analysis of Lm cases from the years 2012-2016 was used to calculate the expected case numbers for years 2013, 2014, 2015, and 2016 in the Gauteng province (Mathebula et al., 2016)[2]. Because there were only 3 cases in the 2016 cluster, researchers needed to estimate the baseline number of cases.

When determining if a cluster of diseases is classified as an outbreak or epidemic, it is essential to know what the baseline number of illnesses is in the population of interest. An epidemic refers to an increase in the number of cases of a disease, above what is normally expected in that population in that area, and an outbreak is defined the same but is often used for a more limited geographic area (Centers for Disease Control and Prevention [CDC], 2012).

Figure 2. Distribution of Laboratory-Confirmed Cases of Listeriosis, According to Outbreak Week and Major Events (January 1, 2017 to August 21, 2018) (Thomas et al., 2020).

Case definitions are used in outbreak investigations to help identify cases who are associated with the outbreak. A case definition includes criteria such as the subject population, implicated location, time, clinical features, and/or laboratory test results if available (CDC, 2012). The initial case definition for the primary listeriosis outbreak included all cases of listeriosis that occurred in South Africa from 2017 to 2018. The initial case definition was appropriate due to the lack of whole-genome sequencing (WGS) data at the beginning of the investigation. Multilocus sequencing typing (MLST) was used later to analyse the WGS results from all viable isolates obtained from case-patients. Researchers discovered that 93% of the clinical isolates collected from cases during the outbreak period were Lm ST6 (Thomas et al., 2020; Gerner-Smidt). The case definition later included sequence typing information to increase the likelihood of identifying a common source (Besser). This finding also showed that the outbreak strain of Listeriosis was definitively the Lm ST6 strain.

Further, we note that investigators thoroughly analysed the theoretical possibility that Lm ST6 was coming from more than just Tiger Brands’ polony products. In short, after conducting environmental investigations at all 157 ready-to-eat meat production facilities in South Africa, there was no Lm ST6 in any other products or facilities except Tiger Brands.

Together with the NCID’s clear statements that Tiger Brands polony products were the source of the outbreak, based on epidemiologic and environmental evidence, the constellation of all evidence conclusively establishes that Tiger Brands’ polony products were in fact the sole source. There is no additional analysis that will materially change these facts.

Based on its investigation findings, the Minister of Health issued a recall of Tiger Brand’s ready-to-eat meat products produced at the Enterprise facility. The Minister of Health also recalled all ready-to-eat meat products produced at Rainbow Foods, but epidemiologic and environmental findings during the investigation showed that this was a precautionary measure only—i.e., the Listeria identified at the Rainbow Foods’ production facility on environmental testing was not Lm ST6, and therefore had no causal association with illness in the outbreak. See Minister of Health March 4, 2017 Statement. Shortly after Tiger Brands’ recall, the outbreak essentially stopped (Figure 3).

Figure 3. Epidemic curve of laboratory-confirmed listeriosis cases by date of clinical specimen collection (n=1 038) and sequence type (ST) (n=564), South Africa, 01 January 2017 to 5 June 2018 (n=1049)

The environmental and epidemiologic investigative findings establish the likely causal nexus between Tiger Brands’ polony products and most all Listeriosis cases that occurred in South Africa before, during, and after the outbreak period. (Coulombier).  As stated above, 93% of clinical isolates that underwent sequencing were shown to be Lm ST6, the strain that was both epidemiologically associated with illness and repeatedly found in the production environment at the Enterprise facility, and nowhere else. But not all isolates could be sequenced, due to the lack of laboratory resources and personnel available (Besser). Based on the high percentage of Lm ST6 clinical isolates, it is highly likely that a similar percentage of non-sequenced isolates would have been Lm ST6 if sequencing could have been done (Coulombier). As further support that there was no difference between the distribution of sequence types among the non-sequenced samples and the distribution of sequence types observed in the sequenced samples, the process of selecting case isolates to be sequenced was not biased. Therefore, it is a statistically valid and provable fact that, in the absence of evidence to the contrary—i.e., sequencing that showed that a clinical isolate was not Lm ST6–a listeriosis patient diagnosed during the outbreak period had a > 90% probability of being related to the outbreak even without confirmed laboratory results (Gerner-Smidt).

After detecting the outbreak, the Centre for Enteric Diseases, a part of the National Institute for Communicable Diseases, conducted a nested case-control study that provided evidence that cases with Lm ST6 infections were more likely to have eaten polony than those with non- Lm ST6 infections (Thomas et. al, 2020). In outbreak investigations, case-control analysis is performed to estimate the odds ratio for the association between specific food items and the outbreak-associated illness. For this nested case-control study, case patients were those with Lm ST6 infections, and control patients were people infected by another strain of LM (i.e., not Lm ST6) during the outbreak period. Results from this study show that the odds ratio was 8.55 with a 95% confidence interval of 1.66 – 43.35. An odds ratio is a measure of association between the odds of becoming ill from consuming a specific food item versus the odds of becoming ill without having consumed the specific food item (Coulombier). An odds ratio of 8.55 signifies that the odds of having eaten polony in Lm ST6 cases is 8.55 times greater than the odds of having eaten polony in non-Lm ST6 cases. Based on the calculated confidence interval, this result is statistically significant because the confidence interval does not include the null value of 1. Therefore, 95% of the time, the true odds ratio fell within this interval.

Prior to the study, food history interviews were conducted to generate a hypothesis as to which food item could have been the source of the outbreak (Coulombier). The food histories were conducted with the use of a standardized questionnaire that inquired as to food consumed by a case-patient over the four weeks prior to onset of symptoms. Open-ended questions were posed to Listeriosis cases to understand each case’s food habits, such as where they purchase food, name of restaurants patronized, and use (and name) of informal food vendors. Closed-ended questions were posed to determine each case’s exposure to specific food items associated with outbreaks in the past and locally consumed foods thought to pose a high risk for listeriosis such as processed meats (e.g., biltong), cold meats (e.g., ham, polony), soft cheeses, raw milk, and raw vegetables. Brand preferences were also captured in the form.  The combination of open and closed-ended questions was and continues to be standard practice for the conduct of epidemiologic investigations internationally and provided investigators with high value data for consideration alongside other epidemiologic and environmental information.

The food history interviews were completed by November 1, 2017. The epidemiologic methods utilized throughout this investigation, including the case-control, were robust and mirrored those used in high-level investigations throughout the world. The investigators’ multi-disciplinary investigative methods were fully appropriate for the outbreak circumstances (Besser).

On January 13, 2018, febrile gastroenteritis developed in 10 children from a nursery in Gauteng Province. Several stool samples were collected from the children, and one yielded Lm ST6. Sandwiches prepared and eaten at the nursery were the only common food exposure, and polony was the common ingredient. Polony was recovered from the nursery refrigerator, and Lm ST6 was identified in the polony produced at Tiger Brands Enterprise Facility in Polokwane (Thomas et al., 2020).

On February 2, 2018, an environmental investigation took place at the Tiger Brands Enterprise Facility in Polokwane following the discovery at the nursery (Gerner-Smidt). Of 317 environmental samples taken from the Polokwane facility, 47 tested positive for Listeria monocytogenes, and of the 47 that tested positive, 34 were subtyped as the outbreak Lm ST6 strain. Additionally, two of 13 samples of unopened polony loaves collected at the facility tested positive for Listeria monocytogenes, and both were subtyped as the outbreak Lm ST6 strain.

These facts stand in stark contrast to the investigations at all other South African ready-to-eat meat producers, during which investigations no Lm ST6 was recovered in any food or environmental sample.

The fact that the public health investigation involved environmental inspections and sampling at the production facilities of other ready-to-eat meat producers is remarkable. Indeed, the public health investigation of this outbreak was unprecedented in scope, even internationally, as it is, in our experience, unprecedented to engage in such robust investigation of producers whose products are not epidemiologically associated with an outbreak. Thus, the only epidemiologic evidence establishes that Tiger Brands, and Tiger Brands alone, produced product contaminated by Lm ST6 during the outbreak period. By incorporating findings from the epidemiologic, environmental, microbiologic, and traceback data, investigators provided conclusive evidence that the source of the outbreak was polony produced fromTiger Brands Enterprise Foods Polokwane production facility, and that there were no other possible causes.

Further, and as set forth previously, the Minister of Health identified Tiger Brands’ polony products as the source of the outbreak on March 4, 2018, and instructed Tiger Brands to recall all its ready-to-eat meat products. At the point in time that Tiger Brands’ polony products were taken off of store shelves and were no longer widely available for purchase and consumption in South Africa, the outbreak ended and listeriosis cases in South Africa shortly returned to their pre-outbreak baseline. As Figure 3 demonstrates, by mid-April 2018 (6 weeks after recall), fewer than 5 cases were reported weekly. Regarding those individuals who became ill between the date of Tiger Brands’ recall and mid-April 2018, listeriosis cases continued to become ill by consumption of Tiger Brands’ polony products that were purchased before the date of the recall, which was to be expected given the lengthy incubation period for listeriosis generally (from 3 days to over one month), or from Tiger Brands’ polony products that were simply not removed from store shelves in time.

