Pregnant woman diagnosed with listeriosis: illness linked to Jersey business El Ranchero del Sur, LLC’s cheese

Listeria is scary stuff, especially for pregnant women. Pregnant women make up nearly one-third of all cases of listeriosis, due to natural hormonal changes of pregnancy that weaken the immune system. While the mother normally survives an infection during pregnancy, the perinatal/neonatal mortality rate is greater than 80%.

According to an alert sent from the New Jersey Department of Health and Senior Services to a couple of barfblog readers, El Ranchero del Sur, LLC of South River, NJ has a listeria problem in their cheese products. Consumption of their products have been linked to listeriosis in a pregnant woman and investigators have confirmed the presence of the pathogen. In queso fresco, again (here, here, etc).

The New Jersey Department of Health and Senior Services (NJDHSS) Food and Drug Safety Program (FDSP) is warning the public not to consume any cheese products produced by El Ranchero del Sur, LLC of South River, NJ. On March 2, 2012, a 38-week pregnant woman was diagnosed with Listeria monocytogenes infection at a New Brunswick hospital. Subsequent investigation by the Middlesex County Health Department and product analysis by NJDHSS Public Health Environmental and Agricultural Laboratories confirmed the presence of L. monocytogenes in a sample of Los Corrales Queso Fresco Fresh Cheese and Banana Leaf code dated 03/16/12.

Listeria monocytogenes is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

FDSP, with assistance from the U.S. Food and Drug Administration (FDA), has obtained a voluntary closure by the firm’s owner while the products and facility are investigated for the presence of L. monocytogenes. All products and ingredients at the facility have been placed under embargo pending the outcome of laboratory testing for L. monocytogenes.

El Ranchero del Sur, LLC has pledged to conduct a voluntary recall through the FDA and is contacting its customers to arrange for the retrieval of all of their cheese products. El Ranchero del Sur cheese products can be found primarily in Mexican and Latin American grocery stores, restaurants, and other hispanic food establishments under the name brands El Ranchero, Los Corrales, and Carnes Don Beto with the plant number 34-0013669 marked on the label. All products are 14 ounces in weight except for the Queso Hebra Oaxaca String Cheese ball in 10 pound packages.
FDSP is requesting local health departments to investigate retail food establishments, in their respective jurisdictions, which are likely to sell or use these products in food service, and take actions to remove from sale or service all of the products described above, of all types and code dates.

If you have any questions, please contact Alan Talarsky, Dairy Project Coordinator, FDSP at (609) 826-4935. Thank you for your assistance in this matter.

Pregnancy, protein and listeria: are mums-to-be ‘too cautious’ on risk foods?

"How long have you been pregnant,” I asked the thirty-something as we filled our plates during the catered lunch at a meeting in 2000 in Ottawa.

“About six weeks.”??

The American media had been filled with coverage of listeria after the 1998-1999 Sara Lee Bil Mar hot dog outbreak in which 80 were sickened, 15 killed and at least six pregnant women had miscarriages. Risk assessments had been conducted, people were talking about warning labels, and especially, the risks to pregnant women. ??There was no such public discussion in Canada.?? So as I watched the pregnant PhD load up on smoked salmon, cold cuts and soft cheese for lunch, I wondered, do I say something?

One of the biggest risks in pregnancy is protein deficiency. What if smoked salmon, cold cuts and soft cheeses were this woman’s biggest source of protein? (Turns out they were.)?? Another risk factor is stress. I didn’t want to freak her out. Besides, who the hell am I to say anything? ??We sat together during lunch and chatted about babies, her aspirations and how she was feeling. Eventually I introduced the subject of listeria by talking about a risk assessment that had recently been published by the U.S. Food and Drug Administration, and that maybe she would be interested in looking at the results. I felt sorta goofy.
Professor Clare Collins of the University of Newcastle studied the eating habits of 7000 Australian women to see if they were missing out on important nutrients as a result of avoiding "risky" foods that potentially carried listeria.

9News reports some pregnant women are being overly cautious about avoiding what are traditionally considered "no-no" foods, such as soft cheese, pate and sashimi, a researcher says. Oysters, smoked fish, delicatessen meats, salad bar salads and pre-cut fruit are also considered high risk for carrying the Listeria monocytogenes.

Reporting her findings in the journal Public Health Nutrition, Prof Clare said her study found that women who ate the most listeria foods reported more frequent miscarriages, but had high levels of the nutrients needed to have a healthy baby.

Conversely, those who ate moderate or low amounts of listeria foods had less miscarriages but also lower levels of nutrients like calcium, folate and Omega 3 acids.

