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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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.

The Tiger Brands polony listeriosis outbreak began at the start of 2017 and was officially declared over in September 2018 with 1,065 confirmed cases and at least 218 deaths. 

Food contaminated with Listeria may not look or smell spoiled. Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache, and neck stiffness. Young children are particularly susceptible to the infection.

Candess Du Preez picked up her 3-year-old daughter Jordin and her cousin Riley from their crèche (preschool) where they attended school daily. On Thursdays, the children were fed polony sandwiches for their afternoon snack.

But when the children returned home, something was off. Neither Jordin or Riley ate dinner.

“The next day, they woke up as normal,” Du Preez told Food Safety News. Candess and her mother walked Jordin and Riley to the crèche. They left early as the kids were being fed breakfast.

As they walked to school, Du Preez noticed her daughter was more tired than usual. “I thought she was just being tired, and I asked, ‘Okay, are you sure you’re okay?’”

“When we got to the crèche, we just thought it was one of those days they were tired. We left them and excused ourselves like normal.”

But the day turned out to be anything but normal. By early that afternoon all of the children in the crèche had to be rushed to a nearby clinic.

“When I got there, Jordin was already on oxygen. Jordin was the only one at that point on oxygen, the others were just vomiting and lame. They were tired, and lame, and vomiting,” Du Preez said. “She was blue.”

Jordin’s parents were terrified that their daughter might die. 

For the next week, her parents, Joseph and Candess Du Preez, stayed as close as possible. “We slept in the parking lot by the hospital, because we didn’t want to leave her.”

During the week that the children were quarantined, investigators came to the homes of the parents to see if they had contracted the illness there. As Seventh-Day Adventists and vegans, the Du Preez do not eat meat. The Du Preez were confident the polony connected to the national outbreak wasn’t from their home.

The investigators also searched the crèche, and there they found a piece of the polony sandwich. The polony found was the Tiger Brand’s polony implicated in South Africa’s Listeria outbreak.

Jordin was uncomfortable and couldn’t sleep without her parents. She routinely removed IVs, making it difficult for doctors to administer treatment. The Du Preezs would see their child in the morning with swollen feet. She was in intense pain from headaches and vomiting, and doctors were concerned about Jordin’s kidneys and the damage they were suffering.

“It was a terrible thing to go through. It was life and death.”

Jordin, Riley and the other children began to improve and were able to return to their homes, though treatment for their Listeriosis continued for the next month.

Jordin and her cousin Riley are eight now, but they still deal with the complications of their infection, including constant pain and headaches. Jordin needed sinus surgery to treat her sleep apnea.

Du Preez says dealing with the health issues has been emotionally and financially brutal. 

When asked if she holds any resentment toward Tiger Brands, Du Preez said, “I do. I do. I do. 

“They are guilty, but it’s been so many years now and we are still suffering, the children are still suffering. They are found guilty, yet they deny and deny.

“It’s been five draining years. It’s been very draining.

“Just because we went to a government hospital does not mean we are not paying. We are paying. My husband almost lost his job. He is the only breadwinner in the house.

“How many other families have been affected?” she asked.

Along with the 1,000 people affected by the Tiger Brand’s listeriosis outbreak, Jordin is represented by Richard Spoor Attorneys and is still in a legal battle with the company over damages caused by the outbreak.

Tiger Brands has been fighting the lawsuit relating to its part in the deadly outbreak. The Seattle firm of Marler Clark LLP is serving as a consultant for the case attorneys. The attorneys are representing the victims on a contingency basis.

To read more about the impact of this outbreak, please see:

• South African mother loses newborn to listeriosis in 2018 Tiger brand polony outbreak
• Tiger Brands outbreak killed young mother, leaving her twin sisters to raise her daughter
• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and their fears for his future

More background information about the 2017-2018 South Africa Listeria outbreak can be found here.

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The Supreme Court of Appeal ruling reverses a Gauteng High Court verdict on whether subpoenas issued against third parties were relevant to the class-action. Tiger Brands is facing a class-action following an outbreak of listeriosis between January 2017 and September 2018 that sickened more than 1,050 people, killing 218.

People contracted Listeria monocytogenes infections after eating contaminated ready-to-eat meat products, such as polony, made at a factory in Polokwane by Enterprise Foods between October 2016 and March 2018. At the time Enterprise Foods was owned by Tiger Brands.

The Supreme Court of Appeal judgment paves the way for the next step in the legal process.

Tiger Brands subpoenaed other meat producers and laboratories to see if, during the period that they are accused of distributing contaminated food, others might have done so as well. This might have diluted the harm for which they may be liable.

Class action proceedings were filed against Tiger Brands by Richard Spoor Attorneys to get compensation for victims. Richard Spoor Attorneys is representing people affected by the outbreak and Marler Clark LLC of Seattle is serving as a consultant. The first stage will determine whether Tiger Brands is liable while a second case would determine damages.

Relevance to class action
Richard Spoor said in the past 18 months the case has stalled while Tiger Brands “engaged in a fishing expedition.”

“Tiger’s strategy of delay and blame sharing has cost the victims dearly, many, including infants with severe brain injuries, who require medical care and counseling to cope with their loss or disability have been denied it and have endured great hardship as a result,” he said.

Spoor added he hoped the judgment would serve as a wake-up call for the company.

The National Institute for Communicable Diseases (NICD) investigation focused on Listeria monocytogenes sequence type (ST6) when it was found that results from clinical tests matched those from the Polokwane facility. In April 2018, Tiger Brands revealed it had received independent lab tests which detected ST6 in samples of ready-to-eat meat products from the factory.

Subpoenas were issued against 11 parties including Deltamune and Aspirata, which are commercial testing laboratories. As well as firms including Federated Meats, Curly Wee Boerdery, Ibis Piggery, Molare Investments and Winelands Pork that supplied raw meat products to Tiger Brands.

Tiger Brands had already amended them by reducing the number of documents requested but the other parties still objected to the demand. Such documents may have helped the firm argue it was not the only one responsible for the outbreak.

The court ruled that Tiger Brands’ argument to investigate whether it was the sole source of the outbreak was not relevant to the class-action as claimants are only seeking to hold it responsible for harm. It added the demand for documents was “speculative” and seemed to be based on the hope it would find a basis for co-liability with another party.

A Tiger Brands statement said the outbreak had 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.”

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Over the course of their first eight years of marriage, South African Thenjiwe Dodo and her husband tried to have a child. In 2018, after eight years, and eight miscarriages, Thenjiwe was one month away from delivering her firstborn.

Thenjiwe was extra careful about what she ate while pregnant, knowing the fragility of the life inside her.  At eight months into her pregnancy, Thenjiwe had no way of knowing that Tiger Brand polony was contaminated with Listeria.

“When I bought the polony I knew I could trust them with my life. And I knew that because I was pregnant, I needed to eat more healthy than ever,” she told Food Safety News.

The Tiger Brands polony listeriosis outbreak began at the start of 2017 and was officially declared over in September 2018 with 1,065 confirmed cases and at least 218 deaths. 

Thenjiwe suffered through a terrible bout of listeriosis that left her and her child’s life in danger,  At the time, she had no idea it was connected to the polony she had eaten. It wasn’t until thousands of others in South Africa became sick, and the connection was made to the polony, that Thenjiwe remembered having had the Tiger Brand product before her illness. 

Though Thenjiwe recovered from her lengthy fight with listeriosis, and she gave birth. Her newborn son was severely impacted by the infection and died just 16 days after his birth.

Thenjiwe has a lot of anger toward Tiger brands.

“I do not buy anything from that brand anymore. They took away something that I was waiting for almost eight years of my life.”

Along with the 1,000 people affected by the Tiger Brand’s listeriosis outbreak, Thenjiwe is represented by Richard Spoor Attorneys and is still in a legal battle with the company over damages caused by the outbreak.

Tiger Brands has been fighting the lawsuit relating to its part in the deadly outbreak. The Seattle firm of Marler Clark LLP is serving as a consultant for the case attorneys. The attorneys are representing the victims on a contingency basis, meaning without charging them. 

To read about the impact of this outbreak, please see:

• Tiger Brands outbreak killed young mother, leaving her twin sisters to raise her daughter

• Mother describes uncertain future for her daughter after listeriosis infection

• Uncertainty after the outbreak — ‘My niece may not know her father has died’

• Parents describe their baby’s ongoing treatment and their fears for his future

More background information about the 2017-2018 South Africa Listeria outbreak can be found here.

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The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product, similar to baloney and called polony, made at a plant in Polokwane run by Enterprise Foods, which at that time was owned by multinational Tiger Brands.

Phumzile Banze fell ill in March 2018 and had to have her first child by an emergency C-section.

“I used to pray a lot. I would say to others affected by the outbreak that they should put their hope in the hands of God because I lost hope that my son would live seeing that people were dying because of this outbreak. I was so excited to have him in my life but this outbreak didn’t allow me to have the chance to celebrate my newborn. His hair was cut off. I didn’t get to enjoy him that much for the first few days of his life.”

Sibusiso, who is now 3 years old, had to go hospital for check-ups until he was aged 1 but has since made a full recovery.

Almost lost their first child
Phumzile said she started feeling sick while pregnant.

“I had diarrhea and I used to collapse but I didn’t know it was Listeria. I had pains so I went to the local clinic but they told me the baby was not due. I went back home and stayed home a week or two before going to the hospital,” said the 24-year-old.

“When they looked they said the baby’s heartrate was beating slowly and I was about to lose the baby. So I had to rush for an emergency C-section. When he arrived, the baby went to ICU. I gave birth on March 21 then I started to see the baby after March 23. When I arrived the baby was not breathing well, the moment I gave him milk he was better but when I asked the doctors they didn’t tell me what it was.

“Luckily I found a doctor who explained to me that he had an infection in the brain. The infection was now starting to spread to the whole body. They took blood to the lab and tested it. They found it was Listeria so they had to put him on a drip for him to get antibiotics.

“For 12 days he stayed at the hospital so I used to go and visit him each and every day. I was discharged on March 23 so I didn’t get any treatment for Listeria. My son was at the hospital for the first 12 days of his life.”

The stay-at-home mum was with her family and partner, Bongani, in Gauteng, Johannesburg at the time of the incident.

“I used to crave Kota (a type of South African sandwich) and buy them a lot. One day I didn’t have money so I told my partner Bongani to come with polony and when he came back with it I used to eat it. We didn’t take it seriously about this outbreak. I had never heard of Listeria. I never used to watch the news so every time when I have craved Kota I would go and buy it because it has Russians, polony and viennas. I used to eat it by itself, a week didn’t go by without me eating Kota. Now, I don’t eat polony anymore.”

Phumzile said she doesn’t plan too much for the future but hopes to stay happy and healthy together with her family as the couple now also have a 4-month-old baby girl.

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Following the declaration of the Listeria outbreak in December 2017, a multi-sectoral outbreak response was initiated. Findings were shared by the Minister of Health, Dr. Aaron Motsoaledi at a public media briefing on 4 March 2018 (statement available at www.nicd.ac.za), and are summarized below. In addition, the National Department of Health requested a full recall of implicated processed meat products.  According to Dr. Aaron Motsoaledi:

In our constant search for the source of the outbreak and the treatment of people who are affected, a team from the NICD has interviewed 109 ill people to obtain details about foods they had eaten in the month before falling ill. Ninety-three (85%) people reported eating ready-to-eat (RTE) processed meat products, of which polony was the most common followed by viennas/sausages and then other ‘cold meats’.

On Friday 12th January, nine children under the age of 5 years presented to Chris Hani Baragwanath Hospital with febrile gastro-enteritis. The paediatrician suspected foodborne disease, including listeriosis, as a possible cause. The environmental health practitioners (EHPs) were informed and on the same day visited the crèche, and obtained samples from two unrelated polony brands (manufactured by Enterprise and Rainbow Chicken Limited (RCL) respectively) and submitted these to the laboratory for testing.

Listeria monocytogenes was isolated from stool collected from one of the ill children, and from both of the polony specimens collected from the crèche. These isolates were sent to the NICD Centre for Enteric Diseases, and underwent whole genome sequencing and genomic analysis. The ST6 sequence type was confirmed on all three isolates on Saturday 27th January. Remember that in the last press conference I informed you that from clinical isolates obtained from patients (patient blood), 9 sequence types of Listeria monocytogenes were isolated and 91% were of sequence type 6 (ST6). We had then concluded that time that this outbreak is driven by ST6.

Following the lead from the tests performed on these children from Soweto and the food they had ingested, the EHPs (Environmental Health Practitioners), together with the NICD and DAFF representatives, accompanied by 3 technical advisors from the World Health Organisation in Geneva, visited a food- production site in Polokwane and conducted an extensive food product and environmental sampling.

Listeria monocytogenes was isolated from over 30% of the environmental samples collected from this site, which happens to be the Enterprise factory in Polokwane.

To conclude the investigation, whole genome sequencing analysis was performed from this Enterprise factory and the results became available midnight or last night. The outbreak strain, ST6, was confirmed in at least 16 environmental samples collected from this Enterprise facility. 

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

According to the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/ National Health Laboratory Service (NHLS) the current number of ill and deceased are as follows:

As of 26 July 2018, 1060 laboratory-confirmed listeriosis cases have been reported to NICD from all provinces since 01 January 2017.

To date, 749 cases were reported in 2017, and 311 cases in 2018. Females account for 56% (549/979) cases where gender is reported. Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age. Most cases have been reported from Gauteng Province (58%, 614/1060) followed by Western Cape (13%, 136/1060) and KwaZulu-Natal (8%, 83/1060) provinces. Final outcome data is available for 76% (806/1060) of cases, of which 27% (216/806) died.

Justice delayed, will not be justice denied.

Meshack Mahlngu fell ill in late 2017 during South Africa’s Listeria outbreak — a week before he was scheduled to take his exams.

Mahlngu said the experience was “really mentally straining” as he was focused on his final exams. In South Africa, matriculation, also known as matric, is the final year of high school and the qualification received on graduating.

Impact on studies
“My situation was I contracted the disease while I was in the final year of school. I had it a week before I was taking my exams so spent the first month of them at hospital while I was diagnosed with listeriosis,” he told Food Safety News.

