Anger and blame has erupted over the dismal handling of the listeriosis outbreak after the outbreak was at long last traced to a Tiger Brands factory in Polokwane, writes MedicalBrief. Of the 180 deaths, so far, 78 have been infants.
Government has blamed a lack of cooperation by producers of cold meats for a delay in finding the cause of a listeria outbreak that has killed 180 people in the past year. Polity reports that the government, which has been criticised for taking too long to find the source of the disease, on Sunday linked the outbreak to a meat product known as "polony" made by Tiger Brands unit Enterprise Food. It also said it was investigating an RCL plant.
The report says both firms, which have said they are fully cooperating with the authorities, suspended processed meat production at their plants after health authorities ordered a recall of cold meats associated with the outbreak from outlets at home and abroad.
South Africa's Health Ministry said the source of the outbreak was found after pre-school children fell ill from eating polony products traced to processed meat producers. "The meat processing industry was not cooperating for months. They did not bring the samples as requested. We had long suspected that listeria can be found in these products," the ministry's communications director, Popo Maja was quoted in the report as saying. "It is not that we are incompetent, or that we have inadequate resources," he said, without naming any companies. He said all firms in the industry were being examined.
The report says, according to Euromonitor International, South Africa's processed meat market grew about 8% in 2017 to a retail value of $412m. Tiger Brands has a 35.7% market share, followed by Eskort Bacon Co-Operative with 21.8%. Rhodes Food, RCL Foods and Astral Foods each have less than 5%.
Rhodes said it produced processed canned meat, which it said was more regulated and different from the cold processed meat manufactured by its rivals. Both Rhodes and Astral said their products were safe.
According to the report, Health Minister Aaron Motsoaledi had said on Sunday the outbreak had been traced a Tiger Brands factory in the northern city of Polokwane. The authorities have not said when they could conclude tests on RCL Foods, which has a plant under investigation.
The minister told South Africans not to consume any ready-to-eat processed meat due to the risk of cross-contamination, a directive that will hit a popular food segment in Africa's most industrialised economy.
The report says the announcement prompted a frenzied clearing and cleaning of the shelves by local supermarkets chains Shoprite, Pick n Pay, Spar and Woolworths, which also urged consumers to return the meats for refunds.
Zambia's high commissioner to South Africa, Emmanuel Mwamba, urged South African retail chain stores operating in Zambia to recall ready-to-eat meat products imported from that country following the confirmation of the source of listeria bacteria. Mozambique said it was suspending imports of South African processed meat.
Health Ministry officials are pushing for a review of the key laws governing food safety, after the outbreak exposed shortcomings in their powers to obtain potentially life-saving information from companies and private laboratories, reports Business Day. Officials want to revise the Foodstuffs, Cosmetics and Disinfectants Act to strengthen their hand in getting information from companies about food-borne pathogens detected in their facilities and in obtaining samples from private laboratories in the event of an outbreak, said the department’s director of food control, Penny Campbell. The provision of such information and samples is voluntary.
Campbell is quoted in the report as saying that the department had repeatedly written to private laboratories and food industry associations requesting information to help trace the source of the outbreak but had been largely ignored. None of the key players from the South African Meat Processors Association were co-operative, and only 23 of the 83 members of the Consumer Goods Council provided a list of listeria-contaminated food.
The National Laboratory Association did not respond to their call for assistance in tracing the source of the outbreak. Only Milk SA proved helpful and provided detailed information about the safety of raw and pasteurised milk, she said.
Juno Thomas, head of the Centre for Enteric Diseases at the National Institute for Communicable Diseases (NICD), said their investigation had been "retarded because of the constant challenges with the food industry" who "should have been more proactive and engaging". "There was a lot of resistance and mistrust from companies, and their response was very limited. Only two private food testing laboratories shared listeria isolates for (genome) sequencing. The others refused, citing confidentiality issues," Thomas said.
Campbell said the Act also had to be revised to give environmental health practitioners the powers to order a product recall, rather than relying on provisions in the Consumer Protection Act, which vested these powers in the National Consumer Commission.
Now that the institute has identified the source of the deadly listeria outbreak, the onus is on the food companies to determine how their products had become contaminated. The report says neither RCL Foods nor Tiger Brands had responded to request for comment at the time of publication.
South Africa has just one environmental health practitioner per 30‚000 people‚ three times fewer than the ratio recommended by the World Health Organisation (WHO), reports The Times.
