36 die from listeria infection in South Africa

SA Health minister Dr Aaron Motsoaledi announced the outbreak of the food-borne disease listeria with the National Institute for Communicable Diseases (NCID).

According to the NICD, there have been a total of 557 confirmed cases from all provinces, the majority occurring in Gauteng. Dr Motsoaledi stated 36 people have died due to the disease.

 

Listeria pathogen NCID

Listeriosis is a serious, but treatable and preventable disease caused by the bacterium, Listeria monocytogenes. The bacteria is widely distributed in nature and can be found in soil, water and vegetation. Animal products and fresh produce such as fruits and vegetables can be contaminated from these sources.

Infection with listeria may result in the following three conditions:

  • flu-like illness with diarrhoea including fever, general body pains,
  • vomiting and weakness
  • infection of the blood stream which is called septiceamia
  • meningoencephalitis (infection of the brain).

Although anyone can get Listeriosis, those at high risk of developing severe disease include newborns, the elderly, pregnant women, persons with weak immunity such as HIV, diabetes, cancer, chronic liver or kidney disease.

Motsoaledi says, ‘Listeria monocytogenes is a disease that occurs every year and is seen in our hospitals, typically 60 – 80 cases are detected and treated annually. However, in July 2017 doctors from neonatal units in Chris Hani Baragwanath and Steve Biko Academic hospitals alerted the NICD about unusually high number of babies with listeriosis. This triggered a review of all cases diagnosed in both public and private hospitals.’

In October 2017 the Multisectoral National Outbreak Response Team (MNORT) was briefed on the situation in the country.

Tracing from 1 January 2017, as of 29 November 2017, a total of 557 laboratory-confirmed listeriosis cases have been reported from all provinces. Most cases have been reported from Gauteng (62 per cent, 345/557) followed by Western Cape (13 per cent, 71/557) and KwaZulu-Natal (7 per cent, 37/557).

The age groups that are most affected are neonates, that means the first 28 days of life (37 per cent) and the age group between 15 to 49 years (33 per cent). These two groups comprise 70 per cent of all cases.

Of the 557 laboratory confirmed cases, 34 per cent were from the private health facilities and 66 per cent were from public health facilities. Given that only 17 per cent of South Africans use private health facilities; this proportion of cases from private health facilities is too high. This indicates that the source of the outbreak is likely to be a food product that is widely distributed and consumed by people across all socio-economic groups.

Motsoaledi explains, ‘Out of 557 cases, we are certain of the final outcome (discharge or death) for 70 cases. Of these 70 cases 36 persons have died.’

Food safety in South Africa is managed intersectorally by the Departments of Health; Agriculture, Forestry, and Fisheries as well as Trade and Industry. Local government is responsible for municipal health services, which include the enforcement of food safety legislation. The DTI looks after all aspects of fish and fishery products while DAFF manages meat safety and animal health.

There are four possible sources of listeriosis in general.

  • directly at origin e.g. farm
  • food processing plant
  • retail
  • food preparation at home

Motsoaledi says, ‘But we believe for this particular outbreak, the most likely possible source is contamination food at origin e.g. farms and agriculture as well as food processing plants.’

The source of this outbreak is currently being investigated, and all the stakeholders are cooperating with the investigation led by the NICD. Environmental Health Officers are following up diagnosed cases and are visiting their homes to sample food where available.

There are 23 private food testing laboratories that are accredited by SANAS (South African National Accreditation System) which reports to the Department of Trade and Industry. These laboratories have been requested to provide data on listeria to date, as well as to provide isolates to the NICD. Thus far two have voluntarily submitted isolates from food samples. Additionally five food and laboratory associations have also been requested to provide information to their members that have been testing for listeria.

These are:

  • South African Meat Processors Association (SAMPA)
  • South African Milk Processors Association (SAMPRO)
  • Milk South Africa (MILKSA)
  • Consumer Goods Council
  • National Laboratory Association

Government Laboratory Systems are also communicating their information to the NICD.

The NICD has made information available on their website regarding Listeriosis, including frequently asked questions (FAQs), clinical management guidance, and laboratory testing methodology.

The Food Control Division within the national Department of Health has distributed information about the outbreak to food industry stakeholders. The MNORT is considering including Listeriosis as a notifiable medical condition.

Motsoaledi says, ‘Whilst we continue with the investigation, the WHO has advised on following five keys to food safety:

Keep clean. Wash your hands before handling food and often during food preparation. Please do not get tired of washing your hands if it means washing hundred times a day, please do it!

If you are handling or storing raw food, do not touch already cooked food unless you have thoroughly washed your hands and food preparation utensils. In other words separate raw from cooked food.

Cook food thoroughly, never eat half cooked or uncooked food especially meat products. Food that does not usually need cooking before eating, needs to be thoroughly washed with clean running water. For families with no source of clean running water need to boil their water before domestic use.

Keep food at safe temperatures. Food to be kept cold should be refrigerated and food to be served hot should be served hot.

Use safe water for domestic use at all times and use pasteurised milk products. In situations where pasteurisation is not possible, for own domestic consumption, please boil the milk prior to use.’

Members of the public can call the following numbers:

NICD Emergency Operations Centre during working hours (011 386 2000)

For Health workers:

The NICD Hotline for Clinical Emergencies after hours (082 883 9920)