“I took my exams, I wrote my first two papers in the hospital and managed to go back to school when I was discharged. I got the average result, to say I passed, but for the student I was I didn’t get the results I was expecting and could have done better.

“Through the time in school I didn’t have it easy up to that point but wouldn’t say it really affected me that much because I still tried to put myself in therapy and I’m trying to cope with things that I understand. I was in hospital for post-traumatic stress disorder (PTSD) linked to the incident, as it was scary, I was still in school. There was some trauma after my illness but I’m physically OK now.”

Mahlngu lives in Johannesburg with his mum and has two younger sisters — one aged 15 and the other is 11.

“I was in the hospital for more than a month. My mum visited more than anyone, she was the one going through with all the experts when they gave me care and the expenses were doubling every time. I had never heard of Listeria or had food poisoning until I contracted the disease,” he said.

“There was a guy I knew a lot, he was a childhood friend from school and he died from listeriosis. He was a few years older than me at that time, he was 20 and I was 17.”

The now 21-year-old remembers being in church in August 2017 when he started to feel unwell.

“On Sunday at church I had a headache and the next day at school it became a severe headache and it continued the day after and then at night on the third day I decided to go to hospital. I was supposed to call an ambulance but managed to go there with my father. When we got there I was still having the headache and I got to the emergency room and was diagnosed there.”

College plans
The 2017 and 2018 listeriosis outbreak in South Africa was linked to ready-to-eat (RTE) meat products and caused more than 1,050 illnesses and at least 218 deaths.

It was traced in March 2018 to a RTE processed meat product called polony, which is similar to boloney, made at a factory in Polokwane run by Enterprise Foods, then-owned by Tiger Brands. In August 2020, Tiger Brands agreed to sell its processed meats division, which includes Enterprise Foods.

Mahlngu used to eat polony all the time at school and at home but now avoids it.

“I try to avoid a lot of products that are related to the ones that faced listeriosis, not because of Tiger Brands per se, just for health purposes. I believe they have made the correct arrangements to solve the mistakes they had that year. Mistakes happen, life is life, but I would appreciate an apology from them to the community of its customers. It wasn’t on purpose, they were not trying to kill us.”

The future for Mahlngu includes finishing a financial accounting course.

“I did my first year when I turned 18. I have two years left to finish the course. I am on hold due to financial difficulties but definitely want to finish it, that is my main goal right now,” he said.

“My future holds a lot of brightness and joy. I have a lot of plans that I believe will come true. I am pending on the college degree in financial accounting, if I can finish it that will be one of my short term goals.”

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Joseph Kadango, who lives in Johannesburg, spent months in hospital after becoming infected, lost his job and couldn’t support his family.

He used to buy meat such as Russians, Viennas, chicken and polony for breakfast while shopping.

“After a month they stopped and said we don’t sell that stuff anymore here and it is at that time the listeriosis started for me. They said bring it back but I couldn’t take these things back as I had eaten most of them already. I took all the polony, viennas and Russians of Enterprise and threw them in the dustbin,” he told Food Safety News.

“When I was in hospital I told my brother you must avoid those things in the bin. It is no good to eat. Now I don’t eat polony, Russians or viennas but some other people buy it. I don’t have that stuff anymore, I am afraid to eat it.”

Months in hospital
After feeling sick for a few days, the 44 year old went to see a doctor.

“I thought something was wrong and I started to feel unwell with flu symptoms and then after two days I still had a headache and feeling dizzy so I was not feeling very well. When I went to the doctor’s they said I was not OK and it was some disease. They checked me, gave me an X-ray and saw something and said it was listeriosis from something I ate. They asked me what I ate all the time. I was vomiting, my head was paining, my brain was confused and I was just like a child,” said Kadango.

“I was in hospital for three months and after that they checked me and gave me an injection. I was vomiting too much and not eating. They did something to my spinal cord to drain fluid. Now I am feeling well and getting better, it is not like before when it was very bad.”

The 2017 and 2018 listeriosis outbreak in South Africa was linked to ready-to-eat (RTE) meat products and caused more than 1,050 illnesses and at least 218 deaths.

It was traced in March 2018 to a RTE processed meat product called polony made at a factory in Polokwane run by Enterprise Foods, then-owned by Tiger Brands. In August 2020, Tiger Brands agreed to sell its processed meats division, which includes Enterprise Foods.

No one to support the family
Kadango is now unemployed. He had a business selling items including clothes and shoes before getting ill. He lives at home with three younger brothers and his child, a 16-year-old boy.

“At that time I was working and my business was going well but when I was sick everything started to get complicated with my child going to school,” he said.

“When I was doing the business I was getting profit to help my child and help my family buy food. When I got sick, it was very bad because everyone in my family was looking after me so there was no-one to help them. I didn’t have anything in that time because every time they come to hospital to bring something to me, they used the transport.

“Sometimes in my house there was no food and no one to look after my child it was a very bad situation. Something like this affected me, which is why I never go far. The one I was doing business with is going very far now and he has a big business. I am still here at home with the lockdown and not doing any work.”

He had never heard of listeriosis before getting sick.

“The time it was starting I saw it on TV but I didn’t know anyone who got listeriosis. I heard about it and some of the problems. In my province, I think I got it and another person. Some of the people I saw on TV were explaining about listeriosis.”

Kadango said he was not sure what the future holds for him.

“I try to go somewhere and see my family and do something else. Most of the things are not the same as before I was that sick with listeriosis, it has affected me a lot. It is affecting my life because most of my friends and family said you was wonderful before. Now, you are not going anywhere and doing this and this. I say to them this thing is very dangerous,” he said.

“The family was feeling very bad and me too, I was confused too much. In my life it is only me, they all depend on me as I am the old man in the family. I also had to look after one of my brothers who was ill but he is better now. Since last time I was trying to do something like a business and if I get a job I am going to work but there are not many jobs here with the lockdown.”

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Nthabiseng was a person who loved family above all else. She always wanted to have kids and was blessed with a daughter, Onthathile, who turns 5 this month. Matlhogonolo Chantell and her twin sister Michell Masego Zaza are raising their sister’s daughter. 

Onthathile doesn’t remember much of her mother, who at the age of 35 died from listeriosis in Oct. 2018. Her death was part of a Listeria outbreak in South Africa that was traced to Tiger Brand’s polony — processed deli meat similar to baloney.

However, it wasn’t until 2020 that the family found out what had caused their Nthabiseng’s mysterious illness. They knew only that many people in the country were getting sick.

The listeriosis outbreak began at the start of 2017 and was officially declared over in September 2018 with 1,065 confirmed cases and 218 deaths. 

 In 2018, Nthabiseng was a new mom trying to adjust to the loss of her mother. Her partner, Onthathile’s father, had passed away before he and Nthabiseng could be married. In the two years after his death, she would lose both of her parents. 

Nthabiseng had already defied odds in having Onthathile. After a liver transplant in 2009, and constant medication in the aftermath, Nthabiseng was told she had only a small chance of being able to have a baby.

 She was in and out of the hospital after her transplant, constantly having her liver checked to make sure it was still functioning properly. Her sister said the family had developed a system and routine to make sure Nthabiseng stayed healthy.

 “At a certain time, she takes her meds. She exercises and drinks water. We take a walk in the park. And we pray a lot,” Matlhogonolo said.

Nthabiseng and her family lived in a suburb of Johannesburg,  South Africa, where a trip to the hospital could take as long as three hours depending on the traffic. When Nthabiseng began to get sick, those hospital trips became more frequent. 

 Nthabiseng’s battle with listeria poisoning

 “It was very quick,” Matlhogonolo said. At first the sisters tried to nurse her at home. “Trying to nurse this thing, it was out of control and they could not keep her fever down. And they were referring to her saying that her kidney and liver had become poison in the system. We thought maybe the liver was rejected by her system.”

“She would vomit a lot and she couldn’t keep food down. She lost so much weight. Her eyes were yellow. Her eyes were turning yellow, so we knew something was wrong and something was eating her,” Matlhogonolo said. “She had diarrhea, that wouldn’t stop. It was crazy. She lost so much weight because she was dehydrated.”

The sisters thought that maybe it was tuberculosis or asthma. But they quickly realized this illness was different. “She was not herself. She really changed. She also had these night sweats, like these cold sweats, and we couldn’t understand. And it just kept going on and going on.”

 Nthabiseng was placed into a high care intensive care unit.

Nthabiseng’s family knew that others in the country were getting sick with something similar, but nobody could tell them what was going on. “The hospital and everything and nobody really knew what was making us sick,” Matlhogonolo said. “And we really didn’t understand.”

 Nthabiseng died Oct. 16, 2018, one month after the outbreak had been declared over.

It took until 2020 for a law firm in South Africa to connect the dots and tell Matlhogonolo and her sister what happened to Nthabiseng and that it was connected to the Tiger Brands outbreak. “We found it out this last year what really happened. What really caused it.”

“They found our names in the files and that we could be compensated if we pursued them. I mean we didn’t know, because we were just trying to bury our sister and find our lives,” Matlhogonolo said. The family in a matter of years had gone from six at home to three. 

“The year before both of our parents died and then our sister died, so a lot of things had happened. Our main focus was for us to like to find our feet. Try to find food. Try to make this baby go to kindergarten. My twin and I were like 24. It was too much to take in. So we just had to grow up.”

 Life after Nthabiseng’s passing

Matlhogonolo wishes Tiger Brands officials had come forward as soon as the outbreak happened. She wishes the multinational company would compensate people and make the public aware that the outbreak was its fault. But she isn’t angry at Tiger Brands. “It’s not good for us to hold onto rage or anger. We understand that things do go wrong in life. But I am disappointed that a big brand like them has never stepped out and looked for people that have had their lives damaged. A lot of people lost their loved ones.”

 “You can imagine as young as we were having no one to rely on, living in a society where they aren’t supporting young black women is really hard. It is a struggle.”

“Knowing that Tiger Brands have done something like this, and they have never come out and said that they are sorry. And really show remorse and compensate. I am really disappointed in their brand. I would say I am disappointed, but I am just praying that justice is going to be served.”

“What I am crying for is her child. She deserves quality education. She deserves quality life. I am being like 26 there are still a lot of things that I need to do for myself and for if I grow old. And being a student like I am, they didn’t think about how people like us really need to be taken care of.”

 “They should make amends for the mistakes.”

 More background information about the 2017-2018 South Africa Listeria Outbreak can be found here.

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James Nsayi is now 5 years old. He was diagnosed with listeriosis during the outbreak and suffers from epilepsy.

The outbreak was linked to ready-to-eat (RTE) meat products and caused at least 1,050 illnesses and 218 deaths. It was traced in March 2018 to an RTE processed meat product called polony made at a factory in Polokwane run by Enterprise Foods, then owned by Tiger Brands. In August this year, Tiger Brands agreed to sell its processed meats division, which includes Enterprise Foods.

Mario Nsayi, James’s father, said before becoming sick the youngster never had a problem with health and was a normal child.

“We had never been admitted to hospital before and never worried before. He was a good boy, playful and full of jokes. Since he became sick it has been a challenge for us as a family and then came the Coronavirus lockdown. His situation has changed our lives,” he said.

Initial illness
James is the youngest child of Mario and Emma. The oldest is 13-year-old Maxwell and 10-year-old Stalvie is in the middle.

“We normally bought polony and other sausages and James used to have it for lunch but as a young boy he used to just cut off a piece and eat it on its own so he had the plain one a lot. Sometimes Maxwell and Stalvie had it for lunch. Now we don’t eat it, since what happened I stopped buying it for the kids as I am scared something else will happen again,” said Mario, who was a tour guide in Cape Town before losing his job earlier this year because of the pandemic.

James fell ill in September 2017 and was admitted to Somerset Hospital for one month with a fever, loss of appetite, and vomiting. He then had a seizure and was sent to Red Cross War Memorial Children’s Hospital.

“He was in the intensive care unit and they discovered it was listeriosis. He was in ICU for two weeks on a machine in a coma, he couldn’t breathe himself, the machine was keeping him alive. He stayed there for two weeks and became a bit better and was sent back to Somerset Hospital. After two weeks he had another seizure. All together James spent three months in hospital,” said Mario.

“The other kids are very traumatized, it (was) Maxwell’s birthday in October. I couldn’t celebrate it because James was very sick, it was a big problem. That has affected him as well. As a child, he says my birthday is not celebrated, not even a cake for me because mum and dad are in hospital. My mother was looking after the children while my wife and I rotated at hospital. We couldn’t leave James alone as it was too serious, you are worried all the time and don’t know what might happen next.

“He lost his memory so he had to learn my name, when he came home from hospital he couldn’t remember me, his brother, he forgot everybody so it was very difficult.”

Follow on problems
About six months later, James started having seizures. He was taken to hospital before being discharged after treatment. However, after another three months, he had another more serious seizure.

“I said to the doctor we need to understand what is going on as we can’t continue like this — seizure and back. One day he’ll have a seizure and we are not there and he is gone forever. They sent us back to Red Cross Hospital and they realized his brain was affected by listeriosis and he had epilepsy.”

Nobody in the family has epilepsy, according to Mario and he wanted to be sure before giving his son treatment.

“The doctor said if you want to save your son you have to do the treatment. If we don’t do it and he has a seizure then gone, finished, he is never coming back. At the beginning we were giving him medication in the morning, lunch and evening. Six months later he had a seizure again and the doctor said the dose needed increasing,” he said.

James was started on Epilim syrup but is now taking a tablet. He will be observed for two years and treatment may be changed if there are no more seizures.

Coping and moving forward
Mario said his son is not the same since the illness.

“He is not like before. I am afraid to take him somewhere when it is too hot. I try to play soccer, rugby or tennis with him. We go in the garden to run and keep him fit. I always keep an eye on him. He is not like a normal child due to what he went through and the epilepsy caused by Listeria. For Maxwell or Stalvie I have no worries but James I always worry where is he, what is he doing, why is he quiet? The rooms are upstairs where we live and if they are watching TV downstairs every 10 minutes I must call James. It is a scared life, something else can happen if I am not there.”