"In those with moderate and low exposure there was no excess risk of miscarriage but the problem was their nutrient intakes were then worse," Prof Clare said.

"We’re saying pregnant women need to be given more advice on how to eat healthy. If all they hear is risky foods, and they drop out all the potential listeria foods, their micro nutrient intake is going to be really bad.”

She said the existing listeria guidelines for pregnant women were entirely legitimate but needed to be rewritten to provide more information about what could be eaten, as well as what should be avoided.

There were 65 cases of listeriosis in Australia in 2008, 12 during pregnancy and one that was fatal.

Is toxoplasmosis underestimated in the food supply?

When toxoplasma in pork ranked second in last year’s top 10 riskiest combinations of foods and disease-causing microorganisms at $1.2 billion a year, some wondered, what?

Now the Brits have chirped in, saying much more needs to be known about Toxoplasma gondii in the country’s food and especially the impact on pregnant women.

The UK Food Standards Agency’s (FSA) Advisory Committee of the Microbiological Safety of Food (ACMSF) is seeking stakeholder views on its draft report relating to toxoplasma in the food chain (available at http://www.food.gov.uk/multimedia/pdfs/consultation/criskprotoxoplasmafoodchain.pdf).

According to the UK National Health Service (NHS), food sources include undercooked or raw meat, raw cured meat (including Parma ham, salami) and unpasteurised goat’s milk, and the infection can pass between humans from a pregnant woman to an unborn baby.

Although toxoplasmosis usually only causes mild flu-like symptoms in adults, the ACMSF said it can be fatal to babies, and has been linked with associated jaundice, eye infections and seizures.

The FSA’s scientific advisory committee was asked to consider whether current evidence indicates a food safety issue that needs to be addressed, what food sources could present a significant risk and identify further work needed on UK prevalence and foodborne sources of toxoplasmosis.

38 sick, many pregnant in 2008 listeria in pasteurized cheese outbreak in Quebec; cross-contamination affected hundreds of retailers

Fall 2008 was a crappy time in Canada. While the Maple Leaf listeria-in-deli-meats outbreak would kill 23 and sicken 56, a listeria-in-cheese outbreak plagued Quebec (that’s in Canada, according to some), sickening lots, especially expectant mothers.

Amy was pregnant, heightening sensitivities.

At the time, public attention and concern in Quebec was far more focused on the plight of cheesemongers than the sick and several dead. Regulators took some tough steps to limit the outbreak but in a culture that values tradition, the Quebec Minister of Agriculture was forced to capitulate and change his tune from, "The province is not there to compensate. We aren’t an insurance company," to offering a three-year, $8.4-million aid package, along with $11.3-million in interest-free loans to Quebec’s small cheese producers and retailers less than three weeks later.

Government health-types in Quebec have now offered their version of events in the current issue of the Journal of Food Protection.

Although numbers of sick people were all over the place at the time, the researchers conclude there were 38 confirmed sick with the same strain of Listeria monocytogenes (LM P93) across Quebec from June through Dec. 2008, including 14 pregnant women and two babies born to asymptomatic mothers. There were two elderly deaths and three neonatal deaths.

The traceback of many brands of cheese that tested positive for LM P93 collected from retailers identified two cheese plants contaminated by L. monocytogenes strains on 3 and 4 September. PFGE profiles became available for both plants on 8 September, and confirmed that a single plant was associated with the outbreak. Products from these two plants were distributed to more than 300 retailers in the province, leading to extensive cross-contamination of retail stock.

So where is that local cheesemonger you know, trust and can look in the eye, getting their cheese from?

The abstract is below:

