Health Department warns on deadly SA listeriosis outbreak

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FocusMotsoaledi

Aaron Motsoaledi

The SA Health Department has warned on an outbreak of listeriosis that has claimed 36 lives and infected almost 600 people. Dr Aaron Motsoaledi said this particular outbreak of the disease, which has a 20%-30% mortality rate,is from a food source consumed by both the rich and the poor, and the contamination points may well be farms and food processing plants.

Business Day reports that Health Minister Aaron Motsoaledi said at least 36 people have died in the past 11 months and 557 cases had been detected this year alone. That is as much as 10 times the usual annual rate of 60-80 cases recorded.

“Most cases (62%, or 345 cases) have been reported from Gauteng‚” Motsoaledi said. The Western Cape had reported 71 cases, followed by KwaZulu-Natal with 37 cases. “As you can see the three provinces alone are responsible for 82% of the total cases. The remaining 18% is distributed in the remaining six provinces‚” Motsoaledi said.

He explained that the disease was “a serious‚ but treatable and preventable disease caused by the bacterium‚ Listeria monocytogenes”.

People with the disease usually suffer from a flu-like illness‚ diarrhoea accompanied by a fever‚ general body pains‚ vomiting and weakness. This can lead to septicaemia and meningoencephalitis‚ which is an infection of the brain.

“The bacteria is widely distributed in nature and can be found in soil‚ water and vegetation. Animal products and fresh produce such as fruits and vegetables can be contaminated from these sources‚” Motsoaledi said.

While anyone could contract the disease‚ those who could most easily contract it are new-borns‚ the elderly‚ pregnant women‚ and people with weak immunity‚ such as those with HIV‚ diabetes‚ cancer‚ and chronic liver or kidney disease.

 

Motsoaledi said that tracing as far back as 1 January, 2017 up until 29 November, 557 laboratory confirmed cases have been reported, reports News24. Of the 557 cases, the Health Department has found the final outcome of 70 confirmed cases of listeriosis. “Of these 70 cases, 36 persons have perished,” said Motsoaledi.

Head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD), Dr Juno Thomas said the number of deaths will increase as they receive final outcome data on the reported cases.

Motsoaledi added that whilst anyone can get the diseases, which has a mortality rate of between 20%-30%, those at a high risk of developing the disease are new-borns, the elderly, pregnant women and people with weak immunity systems such as HIV or cancer sufferers.

The World Health Organisation has advised on food safety measures which includes; that people should keep clean especially when handling food, food should be cooked thoroughly; raw food should not be eaten; use safe water, keep food at safe temperatures and use pasteurised milk products.

The source of the outbreak is currently being investigated, but Motsoaledi said it’s believe that this particular outbreak is from a food source that is being consumed by both the rich and the poor, and the contamination points may well be farms and food processing plants.

 

Thomas said the first documented outbreak of listeriosis was from August 1977 to April 1978 when 14 cases from the Johannesburg area were reported. According to a Daily Maverick report, sporadic cases occur throughout South Africa.

“In January to September 2015, seven cases were reported from a tertiary hospital in the Western Cape province. No common source of exposure was found amongst these cases, although at least five of the seven were shown to be related to laboratory examination,” said Thomas.

This outbreak was caused by an increase in the unusually high number of babies with listeriosis. “The disease is not new but in July 2017 doctors from neonatal units in Chris Hani Baragwanath and Steve Biko Academic Hospital alerted NICD about an unusually high number of babies with listeriosis,” said Motsoaledi. He said this triggered a review of all cases diagnosed in both public and private hospitals. Of these 557 cases, 34% are from the private health facilities and 66% are from public health facilities. “Given that only 17% of South Africans use private health facilities; this proportion of cases from private health facilities is too high,” said Motsoaledi.

He added that this indicates that the source of the outbreak is likely to be a food product that is widely distributed and consumed by people across all socio-economic groups. “Food safety in South Africa is managed to intersect orally by the Departments of Health; Agriculture, Forestry, and Fisheries as well as Trade and Industry,” said Dr Motsoaledi.

He explained that local government was responsible for municipal health services which include the enforcement of food safety legislation. “The DTI looks after all aspects of fish and fishery products while DAFF manages meat safety and animal health.”

The report says Gauteng Health could not comment immediately on the outbreak as the most highly affected province.

Although anyone can contract listeriosis, the most vulnerable groups to be affected are new-born babies, the elderly, pregnant women, people with weak immunity such as HIV, diabetes, cancer, chronic liver or kidney disease.

Motsoaledi explained that the age groups that are most affected are neonates, which means the first 28 days of life, and the age group between 15 to 49 years. “These two groups compromise 70% of all cases,” said Motsoaledi.

“The incubation period varies and can be between 3-70 days (median 3 weeks). Up to 10% of people may be asymptomatic carriers. This figure may be higher in abattoir and laboratory workers who work with Listeria monocytogenes cultures,” said Thomas.

 

The Times reports that here are 10 things we know about the disease thus far:
1) The department said it does not have any readily available data on past mortality rate figures associated with Listeriosis as it was previously not flagged as a notable disease.
2) The alert of a possible outbreak was noted in July when Gauteng doctors from neonatal units in the Chris Hani Baragwanath and Steve Biko Academic hospitals raised the alarm when they recorded an unusually high number of babies with listeriosis.
3) Gauteng accounted for the bulk of the cases‚ with 345 reported thus far. The Western Cape had the second-most reported cases (71) followed by KwaZulu-Natal with 37 cases.
4) There are four possible sources of the disease –
• where food is collected‚ (farms)
• food processing plants
• retail stores
• food preparation at home
5) The Health Department believes this particular outbreak of listeriosis is most likely because of the contamination of food from farms or food processing plants but the source is still being investigated.
6) The Health Department said the large proportion of cases across the public and private health sectors (66% and 34% respectively) indicates that the source of the outbreak is likely a food product that is widely distributed and consumed by people across all socio-economic groups.
7) There is no vaccine to prevent infection. However‚ preventative measures include –
• Washing hands before handling food and during food preparation.
• Separating raw food from cooked food.
• Cooking food thoroughly and never eating half-cooked or uncooked food‚ especially meat products. Food that does not need cooking needs to be thoroughly washed with clean water.
• Keep food at safe temperatures.
• Clean water for domestic use at all times and use pasteurised milk products. In domestic situations where pasteurisation is not possible‚ boil the milk prior to use.
8) The most common foods to be contaminated are raw or unpasteurised milk as well as soft cheeses‚ or vegetables‚ processed foods and ready-to-eat meats and smoked fish products.
9) Symptoms for someone who has the disease include flu-like illness‚ diarrhoea accompanied by a fever‚ general body pains‚ vomiting and weakness. It can also lead to infection of the bloodstream‚ or septiceamia‚ and meningitis – an infection of the brain.
10) Listeriosis is treatable and preventable.

Business Day report
NICD alert
News24 report
Daily Maverick report
The Times report


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