Tag Archives: Pregnant

Listeria outbreak in Belgium, 2006-2007, especially dangerous for pregnant women

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Yesterday’s issue of Eurosurveillance contained an excellent piece of epidemiological field work concerning an outbreak of listeria in Belgium in 2006 and 2007. Edited excerpts below:

A total of 11 cases appear to have been involved in this episode (six in 2006 and five in 2007). Of the positive cultures of these patients, nine were from blood and two from cerebrospinal fluid; four cases were pregnant women or newborns. One pregnant woman had a twin stillbirth. The episode was not geographically clustered, as the isolates were received from three different regions in Belgium: Flanders, Wallonia and Brussels.

The episode was first recognised by the BLRC in November 2006. Only on four occasions were patients asked about their food habits. No standardised questionnaire was used. Suspected food samples were taken from the patients’ refrigerators or from the same batch of the suspected food at the retail level. Smoked salmon was sampled because in a case of preterm birth, the mother remembered having eaten smoked salmon. Raw beef brains were the only suspected food item in a case of septicaemia. The woman with the twin stillbirth reported having eaten pre-packed lasagne; this food item was suspected after some of her housemates presented with gastroenteritis. However, L. monocytogenes could not be detected in any of these samples.

The combination of serotyping, metal resistance typing and PFGE led to the identification of 11 identical isolates. The episodic strain was of serovar 4b, sensitive to arsenic and cadmium and belonged to pulsovar A. Six of them were isolated within a period of a few weeks which is exceptional for a small country like Belgium. Besides the cluster isolations in 2006, the episodic strain was isolated from a further five patients in 2007, indicating a long extension of the episode which went on until July 2007.

The source of contamination was not detected. Two factors may have contributed to this failure: no systematic interviewing of the patients and unsuccessful food sampling. During this episode only four patients were contacted by community health inspectors and only three different food samples were taken which proved to be negative for L. monocytogenes in 25 g.

Serovar 4b is not unusual. In Europe and North America, most published outbreaks of listeriosis in the past 20 years have involved 4b. In addition, strains of serovar 4b tend to be overrepresented in perinatal listeriosis, suggesting that they may have special virulence attributes for pregnancy and breach of the blood-placenta barrier. In the cluster described here, four of the 11 cases were pregnancy-related.

It is presumed that the episodic strain was particularly virulent because it involved a relatively high number of pregnancy-related cases and meningitis cases, four of 11 and two of 11 respectively. According to annual data from the BLRC, strains from cases with maternal-neonatal listeriosis represent 10% of the total number of clinical strains; a similar proportion is observed for cases with meningitis.

This episode would have passed unnoticed had not the BLRC performed strain typing. Efficient monitoring of listeriosis requires systematic interviewing of the patients using a standardised questionnaire. Close cooperation between community health inspectors, the Belgian Federal Agency for the Safety of the Food Chain (FASFC) and the BLRC would result in a rapid linking of sporadic cases and enhance the chance of finding the infection source in outbreaks.
 

Pregnant Pam doesn’t eat pate on The Office

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I don’t know if Jenna Fischer is pregnant in real life, but her character, Pam Beesley, on television’s The Office, most certainly is.

On last night’s new episode, Pam was trying to set Oscar up with a dude from the warehouse. She introduced Oscar by saying he made the pate, and she can’t get enough of Oscar’s pate – although she wasn’t shown eating the pate.

This is good, because as real live pregnant woman Amy blogged, pate and other refrigerated ready-to-eat foods are not a good idea for expectant moms due to the listeria risk.

Michael McCain of Maple Leaf Foods, the Canadian company that killed 22 people with listeria-laden cold cuts last year, was honored again today as a visionary leader, yet he has never publicly said whether pregnant women should eat his cold-cuts. Or pate. Glad The Office got it right.
 

Raw milk: save the family farm while making kids barf?

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The N.Y. Times has a story running in tomorrow’s edition flaunting the value of raw milk as a way to save the family farm because a small percentage of people pay a hefty premium for the raw stuff.

The story lacks any mention of adverse health effects from raw milk , other than quoting an FDA type as saying, “raw milk should not be consumed by anyone, at any time, for any reason.”

Such proclamations are not particularly persuasive.

The story, like many others, notes that people want to know where their food comes from; but that doesn’t make food safer. Knowing how to control and minimize the spread of dangerous microorganisms makes food safer, whether it’s from around the corner or around the globe.

The Times story does however make mention of the Quebec listeria outbreak of 2008 that was traced to cheese made from unpasteurized milk, stating that “one person died; more than 30 became ill,” and proclaiming that the government went crazy recalling nearly 60,000 pounds, of cheese from hundreds of producers.