Following the findings by the NICD, Tiger Brands conducted its own internal investigation into the outbreak. During this internal investigation, based on information set forth in the discovery conducted to-date and Tiger Brands’ various public statements, Tiger Brands confirmed the presence of the Lm ST6 outbreak strain in both its products and various locations in the production environment at the Enterprise facility. Tiger Brands issued several public statements to this effect.

In a SENS statement dated 19 March 2018, Tiger Brands issued the following public statement:

“On 15 March 2018, Tiger Brands received confirmation from independent laboratory tests corroborating the DoH’s findings of the presence of LST6 in the environment at its Polokwane Enterprise Foods manufacturing Facility. In addition, there was a positive detection of LST6 on the outer casing of two samples.”

On 26 March 2018, Tiger Brands issued a public statement on its website reiterating the independent laboratory results announced in the SENS statement of 19 March 2018 as aforementioned which confirmed the presence Lm ST6 in the Tiger Brands Polokwane Facility. In the 26 March press statement, Tiger Brands CEO, Mr Lawrence Mac Dougall commented on this discovery and, inter alia, stated as follows:

“We are investing all our time and energy into not only understanding the cause of the LST6 detection, but also how it could have come into our facility.”

In a statement to shareholders dated 23 May 2018, Mr Mac Dougall stated that:

“The detection of the presence of Listeria ST6 in our factory in Polokwane was disappointing to us given our compliance with best practices and prevailing standards.”

In a SENS statement dated 25 April 2018, Tiger Brands reported that it had received independent laboratory test results following its own internal investigation which confirmed the presence of the Lm ST6 in samples of ready-to-eat meat products manufactured at the Polokwane Facility:

“The purpose of this announcement is to update shareholders on the results of the independent laboratory re-testing which was carried out in respect of the presence of LST6 in the above samples which were manufactured at the Enterprise Polokwane processing facility. On 24 April 2018, Tiger Brands received confirmation of the presence of LST6 in these samples.”

From both the NICD’s and Tiger Brands’ investigations into the outbreak, there is no evidence that the outbreak had any source other than Tiger Brands’ polony products. There is no epidemiologic support for that proposition, and there is no environmental support for that proposition because NICD found no other positive Lm ST6 samples at any other facility that produces ready-to-eat meat. In fact, Tiger Brands has, in unequivocal terms, admitted to this responsibility. For example, in the request Further Trial Particular, Tiger Brands affirmed its responsibility for Lm ST6 cases:

“Tiger Brands statement of 24 April 2018 was correct. Tiger Brands learnt that laboratory tests had found ST6 in ready-to-eat meat products from its Enterprise Foods manufacturing facility in Polokwane. It accepts that the laboratory findings were correct.”

“Tiger Brands does not know to what products the contamination extended or over what period it occurred. It accepts, however, that ST6 contaminated products from its Polokwane facility probably infected some of the people who suffered from listeriosis during the outbreak.”

“The defendants accept the test results that L. monocytogenes was detected in the polony water coolers at the Polokwane facility.”

Further, and following the Supreme Court of Appeal’s ruling in the third-party subpoena’s litigation, Tiger Brands issued the following statement to the press:

“On Friday, 4 February 2022, the Supreme Court of Appeal overturned the earlier order of the Gauteng Division of the High Court, Johannesburg which required various third parties to hand over epidemiological information relating to the listeriosis outbreak.”

“The 2018 listeriosis outbreak affected many South Africans. We are saddened by the impact it has had on the lives of the victims and those who have lost loved ones from the outbreak. Tiger Brands reiterates its commitment to ensure that a resolution of the matter is reached in the shortest possible time, in the interest of all parties, particularly the victims of listeriosis.”

That Tiger Brands is liable for the manufacture and sale of contaminated polony products that injured people is beyond doubt; the scientific findings from the multi-disciplinary investigation allow only this conclusion, and the functional life of the outbreak ended when Tiger Brands was ordered to withdraw its products from the market. The epidemiologic implications of NICD’s sequencing effort are conclusive, which is the preliminary point made by SAAFOsT, in which organization Tiger Brands is a custodian member, in its December 2017 statement that:

“This is undoubtedly one of the worst listeriosis cases in global history. A large percentage (74%) of all the clinical isolates belong to the same sequence type i.e. ST6—this means that these isolates originate from a single source, most likely a food product on the market.”

What SAAFOsT did not have the benefit of then knowing, however, was that sampling at Tiger Brands’ Polokwane facility would validate in every respect the epidemiologic implications from NICD’s sequencing efforts on human isolates.

We are now beyond four years from the date that the NICD announced the association between Tiger Brands’ polony products and the outbreak, and the work done by all parties has only generated more evidence that the NICD’s and Tiger Brands’ conclusions are accurate. There is no evidence to the contrary.

_____________________

[1]  Note: 23 October 2016 to 3 September 2018 is the “Outbreak Period” in the Certification Order.

[2] The oldest South African CT4148 isolates date from September 2015 and are related to a cluster of three cases of listeriosis in Western Cape Province28; this finding suggests a potential epidemiologic link to the 2017–2018 outbreak. Thomas, et al., 2020

References

Besser, J. (2020). Expert Opinion Regarding a Listeria Outbreak in South Africa Involving Tiger Brands Limited.

Coulombier, D. (2020). Expert Opinion Regarding a Listeria Outbreak in South Africa Involving Tiger Brands Limited.

Gerner-Smidt, P. (2020). Expert Opinion on Subtyping Aspects of the Listeria Outbreak in South Africa Involving Tiger Brands Limited.

Smith, A. M., et al. (2019). Outbreak of Listeria monocytogenes in South Africa, 2017-2018: Laboratory Activities and Experiences Associated with Whole-Genome Sequencing Analysis of Isolates. Foodborne Pathog. Dis. 16(7): 524-530. doi:10.1089/fpd.2018.2586

Thomas, J., et al. (2020). Outbreak of Listeriosis in South Africa Associated with Processed Meat. N. Engl. J. Med. 382: 632-643. doi:10.1056/NEJMoa1907462

Tiger Brands SENS statement dated 19 March 2018, “Financial Impact of Product Recall and Suspension of Operations at the Polokwane, Germiston, Pretoria and Clayville Processing facilities of Value-Added Meat Products (“VAMP”); Institution of Class Action; and Results of Independent Tests carried out in respect of the presence of Listeria monocytogenes ST6 type (“LST6”)”

Tiger Brands Public Statement dated 26 March 2018, “Tiger Brands Listeria Update”

Tiger Brands SENS Statement dated 23 May 2018, “Unaudited group results and dividend declaration for the six months ended 31 March 2018.

Tiger Brands SENS Statement dated 25 April 2018, ‘Results of Independent Tests carried out in respect of the presence of Lister monocytogenes ST6 type (“LST6”)’

Tiger Brands response to Plaintiff’s Further Particulars

Rose, “Tiger Brands Tall Tale”. Financial Mail, 10 February 2022.

Shuping, L., et al. (2015). Investigating a cluster of Listeria monocytogenes cases in the Western Cape province of South Africa, September 2015.

NICD. (2016). Investigation of Listeria monocytogenes cases at Charlotte Maxeke Johannesburg Academic Hospital in Johannesburg, December 2016.

NICD, Listeriosis Outbreak Situation Report. Dated 11 June 2018.

SAAFOST, “Listeriosis Outbreak in South Africa – Latest! By Dr Lucia Anelich, SAAFoST President”. Dated 20 December 2017.

A DG Sante audit in Morocco, in March and April 2023, looked at microbiological contamination in food such as strawberries, leafy crops like lettuce, tomatoes, herbs and spices.

A 2015 audit found the safety of FNAO was mainly guaranteed by inspections and certifications of private standards. Also, the effectiveness of official controls was undermined by limited laboratory capacity for microbiological testing.

Moroccan situation
The latest audit also found microbiological food safety at primary production depends on good agricultural practices, inspections by buyers and private certification systems.

Officials could not provide data on the number of farms that are producing or supplying for export to the EU but did share post-farm gate information.

There are no official controls to verify measures taken on farm to prevent microbial contamination during growing and harvest but documentary checks take place afterwards. The absence of controls at these stages could present a problem in outbreak situations, said auditors.

