Editors Note: This article first appeared in the Daily Mail and is republished here with the permission of Hugh Pennington. 

Almost two weeks have passed since news emerged of a Listeria outbreak linked to ready-made sandwiches provided to patients in hospitals.

Yet until yesterday (June 18) we had been told absolutely nothing beyond the names of four hospital trusts where some of the patients died or where others had fallen ill.

Last night, we learned that one of the victims was Ian Hitchcock, 52, a businessman and father of twins, from Crich in Derbyshire.

Our thoughts must go to his grieving family. But as a scientist I also have to ask why it has taken so long for even this sliver of information to be shared?

The health authorities have a duty to ensure no more people are put at risk of death. And to try to ensure that we — as doctors, scientists and indeed the wider public — all need to know more about those who got sick and recovered, or who succumbed to listeriosis, a potentially fatal form of food poisoning. This is not out of prurience, but to better safeguard the health of others.

Listeria can present in various ways — which is why diagnosis is so difficult — but among the complications are sepsis and meningitis, two of the nastiest and hardest illnesses to treat. Anyone at risk should know about it sooner rather than later.

Remarkably, and in my view wrongly, the information needed is largely being denied to us. It is only after pressure from the Daily Mail that any details at all have been released.

Tory MP Nadine Dorries, a former nurse, this week called for “full transparency and openness about those who have died.”

She added: “I don’t understand why they don’t tell us the age or sex — or what conditions they were in hospital for. All these would be relevant.”

Tory MP Nadine Dorries, a former nurse, has previously said: “The issue needs dealing with now, and we need full transparency and openness about those who have died.”

She is right. It is in the public interest that the age, gender and reason why the victims were originally admitted to hospital are released as a matter of urgency.

If, for example, a high percentage of victims in the latest outbreak were aged over 80, then that would be helpful to know, allowing doctors and nurses to pay close attention to that demographic.

If more men than women have died — and Listeria infections are generally more common in men — that would be highly relevant, too.

Suffering
Did any or all of the victims have compromised immune systems, perhaps because of treatment they were undergoing for cancer, or because they were receiving immuno-suppressant drugs? It is understood that Mr. Hitchcock was being treated for cancer.

Such information can be vital, even life-saving, to other patients undergoing the same treatment or with the same conditions. For the moment, however, we have no answers to these questions.

Instead, all we have heard from the relevant hospital authorities is either a deafening silence or bleating about “patient confidentiality.”

Of course I have the utmost respect for the principle of patient confidentiality. It is right that anyone suffering from an illness — or who sadly succumbs to it — can, along with their families, expect a high degree of privacy in almost all circumstances.

The situation is more complicated, however, during the outbreak of a serious and potentially dangerous infection such as listeriosis. Let’s not forget that it killed 33 people in Britain during 2017.

That pregnant women and babies as well as the elderly are particularly vulnerable to the illness makes it all the more vital that certain key facts are released.

Listeria can incubate in the human body for a month or more. Patients who might have been in hospital some weeks ago or who may still be on the ward have the right to understand what, if any, risk they may have been exposed to and what symptoms to watch out for.

And their worried families deserve the same.

I’m old enough to remember the Aberdeen typhoid outbreak of 1964. In that case the names and addresses of the 400 or so infected people, who had all eaten corned beef from Argentina, were printed in the local paper almost before they’d seen a doctor. Miraculously, none of them died.

I’m not, of course, advocating a return to that level of media scrutiny. But as a bacteriologist who has spent much of his career investigating the medical consequences of poor food hygiene, I do know that — now, and for some time to come — it will be to the wider community’s benefit if there is full disclosure of facts relevant to protecting the public’s health.

In the course of my career, I’ve headed two public inquiries into outbreaks of illness caused by the better-known bacterial infection, E. coli. In both cases the public received far more information than has been released this time. One was an outbreak at schools in South Wales in 2005. This was rapidly traced back to a single butcher.

The other, which turned out to be the deadliest outbreak of this particular form of E. coli in recent British history, hit central Scotland in 1996 and was again linked to one meat supplier. A hospital, an old people’s home and a pub were all affected.

Some 21 people died in that outbreak. Thanks to strategic and considered release of information, however, doctors knew that although some children as young as 10 were infected and became seriously ill, the elderly were at the highest risk of dying. Treatment was adjusted accordingly.

