Listeriosis in the United States

Benjamin J. Silk, PhD, MPH

Staff Epidemiologist
Enteric Diseases Epidemiology Branch, CDC

Public meeting on the Interagency Retail

Listeria monocytogenes Risk Assessment

May 22, 2013

National Center for Emerging and Zoonotic Infectious Diseases

Division 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 Bloodstream infection, meningitis

immunocompromising conditions

Older adults Bloodstream infection, meningitis

 Incidence by Risk Group, 2004–2009
Illnesses per
100,000 people
5 Pregnancy-associated
4.5
4
3.5
3
2.5
2
Adults ≥65 years old
1.5
1
0.5 Overall incidence

0
2004 2005 2006 2007 2008 2009
 Listeriosis is rare, but deadly

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

96,000 30 0.5%
E. coli O157

Scallan E et al, Emerging Infectious Diseases, 2011

 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
New regulatory policies and industry efforts
begin targeting meat processing

Data from sentinel site surveillance (FoodNet since 1996)

Hot Dog Outbreaks, 1998–2011:
A Regulatory Success

Years No. cases No. deaths/fetal losses

1998 112 14
1999 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 losses
1998 0 0
1999 7 2
2000 30 4
2001 28 0
2002 54 8
2003 0 0
2004 0 0
2005 13 1
2006 0 0
2007 0 0
2008 0 0
2009 0 0
2010 8 2
2011 0 0
Cartwright E et al, Emerging Infectious Diseases, 2013
 U.S. Listeriosis Incidence, 1986-2011
New regulatory policies and industry
efforts begin targeting meat processing

Data from sentinel site surveillance (FoodNet since 1996)

 Advent of PulseNet, 1998
PFGE
Participating
patterns
laboratories

National
database
 Advent of PulseNet

Before PulseNet Era of PulseNet

1978-1997 (20 years) 1998-2004 (7 years)
5 outbreaks (2 multistate) 13 outbreaks (4 multistate)
Average 54 cases/outbreak Average 22 cases/outbreak
New Opportunities in 21st Century
 U.S. Listeriosis Incidence, 1986-2011
New regulatory policies and industry efforts
begin targeting meat processing

Lack of progress

Healthy People 2020 Goal

Data from sentinel site surveillance (FoodNet since 1996)

 Listeria Initiative

 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
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
15
14 Hispanics
13
12
11
10
9
8
7
6
5 Non-Hispanics
4
3
2
1
0
2004 2005 2006 2007 2008 2009
 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

Prevention Epidemiological
Measures Investigation

Applied
Research
For more information please contact Centers for Disease Control and Prevention

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Visit: 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 Diseases

Division of Foodborne, Waterborne, and Environmental Diseases