Authorities have not considered the risk of environmental Listeria contamination at operators handling products intended to be eaten raw, as requested by EU legislation. Inspectors also demonstrated limited knowledge and expertise of how to verify food firms’ management of Listeria monocytogenes risk.

Moroccan officials said a new rule for ready-to-eat food businesses to take Listeria samples in processing areas and on equipment as part of their sampling plans should apply from the end of 2023.

The lab network is good but there is no official laboratory with accredited methods to detect Shiga toxin-producing E. coli (STEC) and foodborne viruses. A National Reference Laboratory for foodborne pathogens is planned for the future and accreditation should be achieved in 2024.

“The lack of accredited methods for these foodborne pathogens, in conjunction with the absence of national reference labs supporting the official laboratories, could have an impact on the reliable laboratory investigation of FNAO,” said auditors.

Portugal findings
A DG Sante audit in February and March 2023 in Portugal covered FNAO, including seeds intended for sprouting and sprouts.

There is a risk-based system for onsite controls but there are gaps in identifying high-risk growers and in the registration of processors. It is also not geared towards crops at primary production level which pose the greatest microbiological risks. This means products with potentially high food safety risks may not be subject to official controls, said auditors.

The audit team found training did not enable all inspectors to assess correctly some aspects of the operators’ own-check quality assurance systems regarding the time and place of Listeria monocytogenes sampling and HACCP.

During the second half of 2023, training will be reinforced on Listeria testing, cross-contamination, and critical control points. Several sessions on HACCP have already been carried out involving the General Directorate of Food and Veterinary Affairs (DGAV) and the Portuguese Meat Industry Association (APIC).

At the time of the visit, three sprout-producing operators were approved. However, one had ceased activities and another was suspended after detection of STEC in sprouts. A root cause investigation found problems with the water supply. A third was suspended after an inspection observed by the audit team. This was lifted after non-conformities were corrected.

At processing sites, auditors noticed produce dropped on the floor was put back on the transport belt, and workers did not change gloves after touching the floor. Condensation on ceilings over exposed produce was not always detected and dealt with efficiently.

Suitable lab capability is in place but authorities had yet to designate a National Reference Laboratory for foodborne viruses, which is against EU rules. This was addressed with INSA being named as the NRL in June 2023.

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According to the company’s recall notice the recalled products are:

• Sliced Homestyle Summer Sausage, approximately 16 oz. packages, packed with “Best if used by” dates of 09/30/23 and before
• Cracker-sized Sliced Summer Sausage, approximately 8 oz. packages, packed with “Best if used by” dates of 09/30/23 and before
• Country Smoked Sliced Ham, approximately 2 lb. packages, packed with “Best if used by” date 09/11/23 and before
• Country Smoked Ham Steaks, approximately 0.4 lb. packages, packed with “Best if used by” date 09/11/23 and before
• Country Smoked Shaved Ham, variable weight packages, packed with “Best if used by” date 09/11/23 and before
• Cooked Ham, approximately 1 lb. packages, packed with “Best if used by” date 09/11/23 and before
• Beef Stick Snack Bites, approximately 12 lb. packages, packed with “Best if used by” date 11/05/23 and before
• Smoked Sliced Ribeye, approximately 1 lb. packages, packed with “Best if used by” date 09/11/23 and before

Product labels also have a mark of inspection with establishment No. 742.

As of the posting of the recall notice, no illnesses had been reported as a result of consuming these products. Anyone with signs or symptoms of a foodborne illness should contact their doctor.

Consumers who have these products can discard them. Consumers with questions about this recall can contact Salmon’s Meat Products at 920-845-2721 option 2.

Salmon’s Meat Products is owned and operated by Ebert Meats, LLC.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalledproducts and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News,click here)

The affected brands are Kroger, Food Lion and Signature. Food Lion previously posted its own recall of frozen mixed vegetables and frozen sweet corn products because of contamination with Listeria monocytogenes.

There is concern that consumers may have the recalled frozen vegetables in their homes because of the products’ long shelf life.

To date, there have been no actual consumer reports of human illness associated with this products according to the recall notice supplied to the Food and Drug Administration by Twin City Foods Inc.

“The recall has been initiated because finished products may potentially be contaminated with the Listeria monocytogenes, based on one customer’s third- party lab results for the IQF (individually quick frozen) sweet cut corn,” according to the recall notice.

Consumers can use the following information to determine whether they have the recalled products in their homes:

Consumers who have purchased the affected products are urged not to consume the products and immediately return them to the store where they purchased them for a full refund.

Consumers with any questions may contact Twin City Foods at 360-629-5678.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled products and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News,click here)

The ice cream, made by Real Kosher Ice Cream of Brooklyn, NY, has been found to be contaminated with the same strain of Listeria monocytogenes as that found in samples from two patients. Both patients, one in New York and the other in Pennsylvania, have been so sick that they required hospitalization.

The company issued a recall of certain ice cream products earlier this month after a link was established between the sick people and its products.

In information released yesterday, the FDA confirmed that Listeria Monocytogenes matching the sick people’s samples was found in an unopened sample of the implicated ice cream during testing by the Pennsylvania Department of Agriculture.

Also, the New York Department of Agriculture and Markets found the outbreak strain of Listeria Monocytogenes in five finished samples of “Soft Serve On the Go” ice cream cups collected from the company’s manufacturing facility.

The ice cream was distributed in California, Colorado, Connecticut, Washington D.C., Delaware, Florida, Illinois, Massacheassetts, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, New York, Ohio, Oregon, Pennsylvania, Virginia and West Virginia.

The company is recalling all flavors of its Soft Serve On The Go 8-ounce ice cream cups”

• Soft Serve On The Go Vanilla Chocolate 
• Soft Serve On The Go Razzle
• Soft Serve On The Go Caramel 
• Soft Serve On The Go Parve Vanilla Chocolate
• Soft Serve On The Go Sorbet Strawberry Mango
• Soft Serve On The Go Lite Peanut Butter

The FDA is continuing to investigate the outbreak along with state officials and the U.S. Centers for Disease Control and Prevention. 

Additional patients are likely part of the outbreak because of the lag time between when people become ill and when testing, confirmation testing and reporting are done. Also, it can take up to 70 days for symptoms of Listeria infections to develop. 

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any of the recalled ice cream and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News,click here)

28 foodborne outbreaks were reported in 2022, eight more than in 2021. In these outbreaks, 128 people were affected, which is more than the 92 cases in 2021.

Overall, 57 people had to be hospitalized in connection with incidents in 2022, and there were four deaths. They affected between two and 30 people.

Salmonella tops the table
Salmonella was the most common agent, with 80 patients in 11 outbreaks. In second, was Campylobacter with eight episodes and 17 patients, followed by five outbreaks of Listeria monocytogenes that sickened 17 people. All of them were hospitalized, and four died.

Two norovirus outbreaks affected ten people and one each of E. coli and Shigella sonnei, with two patients reported.

The Ferrero chocolate monophasic Salmonella Typhimurium outbreak sickened 14 people in Austria, and five were hospitalized.

Another Salmonella Typhimurium outbreak, but with a different sequence type, affected 30 people in Austria. Ten of them had to be hospitalized, and the contaminated food was suspected to be chocolate.

One Listeria outbreak caused five infections, and two people died. It started in 2020 with three people falling sick and one death, and in 2021 two people were affected, and one died. Infections were caused by eating contaminated dairy products. A country-wide product recall and production in the implicated milk processing plant of Käserei Gloggnitz was stopped.

Another outbreak included three people, who were all hospitalized. The food vehicle was contaminated bacon.

Two outbreaks were acquired abroad, one due to Campylobacter after a stay in Ecuador and another by Shigella sonnei after travel to India.

Control results
Austrian authorities have also published results of several recent controls. One covered the implementation of hygiene requirements and verification of self-checks in approved high-risk establishments that process food of animal origin.

A total of 1,648 samples were taken from 192 companies as part of the campaign in 2022. Of these samples, 1,347 were environmental tests. Those sampled were 99 dairy, 60 meat and 33 fish businesses.

A total of 301 food samples from across the country were examined with six non-compliances. Five of 198 milk samples were problematic. One time each because of E. coli, coagulase-positive staphylococci and histamine content. Two samples had misleading information on shelf life.

One of 36 fish samples was rejected because of Listeria monocytogenes. All 67 meat samples were satisfactory.

In the environmental analysis, Listeria monocytogenes was detected in 41 samples and Listeria species in 74 samples.

Food and environmental samples were tested for Listeria at 156 companies. It was detected in environmental samples from 35 sites. In three of these establishments, there were also indications of Listeria in food samples. Of the 121 sites where no Listeria was detected in environmental samples, there were three plants with signs of the pathogen in food samples taken from the same site.

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The Food Lion company issued the recall for its frozen sweet corn and frozen mixed vegetables after tests showed Listeria monocytogenes.