Infected
The General Medical Council’s own guidelines allow for “relevant information” to be released after a patient’s death under certain circumstances — including when it is in the public interest.

Yet Public Health England (PHE) has restricted itself to a mealy-mouthed statement, saying: “We never confirm any information about patients affected unless there is a risk to the public’s health. Confirmation of those details is a matter for families and their doctors.”

But hang on a minute. This is an outbreak of a potentially fatal bacterial disease that has already claimed five lives in hospitals across England. We know the company at the centre of the outbreak, the Good Food Chain, supplied 43 NHS trusts, and other patients have been infected by sandwiches or salads contaminated by listeria. And we know the bacterium has a long incubation period.

So how can PHE be so certain there is no further “risk to the public’s health”?

The first inquests into the deaths of victims — Ian Hitchcock, who was treated at the Royal Derby Hospital, and another patient treated at Manchester Royal Infirmary where two other patients died — open tomorrow.

It is likely there will be inquests into the deaths of the other three victims, too.

But if PHE took responsibility for aggregating the information of all those who have died, stripping it of anything that could identify individuals — a particularly rare illness, for example — I believe that would safely balance confidentiality concerns with the very real need for more information.

The fact is that mounting public unease would be hugely reduced if patients, together with their concerned families, knew what the dangers were and their level of risk.

A small minority would then know they had valid concerns and could seek advice from their doctor accordingly.

The sandwiches linked to the outbreak have now been removed from the food chain, but a threat of infection remains — and will continue to do so for a few weeks yet.

We need to know who is at the highest risk — and we need that information now. Without it, there is a real danger that more people will die needlessly as a result of the authorities’ shameful silence.

About the author: Thomas Hugh Pennington, often identified as one of Britain’s best known scientists, received the Lister Medal of the Society of Chemical Industry in 2009 in recognition of his work. The medal is named after Sir Joseph Lister, the British surgeon who first introduced antisepsis — sterile conditions and infection control — into routine hospital applications. Sir Joseph pioneered the field of bacteriology in the late 19th Century. The medal was first awarded to Sir Alexander Fleming, who discovered penicillin, in 1944. It has since been awarded a further 14 times to eminent scientists working at the interface of chemistry and medicine.

Pennington was Chair of Bacteriology at the University of Aberdeen from 1979 until his retirement with emeritus status in 2003. Of particular interest has been his work on E.coli 0157 outbreaks and influenza pandemics. He has examined how the treatment of these has been influenced by evolution and history. Professor Russell Howe, chair of chemistry from the University of Aberdeen and chair of the Scotland Section of the Society of Chemical Industry, said: “Professor Pennington is a renowned bacteriologist following in the footsteps of Joseph Lister, and as a media spokesperson he embodies the Society’s goals of relating the chemical sciences to industry, medicine, and the general public.”

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On May 7, 1964, a catering-size can of corned beef from Rosario, Argentina, was opened in a supermarket in central Aberdeen. Half the contents were put on a shelf behind the cold meat counter and the other half went into the window.

The weather was warm. The sun shone on the meat. Corned beef is cooked in the can and should be sterile. But it wasn’t. It had been contaminated after cooking when the can was cooled with untreated water from the River Parana.

Into this river, 66 tons of human feces and 250,000 gallons of urine were discharged every day from Rosario, where typhoid was common. The bacteria in the corned beef in the window grew vigorously.

Toll rising

The first person to fall ill developed symptoms on May 12. Making an initial diagnosis is not easy; it usually starts with a high fever, which can have many causes.

In Aberdeen, the first definitive diagnoses were made on May 20. By midnight, 12 were in the hospital, and, until June 13, daily hospitalizations never fell below double figures. The outbreak then fizzled out. At its end, 503 had been admitted to the hospital with typhoid, 403 with bacteriological confirmation.

Among those affected, there was a significant over-representation of women aged 15 to 25 living in the more prosperous west end of the city. The probable explanation is that a slimming regime incorporating cold meats and salad was popular at the time.

Nobody died from typhoid in the outbreak, thanks to antibiotics, so in that regard it was modern. Its media coverage, by TV, would be recognizable today, too. But some aspects of its management were conducted as though World War II was still in progress. The names and addresses of those admitted to the hospital were published in the local paper and the end of the outbreak was announced as the “all clear.”