The Times story appears to be something about government out-of-control, although it’s a mish-mash.  And it fails to mention that the 2008 Quebec outbreak, led to 38 hospitalizations, of which 13 were pregnant and gave birth prematurely. Two adults died and there were 13 perinatal deaths. Recent research has demonstrated listeria can cause illness in fetuses and infants at much lower doses than previously thought.
 

An updated table of unpastuerized milk and cheese outbreaks is below.

http://bites.ksu.edu/raw-milk-outbreaks

Listeria causes illness in fetuses, infants, at much lower dose than previously thought

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Chapman is here in Manhattan (Kansas) for a couple days, delivering a seminar later today, hanging out at the Missouri-Kansas State football game tomorrow, and primarily helping plot our research and extension activities for the next few years.

We’ve both sired offspring in the past year-and-a-bit, so the issue of listeria and pregnant women has been a recurring theme – on barfblog.com, in research proposals, and in our microbiological nerd discussions.

Researchers from the University of Georgia reported in the journal, Risk Analysis, this month, that pregnant women may get ill from Listeria at lower doses than previously thought.

The risk of fetal or infant mortality among pregnant women who consume food containing 1 million cells of the food-borne pathogen Listeria monocytogenes in soft cheeses and other food is estimated at about 50 percent, suggesting five stillbirths potentially could occur when 10 pregnant women are exposed to that amount.

A previous risk assessment estimated more than 10 trillion cells would result in stillbirths to 50 percent of pregnant women exposed, researchers said.

"We’re not saying there’s a new epidemic here, we’re suggesting we’ve come up with a more accurate method of measuring the risk and how this deadly bacteria impacts humans, especially the most medically vulnerable among us," study co-author Mary Alice Smith of the University of Georgia said in a statement.

When estimates are extrapolated from data in tests on laboratory animals, the results showed "Listeriosis is likely occurring from exposure to lower doses than previously estimated," Smith said.

That’s a convoluted way of saying Listeria happens, and it’s probably more deadly than anyone thought for developing babies. Given the ridiculously low levels of awareness amongst physicians, health professionals and expectant mothers, new messages using a variety of media are needed so parents-to-be are at least aware of the risks of certain refrigerated, ready-to-eat foods.

The Centers for Disease Control and Prevention (CDC) has estimated approximately 2,500 cases of Listeriosis occur annually in the United States, with about 500 cases resulting in death. In 2000, Listeria exposure resulted in a higher rate of hospitalization than any other food-borne pathogen and more than one-third of reported deaths from food pathogens, the CDC says.
 

Deli clerk refuses to sell UK mom-to-be cheddar cheese, says pregnant women shouldn’t eat cheddar; wrong

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From the a-little-knowledge-is-dangerous category, a UK deli clerk at a Sainsbury’s supermarket refused to sell a pregnant woman a piece of cheddar cheese until she lied and promised she wouldn’t eat the cheese.

Janet Lehain wrote in a letter of complaint to Sainsbury’s that the female clerk at the Clapham, Beds store was "patronising" and said, “how lucky my generation are to have such information available as this was not the case ‘in her day’."

Sainsbury’s said the worker was wrong, adding,

"It isn’t policy to refuse a sale on grounds goods may be unsuitable for pregnant women."

Whatever the policy is, Sainsbury’s could at least get the information correct: there are certain soft cheeses that should be avoided by pregnant women because of the potential to support growth of listeria. Amy has written extensively about this.

Me, I view the grocery store and the restaurant as my laboratory. I watch and ask questions of people, especially front-line staff. The head of food safety back at corporate HQ may know the correct food safety answer, but are they providing support to front-line staff, the people customers are most likely to interact with? That’s why we do food safety infosheets, a tool to provide continuous updates to employees, and that’s why we do secret shopper experiments.

The key findings after sending trained shoppers to a bunch of stores in southern Ontario in 2004?

“Although many grocery store employees appeared confident in their food safety knowledge, when asked for storage and handling advice, many were unaware of the proper methods within their department and were willing to offer incorrect advice. This advice often conflicted with the food handling information posted throughout the grocery store.”

Any organization is only as good as its weakest link. There’s already enough bad food safety information out there.

Secret shopper: Grocery store employee food handling practices from a customer’s perspective
01.aug.05,
Food Protection Trends
Lisa Mathiasen and Doug Powell

http://www.foodsafety.ksu.edu/en/article-details.php?a=3&c=11&sc=82&id=840

Food safety is critical along the entire agri-food chain, but it should be emphasized particularly in grocery stores because this may be the last opportunity to prevent food from becoming contaminated before it is purchased.

