25 sickened: Listeriosis outbreak linked to consumption of raw milk brie cheese in France

As Australia reviews its ban on raw milk cheese – with the usual arguments about good and bad bacteria and artisinal crafsmanship  – the Institute of Health in France reports that on Oct 1, 2012, six human cases of Lm infection with the AscI/ApaI PFGE pattern 210792-210792 over the previous 6 weeks were identified by the National reference center for Listeria. PFGE-typing using restriction enzyme SmaI identified 2 distinct profiles, D and Q.

brie-nov2012b1On Oct 22, additional PFGE-matching cases were identified. An outbreak investigation was initiated to identify the source of contamination and guide public health actions. We defined a case as a Lm infection with a PCR-genoserogroup IVb and the PFGE AscI/ApaI 210792-210792 profile diagnosed in France between Aug 1, 2012 and Feb 11, 2013. SmaI Q-associated cases were considered epidemic whereas SmaI non-Q-associated cases were considered non-epidemic. Cases’ food consumption history was collected using a standard questionnaire. We conducted a case-case study, aiming at comparing the food consumption history of both epidemic and sporadic listeriosis cases identified during the same period, as well as traceback and traceforward investigations.

The implicated cheese factory was inspected. Food and environmental samples were collected.

Twenty-five cases were identified (11 epidemic cases). Dates of diagnosis ranged from Sep 4, 2012 to Nov 20, 2012. Consumption of raw milk brie cheese was significantly associated with the outbreak SmaI Q strain (Odds Ratio 35, IC95% [5-366]). Traceback and traceforward investigations identified Cheesemaker. A as the likely source of infection. Cheesemaker inspection did not identify any hygiene violation. Food and environmental samples did not yield the outbreak strain. A point-source contamination of the raw milk is suspected to have occurred.

(Thanks to Albert Amgar for forwarding the document.)

Hepatitis E prevalent in French raw pork liver products

Hepatitis A is a commonly known pathogen in the food safety world – hepatitis E isn’t. There have  been a few papers detailing illnesses and outbreaks linked to the uncommon viral pathogen (mostly all out of Europe and Asia).The November issue of Emerging infectious Diseases has a paper that shows high prevalence of hep E in French raw pork liver products (used by some fancy restaurants).Screen Shot 2014-10-09 at 2.06.51 PM

Frequent hepatitis E virus contamination in food containing raw pork liver, Franc

Emerging Infectious Diseases, Volume 20, Number 11, November 2014

Nicole Pavio, Thiziri Merbah, and Anne Thébault

http://wwwnc.cdc.gov/eid/article/20/11/14-0891_article

Highlights:

Food products containing raw pork liver are suspected to be vehicles for transmission of hepatitis E virus. Four categories of food products, comprising 394 samples, were analyzed to determine hepatitis E virus prevalence. Virus was detected in 3%–30% of the different categories. Phylogenetic analysis showed high identity with human and swine sequences.

HEV is the only hepatitis virus that can infect species other than primates. HEV infects many animal species, especially pigs, in which a very high prevalence has been described (2). Infections acquired in Western countries involve strains that are genetically similar to local swine strains, suggesting an autochthonous origin. Although water is the main vector of contamination in countries to which HEV is endemic, the origin of sporadic cases in other areas is more likely zoonotic. Direct contact with infected animals and consumption of infected meat are possible transmission pathways (2).

In 2011, four different categories of food products in France that were marketed by the food industry were identified as containing raw pork liver and sold to consumers to be eaten without cooking. These 4 categories were 1) figatellu and fitone, 2) dried salted liver, 3) quenelle and quenelle paste, and 4) dried or fresh liver sausages. HEV can be heat-inactivated by thorough cooking at 71°C for 20 min (9); however, consumers might not apply such precise thermal treatment. Thus, these food products might be able to transmit HEV. All 4 categories were local regional culinary specialties from eastern or southeastern France.

Screen Shot 2014-10-09 at 2.04.22 PM

Listeria still isn’t nice to pregnant women (and others)

This study describes trends in the incidence of pregnancy-related listeriosis in France between 1984 and 2011, and presents the major characteristics of 606 cases reported between 1999 and 2011 to the French Institute for Public Health Surveillance through the mandatory notification system.

amy.pregnant.listeriaThe incidence of pregnancy-related listeriosis decreased by a factor of 12 from 1984 to 2011. This reduction was a result of progressive implementation of specific Listeria monocytogenes control measures in food production. A lower incidence of pregnancy-related listeriosis was observed in regions with a lower prevalence of toxoplasmosis. Given that dietary recommendations in pregnancy target both toxoplasmosis and listeriosis prevention, we suppose that recommendations may have been delivered and followed more frequently in these regions.