At least part of the blame for the outbreak lies with the government, according to Mario.

“It is important for government inspectors to monitor food chain programs and make sure the product we are eating is safe. If the factory is not clean, it can affect citizens. At the end of the day it is extra cost for medication. Imagine, James spent three months in hospital, all that costs money,” he said.

“As consumers we go to the shops, I put what I buy in the fridge, but we cannot go and investigate. If I say I like polony let’s go and see how they make it, they’ll kick me out but the government has inspectors to make sure people like Tiger Brands are doing a proper job. The government gives them a license to make products the consumer will buy. It needs to make sure hygiene is a priority.”

Mario said it was important for other families going through similar things to find a way to cope.

“It is not something we planned ourselves, it was not our fault. It was an outbreak, there are consequences and people who fall victim of it. We need to accept it. Some people lost their lives to listeriosis and others recovered 100 percent. Unfortunately, I thought my son recovered but now he has epilepsy and this affects emotionally my life,” he said.

“As a parent we need to be courageous, James needs me and my wife and we need to make sure everything is balanced at home. We need to support the children. This Listeria story mustn’t affect James’s life or his future. I still have hope James will recover fully and one day it will be a thing of the past.”

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The transaction includes two separate deals — Molare Proprietary Ltd. will buy the abattoir business at Olifantsfontein and Silver Blade Abattoir Proprietary Ltd., a wholly-owned subsidiary of Country Bird Holdings, will acquire the meat processing businesses at Germiston, Polokwane and Pretoria.

Molare, a major supplier of pigs to the abattoir business, will pay 117 million Rand ($6.7 million) for this deal while Silver Blade has agreed a 311 million Rand ($17.8 million) purchase for the meat processing businesses and all the inventories with the transaction expected to be effective beginning in November this year.

Listeria outbreak
The value added meat products (VAMP) business units operate from an abattoir and three meat processing facilities in South Africa, where they produce and package products such as polony, viennas, bacon and sausages.

The listeriosis outbreak began in 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths and is now the subject of a class action law suit. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at the plant in Polokwane and run by Enterprise Foods, which is owned by Tiger Brands.

Country Bird operates the Supreme Chicken brand, which provides frozen chickens for households, Nutri Feeds brand, which is active in animal nutrition, Opti Agri brand supplying day old chicks into the poultry market, Country Bird Logistics brand which provides a wholesale branch to Country Bird´s operations and poultry related operations in eight other African countries.

Noel Doyle, CEO of Tiger Brands, said almost 1,000 jobs will be safeguarded with the sale of the business.

“This is no small matter, particularly given the escalating unemployment in South Africa in the context of the severely constrained environment and poor economic outlook. We felt that it was our duty to our employees, customers and consumers to ensure that the processed meats category – an important source of protein to many South Africans – properly recovered after the listeriosis outbreak,” he said.

No impact on class action
Tiger Brands conducted a review in 2017 looking at selling its VAMP business. However, the outbreak and closure of manufacturing facilities delayed the evaluation. When the business re-opened at the beginning of the 2019 financial year, a review was started.

In late 2019, a Tiger Brands stock market statement said the business was “not an ideal fit within its portfolio” and that consideration should be given to exiting the category with several offers received.

Tiger Brands said the transactions do not impact the class action law suit or affect its commitment to resolve the ongoing legal process. Any potential liability under the class action will not transfer to the new owners.

“We cannot overstate the significant and far reaching consequences of the listeriosis crisis, particularly on the victims of the outbreak and their families. Tiger Brands remains committed to following due process to ensure that an equitable resolution of the matter is reached in the shortest possible time,” said Doyle.

In June, the Johannesburg Division of the Gauteng High Court ruled in favor of Tiger Brands telling the National Institute for Communicable Diseases (NICD), two accredited national laboratories and some meat producers to provide epidemiological information for the class action lawsuit.

Tiger Brands said the ruling would help provide access to information relevant to the proceedings and enable parties on both sides to move matters forward. The firm issued subpoenas in May 2019 to NICD and other parties requesting the information and later filed an application to the High Court.

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Beulah Rhode (Roberts) started experiencing flu-like symptoms and felt constantly fatigued in mid-May 2018. She was in the hospital from June to August. In July, she went into a coma and was on life support until late August 2018. Tests while she was in the hospital were positive for listeriosis. After waking from the coma, Beulah had lost the ability to speak, read, write, and walk.

The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

Visits to three hospitals
Beulah, who lives in Cape Town, saw two doctors who diagnosed her with a slight fever. She took a week of sick leave but her mother, who is a theatre nurse, convinced her to go to the hospital.

“I was feeling tired all the time like I had the flu. I saw the GP before I got sick because I said why do I feel like I have the flu but I’m not really flu-ish? The first hospital said you’re fine you’ve probably got a bit of flu. At the second hospital I went into the emergency room and doctors told me the same thing. They said maybe I have the flu but I was like no it is not, something felt different,” she told Food Safety News.

“When I went to my house, my mum called and said I want to check on you as you’re not feeling or looking well, then she took me to a different hospital and my journey with listeriosis happened.”

The 35-year-old was in hospital for three months and physical rehab for two months to learn to walk, talk, read, write and how to use a knife and fork again. She was discharged in October 2018.

“That was very frustrating as I have always been motivated and able to do everything for myself. In my life before I could take my three dogs and go and walk with them. I don’t have the physical ability to do this the way I used to before. After rehab I was at home for five or six months and then the company I was working for gave me temporary disability for that period I was not working,” said Beulah.

“During that time I was thinking would I be able to do my job again because the listeriosis affected my brain. I realized it was so difficult because I couldn’t send a text message from my phone because of the spelling of a word. I have a bachelor’s degree in law, I was enrolled to do my Master’s degree and suddenly I couldn’t spell a simple word.”

Going back to work
Beulah said her job as a qualified advocate involves a lot of responsibility and there was no replacement cover in the time she had off. She returned to work in February 2019.

“I was under pressure to pick up where I left off but with the brain having an injury it is impossible to do that. That is the hardest part, my brain wasn’t performing the way I was used to and the same thing for my body,” she said.

“I’ve been blessed in many ways but my biggest challenge is the brain doesn’t recover as quickly as, especially employers, think. Because it is not a physical injury they can see like a broken leg, if it’s a brain, emotions or self-confidence they can’t see that but you feel it.

“For me, every day when I walk into my floor and office it is “oh, here we go” it takes a lot of courage to stand up in a room and speak about things I am struggling to remember. The good thing is it has cleared up a lot of things in terms of what we are lacking, especially in labour law and I could focus on that for a Master’s degree topic when I am ready to commit to it.”

Beulah said the first six months back at work were “terrible” as she was a shadow of her previous self.

“It was very challenging and traumatic because I didn’t know what was happening, I didn’t understand myself because part of your brain is still not processing what’s happened because half of it you don’t know due to the coma. When I did come to I was on life support, so a lot started opening up in terms of what actually happened in that time and that obviously affected me emotionally.”

Beulah’s neurologist and physician recommended she see an expert for a neurocognitive assessment.

“I went to see him in August last year and we did a three hour session with exercises on how the brain responds to questions, lighting, memory and all those things. He provided a report on my capabilities at that stage which were very poor compared to before the incident,” she said.

“He recommended a follow up within six months. The six months after August were very traumatic. I had an epilepsy episode at work in late August as a result of listeriosis which left a scar on the brain and that is causing the connections from the brain to the body to sometimes go crazy.

“Three weeks ago I was in hospital for a week with migraines, my neurologist did another scan and he said it was the scarring that was causing it. A week ago I went to the neuropsychologist for my follow-up assessment and he gave me a very good report. There are a lot of functions that are not at 100 percent yet but I have increased by 80 percent compared to the exercises we did in August.”

From death’s door to marriage
Beulah got married to Envor Rhode this month. Speaking before the big day, she described the occasion as bittersweet.

“It is quite bittersweet because I am thinking this is the most special day ever. But will I have a headache now the whole weekend? If I think about my quality of life, we have expectations, we want to have kids and we want other things and not just a career but what is the quality of that life when you have to lie down if you have a headache, when you have to be careful as your head can’t get hurt again. It’s things that you’ve never considered and you cannot put a value on it,” she said.

“I have good medical aid so got the best care I could get and not everyone has that available. The same with support at work, a lot of people don’t have the support that I had. I had an income for the entire time, businesses close all the time and if you are sick for nine months they are just going to get rid of you but I walked right back into my job.”

While she was in the hospital Beulah’s parents were called by doctors to say farewell to their daughter. However, hopeful she would regain consciousness they kept her on life support.

“I was resuscitated twice in hospital, putting my parents into a tail spin, as Beulah doesn’t get sick but she is in ICU. It is very traumatic, my mum hasn’t got over it. I was at death’s door and now I am getting married. It affects your complete life, your perspective and you either go off on a tangent or you can rise up and I’ve made the decision to rise up. Unfortunately, the listeriosis did not end, it continues every day. My follow-up got cleared, it is out of my body and system but the side effects are still there.”

Emotional journey
Beulah said the third hospital trusted what she said about not feeling well and knowing something was wrong and despite not knowing what the problem was they were determined to find out.

“They did so many tests. My mum was sitting by my side morning and night. My family supported me so much, especially my mum and dad they just believed this is not it for Beulah, she has worked too hard,” she said.

“To myself there were a lot of questions, I was at the top of my game when I got sick so I was confused, why did this happen to me? In hospital and rehab there are a lot of nights lying awake, everyone is sleeping around you, and you are trying to figure out what am I doing here? Look at all these people that can’t walk or talk properly and then I thought oh but Beulah that is who you are right now. In a sense you feel angry, what did I do to have that happen to me and yet it did.”

Initial details about the outbreak were not clear, according to Beulah.

“There was news about it but there was never a name for it, they were saying there is a virus and people must be careful what they are eating but you never heard of someone it happened to, so it didn’t seem like it was here. Even when people heard it happened to me, they couldn’t believe it and didn’t know what it actually was. So we didn’t know enough about it, where we would be at risk and that it was as deadly as it is, it was the last thing on anybody’s mind,” she said.

“I ate polony and a lot of other meats. They wanted to know exactly what I ate and I said I was a single woman living on my own, I would go to the shop and buy things for the month. So when I come home late at night I would throw something in the microwave. It could be a pasta meal or a sandwich. No I don’t eat it now, absolutely not and I don’t buy any brand of polony.”

Beulah said her perspective on life has changed in many different ways and she is looking forward to married life.

“You realize you don’t have as much time as you think and you are here today so make it good. You can have all the cars, titles, degrees and jobs but if you don’t have your health it doesn’t matter what you earn or own or who or what you know,” she said.

“For me it was accepting you are where you are now, so what do you want to do for the next 35 years and I don’t want to spend them running around from 5:30 in the morning and leaving work at 7 or 8 o’clock at night and coming home to feed my dogs, talk to them for a few minutes, have a bath and go to sleep.

“We don’t have kids, we are hoping that is going to come. That is one of the things I shifted aside because of my career. It has to wait until the doctors give me the go ahead when my body has fully recovered. We are working on my health to get it to the optimum level and once the doctor says I am ready then we can try.”

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Petra Bischoff was admitted to the hospital in May 2017 and diagnosed with Listeria meningitis.

She was in the ICU for nearly a month with 20 days on ventilator support. Petra went into a coma and was paralyzed when she woke up. The paralysis extends to Petra’s vocal cords, which makes it difficult for her to speak for any length of time.

‘To be a baby at 69 isn’t easy’
Petra, 71, said listeriosis has ruined her life and that of her daughter.

“I was a very active and happy woman and I cared about my appearance and my health. I ate healthily and exercised regularly. I liked to appear well-groomed and dressed. All of that changed,” she told Food Safety News.

“I was ill two months beforehand and we didn’t know what was wrong. I was feverish, with muscle pains and headaches, an upset tummy and I ended up in hospital. To be a baby at 69 isn’t easy. When I look in the mirror I look at a strange person. I don’t know this person.”

The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

Corne, Petra’s only child, said she noticed something was wrong as her mum was very run down and not like she used to be. The pair live together in Cape Town.

“All of a sudden she started being very tired and lethargic and didn’t want to do anything, just lie down. My mum has more energy than me and she is 30 years older but that did change a month or two before May you could see she was starting to become just despondent with everything and we couldn’t figure out what was wrong.”

Re-learning to walk and talk
Petra was in hospital and rehabilitation for three months including the time on ICU mostly in a coma, one month on a hospital ward and a month in another hospital for rehab.

“In the hospital they rehabilitated her and taught her how to speak, walk and eat again. I visited her every day, I was there more than I was anywhere else. She had to learn everything new because the doctor had explained if your body lies still for so long all the muscle mass goes, so they had to build the muscle mass and retrain the body to do everything. She was very frustrated, angry and stressed. It was very taxing on her, it still is,” said Corne.

“She can’t hear or speak very well due to the damaged vocal cords, her eyesight is very bad so she doesn’t have that quality of life. She doesn’t have good mobility and walks very slowly, her hands sometimes cramp up and we have a full time carer here every day. She’s far better than what she was but it’s still not so that I can leave her alone as sometimes she gets dizzy and bumps into things and she bruises and bleeds easily.”

Petra trained as a color and line consultant in the fashion industry. After working in the real estate industry for 25 years she planned to direct her attention toward her love of interior design and start a business. Petra had bought specialized software to present 3D renderings of designs to clients, and done a course in home staging and property styling.

These plans have been abandoned and Corne lost her job after taking time off to support her mother. She now works in skills development but also used to be in property.

Lifestyle impact
Corne said she has been left mostly alone to deal with her mum’s illness and the heavy financial burden has involved selling property.

“Because she is now a full time responsibility I don’t really go out a lot any more, I was very sociable but now I prefer to stay here to keep an eye on her. I’ve lost quite a few friends as nobody wants to visit someone who is not 100 percent well and fun. This has isolated us in some ways because a lot of her friends don’t know how to cope as she can’t do all the activities she used to with them.