In the wake of the world’s worst ever listeriosis outbreak, questions are now being asked about whether South Africa has enough people checking the health and safety standards for food production. It seems that‚ at least in terms of the number of environmental health practitioners‚ the country is missing the mark.
The report says the WHO recommends a ratio of one environmental health practitioner for every 10‚000 citizens – but South African Institute of Environmental Health president Dr Selva Mudaly said the country was currently closer to one for every 30‚000 South Africans. “We have not met that requirement because of finances and other requirements besides environmental health. There’s water‚ there’s sanitation. So, a municipality has many challenges‚” he said.
Mudaly said South Africa needs a better plan for food safety. “We are not proactive. That’s the problem. We don’t pre-plan‚” Mudaly said. “Maybe the NICD needs more laboratories to deal with this kind of thing.”
Another solution was the formation of a central agency that monitors food safety from “farm to fork”, Gareth Lloyd-Jones‚ MD of food production hygiene at Ecowize is quoted in the report as saying. This‚ he said‚ was the long-term fix to avoiding another listeriosis-type outbreak.
“As a result of this dysfunctional system‚ the industry has been largely self-regulated‚” Lloyd-Jones said. “The standard is effectively driven from the retailer‚ who then monitors the primary production facilities‚ who monitor their supply chain‚ and so on.”
Lloyd-Jones said‚ however‚ the current listeriosis outbreak and product recall was “extraordinary”. “No matter what country you are‚ this was going to be a challenge‚” he said.
Restaurant Association of South Africa (Rasa) CEO Wendy Alberts said in the report they have approved suppliers on their database. They pass on notices from these suppliers to members to keep them up to date. Rasa members include independent restaurants‚ fast food outlets‚ coffee shops‚ hospital canteens and mobile restaurants. Alberts said their members increased their health and hygiene standards after Motsoaledi’s announcement on Sunday.
As anger erupted over the dismal handling of the listeriosis outbreak, it emerged that a shocking 78 of the 180 deaths from the killer disease were infants. The Star reports that according to Thomas, the high number of fatalities included new-borns who were only 28 days old or even younger. “We are concerned that the information regarding the outbreak and the measures to be taken will not reach people, particularly in the peri-urban and rural areas. “Therefore, yes, we are expecting more cases,” she said.
The report says Tiger Brands further raised the ire of the public when it distanced itself from the deaths linked to the foodborne disease. The food brand company said it had complied with the Department of Health and the NICD over investigations relating to the source of the outbreak, which has since been linked to a production facility of one of its brands, Enterprise Foods, in Polokwane, Limpopo.
Early last month, CEO Lawrence MacDougall said Health Department and NICD officials had visited their facilities and obtained more than 400 samples from various products for testing. A week later, he said low levels of listeria had been detected in their products, but that the company took immediate precautions, including the heightened testing of food samples to prevent any contamination. “Prior to Minister Motsoaledi’s media briefing, we received a notice to recall three of our products. As a consumer-conscious organisation we are being extra vigilant, and therefore, immediate action was taken,” MacDougall said.
The company has also suspended all operations at its Polokwane and Germiston facilities as well as supplies to retailers.
As Tiger Brands’ shares plummeted on the stock market, the report says it is unclear what sanctions might be imposed against it and RCL Foods (Rainbow Chicken). Black First Land First, which laid murder charges against the two companies at Hillbrow police station, said heads had to roll.
The EFF said Enterprise Foods and RCL should take the blame for the outbreak. “They must be held accountable for spreading the disease and killing people,” its spokesperson Mbuyiseni Ndlozi said.
The PAC said listeriosis was a result of the failure by the state to regulate food processing in the country. There were also concerns that contaminated food could find its way to dump sites, which were frequented by the destitute. But Maja is quoted in the report as saying that major food stores had assured the government that this won’t happen.
Pressed by journalists, MacDougall reiterated at least five times that there was no “concrete link” between Enterprise products and the 180 deaths thus far from listeriosis. “Nothing,” he stressed at one point. As a result, MacDougall said, the company could not take responsibility for the deaths and would therefore not apologise. “I can’t apologise for something I’m not clear on yet,” he said.
But, says a Daily Maverick report, the NICD flatly contradicts MacDougall. “I’m a researcher, scientist and a doctor and I believe in evidence,” Thomas is quoted as saying. “We have conclusive evidence that links the Enterprise Foods factory in Polokwane with the same outbreak strain that patients all across the country have presented with.”
Thomas said that the strain of listeriosis which is making South Africans sicken and die has “exactly the same DNA footprint” as that identified as being carried by Enterprise products. “There is no doubt in my mind that the foods produced at that factory are the source,” Thomas said. “As far as scientific evidence goes, we have proven this.”