The responsibility for safe food handling has increased for the newer North American supermarkets, which offer a variety of additional food services and products. This research reports on food handling trends discovered by observing the food handling practices of grocery store employees and by inquiring about specific food safety-related topics in supermarkets across southern Ontario.

Ten researchers, trained to portray customers, visited 13 randomly selected supermarkets in Southern Ontario, three times. Observations and information were evaluated against the content of supermarket training programs and current literature. The triangulation of results was used to establish and confirm the observed trends.

During the store visits, a number of poor food handling practices were observed including improper glove use; cross contamination between raw and ready-to-eat meats and poultry; improper food storage; and poor personal hygiene. In addition, although many grocery store employees appeared confident in their food safety knowledge, when asked for storage and handling advice, many were unaware of the proper methods within their department and were willing to offer incorrect advice. This advice often conflicted with the food handling information posted throughout the grocery store.

This research highlights the need for more interactive training specific to individual departments within a supermarket, and will help in the improvement of training resources for grocery store food handlers.
 

Tainted plane food linked to listeriosis increase in Australia

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Our friends are pregnant and recently returned from Australia; I hope they didn’t fly Virgin Blue.

The Australian reports tomorrow morning that two pregnant women gave birth prematurely after eating contaminated chicken wraps that were sold in their thousands on Virgin Blue flights from Brisbane and the Gold Coast, triggering a national public health alert.

The airline confirmed yesterday that up to 5000 flights in May and June could have carried the snacks laced with potentially deadly listeria bacteria.

Five Queenslanders are known to have contracted listeriosis food poisoning after consuming the wraps, including the two women who gave birth prematurely, a known complication of the illness.

Both women and their babies survived.

The Brisbane Times reported yesterday that Queensland Health has confirmed nine cases of listeriosis so far this year, compared to 56 cases nationally. Last year, 12 cases were recorded for the whole of 2008 in Queensland, compared to 68 nationally.

Virgin Blue today in a statement an outside contractor may have been to blame, adding,

"It appears the likely source of the contamination was an ingredient supplied to the manufacturers of the wraps and not Virgin Blue or other companies who received the affected products. Virgin Blue has removed the product from service at the end of June."

Brisbane-based solicitor Mark O’Connor stated what any company should know: Virgin Blue served the food, Virgin Blue is responsible.

"The airline in turn would have to make a claim against the supplier of the food but for passengers, it’s the airline that is liable.”

Virgin Blue should check on its suppliers rather than trying to cover their ass with (bad) PR.

More testing, not inspectors may have prevented listeria says McCain; will test results be made public?

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Micahel McCain, the president of Maple Leaf Foods, was correct yesterday when he told a Winnipeg Chamber of Commerce event that adding more food inspectors to the plant floor would not have made a difference in preventing last August’s listeria outbreak at one of its Toronto plants that caused 22 deaths.

"What is very important to recognize about bacteria is that you cannot see it. We wish you could visually inspect for bacteria, but it can’t be seen with the eyes, tasted or touched."

The head of the $5.2-billion-a-year Toronto-based food giant was adamant that more testing was the only effective way to address the issue and that Maple Leaf has doubled the number of tests being undertaken.

Thank you for that lesson in microbiology, Mr. McCain. Yes, the inspectors’ union in Canada has been shamelessly exploiting the deaths of 22 people to get more shifts for its workers. Good of you to call them on it.

Now to the harder questions, which McCain continues to avoid.

Why didn’t Maple Leaf do more extensive testing prior to the outbreak? It’s not like there haven’t been listeria outbreaks in ready-to-eat refrigerated foods like cold cuts before.

Why won’t Maple Leaf make all of its listeria test results public, especially since it wants to build consumer confidence.

Will Maple Leaf put warning labels on its cold cuts to advise pregnant women and older folks that such products shouldn’t be eaten raw?

And to all the dieticians running the menus at the elderly folks homes where the 22 people died: what were you thinking serving cold cuts? How hard is it to heat a sandwich? Have any of you had any decent food safety training?
 

Listeria-laden cheese hospitalized 38, killed 15 in Quebec last fall; producers want compensation

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Here is what is lost in the gushing about raw-milk cheeses and many other forms of food pornography:

The fall 2008 outbreak of listeria in 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.

But, the discussion in Montreal over the past two days is about the fate of small cheese producers, who are apparently giving up.