Widespread Listeriosis outbreak attributable to pasteurized cheese, which led to extensive cross-contamination affecting cheese retailers, Quebec, Canada, 2008
01.jan.12
Journal of Food Protection®, Volume 75, Number 1, January 2012 , pp. 71-78(8)
Gaulin, Colette; Ramsay, Danielle; Bekal, Sadjia
http://www.ingentaconnect.com/content/iafp/jfp/2012/00000075/00000001/art00011
Abstract:
A major Listeria monocytogenes outbreak occurred in the province of Quebec, Canada, in 2008, involving a strain of L. monocytogenes (LM P93) characterized by pulsed-field gel electrophoresis (PFGE) and associated with the consumption of pasteurized milk cheese. This report describes the results of the ensuing investigation. All individuals affected with LM P93 across the province were interviewed with a standardized questionnaire. Microbiological and environmental investigations were conducted by the Quebec’s Food Inspection Branch of Ministère de l’Agriculture, des Pêcheries et de l’Alimentation du Québec among retailers and cheese plants involved in the outbreak. Between 8 June and 31 December 2008, 38 confirmed cases of LM P93 were reported to public health authorities, including 16 maternal-neonatal cases (14 pregnant women, and two babies born to asymptomatic mothers). The traceback of many brands of cheese that tested positive for LM P93 collected from retailers identified two cheese plants contaminated by L. monocytogenes strains on 3 and 4 September. PFGE profiles became available for both plants on 8 September, and confirmed that a single plant was associated with the outbreak. Products from these two plants were distributed to more than 300 retailers in the province, leading to extensive cross-contamination of retail stock. L. monocytogenes is ubiquitous, and contamination can occur subsequent to heat treatment, which usually precedes cheese production. Contaminated soft-textured cheese is particularly prone to bacterial growth. Ongoing regulatory and industry efforts are needed to decrease the presence of Listeria in foods, including pasteurized products. Retailers should be instructed about the risk of cross-contamination, even with soft pasteurized cheese and apply methods to avoid it.

Leukemia patients, pregnant women at greatest risk of listeriosis

People with certain conditions, including leukemia, other cancers and pregnancy, are at the greatest risk of getting sick from the foodborne bacterium Listeria, French researchers report in a new study.

Doctors and public health officials have known that these conditions make people more vulnerable to listeriosis, but this study is the first to rank the size of the risk for people with each condition.

The results "will help focus risk communication for the medical community," said Ramon Guevara, an epidemiologist for the County of Los Angeles Department of Public Health, who was not involved in the study.

The study looked at nearly 2,000 cases of listeriosis in France — affecting 39 out of every 10 million people — from 2001 to 2008.

Despite its rarity, listeriosis is still considered an important public health concern because it’s relatively deadly compared to other food-borne illnesses, lead author Dr. Véronique Goulet at the Institut de Veille Sanitaire in Saint-Maurice wrote in an email to Reuters Health.

More than 400 of the 2,000 people who developed listeriosis died.

None of the cases involved an outbreak.

About one in six of the listeriosis cases in France affected pregnant women.

Incidence of Listeriosis and related mortality among groups at risk of acquiring Listeriosis
23.dec.11
Clinical Infectious Diseases
Véronique Goulet, Marjolaine Hebert, Craig Hedberg, Edith Laurent, Véronique Vaillant, Henriette De Valk, and Jean-Claude Desenclos
http://cid.oxfordjournals.org/content/early/2011/12/12/cid.cir902
Abstract
Background. Listeriosis is a foodborne disease of significant public health concern that primarily affects persons with recognized underlying conditions or diseases that impair cell-mediated immunity. The degree of risk posed by the different underlying conditions is crucial to prioritize prevention programs that target the highest risk populations.

Methods. We reviewed cases of listeriosis reported in France from 2001 to 2008. Numbers of cases and deaths were tabulated by age and underlying condition. Measures of the impact of specific underlying conditions on the occurrence of listeriosis were calculated. For estimating the total number of persons living with specific diseases, we applied prevalence estimates of these diseases to the French population. Underlying conditions were ranked by the degree to which they increased the risk of listeriosis.

Results. From 2001 to 2008, 1959 cases of listeriosis were reported in France (mean annual incidence 0.39 per 100 000 residents). Compared with persons <65 years with no underlying conditions, those with chronic lymphocytic leukemia had a >1000-fold increased risk of acquiring listeriosis, and those with liver cancer; myeoloproliferative disorder; multiple myeloma; acute leukemia; giant cell arteritis; dialysis; esophageal, stomach, pancreas, lung, and brain cancer; cirrhosis; organ transplantation; and pregnancy had a 100–1000-fold increased risk of listeriosis.

Conclusions. To be effective and acceptable to physicians and patients, listeriosis prevention strategies should be targeted based on evidence of increased risk. Stringent dietary guidance, to avoid specific foods with a high risk for Listeria contamination, should be targeted to pregnant women and to others at highest risk of listeriosis.

’You try to eat better when pregnant’ Baby born with listeria after mom ate tainted cantaloupe comes home

Three months after she was born, Kendall Paciorek is finally home, just in time for Christmas.

The premature girl from Fishers, Ind., is one of the tiniest victims of last summer’s deadly listeria outbreak in cantaloupe, which sickened 146 people, including 30 who died.

JoNel Aleccia of msnbc describes how Kendall (right, photo from msnbc) spent the first several weeks of her life in an incubator, fighting off an infection contracted when her mother ate tainted melon traced to Jensen Farms of Holly, Colo.