“My mum had a lot of friends and now she has one friend left who is in the medical profession, she is a retired nurse, but the others are few and far in-between to come visit. It is because she gets tired very quickly, her voice goes, she can’t hear them well or walk for long periods of time, so she can’t go out as often and everywhere she used to.”

Corne had not heard of Listeria before being told of the diagnosis by a specialized physician but the pair ate cold cut meats regularly.

“Back then I would buy once a week what we called a mixed packet of the olive loaf and I would take some with the polony and some with the peppers in and curry brawn so there was a variety that she could put on her sandwiches in the day if she was at home. Every week we would buy cold cuts. We will not buy or eat any processed meats now, if we want something like ham I will buy gammon, cook it and cut it up.”

Bearing responsibility: ‘I didn’t get my mum back’

Tiger Brands should bear responsibility after they put the public in danger, according to Corne.

“Apart from the fact so many people have died it is also the quality of life for those who contracted listeriosis is so bad. If I look at my mum, I didn’t get my mum back. So they should take responsibility for this and the Listeria in their plant. They should have pulled those products so people wouldn’t buy it,” she said.

“Tiger Brands bears the biggest responsibility but our government and the health department should also be brought to book for this as well because they obviously didn’t do all the tests that needed to be done to check the health and safety of those plants.”

Corne said the future at the moment is looking pretty dire.

“Her medical costs between the carer and the medication, vitamins and minerals to keep her going are high, as it compromised her immune system. It has affected everything. So financially it has ruined us. I couldn’t finish my degree because I have so many costs to cover that I can’t still pay for my studies so my career path ended as well,” she said.

“It is also a big emotional burden because I don’t ever know in the morning when I go if I am going to be phoned if she is not alright, does she need to go to hospital, she is ill a lot and depressed a lot which makes me depressed a lot, so it has diminished our quality of life and made us withdraw socially.”

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Elizabeth Matthee, 73, fell ill in January 2018 and was in and out of hospital until early August of that year. Doctors initially thought the source of illness was her knee, but in March 2018, she was asked to return to hospital because tests confirmed she had listeriosis.

Elizabeth lives in an old age care home. Prior to her illness she enjoyed reading and watching TV and used to sit outside chatting and laughing with others at the home. The pensioner was able to move around with assistance. Her immune system has been severely hampered by listeriosis and she now depends on full-time care.

The listeriosis outbreak began at the start of 2017 and ended in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

Emotional impact
One of Elizabeth’s daughters, Christina Tiana Verhave, said she was a very bubbly, cheery type of person.

“We had absolute hell with touch and go situations continuously. This took a toll on my mother’s will to live, her spontaneity and her outlook on life in general. You could hear her laugh when you walk down the hall and everybody that knows her knows she will always have a joke, doesn’t matter if she is in pain or not. This took away her spirit because she was feeling so ill for so long, and she is still not well. At one stage she told me she doesn’t want to live anymore,” she told Food Safety News.

Having some polony was part of the regular routine for Elizabeth.

“Every single night she wanted Enterprise French or garlic polony, viennas from Spar or Woolworths with bread and coffee, that was her treat and she loved to have it for supper. Needless to say she is not touching polony since she found out what happened. I can’t even dare to ask her if she wants something like that. We eat ham but I don’t like polony so what we buy for my mum is different than what we eat. I thought they cleared everything to say it is safe now but I will never ever buy it again,” said Christina.

In and out of hospital
Elizabeth was first admitted to hospital in February 2018 due to an infection in her knee. The same month she was hospitalized with a urinary tract infection and more knee problems.

In early March, blood tests showed she was positive for Listeria monocytogenes and after three weeks of treatment she was discharged. At the end of the month she was admitted again complaining of constant severe headaches, vomiting, and diarrhea. Her blood culture was negative for Listeria but a stool culture showed Clostridium difficile toxin. She was discharged one week into April.

Elizabeth had to go to hospital several times in April and May complaining of leg pain. She was readmitted in mid-June with complaints of nausea as well as stomach and leg pain but insisted on being discharged.

She was admitted again one week into July for symptoms of pneumonia and herpetic pharyngitis. She had developed sores in her mouth and had not been eating properly. Elizabeth remained in hospital until early August.

Christina said she was in and out of hospital with her mum and it was a never ending story.

“It was a long, long trial for us to get her to be healthy again. Now the knee is acting up again, it is smelling so bad, and I have another appointment at the hospital for a check-up,” she said.

“At first she fell ill with fever, we didn’t know what was going on so we took her to hospital, they couldn’t find what was at fault but they gave her some antibiotics and sent her home. We went again and eventually the second or third time as they were loading her into the ambulance, her knee where she had a previous knee replacement, the scar popped open and started draining. When they took her in hospital they did a swab and tested it. They sent her home again and it took a couple of weeks before they realized that she had listeriosis. The doctor phoned me and said I must bring her back immediately.”

Elizabeth’s treatment was further complicated by the fact she is allergic to penicillin, one of the antibiotics used to treat listeriosis.

“In hospital she was lethargic, she did know who I was but she had stories in her head that weren’t true and she got aggressive at a stage. They said it was the listeriosis treatment she was on,” said Christina.

“There was a fluid build-up in her ear drums because of the infection. So she couldn’t hear when we were talking to her and that made her more anxious and upset. We had to put our mouth by her ear and talk really loud for her to hear a kind of noise. She didn’t know what was going on around her.

“I’m with my mum every day at hospital, I sometimes drive there twice a day because the health care here is not good. I go and check up on her and see she is eating and drinking and I feed her if I need to and brush her teeth. I just look after her, I can’t not do that, I will never sleep if I were to leave her and not see her every day and know she is alright. I can see my mum is going downhill. I can feel when I touch her arms that her bones are brittle.”

A lasting memory
Christina said there is one occasion that she particularly remembers.

“One night I remember, it was a Thursday, the old age home phoned me and said you must come to your mum, so when I got there she was out of it completely and it looked like a dead person lying in the bed. I saw her a week before, I used to fetch her to us at least every second weekend as we are a very close family and she was always game if you say lets do this or that,” she said.

“We phoned the ambulance service and they didn’t come. I was actually praying the Lord would take my mum because it was difficult for me to look at her and see she can’t really breathe.

“The next morning we were sitting by her bed waiting for the ambulance to come. It came Friday evening and then I sat next to her bed at hospital and in the ER until 11 that Saturday morning and a doctor still hadn’t come to see my mum. I had to go home and when I came back nobody knew where my mum was. They put her in a room that was almost like a storage room and left her there. When they read on her chart she had listeriosis they secluded her from everybody else and forgot she was there. She didn’t have her medication that she should have every four to five hours. It was horrifying to find my mother in that condition. We had so many bad experiences in hospital.”

Christina said she had heard of Listeria on the news but didn’t give it much attention.

“It was only when the doctor said your mum has listeriosis I said will you refresh my mind and then it all dawned on me. Since then people have been treating her differently because they are scared to be close to people with Listeria, they think she is contagious. It was an experience, we had to explain to staff working with her and people sharing the room that they are safe and she can’t infect them.”

Christina is a single mother, working long hours in a bookkeeping and accounting job and she sometimes relies on her sister to help with her 11-year-old son.

“You have to be strong and carry on for your family’s sake. It gets to a point where I work in the evening and at weekends and rush from the hospital to work and back to hospital and then I come home and see everything is sorted with my son. Tomorrow morning you get up at 5am and start your day, I go to the hospital before work to see she is fine and then to work, sometimes I will go during lunch if I know I can’t make it after work. I don’t know what the future holds, I am just trying to survive from one day to the other.”

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Lawrence MacDougall will retire from the company effective Jan. 31, having reached the firm’s mandatory retirement age of 63.

MacDougall has been at the helm of Tiger Brands since May 2016. Prior to that he was executive vice president and regional president for Eastern Europe, Middle East and Africa at Mondelez.

In March 2018, a listeriosis outbreak in South Africa was traced to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands. The outbreak began at the start of 2017 and ended in September 2018 with 1,065 confirmed cases and 218 deaths.

The current chief financial officer at Tiger, Noel Doyle, has been appointed as CEO effective Feb. 1.

Board chairman, Khotso Mokhele, said: “We want to thank Lawrence for almost four years of devoted service which involved many accomplishments and wish him all the best in his upcoming retirement and future endeavours.

“After a rigorous and extensive search process, the board and I are pleased to have appointed someone of Noel´s calibre, experience and ability to fill the CEO position.”

Tiger Brands said an update on the CFO position will be made in the future.

The company is considering selling its Value Added Meat Products (VAMP) business, which includes Enterprise Foods with the formal due diligence process underway. A strategic review was started in 2017 but the outbreak and closure of manufacturing facilities delayed the evaluation. When the business re-opened at the beginning of the 2019 financial year, a review was started.

Tiger Brands plans to fight a lawsuit relating to its part in the deadly outbreak. The first stage of the process deals with liability. Damages would be handled at a second stage if the court finds the firm liable.

Richard Spoor Attorneys is representing more than 1,000 people affected by the listeriosis outbreak. The Seattle firm of Marler Clark LLP is serving as a consultant for the case attorneys.

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The study analyzed the effect of the Listeria monocytogenes outbreak on consumption patterns of processed cold meat products by students at North West University, Mmabatho South Africa.

The 2017-2018 listeriosis outbreak was traced to contaminated processed meats produced by Enterprise Foods, a subsidiary of Tiger Brands, in Polokwane. About 1,060 cases were confirmed and 216 people died.

The North West University Mafikeng Campus has 12,864 registered students. Surveys and interviews were conducted from June to July 2018. Recently findings published in the IOP Conference Series: Earth and Environmental Science journal.

Difference between men and women
Students were questioned on their consumption patterns before the outbreak, effect of listeriosis on consumption of processed cold meat, and factors that affect eating patterns.

Of the 175 females surveyed, 60 of them continued eating processed cold meat but less often while the remaining 115 stopped consuming it. From 180 male students sampled only 12 changed their consumption pattern.

Male students consumed processed cold meat more than females regardless of news of the outbreak, indicating females are more concerned about food safety while males are more worried about hunger satisfaction and convenience.

Only 23 percent of surveyed students had a regular meal time because of academic obligations and differing schedules. This resulted in students grabbing something to eat quickly and most foods at their disposal were items with processed cold meat products, according to the researchers. The outbreak led to most students spending more time preparing meals and this may have a negative effect on academic performance.

Price and convenience
Fresh meat is more expensive than cold meat, it does not last as long and with the limited budget of students it becomes more economical to purchase processed cold meat. Those who preferred processed cold meat said so because of convenience and taste.

Students who lived on campus consumed less processed meats after the outbreak but those who resided off campus, and had to wait for classes to end before they could go home, would purchase food at the cafeteria or food stalls which served mostly processed cold meat.

Researchers found one way the outbreak did not influence student’s consumption of processed cold meat was because they did not have other options so most respondents said they only changed brands and not products.

Results showed there were socio-demographic factors which influence consumption of processed cold meat by students. Parameters such as gender, income, residence, consistent meal time, meal preferences, price of alternatives and academic level influenced consumption of cold meat before, during and after the outbreak.

Researchers said policymakers should try to eliminate reported difficulties faced by consumers in adapting to changes in consumption and purchase of recalled food during an outbreak by being product and brand specific and clear on what is safe to eat so people do not rely on rumours. A lot of confusion was caused by the recall and students also lost faith in other brands.

Salmonella school outbreak
Meanwhile, another study has detailed an outbreak where 164 children fell ill after eating processed maize meal, beans and vegetables at a South African school.

The outbreak occurred among schoolchildren who were given food by the government-sponsored National School Nutrition Programme (NSNP) at a public primary day school in North West province, South Africa. It was the first large foodborne outbreak linked to NSNP in this region of the country. Despite the outbreak being in 2014 the study was only recently published in the Southern African Journal of Infectious Diseases.

Salmonella Heidelberg was the causative agent in 92 percent of the cases. The median duration of illness was two days with a case fatality rate of 0.6 percent. A hospitalization rate of 5.5 percent was estimated for severe cases. The main food product contaminated was samp, a processed maize meal, which was poorly stored and prepared.

A common bacterial strain of Salmonella Heidelberg was found in stool samples from 10 cases and two asymptomatic food handlers. Kitchen facility swabs were unsuitable for lab testing. Only cooked samp was confirmed to have a strain of Salmonella Heidelberg matching that isolated from stool samples. The outbreak occurred over five days.

Direct infection from eating contaminated samp was the most likely source of the outbreak but there were 18 additional secondary cases. Eleven of these, including a 4-year-old who died, occurred in a household following consumption of samp taken home after school.

Environmental health investigations revealed problems with food safety practices including lack of staff training and absence of records on food safety according to hazard analysis and critical control points (HACCP) principles.

“Regular training plus screening of food-handlers, strict personal hygiene, appropriate food-handling and storage and proper disinfection of environmental surfaces remain crucial to prevent further transmission of Salmonella Heidelberg,” said researchers.

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It’s Dec. 24, do you know where your name is?

Here at Food Safety News we’ve been checking the year-end Naughty & Nice Lists and we’re ready to nominate some names. When it comes to candy or coal, one thing is as sure as Santa’s annual review — every year has its share of sugar plums as well as plum pits, and 2019’s been no different in that regard.

Some entries on our lists can be considered as representative of countless others.

For example, legislators on our Nice List are but a small sample of elected officials who are trying to do the right thing. Many government administrators and appointees also stand as cases in point for their counterparts at all levels of our democratic republic.

Industry also has it’s goods and bads, from companies that are repeat offenders to trade association scientists who are willing to stand up and talk about uncomfortable realities.

But first, an entry from
the On the Bubble List:

In 2019, Scott Gottlieb, the now former FDA commissioner, was beginning to show that his span of control was going to treat food safety equally with the drug and medical side of the house. We  were impressed, but then he quit because he decided his job was too far from his wife and daughters, who remained in Connecticut. Nice to them. Naughty to the rest of us.