Dr. Ian MacQueen, then Aberdeen’s medical officer of health, took control of the outbreak. Opinion in Aberdeen is still divided about how he handled it. Some say he saved the city, others say that his antics verged on the ridiculous.

I belong to the latter camp. MacQueen believed that dramatic statements of risk were necessary to prevent the spread of infection. Thus Aberdeen became, in his description, the “beleaguered city,” and beef cattle raisers in Paraguay, Kenya and Tanzania suffered economically as importing meat came to be seen as high risk in the initial panic about the source.

MacQueen recommended that nobody should paddle in the sea, and the main thoroughfare, Union Street, was sprayed with disinfectant. There was an obsession with “wave after wave of infections” occurring because of poor personal hygiene.

In truth, this was always very improbable. There was no person-to-person spread. All the infections were caused by eating contaminated corned beef or cold meats cut with the same slicer. New cases continued to appear not because the source of infection was still active but because the incubation period — the time between being infected and falling ill — was often long.

The modern picture

Could the kind of events that happened in Aberdeen 50 years ago be repeated? Cans of food are unlikely to be the source nowadays because canning practices are almost certainly better (even if, as we saw in the horse meat scandal, the label does not always accurately describe the contents). Typhoid is still common in countries whose drinking water is regularly contaminated with human feces – the 2004-2005 outbreak in Kinshasa affected 42,564 and killed 214.

But an even nastier organism caused the most recent big foodborne outbreak in Europe. Like the Aberdeen outbreak, it started in May and went on until the end of June, and, like Aberdeen, it also affected women much more commonly than men. But it happened in 2011 in Germany.

The organism was E.coli O104:H4, a brand-new bacterium that had evolved as a hybrid of two other disease-causing E.coli strains. More than 3,500 fell ill, 855 developed serious complications and 53 died.

Just as in Aberdeen, the organism was imported. It came on the surface of fenugreek seeds, which had left Egypt by boat on Nov. 24, 2009, and eventually arriving at an organic sprout producer near Hamburg on Feb. 10, 2011.

Seed sprouting is ideal for bacterial growth. But identifying the seed sprouts as the cause of the outbreak was difficult and slow because they were used as a salad garnish and many victims were not aware that they had eaten them. That women were more commonly ill pointed to salads, but photographs taken at meals were invaluable.

It was all very embarrassing for the German public health authorities, particularly when the Hamburg health minister mistakenly announced that the organism that had caused the outbreak had been found on Spanish cucumbers, causing serous economic damage to that industry. Shades of Dr. MacQueen!

Lessons from Hamburg

This mistake illustrated the limits of modern lab technology. We might now be in a position where we could genome-sequence E.coli 0104:H4 quickly, but because it was a new strain, the authorities initially confused it for the more prevalent E.coli 0157:H7. When they found this latter bug on the cucumbers, they thought they had found the culprit. New bugs will always make life difficult for scientists.

The German outbreak also pointed to another unavoidable issue: the Egyptians initially denied responsibility. Whatever your technological advances, politics is still likely to slow you down. One bright spot here, though, is that the Chinese are much more cooperative than they once were. This is vital given that the country’s size and relative concentration of people makes it quite a likely source for outbreaks.

Another important step forward has been global food safety standards. The worldwide adoption of the hazard analysis critical control points system – HACCP — originally developed by NASA to protect astronauts from food poisoning, makes it less likely that the world food supply could lead to a major epidemic — even if some countries are still more diligent than others.

Having said that, food poisoning is more common than a century ago (albeit not dysentry spreading from person-to-person or tuberculosis in milk). The Ministry of Health for England and Wales recorded 59 food poisoning incidents during the years 1931-1935, compared to more than 73,000 in 2012, itself a gross underestimate because most people with food poisoning don’t seek medical advice.

The number of sufferers from the UK’s number-one cause, Campylobacter, has been convincingly estimated at 500,000 people each year. To some extent this is down to better diagnosis, but probably not entirely. The realities of 21st century mass production of cheap meat are likely to have driven up infection, for example.

Above all else, the big lesson from Germany was that a major outbreak could still take us completely by surprise. With microbes evolving as they do, we can be certain it will happen again.