The recall includes 16-ounce bags of frozen Food Lion Mixed Vegetables with the UPC 0003582600509. Customers may have purchased the vegetables between Jan. 19, 2023 and Aug. 19, 2023.

The recall also includes Food Lion Super Sweet Corn  with the UPC 0003582607985. Customers may have purchased the corn between Nov. 7, 2022, and Aug. 19, 2023.

As of the posting of the recall, no confirmed illnesses had been reported to the grocery chain.

Customers can returned the recalled products to Food Lion stores for refunds.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled productsand developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News,click here)

In a 2019 outbreak associated with pre-packed sandwiches supplied to hospitals in England, seven patients died of listeriosis.

Following this incident, the FSA said it would review its 2016 listeriosis guidance. The research was commissioned to look at awareness, implementation, and perceived effectiveness of the guidance, including barriers to implementing it in full.

The recent report covers findings from 39 respondents within National Health Service (NHS) Trusts and 445 from Health and Social Care (non-NHS Trust) settings, such as nursing homes, home care service providers and hospices, in England, Wales, and Northern Ireland.

An online survey was sent to all NHS Trusts in the three nations between November and December 2021. In the majority of cases, the survey was completed by the catering manager, who was responsible for food safety. IFF Research carried out the survey of non-NHS settings by telephone. Fieldwork took place in August and September 2022. IFF Research interviewed the person with overall responsibility for food safety — this was often the general manager.  

Health and social care findings
In non-NHS Trust settings, 63 percent had some knowledge of the guidance. However, 36 percent did not know anything about the document or were not aware of it.

More than half trained kitchen staff (57 percent), nurses, midwives or carers (55 percent) and management personnel (52 percent) in controlling the risk of Listeria monocytogenes. About a third trained staff who sell or serve food as their main role.

The majority were aware of at least some of the risks associated with chilled ready-to-eat foods from Listeria. Almost all agreed that cleaning of all food contact surfaces at their site controlled the risk of the pathogen.

Just less than half reported the maximum temperature that chilled RTE foods reached during storage in areas for patients or residents was 5 degrees C (41 degrees F), which is in line with FSA guidelines. About one-fifth said the max temperature was 8 degrees C (46.4 degrees F), which is the legal requirement, and just over a quarter did not know. Two percent reported that these foods reached temperatures over 8 degrees C for more than four hours.

A high proportion, 80 percent, agreed the maximum shelf-life for RTE sandwiches sold or distributed on their site was day of production plus two days, although 14 percent disagreed. Only 54 percent said they carried out regular sampling for Listeria.

A fifth reported they were not registered with their local authority. They were compared with the Food Hygiene Rating Scheme (FHRS) listings to ensure the reliability of this finding but results were inconclusive, according to the report.

Parts of the guidance mentioned as being useful in reducing the risk of listeriosis included temperature control and fridges, checklists for preventative practice, information on cross-contamination/infection control, and content on cleaning standards. Some would appreciate it being easier to read, updated more often, or being made more accessible.  

A lack of control over the kitchen area was frequently mentioned as a difficulty, followed by 30 percent who found it challenging to ensure good practice in clients’ homes or residents’ rooms. In total, 38 percent of participants said residents’ lack of understanding of the risks was a barrier to implementing good practice.

Including food safety requirements in contracts for onsite retailers or caterers was not always easy. A quarter reported a lack of control over their supply chain. The most difficult area of Listeria control was to check food safety at suppliers by carrying out unannounced visits every six to 12 months. 

NHS results
Overall, 92 percent of NHS Trusts said they had been using the FSA guidance on listeriosis before taking part in the survey.

Nearly all trusts said their kitchen staff received training on how to control the risk of Listeria monocytogenes. Slightly fewer said service and food retail staff had this training whilst 55 percent of ward staff and 21 percent of volunteers were trained. 

Things that made it difficult to implement the guidance in full included a lack of control over food service and their supply chains, high staff turnover and a lack of control over food storage. Other factors were it was not a legal requirement, poor maintenance of equipment and money.

More than half of NHS trusts reported the maximum temperature foods reached during service or storage on wards or other patient areas was 5 degrees C (41 degrees F). A quarter said it was 8 degrees C (46.4 degrees F), with 11 percent reporting it could go beyond 8 degrees C for up to four hours.

A total of 84 percent agreed cleaning of all food contact surfaces controlled the risk of Listeria effectively. About eight in 10 agreed that the maximum shelf-life for RTE sandwiches sold or distributed in the trust was day of production plus two days. Only 13 percent disagreed. Half of respondents said their trust carried out regular sampling for Listeria while almost 40 percent reported this was not the case.

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In 2022, 633 Shiga toxin-producing E. coli (STEC) infections were reported, as well as eight imported cases. This includes 620 confirmed and 13 probable cases. The number rose from 426 cases in 2021.

The highest incidences in 2022 were observed in children younger than 5 years of age, being higher in girls than in boys, according to data from the National Epidemiological Surveillance Network (RENAVE).

A total of 134 hospitalizations were reported and six people developed hemolytic uremic syndrome (HUS). HUS is a severe complication associated with E. coli infections that causes kidney failure. Four of these were younger than the age of 3, one was 10 years old, and the other was an 84-year-old adult.

Three deaths were recorded: one child younger than 3 years old who had HUS, and two adults aged 65 and 93.

For imported cases, two were younger than 10 years of age, and the rest were aged between 22 and 60.

Information on serogroup causing infection was available in 80 cases of which 67 corresponded to O157. One was O107, another was O128 and 11 were recorded as non-O157.

In 2021, two outbreaks occurred with four patients and one case of HUS. In 2022, five STEC outbreaks were reported, resulting in 13 cases and two hospitalizations.

Two were foodborne: one of them, with four cases was associated with consumption of various foods in a bar. In the other outbreak, with two cases younger than 2 years old in a nursery, the suspected food was hamburgers, and E. coli O157 was identified in clinical samples from patients.

Listeria data
In 2022, 460 patients were reported, of which 450 were confirmed, nine were probable and one was imported. In 2021, 375 patients were noted with 38 deaths.

The highest incidence rates in 2022 were found in boys less than 1 year of age, followed by men more than 75 years old and girls less than 1 year of age.

Overall, 67 deaths were reported. The age group with the most fatalities were those over 84 with 20 deaths, followed by those aged 75 to 84 with 19 deaths and 65 to 74 with 16 deaths.

In 2021, two outbreaks had four cases. This past year, nine listeriosis outbreaks were reported with 20 cases and eight hospitalizations.

In three outbreaks, the mode of transmission was food consumption. In one of them, the suspected food was poultry meat, in another it was unspecified meat, and the food implicated in the third incident was unknown. The others were caused by mother to baby transmission.

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The agency reports that the outbreak has ended with 13 patients having been identified. The FDA did not reveal any patient information, such as where the patients lived.

According to the agency’s most recent update, it first reported the outbreak to the public on July 26. The FDA initiated traceback efforts but did not report what food or foods were being traced as part of the investigation.

The Centers for Disease Control and Prevention did not post any information about the outbreak, as is the agency’s practice when a source of the pathogen is not found.

In other outbreak news, FDA has ended its investigation into an outbreak of infections from the microscopic Cyclospora parasite. According to the agency’s update yesterday the outbreak has ended with a patient count of 59, which is up from 55 a week ago. 

For the Cyclospora outbreak, the FDA initiated traceback, sample testing and onsite inspections. However the agency did not report what food was being traced or what was being tested. The agency also did not report what location had been inspected. The FDA first reported the outbreak on July 26.

In an ongoing investigation of illnesses caused by Listeria monocytogenes the FDA confirmed an ice cream product is likely the cause of the infections. The agency first reported the outbreak on Aug. 9, before the source of the pathogen was known.

On Aug. 10 the FDA posted an advisory stating that the outbreak was linked “Soft Serve On The Go” ice cream cups produced by Real Kosher Ice Cream of Brooklyn, NY. Two people have been confirmed as outbreak patients and both have required hospitalization.

The ice cream was distributed to California, Colorado, Connecticut, Washington D.C., Delaware, Florida, Illinois, Massachusetts, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, New York, Ohio, Oregon, Pennsylvania, Virginia and West Virginia.

The ice cream has been recalled. For packaging codes and photos of the recalled products, click here.

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Findings come from a report on inspection work in 2022, including controls over the safety of food, published by the Chief Sanitary Inspectorate (GIS).

In 2022, 6,221 Salmonella infections related to food were confirmed. This is down from the previous year when 8,014 cases were recorded.

As part of the multi-country monophasic Salmonella Typhimurium outbreak linked to Ferrero chocolate, intensified supervision was carried out from April to December 2022. A total of 87 suspected cases were reported, and of these, 38 were sequenced, but none belonged to the outbreak.