The Dark Side, aka The Naughty List

Tiger Brands executives
This year we found out that multi-national, mega-player Tiger Brands plans to fight a class action lawsuit about the company’s part in the world’s largest ever documented Listeria outbreak. The 2017-2018 outbreak in South Africa sickened a minimum of 1,065 people. At least 218 people died. A hearing on the class action lawsuit could occur by mid- to late 2020.

The lawsuit was brought against the company by Richard Spoor Attorneys and LHL Attorneys. In April, Thami Malusi of Richard Spoor Attorneys told Food Safety News the company’s move to fight the class action was expected.

The listeriosis outbreak was traced to a ready-to-eat processed meat product called polony that was made at a plant in Polokwane and run by Enterprise Foods, which is owned by Tiger Brands.

The class action was initiated on behalf of those who were sickened by the contaminated polony and for families who lost relatives in the outbreak. The Seattle firm of Marler Clark LLP is a consultant for the South African attorneys.

Almark Foods
The operators of this company could have been on the 2017 and 2018 Naughty Lists for their role in a three-year Listeria outbreak traced to their peeled, hard boiled eggs, but the outbreak was not reported by public health officials until recent days.

As of this past week, the tally stood at seven people in five states confirmed infected with the outbreak strain of Listeria monocytogenes, according to the Centers for Disease Control and Prevention. One of the patients has died and four have had to be admitted to hospitals.

Illnesses began in 2017, the same year the Food and Drug Administration found the outbreak strain of Listeria monocytogenes at the currently implicated egg factory. The company apparently failed to resolve the problem.

Federal inspectors again found the outbreak strain of Listeria monocytogenes at the Georgia plant in February this year. The operation is currently shut down and will remain so until the company can “further investigate the issue.” The company recalled 200,000 eggs on Friday, Dec. 20.

“We adhere to strict food safety practices and seek to constantly improve our products and processes,” according to the Almark website. “Our ‘Hard-Boiled Eggs’ are produced without any artificial colors, flavors or preservatives.”

The recall includes peeled, hard boiled eggs that have expiration dates as far off as Feb. 26, 2020.

Frank Yiannas and the FDA
This past summer a 12-state E. coli outbreak sickened 23 people, with 11 requiring hospitalization. The source was most likely romaine lettuce, according to the Food and Drug Administration, which didn’t bother to reveal the outbreak to the public until Halloween. Industry also remained mum.

Both the FDA and CDC investigated the outbreak of infections from potentially deadly E. coli O157:H7, but the federal agencies “did not identify actionable information for consumers” and therefore did not reveal the outbreak.

Making the coverup even worse was the context set by the top food safety official at FDA earlier this year.

Frank Yiannas, FDA deputy commissioner for food policy and response, promised safer “smarter” food safety with a more digital, traceable footprint. As it turned out, all the “smarter” food safety talk was just that, talk. The FDA kept the outbreak secret for more than six weeks.

As our editor Dan Flynn said in this year’s roundup of the Top 10 food safety stories of the year, “there’s been no honest explanation as to why the FDA kept the secret.”

When he finally did come clean, Yiannas said the agency opted to go public “to help ensure full awareness by the public and to highlight the ongoing importance of industry actions to help ensure the safety of leafy greens.”

Public Health England
A government agency tasked with part of the responsibility for food safety across The Pond earns a spot on the Naughty List. Public Health England (PHE), or rather the communication by PHE, is lacking. Anyone that works in the sector will know the expertise of PHE staff and the experience, knowledge and technology of the surveillance system ensuring they detect foodborne diseases, likely quicker and more often than some other countries.

But did they communicate about an E. coli O157 outbreak in October, a Salmonella Bredeney outbreak in August, 138 ill from Salmonella Mikawasima as of November, the 45 sick in 2019 from Salmonella after eating British eggs, or 24 Salmonella Enteritidis cases in people on cruise ships visiting the Eastern Mediterranean and Middle East? No. At least not until we asked or another agency revealed details.

How many outbreaks were never revealed? What about Cyclospora that sickened nine in June and then we heard nothing? And more illnesses linked to the Salmonella Enteritidis outbreak from eggs from Poland or the new strain of Salmonella Typhimurium in sheep behind almost 300 illnesses and one death in 2017 and 2018?

Plus, the speed and content of the information shared about a Listeria outbreak from chicken sandwiches sold at hospitals was less than timely or transparent.

The Force, aka The Nice List
Rosa DeLauro and the Congressional Food Safety Caucus
A U.S. representative, Rep. Rosa L. DeLauro, D-CT, has been a food safety champion for years. She heads the Congressional Food Safety caucus, which works to keep foodborne illnesses on the radar in Washington D.C. where the trillion-dollar chunks of the federal budget get the most attention.

A consensus builder, DeLauro has worked with Republicans and Democrats to raise awareness, hold government agencies feet to the fire, and introduce legislation to strengthen protections for the American public.

Among her efforts, and those of her colleagues on Capitol Hill, this year were:

• December GAO report — The GAO is the audit, evaluation, and investigative arm of Congress. It studied seafood imports at the request of Rep. Rosa L. DeLauro and four U.S. Senators: Richard Blumenthal, Dianne Feinstein, Patty Murray, and Elizabeth Warren. The GAO said the members of Congress asked for a review of the FDA’s efforts to use import alerts to ensure the safety of imported seafood.
• Beef plants — Although a single supplier had not been identified, federal officials knew a number of specific beef plants were contaminated with a strain of Salmonella behind a deadly outbreak. But, the USDA wouldn’t name those companies. Seeking to force the U.S. Department of Agriculture to reveal the information, two members of Congress wrote to Agriculture Secretary Sonny Perdue. The legislators played a business card in addition to citing public safety concerns. “By disclosing this data, USDA will foster market-based incentives for safer meat and poultry,” wrote DeLauro and Sen. Kirsten Gillibrand, D-NY.
• Cavi papayas in August — DeLauro demanded that the FDA use its mandatory authority to force Agroson’s LLC to recall Cavi brand whole, fresh papayas. The papayas were likely responsible for a multistate outbreak of Salmonella Uganda illnesses in the United States, according to both FDA and CDC. Agroson’s LLC is the brand’s exclusive distributor and it’s owners flatly refused to initiate a recall.
• Consolidating food safety — Citing fragmented food safety oversight, which is split up between 15 federal agencies, DeLauro and Sen. Dick Durbin, D-IL, sought to scrap the current system and the ineffective laws that regulate it. The Safe Food Act could weave the patchwork system “where no single voice guides industry, retailers and consumers” into a seamless force for safer food in the United States according to Durbin and DeLauro. “We need a common-sense, 21st century way of ensuring food safety — and a single food safety agency is it,” DeLauro said.

Folkhälsomyndigheten and Statens Serum Institut
On the nice list are Folkhälsomyndigheten (Public Health Agency of Sweden) and Statens Serum Institut in Denmark. Throughout 2019 and for the past several years both of these agencies have been contacted on numerous occasions with often short deadlines to meet our online and daily publishing schedule.

Most of their food safety announcements are in Swedish or Danish but they are willing to take the time to speak English and ensure questions are answered and any translations correct. Other agencies are not always as helpful on these public health issues, even when contacted in their native language.

In the quest of Food Safety News to cover international news it would certainly help if other agencies took this approach. So, to Folkhälsomyndigheten and Statens Serum Institut, we say Tack and Tak, respectively.

Trevor Suslow of the Produce Marketing Association
Trevor Suslow, currently vice president for Produce Safety at the Produce Marketing Association, was formerly affiliated with the University of California-Davis. During decades with the university’s Extension Service he did volumes of research with post-harvest produce and freshcut produce. In November he wrote a letter to members of the fresh produce industry amidst yet another romaine outbreak.

Suslow, respected by industry, academia and government, had some choice words for federal agencies, but he also said what industry never wants to hear. Efforts to contain the romaine situation had failed.

“Early on over this past weekend, it was relatively easy to find retail product on shelves with the consumer-facing stickers identifying Grown In information which should have resulted in removal for sale,” Suslow wrote to the industry that pays his salary.

Also, he has had an eye on concentrated animal feeding operations (CAFOs), also known as feedlots, for years in terms of their proximity to fields used to grow produce intended to be eaten raw. Suslow is among those who investigated links between a feedlot near growing fields in Yuma, AZ, that were implicated in a deadly E. coli outbreak.

“. . . the (intent of the) Expanded Food Safety Inspection Act by U.S. Sen. Kirsten Gillibrand of NY. . . is to explicitly give FDA the authority to conduct environmental investigative sampling at any locations it deems necessary to pursue a source of contamination,” Suslow wrote in his letter to the produce industry.

“The focus would include animal feeding operations, compost facilities, and other non-target and off-farm locations deemed relevant. FDA does not currently have full authority to conduct this type of sampling. . .”

Wouldn’t it be nice if all industry advocates were also public safety advocates?

The victims
We don’t know whether all of the foodborne illness victims of 2019 — and their loved ones — were actually nice people. We do know no one deserves to be the victim of food poisoning. No one deserves to lose a relative or friend to food poisoning.

We also know personal stories about real people are among the strongest tools there are to raise awareness about the otherwise faceless legions of those sickened by bacteria, parasites and viruses in foods and beverages.

That’s why we brought our readers interviews with victims of the South African Listeria outbreak.

That’s why we described the horrific consequences of E. coli infections faced by children in an outbreak associated with unpasteurized, raw milk in Tennessee.

That’s why you can count on us being back in December 2020 with another installment of our Naughty & Nice Lists.

Note: Editor Dan Flynn contributed to this column.

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Nomonde Mahule was told during labor that her daughter would not survive as delivery came too early.

The baby was born prematurely at 25 weeks and cried out briefly before passing away. Nomonde was admitted to a hospital in January 2018 and discharged after two days. A few days later the hospital called to tell her she had listeriosis and she was told to get medication from a local clinic.

Nomonde and her partner, Sibusiso Mogale, live in Mpumalanga, South Africa. They were expecting a baby when she contracted Listeria. Nomonde also has a 5-year-old daughter and recently had a baby girl.

The 24-year-old said February and March 2018 was an emotional time as she suffered from grief when she looked at her belly that once carried her baby. The sight of another pregnant woman or baby also brought back feelings of hurt as she recalled the loss of her baby.

The listeriosis outbreak began at the start of 2017 and ended in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

Domestic and work impact
Mogale said the pair had a few names in mind but hadn’t decided as they thought they had more time.

“The preparation we had done was the clothing and certain baby stuff we bought for our daughter and moving to a bigger place because we were initially staying in a one bedroom apartment and then we decided to move to a bigger apartment for the sake of the baby,” he told Food Safety News.

“It was devastating for both of us and tough for Nomonde’s daughter because she couldn’t understand as we were a bit distant. She would want to play, like she used to before, but sometimes when you played with her, as the memory of what had happened was still fresh, you would break down and you don’t want to cry in front of her because she wanted to know why you are crying.

“It is hard to lie to her about something so serious. She would remind her mum now and again where is my baby sister as we had already told her and she had seen the lump on my wife’s stomach.”

Mogale lost his job in electrical engineering after taking time off due to the tragedy.

“It was tough but I think the fact that we were able to support one another helped. I couldn’t handle it at work, I was crying every day, I wasn’t doing my work, I didn’t want to be in the office and was constantly trying to speak to someone. But now that we are alright I am starting to apply for other employment but it is tough I won’t lie. I think that was the toughest period for both of us because we spoke about it only to realize we had never been through such a huge ordeal. For me it was a life changer in more ways than one.”

Cravings while pregnant
Nomonde’s favorite food during pregnancy was polony, especially chicken polony. Now she avoids cold meat and fast foods and has started drinking bottled water.

“We were not eating a lot of polony before but as soon as she got pregnant Nomonde started craving the chicken polony so we bought it quite a few times. She would sometimes eat the polony on its own without putting it on bread or with a salad,” said Mogale.

“Since the incident we’ve tried not to have it but we are told things are back to normal. We are a bit reluctant in terms of buying Enterprise. It is a product that is loved by a lot of people, I myself love Enterprise polony, viennas and Russians but I am just a bit scared right now.

“It is a scary thought but we had no idea about listeriosis, why was the product on the shelves? It could be any other brand from here on, we could try and avoid Enterprise products and then another product becomes a problem.

“As a company they should be more careful because they are distributing products that are consumed by people that are working. I lost my job because of a product that my wife consumed and we lost our baby together. For people to buy their products it needs to be people who are employed.”

Nomonde began feeling abdominal pain in January last year. However, as it would come and go she believed it was a normal pregnancy symptom.

“I went to see a GP who ran some tests to check what it was as he wasn’t sure and he gave me some medication and said come back if the pain persists. So we went and then in the afternoon the cramps had become more painful so I couldn’t sleep and then I went to the bathroom and I saw blood. We went to see our GP in the morning, he sent us to a gynecologist at the Mediclinic Nelspruit. When we got there I already had labor pains so they admitted me and ran a few tests and said I would have a premature baby because I was not due by that time, I was approaching five months,” she said.

She cried twice and that was it
Mogale said at first they were not sure if it was listeriosis or another infection.

“They gave her medication to see if they could slow down the birth so at least she could reach six months. So they tried to keep her in the hospital for a couple of weeks so the premature baby could be born with a higher chance of surviving,” he said.

“I was with her at the hospital and then I left going back home because they said she was going to sleep over. About an hour later she called me and said listen I am going to give birth the doctor said the baby is coming right now, so I went back to the hospital. The doctor did warn us there was no way that the baby will survive, she can be kept in an incubator, but it is not going to help as the baby is not strong enough and her organs are not fully developed.

“I got there and she was already in the delivery room. In our culture we wanted to give her a proper burial, so as soon as she was born, she cried twice and that was it. She passed on a couple of seconds after being born.”

It is important people talk about what happened and don’t try and deal with it alone, according to Mogale.

“It is not easy at all but the best thing you can do is support one another and if you don’t have a partner, family members can support you, don’t try and deal with it on your own. More than anything try to speak about it because it does help, even if it is your friend, a family member or colleague at work it does help the more you talk about it and you can also assist somebody else who doesn’t know when you talk about it. A lot of people in our community couldn’t believe that we went through such a thing, they had heard it from the news on TV far from us and suddenly it is right here.”