She’s strong enough now to sleep in her own crib in the house where big sister Madison, 4, loves to color pictures of Santa.

Officials at the Centers for Disease Control and Prevention declared the outbreak over this month, and the rest of the world seems poised to move on.

But for Kendall and her family, the impact of the foodborne illness caused by a summer snack is just beginning.

“Right now they don’t know what’s going to happen to her in the long term,” said Michelle Wakley-Paciorek, Kendall’s 41-year-old mother. “We were told she could have mental and or physical delays.”

Kendall was one of three newborns diagnosed with listeria infections in the outbreak that largely affected the elderly, according to the CDC. Four pregnant women became ill; one had a miscarriage.

For now, there’s no sign of serious trouble, other than the feeding tube that runs into Kendall’s stomach because the baby has had difficulty eating.

With help, she’s gained weight, now topping 7 pounds, up from 3 pounds, 11 ounces when she arrived suddenly on Sept. 21.

That was a week after the federal Food and Drug Administration announced a voluntary recall of the entire crop of fresh, whole cantaloupe from Jensen Farms.

But for Kendall and her mom, it was already too late.

“We’re thinking I ate cantaloupe sometime in the first three to four weeks of August,” Wakley recalled. “I ate it probably multiple times. You try to eat better because you’re pregnant.”

Wakley never became violently ill. Instead, she suffered headaches, muscle aches, fever and chills for several weeks before she started having contractions during a pedicure.

“I couldn’t even believe I was in labor,” said Wakley, who was rushed to an emergency department and given drugs to halt delivery.

Despite the effort, Kendall was born hours later, but so small and sick that doctors feared for her life.

Blood tests later revealed that both mother and baby were infected with listeria later traced to the tainted Colorado cantaloupe.

The months since then have been a blur of hospital rooms, doctors’ visits and worried conversations about Kendall’s future.

“You almost panic because they tell you about all kinds of learning disabilities and other problems,” she said. “It’s been like an emotional roller-coaster.”

It’s not clear whether Wakley can continue working, or whether she’ll need to quit her job to care for Kendall and her sister full-time. Her husband, Dave Paciorek, 41, is a senior manager at Federal Express.

Pregnant Iowa woman miscarries due to listeria-in-cantaloupe

Mommies-to-be like their cantaloupe too. So the news of the first stillbirth linked to listeria-in-cantaloupe is expected, but nonetheless tragic.

The Des Moines Register reports tonight that a pregnant Iowa woman miscarried recently because of a listeriosis infection she apparently picked up from tainted cantaloupe, state health officials said today.

The unidentified northwest Iowa woman was infected with the same strain of listeria that has been spread via cantaloupe grown by Jensen Farms in Colorado.

The company’s Rocky Ford brand melons, which were recalled Sept. 14, have been tied to at least 18 deaths nationwide.

The woman told state investigators that she bought cantaloupe at an Iowa store a few weeks ago. Officials strongly suspect the melon came from Jensen Farms and caused her illness, but they haven’t proven the theory yet.

Dr. Patricia Quinlisk, the department’s medical director, said that for some reason, listeria bacteria are particularly harmful to fetuses, and infections regularly cause miscarriages.

Quinlisk said about eight or 10 serious listeriosis cases are reported in Iowa each year. She urged Iowans to take precautions to reduce their risk, but she said occasional bacterial outbreaks should not scare people away from the produce aisle.

Pregnant women: don’t eat clay imported to the UK

The U.K. Food Standards Agency is advising pregnant women not to eat clay, sometimes known as ‘sikor’ or ‘shikor mati’, because it may contain high levels of toxic chemicals that could harm their babies.

Clay or earth is sometimes consumed in Asia and Africa, particularly by pregnant women who believe that eating it is beneficial during pregnancy. It is not known how common clay consumption is in the UK, but recent research carried out by De Montfort University found products imported from Bangladesh on sale in shops in Birmingham, Leicester and Luton.

Tests carried out on samples of this baked clay found high levels of lead and arsenic. Exposure to arsenic can be associated with an increased risk of lung, skin and bladder cancer. Exposure to lead by pregnant women, infants or children poses a risk to the development of the brain, which can affect intellectual performance.

Pregnant Aussie mom sues airline over listeria in chicken wrap, premature birth

In Aug. 2009, two pregnant women in Australia gave birth prematurely and seven others were confirmed sick with listeriosis after eating contaminated chicken wraps that were sold to thousands on Virgin Blue flights from Brisbane and the Gold Coast, triggering a national public health alert.

From the outset, Virgin Blue has blamed suppliers.