Poland’s battle to control Salmonella is well-documented. Data from the Rapid Alert System for Food and Feed Network (RASFF) for 2022 shows 190 Salmonella reports concerned poultry meat products from the country, although this is down from 2020 and 2021, and most reports were made by Poland.

The number of establishments operating in the food sector under the supervision of authorities exceeded 560,000, an increase of more than 17,000 compared to 2021.

2022 illness data
A total of 629 cases caused by Campylobacter were registered in Poland, similar to the 631 patients in 2021.

Overall, 135 cases of listeriosis were reported in 2022, compared to 120 cases in 2021.

There were 27 infections caused by enterohemorrhagic E. coli (EHEC) compared to nine in 2021. E. coli was also linked to another 150 illnesses in 2022.

Yersinia was behind 183 cases in 2022 and 142 in 2021; 125 cases of staphylococcal food poisoning were reported as well as one Trichinella infection.

Fifteen cases of botulism were noted, some of which were attributed to the tradition of home-canning foods in the country. This is up from eight cases in 2021.

In 2022, 18 people were poisoned from mushrooms, including 17 hospitalizations but no deaths. This increased from six in 2021.

More than, 57,100 viral infections were registered compared to 23,365 in 2021. Most were caused by rotaviruses but almost 6,000 were because of norovirus and 232 because of Hepatitis A.

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A recall in the United States triggered this recall. The U.S. recall resulted from an individual becoming ill and reporting to have eaten this product. Pennsylvania Department of Agriculture tested samples of product and one sample tested positive for Listeria monocytogenes.

As of the posting of the U.S. recall, two cases of illness have been reported in this outbreak in New York and Pennsylvania. Both individuals were hospitalized, but no deaths have been reported to date.

According to the Canadian Food Inspection Agency (CFIA), the products were distributed in Ontario and Quebec, Canada.

Recalled products:

Consumers should not consume, serve, use, sell or distribute recalled products. Recalled products should be thrown out or returned to the location where they were purchased.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled ice cream and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about possible Listeria exposure.

As of the posting of this recall, no reported illnesses have been associated with consuming these products in Canada.

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and cancer patients with weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

Also, anyone who has eaten recalled products should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

(To sign up for a free subscription to Food Safety News, click here.)

Robert Koch Institute (RKI) scientists assigned 11 notified listeriosis patients to the incident. Despite the risk of Listeria from smoked or graved salmon being known for some time, data shows contamination still exists in production facilities and outbreaks are ongoing with further cases expected, said scientists.

Five people fell ill in 2019, one in 2021, three in 2022 and two in 2023. Five men and six women were affected, aged between 69 and 91 with a median of 79 years old.

One person who was positive for Listeria infection was reported as deceased because of causes other than listeriosis.

A Rapid Alert System for Food and Feed (RASFF) alert identified Listeria monocytogenes in smoked salmon from Poland.

“A RASFF-notification was issued because of an official sample of the mentioned product originating from Poland. Listeria monocytogenes was isolated from that sample. The link to the cluster of human cases was made by whole genome sequencing and comparison to the sequences from isolates of human origin,” said a spokesman for the Federal Office of Consumer Protection and Food Safety (BVL).

Broader problem
The specific sequence cluster type that caused the outbreak was mentioned in RKI’s epidemiological bulletin earlier this year when nine cases were known about.

This was part of wider work that identified 24 outbreaks of listeriosis across federal states with links to smoked or graved salmon products as the cause since 2010.

RKI and the Federal Institute for Risk Assessment (BfR) said measures taken so far don’t seem to be enough to protect consumers.

“The fact that cases continue to occur for many outbreaks, although possible fish products and manufacturers have been identified, casts doubt on the efficiency of measures taken and strategies pursued to minimize Listeria contamination,” they added.

People at an increased risk of listeriosis should only eat fish and seafood that have been well cooked. Smoked and graved salmon products should not be offered to vulnerable groups, such as immunocompromised people and the elderly in healthcare facilities, said the BfR.

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The recall is the result of an individual becoming ill and reporting to have eaten this product. Pennsylvania Department of Agriculture tested samples of product and one sample tested positive for Listeria monocytogenes.

As of the posting of this recall, two cases of illness have been reported in this outbreak in two states, New York and Pennsylvania. Both individuals were hospitalized but no deaths have been reported to date.

“Soft Serve on the Go Cups” were distributed in the states of California, Colorado, Connecticut, Washington D.C., Delaware, Florida, Illinois, Massacheassetts, Maryland, Michigan, Minnesota, North Carolina, New Hampshire, New Jersey, New York, Ohio, Oregon, Pennsylvania, Virginia and West Virginia.

The recalled product reached consumers through canteens, grocery and convenience stores and more.

The recalled product is packaged in 8-ounce, clear plastic cups. The product looks like a soft serve cup served in an ice cream store, with a clear plastic cover with a seal and spoon attached to it.

Recalled products:

The UPC is the only identifiable code on the package. It does not have any LOT number or best by date. All product produced up to Aug. 4 is being recalled.

The company has ceased the production and distribution of the product as FDA and the company continue their investigation as to what caused the problem.

Consumers should discontinue consumption of the product immediately. Please dispose of this product or return it for full credit. 

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any recalled ice cream and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled product should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

(To sign up for a free subscription to Food Safety News, click here.)

The Food and Drug Administration has initiated traceback in relation to the Listeria outbreak, but the agency has not reported what food or foods are being traced. Two patients have been identified, but the FDA has not released any information on them, including where they live.

For the E. Coli O157:H7 outbreak, the FDA confirmed 12 patients were sickened but did not release any information about them. The agency initiated traceback but did not report what food or foods were being traced. The FDA first posted the outbreak on July 12.

Continuing outbreak investigations

In an outbreak of Salmonella Paratyphi B var. L(+) tartrate+ an additional patient has been identified, bringing the total to 37, compared to 36 a week ago. The FDA has not released any information about the patients. The FDA first posted the outbreak on June 14. No source has been identified for the pathogen. The FDA has initiated product traceback, sample analysis and onsite inspections, but the agency has not reported what food is being traced or sampled. It has also not reported what location is being inspected.

In an outbreak of Cyclospora cayetanensis the patient count has increased to 55, up from 47 reported a week ago. The FDA has not released any information about the patients. The FDA first reported the outbreak on July 27. The agency has initiated traceback and onsite inspection, but has not reported what food is being traced or what location is being inspected.

In two other outbreaks of Cyclospora infections the FDA is reporting that patient counts are holding steady compared to this past week with 140 and 69 patients reported. In the smaller outbreak the FDA has initiated product traceback, sample analysis and onsite inspections, but the agency has not reported what food is being traced or sampled. It has also not reported what location is being inspected. In the larger outbreak the FDA has initiated traceback and onsite inspections but has not reported what food it is tracing or what location it is inspecting. 

In an outbreak of E. Coli 026 involving 13 patients the FDA has initiated traceback but has not reported what food is being traced. The agency first posted the outbreak on July 26. It has not released any patient information.

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The recalled organic green kiwifruit is grown in New Zealand, exported to North America and repacked locally for sale in one-pound clear plastic clamshells bearing the Zespri brand and UPC code 8 18849 02009 3, containing fruit stickered with the GTIN bar code 9400 9552.

The organic green kiwifruit subject to the recall was shipped between June 14, 2023 and July 7, 2023, and sold in clamshells at retail locations in FL, GA, IL, IN, KY, MI, NC, NY, OH, PA, TN, TX, VA and WI.  

The recall was the result of a routine sampling by the Kentucky Department for Public Health on July 7, 2023. Since being notified on Aug. 3, David Oppenheimer and Company I LLC has worked with Zespri to trace the product through the supply chain to two grower lots, and immediately ceased the distribution of organic green kiwifruit from the related grower lots as it continues its investigation in cooperation with the U.S. Food and Drug Administration. 

No illnesses have been reported to date.

Consumers who still have any of these products are urged not to consume the product and to discard it immediately. Consumers with questions may contact David Oppenheimer and Company I, LLC at 866-698-2580 or send an email to [email protected].

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Over two months ago, while watching the premiere of the documentary, “Poisoned,” at the Tribeca Film Festival in NYC, I got thinking again about how little in the past 30 years I feel I have moved the needle on food safety – pathogens and certainly, human nutrition.  Now that “Poisoned” is up on the Netflix platform, it has become the most watched documentary in the world – at least for the last few days.

The real issue to me is how do we engage the food industry, policy makers, academics and most importantly consumers, to focus on driving the numbers down on the pathogens that kill us quickly and the products that kill us over time.