The report says MacDougall took care to present Enterprise and its holding company Tiger Brands as a “consumer conscious organisation”, describing their response to the news that listeria had been detected in products as one of “speed and urgency”. Though “low levels” of listeria had been detected in only three products, MacDougall said – frankfurters, smoked Russians and polony – the company had voluntarily halted operations at both its Polokwane facility and its Germiston production plant.
“We have acted way ahead of any expectations of the Department of Health,” MacDougall claimed.
NCID’s Thomas warns, however, that the closure of the two Enterprise factories and the accompanying recall of cold meat products does not put an automatic end to the crisis. Many Enterprise meat products have a long shelf life, she points out, meaning that they could still be sitting in households for some time. While the product recall was issued on Sunday, there is no guarantee that its message will reach smaller shops immediately.
The report says the National Health Department had not responded to a request for comment by deadline, but the ministry now finds itself in the firing line too. Trade union federation Cosatu released a statement blasting the department for its handling of the listeriosis outbreak. “The department could have done more to rope in other stakeholders to assist in the awareness campaign”, Cosatu charged. “These deaths could have been avoided. This is nothing but a failure of political leadership. The ministry and department of health cannot continue to explain away their failures that have deadly consequences.”
But, the report says, Professor Leslie London, head of the University of Cape Town’s department of public health, said that the department’s messaging around listeriosis has seemed appropriately “active”. In situations of scientific uncertainty, says London – as was the case regarding the listeriosis outbreak before its origins were traced – it is often difficult to strike the right balance in public messaging between averting panic and accurately conveying the extent of the public health risk.
London says, however, that the number of deaths in this instance speaks for itself as a major problem. “It all rings an alarm bell: that if there was another kind of (public health) outbreak, would we be prepared?”
The report says the ANC called on the South African Bureau of Standards to “urgently initiate an investigation at various identified food production factories”.
MacDougall claimed, however, that government inspectors looking at the Enterprise facilities declared themselves “very pleased” with the standards of health and safety. When asked if Tiger Brands expected to be on the receiving end of legal action, MacDougall admitted that the company was “preparing” for this outcome.
The report says it is impossible to ignore one aspect of the listeriosis crisis: that the meat products responsible for spreading the disease are favoured mainly by poorer South Africans due to their relatively low cost. On Monday, one journalist sought to make this point by asking the gathered Tiger Brands officials when last they had eaten an Enterprise meat product. “I ate viennas, sausages about four days ago,” MacDougall claimed.
No holidays, "hectic exhaustion", and 05:30 starts – News24 reports that this was life for the team working at the NICD as they struggled to find the source of the deadly listeriosis outbreak. "At many stages we were despairing," said Thomas. "I'm really glad, and proud," said Thomas, after the NICD managed to crack which strain it was and where it originated.
The report says the breakthrough, which also led to the closure of the plant, has provided an opportunity to halt the spread of the potentially fatal bacteria. However, to get to this point a huge amount of work was involved.
The NCID interviewed 109 people who had been diagnosed with listeriosis, to find out what they had eaten in the month before they fell ill. It was discovered that 93 (85%) had eaten ready-to-eat processed meat products, mainly polony, followed by viennas, sausages and other "cold meat".
On Friday, 12 January, nine children under the age of 5, from a crèche in Soweto, Johannesburg, were taken to the Chris Hani-Baragwanath Hospital and a paediatrician suspected a food-borne disease, possibly listeriosis. Environmental health practitioners were informed and visited the crèche and took samples from two polony brands manufactured by Enterprise and Rainbow Chicken Ltd, and from the stool of one of the ill children. Thomas said that samples taken from the crèche and sent for analysis, gave them the breakthrough that they were working so hard for.
The report says the team at the NICD alone included laboratory technicians, scientists, data clerks, assistants seconded from the virology department, people in the sequencing unit, and people who work in the emergency operations centre. "Our laboratory staff worked extra hard. People gave up their December leave to come in," continued Thomas. "We've been working weekends. Last weekend, staff were in at 05:30 to get everything going." "But we are really relieved. At least now the end is in sight."
"We have been chasing every possible lead, going down a lot of rabbit holes, (and there were) a lot of red herrings," Thomas said.
But, the report says, once they had the information about the children at the crèche in Soweto, they worked from there to find out where the food came from to narrow things down. The team also included the World Health Organisation's technical experts and the health and agriculture departments.
