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16/03/18: Health minister fears world’s worst listeriosis outbreak has yet to peak

south_africa_map406x250The world’s worst listeriosis outbreak is not over and will likely sicken others in his country and throughout the region, according to South African Health Minister Aaron Motsoaledi.

And during the past week, Nambia reported its first listeriosis case had sent a resident of that nation to the hospital in a severe condition. In addition, news reports on the death of an elderly man and a woman who has suffered a miscarriage are not included in the latest official outbreak reports by South Africa.

“We are just at the beginning, and we must expect other cases to emerge,” warned Motsoaledi.

In the latest situational update, the outbreak has claimed 183 deaths among a total of 978 confirmed listeriosis cases. The Centre for Enteric Diseases (CED), Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), and the National Institute for Communicable Diseases (NICD)/ National Health Laboratory Service (NHLS) produced the update.

Ten days ago, Minister Motsoaledi announced his finding that a Tiger Brands Enterprise Food production facility is Polokwane, South Africa is the source of the current outbreak. Tiger Brands has since acknowledged the health department report confirming the presence of the ST6 outbreak strain in its Polokwane facility.

“Polony” and other low-priced processed meats were removed from grocery store counters throughout the country.

South Africa health authorities fear Listeria and cross contamination. The ready-to-eat meats are a favourite protein source of the country’s poor.

Experts say cases of listeriosis will continue to occur up to four weeks or longer after the recall of the all the implicated foodstuffs, as the incubation period for listeriosis can be as long as 21 days with a reported maximum of 70 days.

March 8 was the date of the last outbreak-related death. The outbreak’s current fatality rate is 27 percent. Almost seven in ten have required hospital care.

The hardest hit area is South Africa’s northern province of Gauteng, which includes both the cities of Pretoria and Johannesburg. Health clinics in the region report a 50 percent increase in walk-in patients who want tests or assurances about Listeria.

As of March 12, 2018, NICD has counted 978 laboratory-confirmed listeriosis cases from all South African provinces since January 1, 2017. Listeria illnesses in 2017 totalled 748, and 230 so far in 2018.

When reported, females accounted for 56 percent of the cases. Ages range from birth to 92 years (median 19 years), and 42 percent are neonates aged less than 28 days. Of neonatal cases, 96 percent had an early-onset disease (birth to ≤6 days).

Gauteng Province accounted for 59 percent of the cases, followed by 12 percent from the Western Cape, and 7 percent from the KwaZulu-Natal provinces.

The outbreak impacts both public and private healthcare sectors. Public facilities account for 65 percent of the cases, and private facilities figure at 35 percent.

Blood cultures were positive for Listeria monocytogenes in 720 of the 978 cases or 73 percent of the specimens. While 211 or 22 percent, positive Listeria results were found in the cerebrospinal fluid. In about 7 percent of the cases, positive results turned up from stool samples, pus, abscesses, or other liquids.

Among the neighbouring countries now banning imports of South African processed meats are Kenya, Zimbabwe, Mozambique, Namibia, and Zambia. Some have also blocked dairy products and fruits and vegetables. Botswana has recalled South African products, and Malawi is doing an additional screening of such imports.

Such actions are putting South Africa’s processed meat industry under pressure. The country’s “Red Meat Industry Forum” has charged “Listeria hysteria” fed by “misinformation” is having a devastating impact on both the processed meat industry and the entire red meat industry.

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