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Published Date: 2018-09-05 09:40:00
Subject: PRO/AH/EDR> Listeriosis - South Africa (15): fatal, ST6, end of outbreak
Archive Number: 20180905.6007973
LISTERIOSIS - SOUTH AFRICA (15): FATAL, ST6, END OF OUTBREAK
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[1]
Date: Mon 3 Sep 2018 17:17 SAST
Source: Business Live [edited]
https://www.businesslive.co.za/bd/national/2018-09-03-listeriosis-outbreak-officially-over-says-aaron-motsoaledi/


The government has declared the end of the listeriosis outbreak, the world's deadliest on record, and has withdrawn advice against consuming ready-to-eat processed meat products.

And the Enterprise factory in Limpopo, identified as the source of the outbreak, could reopen in October [2018], health minister Aaron Motsoaledi said in Johannesburg on [Mon 3 Sep 2018].

The listeriosis outbreak has been costly for Tiger Brands, with recall-related costs amounting to Rand 365 million [about 23.9 million] for the initial insurance claims, spokesperson Nevashnee Naicker said. The packaged goods company lost a further Rand 50 million [about USD 3.27 million] a month as operations ceased.

The National Institute for Communicable Diseases also identified _Listeria_ at RCL's Rainbow Foods, resulting in a recall of all ready-to-eat processed meat products from the facility.

The country has destroyed more than 5800 tons of recalled meat since the beginning of March [2018], when it linked the products to the outbreak and named a plant owned by Tiger Brands as the source of the crisis.

More than 200 people died from listeriosis between January 2017 and [26 Jul 2018] and 1060 cases of the illness were identified, according to the National Institute for Communicable Diseases. No new cases caused by the outbreak strain have been identified since the 1st week of June [2018] and incidences have dropped to pre-outbreak levels, Motsoaledi said, adding the outbreak has been declared over. It is still unclear how the bacteria strain entered the affected factory, Motsoaledi said.

"Today's announcement means that ready-to-eat processed meat can now be safely consumed, as before the outbreak," he said. South Africans are now free to eat "kotas", a popular township meal made of a quarter loaf of bread stuffed with chips, cheese, and cold meat.

[Byline: Penelope Mashego]

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[2]
Date: August 2018
Source: National Institute for Communicable Diseases (NICD) [edited]
http://www.nicd.ac.za/wp-content/uploads/2018/08/An-update-on-the-outbreak-of-Listeria-monocytogenes-South-Africa.pdf


An update on the outbreak of _Listeria monocytogenes_, South Africa
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As of 14 Aug 2018, a total of 1064 laboratory-confirmed listeriosis cases has been reported to NICD since [1 Jan 2017 (Figure 3 [all figures are available at the source URL above]). Most cases have been reported from Gauteng Province (58 percent, 612/1064) followed by Western Cape (13 percent, 139/1064) and KwaZulu-Natal (8 percent, 84/1064) provinces. Cases have been diagnosed in both public (64 percent, 683/1064) and private (36 percent, 381/1064) healthcare sectors. Outcome is known for 828/1064 (78 percent) patients, of whom 218 (26 percent) have died (Figure 4).

Females account for 56 percent (576/1039) of cases where gender is reported. Where age was reported (n=1043), ages range from birth to 93 years (median 19 years) - Figure 5. Neonates aged 28 days and less account for 43 percent (444/1043) of cases. Of neonatal cases, 95 percent (424/444) had early-onset disease (birth to 6 days or less).

Although outbreak-related cases have declined sharply, sporadic cases (that is, not epidemiologically linked) continue to be reported, as expected. Therefore, healthcare workers are encouraged to continue providing risk reduction guidance to persons at high risk for developing listeriosis (pregnant women, neonates 28 days of age and younger, persons older than 65 years of age, and persons with immunosuppression (due to HIV infection, cancer, diabetes, chronic renal disease, chronic liver disease, transplantation and immunosuppressive therapy). Such guidance includes advice on food hygiene (the World Health Organization's 5 keys to safer food [http://www.who.int/foodsafety/publications/5keysmanual/en/] is a useful resource for generic food hygiene advice) and avoidance of at-risk food.