Cases reported between 1999 and 2011 (n=606) were classified as maternal infections with ongoing pregnancy (n=89, 15%), fetal loss (n=166, 27%), or live-born neonatal listeriosis (n=351, 58%). The majority of live-born neonatal listeriosis cases (n=216, 64%) were preterm births (22–36 weeks of gestation), of whom 14% (n=30) were extremely preterm births (22–27 weeks of gestation). Eighty per cent of mothers reported having eaten high risk food during pregnancy. A better awareness of dietary recommendations in pregnant women is therefore necessary.

Eurosurveillance, Volume 19, Issue 38

D Girard, A Leclercq, E Laurent, M Lecuit, H de Valk, V Goulet

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20909

 

Listeriosis, caused by Listeria monocytogenes, is an important foodborne disease that can be difficult to control and commonly results in severe clinical outcomes. We aimed to provide the first estimates of global numbers of illnesses, deaths, and disability-adjusted life-years (DALYs) due to listeriosis, by synthesising information and knowledge through a systematic review.

Methods

We retrieved data on listeriosis through a systematic review of peer-reviewed and grey literature (published in 1990—2012). We excluded incidence data from before 1990 from the analysis. We reviewed national surveillance data where available. We did a multilevel meta-analysis to impute missing country-specific listeriosis incidence rates. We used a meta-regression to calculate the proportions of health states, and a Monte Carlo simulation to generate DALYs by WHO subregion.

Findings

We screened 11 722 references and identified 87 eligible studies containing listeriosis data for inclusion in the meta-analyses. We estimated that, in 2010, listeriosis resulted in 23 150 illnesses (95% credible interval 6061—91 247), 5463 deaths (1401—21 497), and 172 823 DALYs (44 079—676 465). The proportion of perinatal cases was 20·7% (SD 1·7).

Interpretation

Our quantification of the global burden of listeriosis will enable international prioritisation exercises. The number of DALYs due to listeriosis was lower than those due to congenital toxoplasmosis but accords with those due to echinococcosis. Urgent efforts are needed to fill the missing data in developing countries. We were unable to identify incidence data for the AFRO, EMRO, and SEARO WHO regions.

Funding

WHO Foodborne Diseases Epidemiology Reference Group and the Université catholique de Louvain.

The Lancet Infectious Diseases, doi:10.1016/S1473-3099(14)70870-9

Noordhout, Charline Maertens De, Brecht Devleesschauwer, Frederick J. Angulo, Geert Verbeke, Juanita Haagsma, Martyn Kirk, Arie Havelaar, and Niko Speybroeck

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(14)70870-9/abstract

18 sickened in 2012; E. coli O111 in a French nursery

(Thanks to my food safety friend Albert for sending this along.)

Three cases of hemolytic uremic syndrome (HUS) occurred in 15 days and the cases were notified to the Institute for Public Health Surveillance (VS) November 5, 2012 suggesting clustered cases of infection with enterohemorrhagic E. coli (EHEC).

nurseryAn exploratory investigation, a retrospective cohort of 89/94 children (95%) and 28/36 (78%) and personal prospective surveillance was carried out at a common exposure and to determine the extent of the epidemic . Screening in the family circle of confirmed cases and among children and staff was conducted. EHEC was detected by PCR (polymerase chain reaction) in feces, and positive samples were cultured for strain characterization.

A confirmed case was a child or crèche staff who submitted between 10 October 2012 and 17 January 2013, signs of gastroenteritis and/or HUS EHEC O111 isolation; probable case presented bloody and/or stool HUS and a positive PCR; a possible case had presented with diarrhea at least 3 loose stools in 24 hours and consulted a doctor.

Eighteen cases (6 confirmed, 1 probable and 11 possible) were identified among children. The epidemic curve evoked human transmission. The attack rate was 20.2%, 6.7% considering only confirmed cases. Attendance of group A was significantly associated with the disease (RR = 3.1 95% CI [1.3 to 7.1]). Household contacts of confirmed cases, 17% (3/18) were asymptomatic. Screening identified 4% (3/80) of asymptomatic children. 