Thomas said that while the NICD team was working on the listeriosis outbreak, they had to keep up with all other notifiable diseases, such as cholera. Any "nice- to-know" projects, such as research, was put on hold.
The report says it was at 00:00 on Saturday, 3 March that the breakthrough came. Mushal Ali, an NICD bio-informatitian (they use computer technology to analyse biological information), had postponed his planned holiday to Sudan in December to help solve the listeriosis crisis.
Unable to put the visit off any longer, he boarded a plane on Saturday morning and, when he landed, instead of starting his holiday, he checked back in to the work WhatsApp group, fired up his computer and continued working, staying in touch via email.
Ali analysed the entire genetic and DNA sequence of the whole bacteria, to determine which strain it was. "I was waiting at home on Saturday night," said Thomas. At 00:00 Ali let her know that the strain of listeriosis had been identified, and the source confirmed. "Then we immediately informed the minister," said Thomas. "It was exhausting, it was hectic."
Maja said the department's priority was to get the products off the shelves, so they have not yet determined the scale of the operation. The department has not pronounced yet on what the companies must do with the recalled products, because it is not sure if it has the legal authority to do so.
More than 16 environmental samples from the Enterprise Polokwane factory tested positive for the listeriosis monocytogenes strain ST 6. The Times reports that the results were confirmed by the NICD as the strain to blame for the outbreak that killed 27% of patients in South Africa. “The National Consumer Commission has issued the manufacturer Enterprise involved with food recall notices‚” Motsoaledi said.
The report says this particular strain of listeria monocytogenes that infected so many people is sequence-type 6 and was particularly “virulent”. It was transmitted from food.
“It is the worst outbreak in global history,” Professor Lucia Anelich from Anelich Consulting Food Safety Solutions said earlier.
One of the reasons it is so hard to find is because, even in solid food‚ a scientist may sample the infected food and not find it. For example‚ a slice of polony could be tested and have none of the microorganism. But a different slice could have it. Anelich said: “A micro-organism in a solid food is not homogenously distributed throughout food. A statistical sampling technique has to be used to ensure it is detected.”
It is also difficult to find in factories. Anelich said it could hide away in niches in the factory environment in cracks or bad joints and pipes. Even if you sanitised a factory‚ you could miss the bugs‚ hiding in cracks‚ she said. Listeria bacteria can sense when it is near other bacteria and secrete a sugary goo. This substance is called a biofilm and can allow the bacteria to live on inanimate surfaces. The biofilm protects the bacteria from cleaning agents. “A detergent could get superficial cells but leave behind some bacteria.”
The report says a Rainbow Chicken factory in Wolwerhoek in Sasolburg also tested positive for listeria monocytogenes – but it was not the strain causing this current outbreak. The report says, however, that polony made by Rainbow Chicken has also been recalled.
Listeria is killed by heat.
The listeriosis crisis may have been triggered by a chicken paste known as "white slime", a meat scientist is quoted in Business Insider South Africa as saying. South African polony and other process meats must contain 75% of "meat equivalent" under legislation that is 45 years old. The meat equivalent is calculated by determining the total amount of nitrogen in a sample and multiplying by a factor of 30. It can include all kinds of protein, including soy, pork fat – and also mechanically deboned chicken, says Louw Hoffman, a professor in meat science at the University of Stellenbosch.
Also called "white slime", the US government's official definition of mechanically deboned chicken is: "a paste-like and batter-like poultry product produced by forcing bones with attached edible tissue through a sieve or similar device under high pressure to separate bone from the edible tissue".
The report says after chicken breasts and thighs are removed, small pieces of chicken remain on the bones. High-pressure machines are used to separate the carcass. The chicken bits are then pureed with small pieces of bone and bone marrow to form a paste that is used in processed meats.
The report says South Africa imported 202m kg of mechanically deboned chicken last year, most of it from Brazil. And, the report says, Hoffman believes South African polony and viennas must contain some of this imported chicken product to help keep the cost of the products down, and to ensure affordability of protein for lower-income groups. “This means that the strain of listeriosis may have originated from overseas.”
Earlier, the report says, the South African Department of Agriculture‚ Forestry and Fisheries said it was looking to temporarily ban meat imports from countries like Brazil to combat the listeriosis outbreak. South Africa also imports mechanically deboned chicken from Thailand (174,000 kg in December 2017), the US (27,000 kg) and Argentina (1,000 kg).
The report says according to one academic study, listeriosis remains an under-diagnosed and under-reported infection in Brazil as it is not a compulsorily notifiable disease in that country.