The end of the outbreak is approaching, and the activities of the listeriosis Incident Management Team are nearing completion. The following actions have been taken to strengthen health and environmental systems to ensure prevention and early detection of future outbreaks, particularly in ready-to-eat processed meat:
1. Listeriosis has been declared a notifiable medical condition under an amendment to the National Health Act.
2. The NICD has developed a system of surveillance and investigation of listeriosis cases including whole genome sequencing (WGS) of all isolates from laboratory-confirmed cases. This allows timeous identification of clusters which may represent outbreaks.
3. The NHLS has strengthened capacity to conduct food and environmental testing for _Listeria monocytogenes_.
4. Almost 900 environmental health practitioners in all health districts have been re-trained in inspection procedures, food safety systems, legislative aspects of food control and tools to support inspections including risk assessment tools and inspection checklists.
5. All production facilities that manufacture ready-to-eat processed meat in South Africa have been identified (n=158) and all but 9 have been inspected by district environmental health practitioners, supported by a core incident management team.
6. An amendment to the Regulations pertaining to the application of the hazard analysis and critical control system (HACCP), (R908 of 2003) was published on 14 Jun 2018 requiring all producers of ready-to-eat processed meat to be HACCP certified by externally accredited agencies within 9 months of publication of this act.
7. Risk communication activities including the dissemination of information pertaining to food safety, avoidance of certain foodstuffs by persons who are at risk for listeriosis, and training of health promoters have been conducted.

Further resources on listeriosis can be found on the NICD website at http://www.nicd.ac.za, Diseases A-Z, under 'Listeriosis'.

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[The 2nd news report above, which is from the South African National Institute for Communicable Diseases (NICD), says that a total of 1064 cases of the listeriosis were identified between January 2017 and 14 Aug 2018.

Over 90 percent of isolates from listeriosis cases linked to the South African "polony" outbreak were sequence type 6 (ST6) (see ProMED-mail post Listeriosis - South Africa (11): fatal, ST6, WHO response 20180330.5718496). ST6 was also identified in "polony", a widely consumed ready-to-eat processed meat product and in environmental samples collected from the facility that processed the implicated product.

Of the 645 _Listeria_ clinical isolates that have been sequence typed, no ST6 isolates have been identified since the 1st week of June 2018 (see Figure 3 from the NICD report above at the source URL). Considering that the implicated "polony" was recalled in early March 2018 and the incubation period of listeriosis is up to 70 days, the 1st news report above says that the South African government has "declared the end of the listeriosis outbreak," the world's largest on record (http://www.who.int/csr/don/28-march-2018-listeriosis-south-africa/en/), and has "withdrawn advice against consuming ready-to-eat processed meat products." - Mod.ML

HealthMap/ProMED map of South Africa: http://healthmap.org/promed/p/179]

See Also

Listeriosis - South Africa (14): fatal, ST6 20180704.5888338
Listeriosis - South Africa (13): fatal, ST6 20180517.5801104
Listeriosis - South Africa (12): fatal, ST6, WHO update 20180504.5782882
Listeriosis - South Africa (11): fatal, ST6, WHO response 20180330.5718496
Listeriosis - South Africa (10): fatal, more cases 20180316.5691653
Listeriosis - Namibia: (OT) Vienna sausage, susp ex South Africa 20180315.5687757
Listeriosis - South Africa (09): fatal, health dept. press release 20180305.5666617
Listeriosis - South Africa (08): fatal, more cases, source found, polony 20180305.5665592
Listeriosis - South Africa (07): fatal, more cases 20180224.5648305
Listeriosis - South Africa (06): fatal, more cases 20180218.5635764
Listeriosis - South Africa (05): fatal, more cases 20180131.5596282
Listeriosis - South Africa (04): comment 20180126.5586393
Listeriosis - South Africa (03): fatal, increasing incidence, ST6 20180122.5577247
Listeriosis - South Africa (02): fatal, increasing incidence, ST6 20180117.5566300
Listeriosis - South Africa: fatal, increasing incidence, ST6 20180108.5545556
2017
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Listeriosis - South Africa (04): fatal, increasing incidence 20171217.5508986
Listeriosis - South Africa (03): fatal, increasing incidence, genotyping 20171206.5487695
Listeriosis - South Africa (02): fatal, increasing incidence, RFI 20171205.5484927
Listeriosis - South Africa: increasing incidence 20171025.5402225
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