I will focus on pathogens as I have for the past 30 plus years. I will leave it to some very smart people who are rightly concerned about the millions of us who become sick and die due to inadequate nutrition – especially the millions of illnesses and deaths due to heart disease, diabetes and obesity caused by ultra-processed foods, salt, sugar, and fat.

There is so much to do, and the list is long. So, what would I do with a Food Safety Magic Wand on day one?

Vaccinate. The first thing I would do is mandate that all food service workers be vaccinated against hepatitis A.  Perhaps to some, not the most pressing food safety issue, but it is forefront of my mind.  In the past few months, I finished up litigation around a hepatitis A outbreak involving one ill food service work who infected nearly 50 people, hospitalizing most, killing four and causing two liver transplants.  With regret, I forced a family-owned restaurant chain to file for bankruptcy.  All of this could have been prevented by a safe vaccine that has been around for decades.  It is time for the restaurant industry and the CDC to step up.

Determinate. Do science-based testing of food products at retail and publish the findings on a regular basis.  It is time to shine some light on the safety of the products that we purchase at retail and make the whole chain of distribution – including retailers — transparent and accountable. It is time to bring back a more robust version of the Microbiological Data Program (MDP).  For a time, the MDP tested fresh fruits and vegetable for human pathogens and when found the tests prompted outbreak investigations and recalls.  The industry embarrassed, had the program killed.

Investigate. Invest in public health surveillance over human pathogens, like, Listeria, E. coli and Salmonella, etc.  A dirty truth is that most culture-confirmed illnesses are never attributable to a food source, so people never know what sickened or killed them. Not because the source was not food, but because we fail to invest adequate resources in the epidemiologists that investigate illnesses and track those illnesses to the cause. Tracking illnesses to the cause gets tainted product off the market and helps us all understand what products and producers to avoid.  We need to continue to invest in the science of whole genome sequencing, so we know with certainty which pathogens are causing which illnesses. Foodborne illness epidemiology helps us understand the root cause of an outbreak and helps prevent the next one from happening at all.

Relegate. Allow public health officials access, especially during an outbreak investigation, to all areas around farms that grow fruits and vegetables.  It is long past time to allow investigators access to neighboring cattle, dairy, chicken, or hog operations that spill billions of deadly pathogens into the environment, via air or water.  We need to think of our growing regions as an integrated system and that all sectors responsible need to play a role.  Access allows investigators to understand the likely cause of an outbreak, and again, what can be done to prevent the next one.

Advocate. Make all pathogens that can sicken or kill us adulterants. In 1994 Mike Taylor making E. coli O157:H7 an adulterant has saved countless lives and has saved the beef industry from my lawsuits. We can do the same for all food producers, especially chicken, turkey, and pork. Remember, in the 1990’s nearly all the lawsuits I filed were E. coli cases linked to ground beef.  Today that is zero.  Think about it.

Educate. Give everyone a thermometer and provide better education to middle and high school teachers and students around food safety and human nutrition policy, not in a dry, technical way, but by sharing engaging history, microbiology, patient stories, and case studies. We need to teach how and why our food can be unsafe and what consumers can do about it.

Consolidate. Finally, make a single federal agency out of USDA/FSIS, FDA, and the food safety parts of CDC, NOAA, and EPA, to oversee food safety and human nutrition. Making food safety and human nutrition its own agency would help increase governmental accountability,  close regulatory loopholes, facilitate the collection and sharing of information and facilitate critical change.  I might have a suggestion for someone to run it.

With the CDC estimating 48,000,000 are sickened each year, 125,000 are hospitalized, and 3,000 die from food, preventing pathogenic foodborne illness is no simple matter. And, if you consider the millions that are impacted by the lack of adequate and safe nutrition, we have a lot to do.  However, it can be done, and the ideas above are a small start.

“Doing anything is better than doing nothing,” my Marine drill sergeant father used to say.  He used to require my brother and I to make our beds every morning and bounce quarters on them.  For the longest time I thought this was punishment.  But it was not punishment, it was accomplishment, that you could build on for the rest of the day.  Doing “little” things, like the six things above, are accomplishments. Doing them starts a process that will continue to make all our lives just a little bit safer.

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Consumer practices deviating from the intended use of a food highlights the need for improved labeling about correct preparation and businesses need to assess the potential impacts of climate change, said scientists brought together by the United Nation’s Food and Agriculture Organization (FAO) and World Health Organization (WHO).

The FAO/WHO Joint Expert Meeting on Microbiological Risk Assessment (JEMRA) met in Geneva, Switzerland, from late May to early June 2023, to perform risk assessments of Listeria monocytogenes in selected foods using models developed since a previous meeting.

In the first meeting, the expert group worked on models for lettuce, cantaloupe, frozen vegetables and ready-to-eat (RTE) fish and said they should be programmed, tested and reviewed.

During the second meeting, several risk assessment models were developed and evaluated to characterize the risk of listeriosis because of consumption of diced RTE cantaloupe, frozen vegetables, and cold-smoked RTE fish. However, the model for lettuce was not ready for evaluation.

The meetings come in response to a Codex Committee on Food Hygiene request to undertake a production-to-consumption risk assessment of Listeria monocytogenes in food. This will inform any future revision of guidelines on general principles of food hygiene to control the pathogen in food.

Main findings
Risk assessment models were considered useful and fit-for-purpose but the dose-response model could be improved by considering additional factors, such as underlying health conditions of those at risk. Experts said the models should remain available as open-source tools.

End-product sampling and microbiological testing on its own had little effect on reducing risk, even when applied to every lot but these methods can help verify the effectiveness of control measures.

In the diced RTE cantaloupe model, use of fit-for-purpose water in primary production and of an irrigation system that avoids contact between water and the edible part of the crop reduced the risk. Poor management of wash water and of environmental hygiene during processing increased risk.

Climate change could increase the prevalence of Listeria in soil, lead to a decrease in agricultural water quality and an increase in storage temperature.

Blanching reduced the risk of Listeria in frozen vegetables. However, post-blanching contamination and growth of the pathogen may occur. If non-RTE frozen vegetables are consumed without adequate cooking, then defrosting practices influence the risk.

Higher Listeria levels on incoming fish and poor environmental hygiene practices during filleting and slicing increased the risk. Addition of lactic acid and diacetate or lactic acid bacteria culture to the product lowered the risk due to reduced growth. For the climate, an increase in initial levels of Listeria in raw fish and in the storage temperature during shelf-life of the product could lead to a bigger risk.

Help on foodborne disease burden wanted
WHO has asked for experts who can contribute to developing estimates of the global burden of foodborne disease. The agency is in the process of updating 2010 estimates that were published in 2015. Revised figures should be available in 2025.

The main role would be participating in a structured expert elicitation study on the attribution of diseases to food and other pathways. A team under Dr. Tina Nane, associate professor at Delft University of Technology, was selected to lead the study through a bidding process.

The Foodborne Disease Burden Epidemiology Reference Group (FERG) is supporting WHO in the efforts. Estimating the global burden of foodborne disease involves different data from various sources.

Systematic reviews and surveillance data will provide an estimate of the true incidence of disease caused by hazards that can be transmitted by food. Then, disease models are used to estimate the impacts of these diseases on mortality and disability-adjusted life years (DALYs). Source attribution is another step in the work. The selection process started Aug. 1, 2023 and continues onward.

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The advice comes from a risk assessment by the Food Standards Agency (FSA) and Food Standards Scotland (FSS) that shows these groups are at a higher risk of severe illness from listeriosis. The risk assessment was prompted by an outbreak of Listeria infections linked to RTE cold-smoked fish.

Past advice listed smoked fish as a food of concern with the recommendation that care should be taken during pregnancy and it should only be eaten by vulnerable groups after being thoroughly cooked.

The FSA, FSS, and UK Health Security Agency (UKHSA) have been investigating the ongoing outbreak since October 2020. There have been 19 linked cases of listeriosis in England and Scotland and four people have died, this is up from the 15 cases and three deaths reported several months ago. Most patients are above 65 years old but one was a pregnant woman. 

In December 2022, Lidl recalled Deluxe Oak Smoked Scottish Louch Trout and Lighthouse Bay Smoked Trout Trimmings, produced by St James Smokehouse. Product testing found Listeria monocytogenes that matched the outbreak strain but levels were below permitted limits.

Potential for serious illness
In RTE foods that can support growth of Listeria, which include smoked fish, the bacterium must not be present in 25-grams of sample when leaving production plants, or businesses must show the products will not exceed the limit of 100 Colony Forming Units per gram (CFU/g) during their shelf life.

As the risk of serious illness from listeriosis increases with age, FSA and FSS are also advising that people older than 65 should be aware of the potential danger posed by products such as smoked salmon or trout and gravlax. Neither the cold-smoking process nor refrigeration kill Listeria.