On Friday, one of those pregnant women, Renee Cherry, launched legal action in the Supreme Court on behalf of her son Zayd Fokeera, now aged almost two, seeking compensation from Virgin Australia.

According to a statement of claim, a pregnant Ms Cherry flew from Townsville to Brisbane, then from Brisbane to Melbourne, on May 23, 2009.

During the flight, it is claimed, Ms Cherry bought a chicken roll from flight attendants, and she suffered listeria poisoning as a result.

"The roll was tainted and not fit for human consumption, as it contained listeria bacteria," according to the statement of claim.

"The listeria bacteria poisoned the blood of the plaintiff’s mother and the plaintiff and caused him to suffer injury."

Zayd was born two months after the flight, suffering from listeriosis, gastro-intestinal injury, developmental delay, and anxiety.

There is a claim for medical expenses and loss of prospective income and earning capacity, as well as damages. A trial before a judge and jury is sought.

A Virgin spokesman said the writ had not been served on the airline, and it could not comment because it had not seen the details of the claim.
 

Should people over 50 heat cold cuts to avoid listeria?

The risk may be small, but the failures are tragic.

Governments routinely warn that immunocompromised people, including expectant mothers and the elderly, should refrain from certain ready-to-eat refrigerated foods like deli meats and smoked salmon because of the risk of listeriosis.

Elizabeth Weise writes in today’s USA Today that the U.S. Centers for Disease Control and Prevention has been saying for at least 11 years now that people over 50 and especially those over 65 should avoid hot dogs, lunch meats, cold cuts and other deli meats unless they are reheated to 165 degrees — "steaming hot" in CDC’s words.

The government also says you shouldn’t keep an open package of sliced deli meat more than five days, all to reduce the risk of infection from a bacteria called listeria. But some question whether the country’s been paying attention.

Barbara Resnick, incoming president of the American Geriatrics Society and a professor of nursing at the University of Maryland, knows of no one over that age who heats deli meats to that level and says she’s never seen a case of listeriosis in a patient.

Neil Gaffney, spokesman for the U.S. Department of Agriculture’s Food Safety Inspection Service said, "When it comes to food safety, we’re serious: People at risk for listeriosis should not eat hot dogs, luncheon meats or deli meats unless they are reheated until steaming hot. Thoroughly reheating food can help kill any bacteria that might be present. If you cannot reheat these foods, do not eat them."

Mike Doyle, a professor of food microbiology at the University of Georgia said about 85% of listeriosis cases are linked to cold cuts or deli meats, and that today almost all packaged lunch meats contain either added sodium lactate, an acid formed by fermentation, or potassium lactate, fermented from sugar, as antimicrobials. That’s what he looks for when he buys cold cuts.

And based on FSIS risk-assessment data, meats sliced at the store pose a greater risk than meats pre-sliced at federally inspected establishments

Listeria and cold cuts were ranked just last week as the third worst combination of a food and a pathogen in terms of the burden they place on public health, costing $1.1 billion a year in medical costs and lost work days, according to a study by the University of Florida’s Emerging Pathogen Institute.

Douglas Powell a professor of food safety at Kansas State University, said, "And you can’t see, taste or smell that it’s there.”

CDC also says don’t keep opened packages of lunch meat, or meat sliced at the local deli, for longer than three to five days. That’s another one no one pays attention to, says Kansas’ Powell.

"Anecdotally, lots of people keep cold cuts in their refrigerator far longer than they should. People keep them for one to two weeks. That’s the key message. If you get it from the deli counter, four days max."

What wasn’t included in the story is evidence of listeria-related tragedies in other countries – countries that may not have approved those listeria-restraining additives.

Twenty-three elderly people died in Canada in 2008 after eating listeria-laden cold-cuts from Maple Leaf Foods. Later that year, listeria in soft cheese in Quebec led to 38 hospitalizations, of which 13 were pregnant and gave birth prematurely. Two adults died and there were 13 perinatal deaths.

The New South Wales Food Authority said last month the Authority provides information on listeria to pregnant women to allow them to make an informed food choice regarding the risk and how to minimize it. It is not to say that every piece of deli meat has Listeria on it, but some foods have a higher potential rate of contamination than others, and it is better to avoid them.

The risk of acquiring listeriosis is low. However the consequences for a pregnant woman contracting listeriosis are dire.

While the Authority may be accused of ‘being over the top’, we may also be accused of neglecting pregnant women if we did not provide this information so pregnant women could make informed choices in what they eat.

Over the last 5 years in Australia there have been between 4 and 14 cases of listeriosis diagnosed in pregnant women or their babies each year. These infections have resulted in the deaths of 8 fetuses or newborn babies.