Mogale said the pair are now looking to the future as they have recently had a baby girl.

“Right now it is growing as a family, my wife wants one more kid, she is hoping for a boy, but I am happy with the two we have now as we have a girl who is a few months old. I want to travel a lot with my family, I am the dad and am surrounded by females so I want to teach them a bit, let them be independent and get a tombstone for our baby girl by the graveyard. I want us to get married, she wants a big white wedding so I need to get a job and save up money,” he said.

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Innocentia Phaahla was pregnant at the time of her illness. In late November 2017 she was hospitalized and gave birth to a stillborn child before being discharged. She was readmitted to hospital in early December and treated for listeriosis, after which she was discharged again two weeks later.

The 29-year-old told Food Safety News that the memory continues to haunt her emotionally.

“Listeriosis made me lose my baby. I delivered early and the baby was a stillborn. I was 22 to 24 weeks pregnant. They discharged me immediately after the delivery and then they told me they were going to call me for the placenta results. After a day or two they called me and said I must go to hospital immediately for treatment as the results showed I have listeriosis. They explained to me that the treatment is a hospital stay for 14 days,” she said.

The listeriosis outbreak began at the start of 2017 and ended in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

Whole-genome sequencing by the National Institute for Communicable Diseases (NICD) in South Africa confirmed the stillborn child contracted the sequence type 6 (ST6) outbreak strain. This type was found in environmental sampling swabs and ready-to-eat processed meat items from the production facility.

Unexpected loss

Phaahla had named the baby boy Matlhogonolo, which means blessings, and said she was thankful for support from her family and fiancée.

“They gave me the support because the loss was a very drastic one, so unexpected. Everything was going well and then suddenly, boom, you know. So it was very disappointing. It is very bad, especially as it was an instant thing. It is not nice losing something special to you,” she said.

“It was an unexpected thing and since I am not working I had no other option than to cremate the body. When they asked me at the hospital what will you do with this body, if you are taking this baby for a burial it means you must bring a hearse, a coffin and the burial itself so I didn’t have any funds then so I decided for the baby to be cremated.”

Phaahla was a regular consumer of Enterprise polony and Russians but refuses to eat them now.

“Normally with my groceries I bought Enterprise polony. Usually I made a sandwich and cut the polony how I wanted it. Since then I am afraid to eat any polony, I don’t eat it now. I am just taking it slowly but it really affected me with eating. I no longer eat polony, so even if they say everything is ok now and back to normal I do not eat it.”

No going back to what caused illness
Enterprise polony has been back on supermarket shelves since late last year but Phaahla said she could not eat it just in case of another problem.

“I’ve read things saying they are clear now and the health agency approved it but I am still afraid because why did it happen the first time? I don’t have that assurance so I decided for myself not to have the polony because how did it come to the shelves the first time then we contracted listeriosis. Now they are assuring us everything is fine so what is the difference now?

“If you know what made you ill I don’t think you would go back to this thing again. Regardless of other people saying it is fine and back on the shelves, what happened the first time when it was on the shelf, they said it was fine and they approved it. So for me it doesn’t make a difference because it happened.”

Authorities also could have done more to prevent or reduce the size of the outbreak, according to Phaahla.

“If the authorities took serious precautions maybe they would realize that there was something wrong. But there had to be an outbreak first so they could get into the investigations and see what was the problem. If they did that first maybe the outbreak would not have happened or not been as large.”

Phaahla lives in Mamelodi, Pretoria, but frequently visited Lephalale in Limpopo to be with her fiancée. She also has a 9-year-old girl.

New arrival helps Innocentia cope
Her pregnancy had been going smoothly but she started feeling sick in her third trimester and, toward the end of November 2017, began experiencing a stiff neck and her health deteriorated rapidly.

In late November, Innocentia developed a fever and experienced contractions. She went to Steve Biko Hospital and doctors concluded she was in labor and the baby had to be delivered urgently.

After only 22 weeks of pregnancy, Innocentia gave birth to a stillborn. The fetus had a rash and a swollen stomach which prompted doctors to run additional tests. After she attended counselling, she was discharged from the hospital on the same day.

Distraught after the trauma, Innocentia went to Limpopo to be with her fiancée. However, she received a call from doctors in early December saying a swab of the placenta had tested positive for Listeria monocytogenes.

They explained that, because of her baby’s diagnosis, she needed to be readmitted to a hospital immediately. Innocentia was afraid to be treated by a different doctor, so travelled back to Steve Biko Hospital where she was also diagnosed with listeriosis. She was hospitalized for 14 days while being treated with antibiotics.

Phaahla now has a 10-month-old baby boy, called Kgothatso, which means my consoler or comforter.

“Now I have a small baby boy so I am happy with my decision of stopping eating the polony. What has helped me cope with the loss is I had to have another baby, I wouldn’t have coped if I hadn’t had another baby. After that tragic thing it was very bad and I had post-natal depression but now I am engaged and looking to the future,” she said.

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The company said as part of a strategic review it had been looking at the possibility of selling its Value Added Meat Products (VAMP) business, which includes Enterprise Foods, in 2017. However, the outbreak and closure of manufacturing facilities delayed the evaluation.

The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths. It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

When the business re-opened at the beginning of the 2019 financial year, a review was started.

Offers received
A Tiger Brands stock market statement said this found the business was “not an ideal fit within its portfolio” and that consideration should be given to exiting the category.

It confirmed there had been “several indicative offers” and a formal due diligence process has been started ahead of a final decision being made.

Company officials said the actions do not affect its commitment to the class action legal process which is underway.

In April this year, owners of Tiger Brands said they planned to fight the lawsuit relating to the company’s part in the outbreak. The first stage of the process deals with liability. Damages would be handled at a second stage if the court finds the firm liable.

The firm of Richard Spoor Attorneys are representing more than 1,000 people affected by the listeriosis outbreak. The Seattle firm of Marler Clark LLP is serving as a consultant for the case attorneys.

Earlier this year, Tiger Brands issued subpoenas to food testing laboratories for information on the identities of those who submitted samples for listeriosis testing and results of these tests during the outbreak period. This action is separate to, but has the potential to delay, the main litigation.

No hearing is planned for this year but it could happen by mid-to-late 2020.

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Gina Moyo was hospitalized for eight days in November 2017. She was quarantined and not allowed to see her two children.

“It really is something I wouldn’t wish on my worst enemy. I don’t think you ever get over it. One of my friends came to see me before they established it was Listeria and the sight she found me in, every time she thinks about it she wakes up in the night sweating as she has never seen anything like that before,” Moyo told Food Safety News.

The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 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 is owned by Tiger Brands.

Lasting impact

Moyo said listeriosis has left a lasting emotional effect on her and her family. She has restricted her diet and is reluctant to eat out. Moyo also has anxiety for her children’s health, especially when they are at school as she has no control over what they are eating.

“We’ll have a function at work and they’ll say come and eat but I have to think 50 times before I eat anything. Already I had a problem but now it is worse because I have to find out what is in it, did they wash it, it messes with my mind. I don’t know if this is going to go or get slower. It makes me wonder how my kids never got ill, it is in the house, I keep thinking what if I would have lost a family member, what would have happened to my kids or my husband?”

The 44-year-old has two children. Her son is now 10 and a daughter of 13 years old.

“The kids don’t really understand what it is, except that their mother was away in hospital and she had this. At school I believe they are being taught about the bacteria itself and the fact that they need to be extra careful. I find my kids saying ‘mummy, before you put any food in the fridge you need to wash the apples’ or whatever it is and when you take it out you need to wash it,” she said.

Polony was not something the family ate all the time but as an occasional snack.

“I wouldn’t say I regularly ate it but I remember buying polony and viennas from Spar. When I got home after work I would be feeling hungry so I would eat a Vienna or some polony before supper. I don’t eat it anymore, I am too traumatized to even look at it. The outbreak came from one of their plants and they should have taken extra care in their food products,” said Moyo.

After the outbreak there was a lot of information about the bacteria and what to eat and avoid but before becoming sick Moyo said she had never heard of Listeria.

“Even after I was told I had this bacteria there was a lot I didn’t know. It was only after I went back to work, about four weeks after coming out of hospital, I heard on the news that listeriosis is a big thing and I got a call from the health agency to interview me about it. Nobody explained what it was or how it came about, I just thought it was one of those bacterias.”

Hospital admission
All the time Moyo was in hospital she was under quarantine as initial tests showed a bacterial infection but further analyses were needed to confirm it was Listeria. The bacterial infection was spreading through her body and had started to affect parts of the brain. During the eight days in hospital, only her husband could see her for a limited time and he needed to wear protective clothing.

Moyo said symptom onset was sudden as she was not feeling sick.

“I went home, made supper, we all ate supper and went to bed. Around midnight I woke up and I had a very high fever and I was shaking. I took some painkillers thinking I was catching the flu but the fever kept going up. Three times in the night I took medication and around 5 o’clock I woke up and I couldn’t feel my feet when I was stepping on the floor.”

After visiting her sister-in-law in hospital, Moyo was heading to work when she had a “locking” feeling in her hands and feet and lost all mobility.

“I drove to the nearest hospital and just as I got out of the car everything just stopped in my body. My hands and everything just totally locked, I could not move them but I was feeling pain. This continued for about a day. My hand was folded in a fist and it would not open. It was only after I started getting injections to try and kill the bacteria then I was able to open my hand. After two days I started to gain mobility. If I hadn’t turned to go to hospital I would be talking another thing as my temperature was very high.”

Moyo was a keen runner and the physician told her this fitness helped because her muscles fought the bacteria.

“I got spasms everywhere, I could see the muscles in my fingers and legs having the spasms. If I had gone to a general practitioner I think we would be talking a different story now and I would be nine feet under. I don’t know what made me go to a big hospital where I could get help from different sorts of doctors. If I had gone to a general practitioner they would have given me painkillers to bring the pain and fever down without doing the extra tests that the hospital did,” she said.

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The largest ever reported outbreak of listeriosis included an alert in mid-June 2017, a peak in mid-November 2017, and identification of the outbreak source in mid-February 2018. It was traced to a ready-to-eat (RTE) processed meat product, called polony, made at a plant in Polokwane run by Enterprise Foods, which is owned by the multi-national corporation Tiger Brands.

Program of inspections
The new regulations follow an agreement between the Department of Trade and Industry (DTI), and Department of Health (DoH) on final publication of the rules for processed meat products. The rules, which are intended to enable inspection of processing plants, will be enforced by the National Regulator for Compulsory Specifications (NRCS), a body that reports to the DTI.

It applies to the handling, preparation, processing, packaging, refrigeration, freezing, chilling, labeling, marking and storage of heat treated and RTE processed meat products and includes microbiological and food safety related requirements of these items.

The NRCS is setting up a regulatory program of inspections throughout the country to enable government and industry to detect any food safety issues early.

Canned meats, raw boerewors, species or mixed species sausages, poultry meat and red meat including cattle, sheep, goat and pig that are untreated or treated so the product still looks like a normal raw carcass, cut, portion or pieces whether fresh or frozen are covered by other legislation.

After a stakeholder consultation, the rules for processed meat products, was gazetted on Aug. 8 and are scheduled to go into force this month.

“This denotes an era of governance where there is effective multi-sectoral collaboration to protect our people from environmental dangers whilst at the same time protecting food and job security,” said Minister of Health, Dr. Zweli Mkhize.

Potential food safety agency
The aim is to effectively regulate categories of processed meat products that are considered high risk so the health and safety of consumers is protected. The DTI will work with the Department of Agriculture, Land Reform and Rural Development (DALRRD) to coordinate enforcement of the legislation as part of the Agricultural Product Standards Act.

Officials from DTI, DoH and DALRRD will also consider creating a dedicated food safety authority for South Africa.

Minister of Trade and Industry, Ebrahim Patel, said it was an important step to ensure consumers are protected against harmful foodborne bacteria.

“Our food industry is important to the country’s economic development and job creation. Jobs in the food industry must be secured through measures that provide consumers with appropriate protection. We have agreed that a task team comprising of officials from the three departments (dti, DoH and DALRRD) be nominated to consider a dedicated food safety authority for the country.”

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Whole genome sequencing (WGS) and epidemiological data were used to determine the source of the outbreak as ready-to-eat processed meat manufactured by Enterprise Foods.

A total of 1,060 cases were reported from January 2017 to July 2018 and 216 people died.

The largest ever reported outbreak of listeriosis included an alert in mid-June 2017, a peak in mid-November 2017, and identification of the outbreak source in mid-February 2018.

“This eight-month timeline was rather remarkable, considering the large number of cases involved and the limited capacity and resources available for foodborne disease outbreak investigations in South Africa,” according to researchers.

The study published in the Foodborne Pathogens and Disease journal described laboratory activities, experiences and results of WGS analysis of Listeria monocytogenes isolates at the Centre for Enteric Diseases (CED). It is a prelude ahead of more detailed articles.

Last month, Tiger Brands, which owns Enterprise Foods, revealed it planned to fight a class action lawsuit relating to the company’s part in the outbreak.

In the study, multilocus sequence typing (MLST) showed that 91 percent of clinical isolates were sequence type 6 (ST6). The rest belonged to 14 different STs (ST1, ST101, ST155, ST2, ST204, ST219, ST224, ST3, ST5, ST54, ST7, ST8, ST87, and ST876).

Listeria monocytogenes ST6 was found in environmental sampling swabs of an Enterprise Foods production facility and in RTE processed meat products including polony, a product similar to bologna sausage manufactured at the site in Polokwane.

ST6 isolates from the Enterprise Foods production facility, including post cooking areas, and from food were shown by single nucleotide polymorphism (SNP) analysis to be highly related to clinical isolates.

Core-genome MLST showed clinical ST6 isolates and Enterprise-related ST6 isolates had no more than 4 allele differences between each other, suggesting a high probability of epidemiological relatedness. The 372 ST6 isolates included 326 clinical isolates, 22 Enterprise food isolates, and 24 environmental isolates recovered from the Polokwane production facility.

Increase in isolates sent to lab
Molecular epidemiology of the outbreak was investigated using WGS analysis of Listeria monocytogenes isolates.