The assessment found that while the risk of contracting listeriosis in higher-risk individuals from cold-smoked fish is low, severity of illness is high. This means there is the potential for serious illness, hospitalization, and death among higher risk groups.  

Uncertainties included the difficulty in estimating the infectious dose for Listeria monocytogenes and how it varies between different vulnerable groups; the long incubation period which can make attribution to a food vehicle difficult; the initial level of contamination and how it multiplies through the food chain; and consumer behavior around use-by dates and temperature abuse.

Professor Robin May, FSA chief scientific adviser, said: “Our risk assessment shows that there is still an ongoing risk to health associated with eating cold-smoked fish for specific groups of vulnerable people, including pregnant women and individuals with impaired immunity. In light of the risk assessment, we are advising that these consumers avoid ready-to-eat cold-smoked and cured fish products.” 

Those with weakened immune systems are people with certain underlying conditions such as cancer, diabetes or liver and kidney disease.

Fish processing details
Cold-smoked fish such as smoked salmon or trout, and cured fish such as gravlax, have not been fully cooked during the production process to kill any Listeria that may be present. Cold-smoked fish is normally labeled as smoked fish on packaging, so processing type is unclear. RTE cold-smoked fish typically comes in thin slices, and can be eaten cold. It may also be found in sushi.   

Smoked fish products that have been heat-treated during production, such as tinned smoked fish, are safe for consumption without further cooking. These products are subjected to a high temperature during processing, which is sufficient to kill Listeria.

Gauri Godbole, consultant microbiologist at UKHSA, said: “While smoked fish has a higher risk of carrying Listeria, the overall risk to the population is very low. However, some people are more likely to get a serious infection including those who are pregnant and those with weakened immune systems. The risk also increases with age. Those who are more vulnerable can be at risk of severe illness such as meningitis and life-threatening sepsis. Listeriosis in pregnancy can cause very serious illness in mothers and their babies.”

UKHSA has identified 31 patients with microbiological and epidemiological links to eight smoked fish incidents between 2015 and June 2023, with eight deaths and three pregnancy associated patients.

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Folkhälsomyndigheten (the Public Health Agency of Sweden) said deaths of three of the older patients were connected to their Listeria infections but it is not clear if they died with or because of listeriosis.

From the end of May to the beginning of July, 10 people contracted Listeria infections caused by the same type of the bacteria. Another four people fell ill in late 2022 from this strain.

Patients are 10 men and four women aged 63 to 93 years old. They live in eight different regions in the country.

Based on information from a questionnaire given to patients about foods they ate before becoming sick, many reported eating gravad or cold-smoked salmon but the exact product that caused the outbreak is not yet clear.

Warning for vulnerable groups
Folkhälsomyndigheten, Livsmedelsverket (the Swedish Food Agency) and regional infection control units are investigating the illnesses.

Livsmedelsverket said Listeria can cause serious illness for people in at-risk groups, such as pregnant women, the elderly and people with impaired immune systems.

“Those who belong to a risk group — or who are to offer food to someone in a risk group — can reduce the risk of infection by following the Swedish Food Agency’s advice on Listeria. Certain foods such as blue cheeses should be avoided completely, while other foods such as cold smoked and gravad salmon should be eaten within a week of the date on the packaging,” said Jonas Toljander, a microbiologist at Livsmedelsverket.

In 2022, 125 listeriosis cases were reported compared to 107 the year before. The median age was 79 and as in previous years, most were older than 80. Overall, 45 people died within one month of diagnosis.

National and local authorities took 266 samples from different types of food to test for the presence or absence of Listeria monocytogenes in 2022. The pathogen was detected eight times. Two of these were vacuum-packed salmon taken as part of work into a suspected food poisoning or complaint.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, people should monitor themselves for food poisoning symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

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Sanjay Gummalla, from the American Frozen Food Institute (AFFI), said the premise that a single cell of Listeria monocytogenes can cause disease does not have scientific basis.

Gummalla previously co-authored an opinion article on Listeria policy in the U.S. and Canada. As frozen foods do not support Listeria growth, they are considered low risk but the older population is an expanding at-risk group and the pathogen can grow at refrigeration temperatures.

The U.S is planning to update draft guidance this year while Health Canada recently released a revised policy for Listeria monocytogenes in ready-to-eat (RTE) foods.

Move away from zero tolerance
Gummalla said the U.S. was in a “default zero tolerance paradigm” and while Canada had taken a risk-based approach focused on the vulnerable population, the U.S. continued to have a hazard based approach.

Attendees heard that Listeria recalls are happening because of positive findings but there is no enumeration so contamination levels are unclear and data is missing. Zero tolerance is not addressing the root causes, it is treating all RTE food as presenting the same risk and limiting implementation of robust seek and destroy verification measures he said.

Gummalla covered how Listeria could be getting into production facilities, its persistence, and environmental monitoring programs.

He said it was a misconception that a good sanitation program is one without any positives. He also questioned whether seek and destroy was the right approach. What were acceptable positive rates in the environment and was there a need to mandate food contact surface testing?

Finished product testing is not an alternative to robust and routine environmental monitoring and sampling should be done well into the production process and not right after the sanitation cycle, added Gummalla. 

Producers of RTE foods must ensure products are formulated, processed, packaged, and stored correctly as they are intended to be consumed without additional cooking steps or processes to eliminate or reduce pathogens. These foods have been associated with illnesses and outbreaks resulting from poor sanitation, inadequate processing, abuse during storage, or modified exposure before consumption that may support growth of pathogens to high enough levels to make people sick.

Not-RTE (NRTE) foods require validated preparation instructions on the label to help consumers with preparation to ensure that the food is safe. There is increasing regulatory and customer pressure to tighten microbiological requirements on NRTE products because of concern about deviation from the preparation instructions.

Standards in different sectors
Another session at the conference looked at performance standards, which are the pathogen reduction levels that must be attained during processing to assure food safety. In some cases, limits have been created over decades of scientific testing. These standards vary depending on the food category.

They can be established based on scientific literature, studies performed by companies, regulatory requirements, or by using risk-based pathogen modeling. For many products, specific guidance for a performance standard is not available because of a lack of adequate data to establish the log reduction necessary to protect public health. In such cases, there is a need for a multiple-hurdle concept.

Stephanie Nguyen, of ConAgra Brands, spoke about performance standards for RTE meat and plant proteins, canned foods and frozen vegetables. Nguyen said there are challenges around making sure any data being used also applies to cell-based meat and plant based or alternative proteins. She added it is important to consider how consumers are handling products, the desire for minimally processed foods, and new technologies like non-thermal processing.

Rico Suhalim, of PepsiCo, covered juices and snacks, including low-water activity foods. Suhalim said people need to know the risk and how to control the hazard, with work potentially extending to suppliers and emphasized the role of validation and challenge studies.

Aaron Uesugi from Mondelez International said, unlike the other areas, there wasn’t really consensus on a performance standard for baked goods or chocolate and the targeted log reduction. Uesugi said it was important to consider if input materials are raw or treated, sourcing destinations and potential post-process contamination.

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As of late today five patients had been identified. All five required hospitalization and three have died, according to the Tacoma-Pierece County Health Department.

All of the patients are or were in their 60s or 70s and all had weakened immune systems, according to the health department, which is working with Washington State Department of Health (DOH) and Thurston County Public Health and Social Services.

The Tacoma News is reporting that “genetic fingerprinting results (whole genome sequencing) indicate that these patients likely have the same source of infection. Patients became ill between February 27 and June 30, 2023.”

State and local public health officials have not yet discovered a source for the bacteria. They are interviewing patients and their representatives to develop a profile.

The state of Washington generally logs 10 to 25 cases of Listeria infection annually, according to the Tacoma health department.

About Listeria infections
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

It can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections, and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn, or even stillbirth.

The Norwegian Institute of Public Health (FHI) reported that three women and one man fell ill in June and were admitted to hospitals. All patients are now either healthy or improving.

They are between the ages of 50 and 80. Two live in Viken, and one each in Vestland and Oslo.

Listeria with the same genetic profile has been detected in samples from all patients, which indicates a common source of infection.

FHI, the Norwegian Food Safety Authority (Mattilsynet), the Veterinary Institute and relevant municipal officials are part of the investigation. The Norwegian Food Safety Authority has interviewed sick people and obtained samples, which the Veterinary Institute has analyzed.

Three out of four people reported having eaten either smoked salmon or smoked trout from Troll Salmon in the period before they became ill. The outbreak strain was found in two packs of smoked salmon from this company. One person had the packages in the freezer.

In July, Troll Salmon recalled smoked salmon with lot number 216 and a date of May 23.

Similar problem in 2022
The strain in this incident is also similar to the one detected in an outbreak of listeriosis in 2022 where smoked salmon was the suspected source of infection.