Ever since last year’s listeriosis outbreak, when provincial inspectors seized tonnes of Quebec cheeses believed to have been cross-contaminated by the listeria bacterium, Fromagerie Lehmann and other raw-milk cheese producers were visited constantly by officials on the lookout for the listeria bacterium.

Like 20 or so others, Lehmann finally gave up on raw-milk cheese altogether.

By some estimates, only 10 Quebec raw-milk cheeses remain. The others now are made with milk that’s been heated to kill unwanted bacteria – and, some say, the flavours of the meadow and the changing seasons.

On Monday, the provincial ombudsman concluded the Quebec government was ill-prepared to handle the outbreak of listeria contamination in some cheese products last summer, but it was right to order a mass recall of the cheeses.

Canadians – Listeria investigator wants to hear from you, or sell you a Sham-Wow

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Sheila Weatherill, Independent Investigator, Listeriosis Investigation, Ottawa, Ont., who apparently has an affinity for upper case, writes in the Times & Transcript this morning,

“Help us to help you! Give me your views on listeriosis.”

Oh, OK. I’m still Canadian, so my views are below the italicized questions asked by Weatherill.

Last summer Canadians began asking themselves whether their food was safe. Even though few had heard of it before, the term "listeriosis" became a household word.

Canadians began asking whether their food was safe a long time ago. Like after E. coli O157:H7 killed 19 residents in a London, Ontario, nursing home in 1985. But I understand history is not your strong suit. Or using Google. Listeriosis has been around a long time too.

I believe that ensuring the safety of our food supply is a priority for all of us. As the independent investigator, I feel a strong obligation to find out the facts and make recommendations to protect the health of Canadians.

I believe that with ready-to-eat meat products, the responsibility lies with the processor, not the consumer. Unless Canadians are supposed to start frying their smoked turkey breast.

I am interested in learning:
* How you first learned about the outbreak (e.g. TV, newspaper, radio, word of mouth)?

I first learned from a BS press release from the Canadian Food Inspection Agency that contained the weasel words, “There have been no confirmed illnesses associated with the consumption of these products.” ??????Usually, CFIA press releases say there have been no illnesses associated with the product in question, if that is indeed the case. The “confirmed illness” was a wiggle phrase that Canadian media dutifully reported and then went back to sleep.
 
* How well do you think the crisis was managed? What else do you think should have been done?
Please let me know what you think. You can go to the "Listening to Canadians" link on the investigation website at www.listeriosis-listeriose. investigation-enquete.gc.ca or send an e-mail to contacts@li.listeriosisenquete.gc.ca.
My role as investigator ends on July 20, 2009. I hope to hear from you soon. Your opinions do count!
All of us have a duty to help ensure that such a tragedy doesn’t happen again.

The crisis was handled poorly. No one –government, Maple Leaf – has provided a full accounting of who knew what when. And Weatherill, your questions suck. Why were nursing homes serving unheated deli meats, a known risk factor for listeriosis – which you may have recently discovered but lots of food science types or readers of newspapers heard about at least 10 years ago. And why are pregnant woman not more explicitly informed of the risks associated with listeriosis and consumption of ready-to-eat foods?
 

Whole Foods – purveyors of food porn

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Baby Sorenne is three-months-old today. She slept eight-straight hours last night. Awesome.

Whole Foods Market figures I’m part of their demographic, and is rolling out a Whole Baby promotion.

Throughout the month, in-store lectures by Whole Body experts will provide shoppers with information on such topics as prenatal top priorities, natural baby care choice, tips and concerns for breastfeeding mothers and top 10 "first food" facts.

I checked out Whole Foods’ food safety expertise, which they claimed they were really good at. Maybe they were using the same nutritionists and dieticians as in all those Canadian seniors’ homes who thought it was OK to feed listeria-laden cold cuts to the immunocompromised elderly. Nowhere in the Whole Foods literature is there any statement that pregnant women should avoid refrigerated ready-to-eat foods like soft cheeses, smoked salmon and deli meats.

But Whole Foods, like so many other groups, does manage to blame consumers for the bulk of foodborne illness, in the absence of any data to support such a claim.

Food safety is pretty high on everyone’s list of "things to be aware of," especially in light of the food recalls and poisoning scares that seem to happen all too frequently. But believe it or not, the ones you hear about on the TV news aren’t the most common — a good deal of food poisoning is caused by improper food handling in home kitchens.

Whole Food customers are paying a premium for foodstuffs, only to be told that the company carefully checks the paperwork for all the products it sells, but can do no better than the minimal standard of government.  “For the thousands of products we sell, that’s the extent we can go to. The rest of it is up to the F.D.A. and to the manufacturer.”

Whole Baby is going nowhere near baby Sorenne.