“This was a massive undertaking for a relatively small reference public health laboratory in South Africa, the Centre for Enteric Diseases, a laboratory that was still in its WGS ‘infancy’ and still in the process of taking “small steps” toward the implementation of WGS for analysis of enteric pathogens,” according to researchers.

The CED is a member of PulseNet International, a global molecular subtyping network for foodborne disease surveillance. It started WGS activities in September 2015.

For 2013 to 2016, a range of 55 to 113 laboratory-confirmed cases of listeriosis occurred annually in South Africa. At the peak of the polony outbreak in mid-November 2017 there were 41 cases were reported in one week. Final outcome was known for 806 out of 1,060 patients, with a 27 percent fatality rate.

At the onset of the outbreak, the team decided to investigate all bacterial isolates using WGS but admitted they did not anticipate the mammoth task that awaited them.

“The weekly number of Listeria monocytogenes isolates received at our laboratory multiplied rapidly, increasing 40-fold at the height of the outbreak. The laboratory staff (two technicians, two technologists, and two scientists) were rapidly overwhelmed with the increased workload. From isolate reception at CED to WGS data availability, the timeline ranged from seven to 10 working days,” according to the report.

As a result of the outbreak, listeriosis has been added to the South African list of mandatory notifiable medical conditions and surveillance systems have been strengthened to help prevention and early detection of listeriosis outbreaks.

Government oversight
A different review, published in the journal Food Control, found the inability of the South African government to effectively regulate the sector is a contributing factor to increased food safety risks.

The study provides an overview of the current state of food safety policies and regulations, challenges and practices in the sector after the listeriosis crisis of 2017 and 2018.

Researchers found enforcement of different regulatory processes is often poorly coordinated.

“Responding to this regulatory environment, food safety activities of the food retail industry include a self-regulatory system reliant on internal and third-party food audits, worker training, external testing, and consumer education,” they wrote.

“Given this fragmented framework and the lack of interaction, it is clear that the governance of the South African food safety system is not ‘fit for purpose’ in that there is a gap in the effectiveness of government regulation and the self-regulation of the formal sector, and a growing risk from an inability to regulate the large informal sector.”

Editor’s note: In February, Joe Whitworth traveled to Johannesburg for Food Safety News to interview people affected by the Listeria outbreak. Victims and their families continue to struggle to overcome its impact. In March, we published a series of stories to help ensure that the public’s voice is heard.

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and fears for his future
• Father of survivor: ‘We were lucky, what about those who were not. .’
• ‘He was my hero’, says mother whose son died because of Listeria
• Man with listeriosis given 50-50 chance tells of toll on family
• Double tragedy for mother due to listeriosis
• Family’s heartbreak at Listeria death
• Mother shares pain after losing baby to listeriosis

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

The lawsuit is being brought against the company by Richard Spoor Attorneys and LHL Attorneys. The Seattle firm of Marler Clark LLP is serving as a consultant for the case attorneys.

The listeriosis outbreak began at the start of 2017 and was declared over in September 2018 with 1,065 confirmed cases and 218 deaths. World Health Organization experts said it was the world’s largest documented listeriosis outbreak ever.

It was traced in March 2018 to a ready-to-eat processed meat product called polony made at a plant in Polokwane run by Enterprise Foods, which is owned by Tiger Brands.

The legal action is on behalf of those who were sickened by polony contaminated with Listeria and families who lost relatives. The Gauteng High Court in Johannesburg granted an order this past December permitting a class action lawsuit to be brought, known as certification.

Liability first stage
“The company intends to defend the class action and . . . is preparing to follow due legal process,” according to a Tiger Brands statement to the stock exchange.

Tiger Brands received a summons relating to the class action lawsuit this week.

No amount of damages is being claimed as the first stage deals with liability. Damages would be handled at a second stage if the court finds the firm liable, according to the statement.

Tiger Brands said the plaintiffs are seeking damages in terms of the Consumer Protection Act; claims in delict (when one party commits a wrong against another); and for exemplary or punitive or constitutional damages.

The company said it had been advised that the law in South Africa does not recognize a claim for exemplary or punitive damages, or constitutional damages of this nature.

Tiger Brands confirmed it has product liability insurance coverage. However, the policy does not cover exemplary or punitive damages.

Before the outbreak, there had been between 60 and 80 listeriosis cases every year in South Africa for the past five years before the outbreak. The country also made listeriosis a notifiable condition for the first time to help track infections.

An expected decision
Thami Malusi, from Richard Spoor Inc. attorneys, told Food Safety News that the move to fight the class action lawsuit was expected despite some thinking Tiger Brands would not oppose it as that is what happened at the certification stage.

“It is also in their interest to have the class action certified because that means instead of facing multiple lawsuits from all the people that contracted listeriosis they would have one unified lawsuit. At the certification stage, they said they will make a case in the defense of their liability if we did bring a case on liability. I think a lot of people in the public space think it was not expected for them to oppose just because they did not oppose at certification.”

Next, a stage called the discovery process begins, this means Richard Spoor will sequester documents from Tiger Brands specifically around testing done in the plant to get a sense of what they did to try and prevent the outbreak. Depending on this process, the anticipated date for a court hearing is the end of this year.

Malusi said the country’s laws do not allow for punitive exemplary damages but progress is being made in that direction.

“Our law is very discriminatory against what you would call the vulnerable members of our society —the elderly, children and the poor — this is because in our law of damages if, for instance, you get injured from someone else’s negligence or willful conduct you will not get much unless you were rich. If you were rich, it means if you get seriously injured and you can’t function as you used to you would have lost a lot of earnings but if you were poor that is not the case,” he said.

“The best way to address that is to allow for punitive or exemplary damages where we say regardless of your economic status if someone strongly violates your rights or causes you damage, you cannot be limited in terms of what you can get by your economic status, we should be able to compensate you by virtue of being a person and having been violated.

“The move toward exemplary damages has not been properly tested in our courts of law and we think this is a good case to do that. If you look at the type of people affected by listeriosis it was generally the young or old people and polony is consumed by poor people in this country.”

Editor’s note: In February, Joe Whitworth traveled to Johannesburg for Food Safety News to interview some people affected by the Listeria outbreak. It’s been eight months since government officials declared the outbreak over, but victims and their families continue to struggle to overcome its impact. In the past weeks, we have published a series of stories to help ensure that the public’s voice is heard.

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and fears for his future
• Father of survivor: ‘We were lucky, what about those who were not. .’
• ‘He was my hero’, says mother whose son died because of Listeria
• Man with listeriosis given 50-50 chance tells of toll on family
• Double tragedy for mother due to listeriosis
• Family’s heartbreak at Listeria death
• Mother shares pain after losing baby to listeriosis

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

Johannesburg — A South African woman described her son as a “hero” after he died due to listeriosis and she was cleared of any symptoms.

Vuyani Moledi became pregnant with a boy while studying at The University of South Africa (UNISA).

She was seven months pregnant when she was rushed to the hospital and two days after her son was born he passed away. Testing during this time by doctors found he had listeriosis. She was discharged after three days in the hospital.

“What I keep telling everyone is that when I had the listeriosis it came out with my son, I was left with none of it whatsoever, I didn’t have any symptoms. That is why I say he is my hero as he basically saved my life. His name was Favour,” Moledi told Food Safety News.

“It was tough last year as I had just lost him. Since then we are trying to be positive. I am trying to be a better person like I would have wanted to be if he was here. So basically I am trying to live a positive life and not be depressed about what happened. I am getting there, I am much better than before,” Favour’s mother said.

“I was seven months pregnant with my son and I gave birth too early, it was unexpected. I lost my son because I ate food that I love. I ate products that I thought were good. We’ve been eating those products and nothing had happened. Why did we lose people we love because of products we thought were safe and healthy for people to eat? It is not fair because we have to live with the pain every day. You say to yourself: I wish I did not buy it, I wish I just left if there.”

The Listeria outbreak in South Africa during 2017 and 2018 infected more than 1,000 people and 200 deaths were linked to polony, a ready-to-eat processed meat, made at a factory in Polokwane by Enterprise Foods, which is owned by Tiger Brands. Polony is similar to baloney products sold in the United States.

Vuyani’s mother is a nurse and on her advice she went home to QwaQwa, a region of South Africa, and the pregnancy went well with the baby moving around a lot. The 27 year old planned to go back to school after giving birth.

In November 2017, Vuyani had Enterprise Brand products including Russians, viennas, polony and ham on numerous occasions. In early December she noticed a lack of appetite and developed a severe headache.

At seven months pregnant she started having contractions and her mum rushed her to Elizabeth Ross hospital in Phuthaditjhaba. Nurses checked the baby’s heartbeat and admitted her. After giving birth the baby was blue, tiny and not breathing or crying so he was put on oxygen to help him breathe.

They were transferred to Manapo Hospital, also in Phuthaditjhaba, and the baby was put in an incubator. After doctors ran blood tests the baby was transferred to ICU and connected to wires, drips and a ventilator.

Vuyani was called to go to the intensive care unit as staff were resuscitating her son but he ultimately died. A week later she got a message from a doctor saying her son died of Listeria monocytogenes. Vuyani was tested and learned she was negative for Listeria.

Moledi said she avoids polony now and was not previously aware of listeriosis.

“I had seen it on TV, at that time they didn’t know what the reason was for listeriosis, I didn’t really read about it. You know how we are as people when you see something you don’t really take it seriously as it is not happening to you at that time,” she said.

“It was one of those foods that was always in the fridge. Anytime I would make a sandwich I would use polony or in the morning I would have eggs, bread and Russians, just normal daily food. Sometimes I would eat them alone. Normally we are advised to cook it, so I would boil water put it in there and eat it. I don’t eat polony or any of those products anymore, I am so scared I have a fear of them.”

Tiger Brands must make sure polony is safe to eat now it has returned to supermarket shelves, said Moledi.

“My message would be in the future they need to make sure their products don’t have any bacteria that can harm people. For crying out loud these are products we trust and they are expensive so if you eat an expensive product you expect it to not have any diseases or bacteria in it,” she said.

“I want to eat something and feel safe and not feel like if I eat it what is going to happen to me? They should put more thought into making sure their products are safe for people to eat because now we have lost our loved ones just because of eating polony.

“I would like something to happen, something must be done about this situation because I feel like it is taken lightly. It is not like HIV, people died of polony, only a few not a lot so it is not being taken seriously, they are not making as big a deal about it as I would want them to. I would like it to be made a big deal as we lost our loved ones.”

Moledi said she received support via social media after her sister posted about what happened.

“The only support I had (after the death of her son) was my family, then my sister posted about it on Facebook and Instagram just to make people aware it is real and it actually does kill people. That is when I got support on social media. My sister was in Thailand but I never felt her absence, she video called me every day, there was never a time when I felt she was not here with me and my three brothers were also there,” she said.

“Losing a loved one, even if you didn’t lose someone due to Listeriosis but they still have those side-effects, try to find the positivity in the pain, I don’t know it that makes sense, but I tried to understand there must be a reason why this had to happen to me specifically, why I had to lose my son because of listeriosis. They should be strong and if they are religious they should pray about it or go for counselling as it helps.”

Moledi is now back at school doing public management and is determined to do something with her life with future plans including possibly living abroad in Europe.

Editor’s note: In early February, Joe Whitworth traveled to Johannesburg, South Africa, for Food Safety News to interview some of the people who were affected by the Listeria outbreak. It’s been nearly eight months since government officials declared the outbreak over, but victims and their families continue to struggle to overcome its impact. In the coming weeks we will be publishing a series of stories to help ensure that the public’s voice is heard.

To read more of Whitworth’s coverage about the impact of the outbreak, please see:

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and fears for his future
• Father of survivor: ‘We were lucky, what about those who were not . . .’

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

Johannesburg — The father of a child who survived the South African Listeria outbreak says he replays the moment a doctor asked if he preferred the mother of his child or newborn baby live.

Mpotseng Moloi went to Linksfield Hospital in Johannesburg on the advice of her doctor and, after admission in early January 2018, had an emergency caesarean section despite Nomahlubi Fezokuhle Moloi being due in early February.

The largest ever recorded Listeria outbreak occurred in South Africa during 2017 and 2018. More than 1,000 people were confirmed infected and more than 200 deaths were linked to polony, a ready-to-eat processed meat, made in a factory in Polokwane by Enterprise Foods, which is owned by Tiger Brands. Polony is similar to baloney products sold in the United States.

Bonginkosi Radebe told Food Safety News he was asked the question when Mpotseng was in the operating room.

“I stood there shaking saying what’s happening? What’s wrong? Then they said ‘they are infected with Listeriosis.’ I said what’s that? I could see the fluid that was drained from inside her, it was greenish like dirty water because there was a pipe. So I was confused, I didn’t know what to do and what to say,” Radebe said.

‘I am lucky’
Radebe said when he was in the hospital with doctors running around, he panicked not knowing what was happening.

“Maybe something is wrong and they do not want to tell you,” he said. “Even now when I am sleeping I can still see that moment when people started running around. I can still hear that doctor asking me the same question: ‘Who do you prefer that must live?’ Even when I am sitting in the house looking at my baby, the tears just come. We almost lost her and I almost lost both of them. So now I am lucky. What about those who were not lucky enough? That is my worry.”

The newborn baby was taken to an isolated room where hospital staff tried to explain Listeria.

“The color of the baby was different, she was yellow, even the hair was yellow. They said the color means it is not normal, she would have to stay in for treatment until she is right. After that I had to stay in the hospital until the mother was discharged. That five minutes felt like hours, my first question was if something goes wrong what am I going to tell her family? What went wrong, you see things like that. I hate being a bearer of bad news,” said Radebe.

Mpotseng, who has lived in Alexandra, a township in the Gauteng province in South Africa, for more than 30 years, said she had heard of Listeria but did not know what it was or where it came from.

“I did know of listeriosis but only on the messages you get on the What’s App groups about be careful of this disease. I didn’t believe it as you always get these messages.”

A community development worker, Mpotseng ate a sandwich with polony in early January 2018.