From April to October 2022, the Norwegian Institute of Public Health detected listeriosis in five people. Sample dates ranged from February to October.

Cases were two women and three men aged 50 to 95 with a median of 72 years old. They lived in four counties: Nordland, Trøndelag, Viken, and Oslo, and all were hospitalized.

“The Norwegian Food Safety Authority is in close dialogue with the business, which must ensure that they do not sell products that represent a possible health hazard for consumers. The Norwegian Food Safety Authority also monitors that the company carries out necessary investigations and implements sufficient measures in production,” said Lindis Folkvord, from Mattilsynet.

At an inspection in October 2022, the Norwegian Food Safety Authority discovered the fish producer’s sampling plan was not sufficient, and that environmental samples had not been taken in line with Troll Salmon’s internal program.

The firm was ordered to take daily samples for a certain time period and to update the sampling plan. It also carried out additional cleaning and disinfection of premises and equipment.

Listeria had been found in two smoked salmon products from the company earlier in 2022, but at a concentration below the legal limit, so they were not recalled. Samples were taken during the monitoring of ready-to-eat food in shops, a program under the Norwegian Food Safety Authority.

During the inspection, Listeria monocytogenes was found in environmental samples from the producer. However, these isolates had a different profile to the outbreak strain but were similar to those taken from the firm’s smoked salmon in the monitoring work.

In 2022, Norway had two Listeria outbreaks with 10 people sick. Infections went up from 20 in 2021 to 31 in 2022. Of these, 27 were infected in Norway and four were infected abroad. All patients were hospitalized. 

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They still remember, and each Aug.23, Maple Leaf Foods recognizes those sickened and those who died in Canada’s 2008 listeriosis outbreak.

Cold cuts from a Maple Leaf Foods plant in Toronto were the source of that deadly outbreak that was known for killing elderly Canadians across several provinces.

The deadliest food-borne disease outbreak in Canadian history resulted in a six- to eight-week product shortage when Maple Leaf shut down operations.

It is no surprise that the International Association for Food Protection, at its annual meeting being held in Toronto this week, would address the historic event. The session titled: “Foodborne Listeriosis in Canada, Are we there yet?” covered most of the bases. “Insights into Progress and Lessons Learned Since Our Infamous Deli-Meat Outbreak,” added if a subtitle was needed.

Heath Canada’s Marie Breton was the panel’s lead-off speaker, providing an in-depth look at her country’s past and future policies for controlling Listeria. She showed how two-thirds of Canada’s listeria policies that were in place by 2011 were in existence by 2008, the year when the listeriosis tragedy occurred.

Lynn McMullen from the University of Alberta at Edmonton said, “One size does not fit all” when considering Listeria and that researchers must consider both the transient and persistence of the pathogen’s strains.

In illustrating how difficult persistent Listeria can be, McMullens showed how Listeria remained in the cheese plant for some seven years. She pointed to the need for improved sanitation practices because of evidence that current procedures “are not enough.”

After the regulatory and research presentations, Randy Huffman from Maple Leaf Foods appeared to tell how the company became an adherent to a food safety culture in response to the deadly outbreak. He credits the company’s former chairman, who from the outset assured Canada their food safety system was among the world’s best. He also said Canada’s regulators were not to blame, just Maple Leaf Foods.

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Using targets based on reported infections of key pathogens could help monitor trends and be used as a trigger to act. However, figures would need to be interpreted carefully because of underreporting, inability to separate food and non-food sources, changes in demographics, and impacts of year to year fluctuations in environmental factors, such as weather.

When reported cases breach the threshold, different steps would be considered including an investigation to identify reasons behind the increase; additional food sampling associated with the pathogen and risk communication to consumers using tailored messages.

FSS currently uses Public Health Scotland data on confirmed laboratory reports for five pathogens to monitor how foodborne illness is changing.

Action level considerations
In April 2017, FSS published a strategy for reducing foodborne illness in Scotland. The focus was microbiological pathogens which have the highest disease burden in terms of incidence, symptom severity and mortality — Campylobacter, Salmonella, Shiga toxin producing E. coli (STEC), Listeria monocytogenes, and norovirus. Work so far has focused on Campylobacter, Listeria and STEC because Salmonella cases are often acquired abroad and many norovirus infections are because of person-to-person spread.

Year on year variation and the low number of reports for certain pathogens in Scotland has made it challenging to create appropriate threshold levels. However, the Food Standards Agency (FSA) has previously developed a trigger system for foodborne pathogens and is reviewing it.

Adoption of Scottish specific levels may be problematic for pathogens with lower case numbers, such as Listeria, where confirmed lab reports are generally less than 20 each year but UK-wide thresholds would need to be considered in a Scottish context.

Four other areas were identified in an update to the strategy: review and strengthen the uptake of interventions to support Campylobacter reduction; support businesses and consumers to minimize the risks of Listeria monocytogenes; understand the epidemiology of foodborne infection in Scotland; and improved targeting of consumer advice aimed at educating the public on the particular risks to vulnerable groups and how they can be avoided.

Work on specific pathogens
Campylobacter remains the biggest cause of bacterial foodborne disease. An FSS-funded source attribution study showed chicken-related strains were most commonly identified in human illness in Scotland.

FSS and FSA are developing a plan to understand how chicken contributes to infection rates, and where interventions need to be strengthened. Results of a survey on pathogens and antimicrobial resistance in retail chicken will be published later this year. Another mapping exercise will help understanding around interventions used in the food chain by farmers, processors and retailers to reduce contamination. Communication with caterers and consumers about the risks of Campylobacter in livers and duck meat and how to prepare them safely will also be a focus going forward.

Data from UK work suggests a reduction in high levels of contamination on chicken in recent years but very little change in the number of sick people or attribution to chicken related strains of Campylobacter.

During the past year, outbreaks and deaths associated with smoked fish and unpasteurized cheese have highlighted the technical challenges faced by small to medium sized producers in controlling Listeria. FSS is looking at risk communication to consumers and public sector procurement and provision of food in care settings.

As Listeria can persist in the production environment and grow at low temperatures there is a need for guidance on shelf life validation to ensure appropriate durability dates are applied, and on the sampling regimes required to verify the effectiveness of cleaning methods in removing Listeria from surfaces and equipment.

Scotland has the highest reported rate of STEC in the UK. In 2022, there were two nursery outbreaks, not caused by food, with 45 sickened because of E. coli O157 and 12 cases in a non-O157 outbreak. Another 26 patients were linked to a large UK-wide cluster for which no vehicle was identified.

FSS will also commission an independent review of the current definition of vulnerable groups, to determine if it can be refined based on up-to-date evidence on the range of underlying health and lifestyle factors that can make people in these groups more susceptible to illness. Findings will be used to support risk assessments and social research to identify communication methods that are most likely to reach the individuals that could be at increased risk.

The agency will continue to monitor trends in foodborne illness with Public Health Scotland and use any changes in reporting which could be having an impact on the figures to prioritize work.

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In a preliminary report, the Foodborne Diseases Active Surveillance Network (FoodNet) says that enteric infections from food have returned to or exceed levels logged from 2016-2018.

FoodNet is made up of public health staff from the U.S. Centers for Disease Control and Prevention, the Food and Drug Administration, the USDA’s Food Safety and Inspection Service and 10 state health departments.

The group tracks data for reported infections per 100,000 people for eight  foodborne pathogens: Campylobacter, Cyclospora, Listeria, Salmonella, Shigella. Shiga toxin-producing Escherichia coli (STEC), vibrio and Yersinia.

The report suggests links between pandemic measures and decreases in foodborne infection rates.

“During 2020–2021, FoodNet detected decreases in many infections that were due to behavioral modifications, public health interventions, and changes in health care–seeking and testing practices during the COVID-19 pandemic,” according to the research report.

Improved hygiene such as more hand washing could also have had an impact on the number of foodborne infections during the peak of the pandemic.

“Many pandemic interventions ended by 2022, resulting in a resumption of outbreaks, international travel, and other factors leading to enteric infections,” researchers wrote.

When compared to the average rate of infections during the 2016-2018 period, the incidence of infections from Campylobacter, Listeria, Salmonella and Shigella were back to the rates experienced before the pandemic.

For cyclospora, STEC, vibrio and yersinia infections increased beyond those logged for the pre-pandemic time period from 2016-2018. 

According to the CDC, Salmonella and campylobacter continue to be the top causes for infections monitored by FoodNet. The agency reports that increases in the use of culture independent diagnostic tests probably contributed to the increased detection of infections.

“Prevention measures targeted at reducing food contamination, including the FSIS-proposed Salmonella regulatory framework for reducing illnesses from poultry, are needed to mitigate the prevalence of disease and to meet Healthy People 2030 targets,” the researchers concluded.  

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