listeriosis in the united states benjamin j. silk, phd, mph staff epidemiologist enteric diseases...
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Listeriosis in the United States
Benjamin J. Silk, PhD, MPHStaff Epidemiologist
Enteric Diseases Epidemiology Branch, CDC
Public meeting on the Interagency RetailListeria monocytogenes Risk Assessment
May 22, 2013
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Foodborne, Waterborne, and Environmental Diseases
Listeria monocytogenes
Found in soil and water
Grows at refrigeration temperatures
Transmitted to people by food
Infection (listeriosis) causes severe disease in vulnerable groups
Higher-risk Groups
Higher-risk Group Illnesses/outcomes
Pregnant women Febrile illness, fetal loss
Newborn infants Bloodstream infection, meningitis
Persons with immunocompromising conditions
Bloodstream infection, meningitis
Older adults Bloodstream infection, meningitis
Incidence by Risk Group, 2004–2009
Pregnancy-associated
Scallan E et al, Emerging Infectious Diseases, 2011
Pathogen Illnesses Deaths Case-fatality rate
Listeria 1,600 260 16%
Campylobacter 1,300,000 120 0.1%
Salmonella 1,230,000 450 0.5%
Shiga toxin- producing E. coli O157 96,000 30 0.5%
Listeriosis is rare, but deadly
U.S. Listeriosis Incidence, 1986-2011
Data from sentinel site surveillance (FoodNet since 1996)
Progress in late 20th Century
Detection of Processed Meats as Source, 1989
U.S. Listeriosis Incidence, 1986-2011
Data from sentinel site surveillance (FoodNet since 1996)
New regulatory policies and industry efforts begin targeting meat processing
Hot Dog Outbreaks, 1998–2011:A Regulatory Success
Years No. cases No. deaths/fetal losses1998 112 141999 4 0
2000-2011
0 0
Cartwright E et al, Emerging Infectious Diseases, 2013
Deli Meat Outbreaks, 1998–2011: A Regulatory Success
Years No. cases No. deaths/fetal losses1998 0 01999 7 22000 30 42001 28 02002 54 82003 0 02004 0 02005 13 12006 0 02007 0 02008 0 02009 0 02010 8 22011 0 0
Cartwright E et al, Emerging Infectious Diseases, 2013
U.S. Listeriosis Incidence, 1986-2011
Data from sentinel site surveillance (FoodNet since 1996)
New regulatory policies and industry efforts begin targeting meat processing
Advent of PulseNet, 1998
PFGE patterns
National database
Participating laboratories
Before PulseNet 1978-1997 (20 years)5 outbreaks (2 multistate)Average 54 cases/outbreak
Era of PulseNet 1998-2004 (7 years)13 outbreaks (4 multistate)Average 22 cases/outbreak
Advent of PulseNet
New Opportunities in 21st Century
U.S. Listeriosis Incidence, 1986-2011
Data from sentinel site surveillance (FoodNet since 1996)
New regulatory policies and industry efforts begin targeting meat processing
Lack of progress
Healthy People 2020 Goal
Developed in 2004 Enhanced surveillance for all cases Nationally-standardized food
history interviews Integration with PulseNet Expedites identification of
common food sources during outbreak investigations
Listeria Initiative
Outbreak from Whole Cantaloupe, 2011
Newly Recognized Sources of Listeriosis, from Outbreaks, 1998–2011
Implicated food vehicle Year No. cases No. deaths/fetal losses
None 1998-2005 0 0 Taco/nacho salad 2006 2 0 Tuna salad 2008 5 3 Sprouts 2008 20 20 None 2009 0 0 Pre-cut celery 2010 10 5 Whole cantaloupe 2011 147 34
Cartwright E et al, Emerging Infectious Diseases, 2013
Mexican-style Cheese Outbreaks, 1998–2011:A Continuing Problem
Year No. cases No. deaths/fetal losses
1998 0 0
1999 0 0
2000 13 0
2001 0 0
2002 0 0
2003 12 1
2004 0 0
2005 12 0
2006 0 0
2007 0 0
2008 8 0
2009 26 0
2010 6 1
2011 2 0
Cartwright E et al, Emerging Infectious Diseases, 2013
Incidence by Ethnicity, 2004–2009
Illnesses per 100,000 people
Outbreak from Imported Cheese that Cross-Contaminated Other Cheeses, 2012
Imported, contaminated ricotta salata was outbreak source
Cross-contamination of other cheeses propagated the outbreak
First U.S. listeriosis outbreak associated with cut and repackaged cheeses
Summary
Progress in late 20th Century• Interventions targeted processed hot dogs and deli meats• Enhanced outbreak detection
New Opportunities in 21st Century• Identify sources of sporadic cases via continued enhancement of
outbreak detection (e.g., Listeria Initiative, whole genome sequencing)• Newly recognized raw produce sources• Persistent sources, especially Mexican-style cheese
• Pasteurized and unpasteurized
• Targeting contamination and cross-contamination in retail settings
Public Health Approach to Prevention
Surveillance
Epidemiological Investigation
AppliedResearch
Prevention Measures
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333Telephone: 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348Visit: www.cdc.gov | Contact CDC at: 1-800-CDC-INFO or www.cdc.gov/info
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious DiseasesDivision of Foodborne, Waterborne, and Environmental Diseases