“At night I realised I had some pains in my belly and my baby was not kicking as normal. I thought maybe she is just growing as every time she grows there is less space. The next day I ate the sandwich again, she played only in the morning then she was quiet,” she said.

“I told the father that I am worried the baby is not playing but I think it is the space, lets not panic. I knew every time I ate and drank water the baby would kick but she didn’t the whole day. The next day she was very quiet, she was not moving at all, I told the father and he said we must call the doctor.”

The doctor told the pair to go to hospital and she was admitted at about eight months pregnant.

Mother and daughter given all-clear
Mpotseng had been pregnant twice before and has two boys, one aged 17 and the other aged 16.

“I knew what was supposed to happen. During the pregnancy you check your baby, they are not the same, but you know this baby is like this and another is like that. I realized earlier that this baby is not playing as much as I am used to,” she said.

“When we got to hospital we were admitted, the nurses checked me and found my fever was too high and the baby’s heart was not beating too well. They called the doctor and he said I had to go for an emergency caesarean right away. A day after delivery the pediatricians and gynaecologist informed us about the diagnosis as they had taken my amniotic fluid for testing and they told us the results showed an infection called Listeriosis.”

Nomahlubi was placed in isolation in the neonatal intensive care unit.

“It affected us emotionally seeing the baby going through tests daily to check all her vital organs were working. It was a traumatic experience to see my tiny baby with drips and wires all over,” said Mpotseng.

“I was in hospital for six days and she was in hospital for 16 days. I went twice a day to visit. When she was discharged I was told that she was good to go but I had to go for check-ups with the paediatricians but everything was normal. I am OK now, I was worried about any disabilities but there were none so she is fine.”

Enterprise polony back in stores
Mpotseng said they gave the two boys polony and bread because it is normal and quick.

“I just started last month to buy it again. It is not Enterprise Foods polony. I will never buy it again. But Bonginkosi did not want to see it, even if I put it in the trolley and said there is no risk anymore, he would tell us no, we cannot take chances. I cook it now, I fry it before I put it on my sandwich,”

Radebe said buying any brand of polony is difficult.

“When you go shopping and she puts polony in the trolley when you arrive at the till and I see the polony and she is not there I take it out. The first time, these things like Listeria, you don’t expect it to happen to you or your family. When you hear people talking about it you think it is going to be something that is far away but when it happened, we struggled a lot. We used to support the brand but now the brand failed us a lot,” Nomahlubi’s father said.

Radebe said he was angry when he saw polony back on the supermarket shelves and heard Tiger Brands was re-opening its Enterprise Foods factory in Polokwane.

“Somebody there in the plant did not do their job. If you work with food you should have somebody who is always there inspecting food,” he said.

“Somebody was lazy and for that they should suffer the consequences because some of the people lost their lives. We are lucky and our luck still makes me scared even today. What about those who didn’t get a chance to talk about it like we are now? They (those responsible for the outbreak) should pay up.”

“It is difficult to come up with something to say to those who lost someone because I am lucky I did not lose anyone. It would take me days to try and figure out what can I say to that person. But I think they should come out, if we can come and stand together and face Tiger Brands there will be justice. Tiger Brands are here making money from South African people so let them pay back now, let them comfort the hearts of those people who lost someone.”

Editor’s note: In early February, Joe Whitworth traveled to Johannesburg, South Africa, for Food Safety News to interview some of the people who were affected by the Listeria outbreak. It’s been nearly eight months since government officials declared the outbreak over, but victims and their families continue to struggle to overcome its impact. In the coming weeks we will be publishing a series of stories to help ensure that the public’s voice is heard.

To read more of Whitworth’s coverage about the impact of the outbreak, please see:

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and fears for his future
• Publisher’s Platform: What does it cost to sicken 1,034 – killing 204 – with Listeria-tainted polony in South Africa?

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

Following the declaration of the Listeria outbreak in December 2017, a multi-sectoral outbreak response was initiated. Findings were shared by the Minister of Health, Dr. Aaron Motsoaledi at a public media briefing on March 4, 2018, (statement available at www.nicd.ac.za), and are summarized below. In addition, the National Department of Health requested a full recall of implicated processed meat products. According to Dr. Aaron Motsoaledi:

In our constant search for the source of the outbreak and the treatment of people who are affected, a team from the NICD has interviewed 109 ill people to obtain details about foods they had eaten in the month before falling ill. Ninety-three (85%) people reported eating ready-to-eat (RTE) processed meat products, of which polony was the most common followed by viennas/sausages and then other ‘cold meats’.

On Friday 12th January, nine children under the age of 5 years presented to Chris Hani Baragwanath Hospital with febrile gastro-enteritis. The paediatrician suspected foodborne disease, including listeriosis, as a possible cause. The environmental health practitioners (EHPs) were informed and on the same day visited the crèche, and obtained samples from two unrelated polony brands (manufactured by Enterprise and Rainbow Chicken Limited (RCL) respectively) and submitted these to the laboratory for testing.

Listeria monocytogenes was isolated from stool collected from one of the ill children, and from both of the polony specimens collected from the crèche. These isolates were sent to the NICD Centre for Enteric Diseases, and underwent whole genome sequencing and genomic analysis. The ST6 sequence type was confirmed on all three isolates on Saturday 27th January. Remember that in the last press conference I informed you that from clinical isolates obtained from patients (patient blood), 9 sequence types of Listeria monocytogenes were isolated and 91% were of sequence type 6 (ST6). We had then concluded that time that this outbreak is driven by ST6.

Following the lead from the tests performed on these children from Soweto and the food they had ingested, the EHPs (Environmental Health Practitioners), together with the NICD and DAFF representatives, accompanied by 3 technical advisors from the World Health Organisation in Geneva, visited a food- production site in Polokwane and conducted an extensive food product and environmental sampling.

Listeria monocytogenes was isolated from over 30% of the environmental samples collected from this site, which happens to be the Enterprise factory in Polokwane.

To conclude the investigation, whole genome sequencing analysis was performed from this Enterprise factory and the results became available midnight or last night. The outbreak strain, ST6, was confirmed in at least 16 environmental samples collected from this Enterprise facility. 

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

According to the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/ National Health Laboratory Service (NHLS) the current number of ill and deceased are as follows:

As of 26 July 26, 2018, there were 1,060 laboratory-confirmed listeriosis cases reported to NICD from all provinces since 01 January 2017.

To date, 749 cases were reported in 2017, and 311 cases in 2018. Females account for 56% (549/979) cases where gender is reported. Neonates ≤28 days of age are the most affected age group, followed by adults aged 15 – 49 years of age. Most cases have been reported from Gauteng Province (58%, 614/1060) followed by Western Cape (13%, 136/1060) and KwaZulu-Natal (8%, 83/1060) provinces. Final outcome data is available for 76% (806/1060) of cases, of which 27% (216/806) died.

Editor’s note: In early February, Joe Whitworth traveled to Johannesburg, South Africa, for Food Safety News to interview some of the people who were affected by the Listeria outbreak. It’s been nearly eight months since government officials declared the outbreak over, but victims and their families continue to struggle to overcome its impact. In the coming weeks we will be publishing a series of stories to help ensure that the public’s voice is heard.

To read some of Whitworth’s coverage about the impact of the outbreak, please see:

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’
• Parents describe their baby’s ongoing treatment and their fears for his future

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

JOHANNESBURG — The Mathole family’s joy at expecting their first baby almost turned to tragedy with a month and a half in hospital when their child was infected with listeriosis.

Onkarabile Olerato Mathole was expected in December 2017 but ended up being born in October. He was treated for 44 days at Akasia Hospital in Pretoria, South Africa. Onkarabile was diagnosed with hydrocephalus and has a Ventriculoperitoneal (VP) shunt in his brain to drain water. At almost 15 months old, he is struggling to crawl or walk.

Hydrocephalus occurs when cerebrospinal fluid (CSF) builds up within the brain. In normal amounts, CSF provides protection for the brain. Hydrocephalus occurs when there is a blockage which prevents excess CSF from draining away.

His mother, Nthabiseng Jane Ramanamane, and father, Thato Oscar Mathole, drove to and from the hospital every three hours for almost two months with their child in an incubator for most of that time.

Onkarabile is one of the cases in the largest ever recorded Listeria outbreak, which occurred in South Africa during 2017 and 2018. More than 1,000 people were confirmed infected and 210 deaths were linked to polony, a ready-to-eat processed meat item, produced in a factory in Polokwane by Enterprise Foods, which is owned by Tiger Brands.

Jane Ramanamane described the experience as “difficult,” especially as the family was so excited at her finally becoming pregnant with their first child.

“With Onkarabile, even still now to play with him in the morning, he wakes us up wanting to play so it has not been easy. The mothers need to keep strong as through our emotions we are giving our babies a hope that one day they will be well,” she told Food Safety News.

Onkarabile’s father, Thato Oscar Mathole, a mechanical fitter at Hernic Ferrochrome Mine, said it has been a life-changing experience and he never thought they could have such a problem.

“It has affected our jobs, I am a mechanical fitter at a mine, you need to be concentrating while you are at work and sometimes I lose my concentration. We have a social worker and I would normally speak to her about the situation because if it affects me I might get injured,” he said.

“Tiger Brands needs to be more careful about their food as what they have done is negligent. They have hired people to check such things and it means one did not do his or her job in the company. Tiger Brands is entirely responsible for our baby being like this and those who have died so they need to check their food and whatever is not OK, they should not take it to the market.

“We just wish Tiger Brands would do the right thing for our children, we are suffering financially and emotionally, this little guy needs special attention, he needs to go to special schools where they can help him properly.”

Thato also said the National Institute for Communicable Diseases (NICD) and South African authorities should have been quicker when they detected there could be an outbreak.

“If 10 people report the same thing they could have reacted to it. I once heard the health minister Aaron Motsoaledi saying listeriosis has been there for years and affected one or two people in a year but if it affects more than five it shows you there is a problem somewhere. I would say there are people who are still not aware of listeriosis or are trying to be ignorant. I would like to say those who don’t know it they must watch out because listeriosis may affect their entire life.”

Polony and Russians (a type of sausage) were monthly groceries and the family normally ate them at home.

“Nthabiseng liked Russians, I don’t normally eat them but she likes it and (while she was pregnant) she was craving more of Russians. We normally eat it on a sandwich and sometimes you would eat it alone. Enterprise (brand) is what we normally ate, as we grew up we knew Enterprise was nice polony but now we do not buy polony anymore as we had the bad experience with Onkarabile,” said Thato.

The family had no idea what Listeria was, having never heard the word until they were told by the hospital.

“It was on 19 October, my wife called me from work, she was experiencing pains, vomiting and had a high fever. When I went there I found her lying on the bench waiting for me, we came home but she said she cannot do it, I thought maybe she was going into labor as she had pains so I took her to hospital,” said Thato.

“When we got there they told us she might be giving birth, they thought she was affected by some kind of bacteria due to her reactions. The next day (Oct. 20) she gave birth to Onkarabile, they immediately took him to ICU and took a blood sample. When the results came back they said they think Onkarabile is infected by some sort of bacteria but it will take seven days to determine what kind.

“After seven days Onkarabile was on the oxygen pipes as each organ in his body was failing, the heart, kidneys, the lungs were filled with water he could not breathe on his own. The blood sample came back and they confirmed the culture of the bacteria is Listeria.

“They also did a scan on his brain and they found Grade 2 bleeding. The bleeding on his brain escalated to Grade 4 and everyone was starting to panic as it was serious. His kidneys and heart started to function but the problem was the brain. They never told us if the mother had listeriosis but it is the only way he could get it.”

That was when the family first heard about listeriosis.

“That is when the matron started to ask us where have we been, what type of food have we been eating and she told us she was going to consult with the NICD. She told us there have been some reports about this disease but they are not sure it was not confirmed at that time,” said Thato.

“I remember when the doctor came and told us it was between life and death for Onkarabile to survive, we didn’t think he would survive. He was hospitalized for 44 days and we were in and out of the hospital every time.”

The Mathole family is trying to move forward. Two months ago, they welcomed a healthy Oratile,  into the world.

Nthabiseng said they had not spoken with anyone else affected by the outbreak.

“We watch YouTube interviews and try to relate with what happened to us. It was really tough especially when I was pregnant again I hope that he comes well as if they were both affected then we were going to struggle. They are two babies actually, when they cry they cry together so it is really difficult. It has affected me as I had to be off work to look after him when he was hospitalized because we were frequently in and out of the hospital and even when he is sick I cannot go to work.”

Thato said it was a day-to-day, on-and-off battle with Onkarabile because of his health.

“It is not sitting well with us as he cannot stand on his own, he cannot do anything every time you have to carry him when he wants to play. It has tampered with our emotions, it is a bad experience that I don’t wish anyone to go through it. I would say (to others in similar situations) that they need to be strong as these babies are little and they don’t know anything, they rely on us and if we start to become emotional it is not going to help them to heal,” he said.

“We are hoping he will get well with the physiotherapies and other professionals we have been taking him to. They are telling us to keep on exercising him maybe as he is still a baby the brain will develop and he will manage to do things on his own.”

Onkarabile’s grandmother is helping the family almost every day. Two of Thato’s sisters and two of Nthabiseng’s sisters and her brother are also offering support.

“To us as a family, Onkarabile is a blessing but through that blessing we have been through some difficulties. In the future we are just hoping Onkarabile will be well and we would see him walking,” said Thato.

“Everyone wishes to see their baby growing up, go to university and doing something with his life. I cannot determine what is going to happen to the future, only God knows what is going to happen to Onkarabile, but we will keep on supporting him to get well.”

Editor’s note: In early February, Joe Whitworth traveled to Johannesburg, South Africa, for Food Safety News to interview some of the people who were affected by the Listeria outbreak. It’s been nearly eight months since government officials declared the outbreak over, but victims and their families continue to struggle to overcome its impact. In the coming weeks we will be publishing a series of stories to help ensure that the public’s voice is heard.

To read more of Whitworth’s coverage about the impact of the outbreak, please see:

• Mother describes uncertain future for her daughter after listeriosis infection
• Uncertainty after the outbreak — ‘My niece may not know her father has died’

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