State-sponsored jazz fail: unlocking France’s secrets to safer raw milk cheese?

Leave it to U.S. National Public Radio to glorify raw milk cheese from France, based on some secret manuscript that requires $20,000 to translate (Amy could probably do it for nothing, but I wouldn’t want to speak on her behalf).

UnknownWhat NPR left out was that some former raw milk cheese producers have switched to using pasteurized milk.

In 2007, while Amy and I were touring around France, she wrote, two of France’s (and thus the world’s) top lait cru Camembert producers, Lactalis and Isigny-Sainte-Mère, announced that they are forgoing the status of “Appellation d’Origine Contrôlée” and switching to cheese made exclusively with heat-treated micro-filtered milk (not quite pasteurized but still an affront to purists).

Lactilis’ spokesperson, Luc Morelon said that although they recognize the importance of Camembert traditions, they’re making the change “[b]ecause consumer safety is paramount, and we cannot guarantee it 100 per cent. We cannot accept the risk of seeing our historic brands disappearing because of an accident in production.” In response to his critics Morelon added, “I don’t want to risk sending any more children to hospital. It’s as simple as that.”

Nice research, NPR.

Dumpster-diving Frenchman bikes for world hunger

Chapman’s been chronicling dumpster-diving for a few years, but now Frenchman Baptiste Dubanchet is on a quest to bike across Europe, surviving entirely on discarded food. The three-month, 1,900-mile journey from Paris to Warsaw is Dubanchet’s way of raising awareness of food waste in Europe and throughout the world.

baptiste-dubanchet.siWhile the world’s restaurants and supermarkets combine to throw away an average of 1.3 billion tons of food each year, according to the UN, much of it remains inaccessible thanks to locked dumpsters, health regulations, or business policies.

 For legal reasons, most establishments have a policy against giving away food waste.

Beetroot suspected of poisoning 40 French students in January

Red beets are suspected of poisoning 40 school children on January 10, 2014, in Lambersart, France.

According to food service provider Sodexo, preliminary laboratory analysis indicates a bacteria on red beats that produces a toxin when stored at room temperature is beets1responsible for the outbreak.

On January 10, 150 children in Lambersart began vomiting and having headaches. After being examined 40 children were diagnosed with “light” poisoning (something may be lost in translation here, but thanks, Amy, for the work, and Luca for the link).

Sodexo says it has changed their beat supplier and is strengthening their regular testing of suppliers.

French pork group Cooperl rejects Salmonella fraud allegations

France’s leading pork processor Cooperl has rejected allegations in a French newspaper report that it knowingly sold meat contaminated with Salmonella before November 2012 using falsified documents.

According to the report in Le Télégramme, between 2010 and 2012, 1,500 tonnes of meat was used in the composition of prepared dishes such as ravioli and charcuterie Cooperl.porkproducts like salami, sausage and cocktail sausages. The lines were said to have been distributed in France and Russia.

The co-operative confirmed its premises were inspected by police in November 2012 “which revealed a probable misinterpretation on our part of the regulations in force.”

Immediately after the inspection, Cooperl improved its analysis protocols for Salmonella. “We are in full conformity with regulatory requirements relating to food quality and safety,” a spokesperson said.

The Brittany-based group added: “We totally reject the allegations of fraud levelled at our company in this report which are completely unfounded.” It underlined the suspected meat had not represented a health risk to consumers.

125 students victims of food poisoning in French canteen

In yet another outbreak of foodborne illness in  France (which Amy helped translate this warm Sunday morning), 125 school students in Lambeth, near Lille, were stricken with fish_headsstomach pains, vomiting and headaches.

According to Marc-Philippe Daubresse, the Mayor of Lambeth, , this “slight” intoxication was due to the fish. But checks were requested to Sodexo, the provider of meals in the city.

68 students sick; pasta bolognese probable source at school

Sixty-eight people, mostly students, were victims of food poisoning, probably from eating pasta bolognese in the canteen of a private vocational school in Yvelines, 50 km west of Paris.

A communications officer with the school said, “65 people were taken to hospitals to pasta bologneseundergo additional tests and all have returned home or boarding with treatment.”

The people who ate the pasta carbonara did not get sick but the school administration also says there had been cases of gastroenteritis for several days in the school.

School meals are cooked on site.