Listeriosis is an under-diagnosed and under-reported infection; however, listeriosis is not a compulsorily notifiable disease in Brazil. We provide an overview of the rates of listeriosis in the United States of America (USA), Europe, Latin America, and Brazil during the past decade. We also report a case of miscarriage caused by listeriosis in which there was no suspicion of this infection. This overview and the case we report serve as reminders of the often-neglected threat of listeriosis and its potential to cause miscarriage while highlighting the necessity of recognizing listeriosis as a compulsorily notifiable disease in Brazil.
Blum-Menezes D, Deliberalli I, Bittencourt NC, Couto CA, Barbosa LN, Santos AM, Pinto GG
Meanwhile, one of South Africa’s most prominent human rights lawyers Richard Spoor says that family members of those who died or those who became ill from listeriosis can bring a class action lawsuit against Tiger Brands. According to a report in The Times, he said only a handful of representatives were needed to start a class action lawsuit. Other affected parties could join the class action suit later.
“You don’t necessarily have to wait…. You can get the ball rolling right away.” The Consumer Protection Act also allows for a class action lawsuit.
Section27 director Mark Heywood said they were not considering a civil suit “at this point”. “We are still studying what is going on.”
Spoor said in the report that a class suit would allow evidence that would otherwise be dismissed. “Every individual case on its own is probably quite weak‚ but taken together I think you could build a very strong case depending on how much evidence there is and what has been preserved.”
Spoor said it was significant that similar cases were breaking out in various places. “It suggests very strongly that we are talking about people who are consuming a product that has been distributed from a single source.”
According to the report, he believed examining individual cases in the bigger picture was vital‚ because customers would not have kept receipts or samples of the food they ate.
Spoor believed Tiger Brands might consider setting up a scheme to pay settlements to families if they ran into legal trouble.
For claims to be pursued, however, victims would have to establish that the manufacturer failed in their duty of care in terms of taking the reasonably necessary steps which were required in order to prevent the food being infected with the listeriosis bacteria.
An IoL report notes that this is according to Kirstie Haslam, partner at DSC Attorneys, the victim will need to prove their diagnosis was a result of eating the infected food as well as where and when the food was purchased. “Should a breadwinner who had a duty to support dependents and was in fact so supporting them, pass away as a result of contracting listeriosis, those dependents may have a claim for the lost financial support which they have suffered as a result. In some instances, they may also be able to claim for the emotional trauma suffered as a result of the death of the family member,” said Haslam.
However, victims should seek legal representation as early as possible. "It would be wise to institute action no later than 3 years after becoming aware that you were infected.”
[link url="http://www.polity.org.za/article/govt-blames-processed-meat-firms-for-delays-in-listeria-probe-2018-03-05"]Polity report[/link]
[link url="http://www.nicd.ac.za/wp-content/uploads/2018/03/Update-on-Listeriosis-Press-Conference-Monday-04-March-2018-FINAL.pdf"]NICD material[/link]
[link url="https://www.businesslive.co.za/bd/national/health/2018-03-07-health-department-pushes-for-food-safety-law-review/"]Business Day report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-03-07-south-africa-doesnt-meet-world-health-standards-for-food-inspectors/"]The Times report[/link]
[link url="https://www.iol.co.za/news/south-africa/gauteng/listeriosis-78-of-killer-disease-deaths-were-infants-13613808"]The Star report[/link]
[link url="https://www.dailymaverick.co.za/article/2018-03-05-listeriosis-outbreak-the-blame-games-begin/#.Wp4gk-hubIU"]Daily Maverick report[/link]
[link url="https://www.news24.com/SouthAfrica/News/listeriosis-time-bomb-what-it-took-to-find-the-source-20180306"]News24 report[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-03-04-breaking-enterprise-polony-identified-as-source-of-listeria-outbreak/"]The Times report[/link]
[link url="https://www.businessinsider.co.za/Trending/pink-slime-may-have-caused-polony-crisis-2018-3"]Business Insider South Africa report[/link]
[link url="https://www.ncbi.nlm.nih.gov/pubmed/23856867"]Study abstract[/link]
[link url="https://www.timeslive.co.za/news/south-africa/2018-03-06-listeriosis-victims-can-bring-class-action-lawsuit-against-tiger-brands/"]The Times report[/link]
[link url="https://www.iol.co.za/news/politics/development/listeriosis-victims-families-can-claim-compensation-lawyers-13627263"]Full IoL report[/link]