LISTERIA IN SOUTH AFRICA: LESSONS FOR A DEVELOPING COUNTRY ELNA M. BUYS (PHD) DEPARTMENT OF CONSUMER AND FOOD SCIENCES

Listeria in South Africa:
Lessons for a developing country

Elna M. Buys (PhD)

Department of Consumer and Food Sciences

  Email: elna.buys@up.ac.za

Key aspects
 What caused it
    Sequence of events
    Statistics and demographics
 Companies involved
    Negative implications
 Management and control of the outbreak
 In the wake of the outbreak: What has been done?
    Stronger food safety management
 The way forward
    Synergy among stakeholders

Brief sequence of events:
                                   July 2017                      LM declared
          Before 2017:            increase in   5th Dec 2017
                                                 announce          notifiable

Timeline          Confirmed cases   Deaths

How it         December 5 2017          550          36
transpired    20
              January 3 2018
                                        647
                                        717
                                                     60
                                                      61
in real       12                        748           67
              16                        767           81
time:         25                        820           82
              February 6 2018           852          107
 Confirmed   number
              15           of cases at the
                                        872 end of   the
                                                     164   outbreak
              20 were 1060 with 216     915 deaths   172
              27                        945          176
               March 4 2018             948          180
              8                         967          183
              26                        982          189
              April 3 2018              999          191
              13 April 2018            1011          193
              20 April 2018            1019          199

NICD?
   South African Institute of Medical Research (SAIMR), National Institute for
    Virology (NIV), Polio Research Foundations (PR) and National Cancer
    Registry joined to form the NICD
      NICD is a major global player in infectious disease intelligence
      Numerous international co-operative agreements
   Historic link: Dr Harvey Pirie co-discoverer of Listeria – 1925
      Deputy Director at the SA Institute of Medical Research
   1st Human case report 1956 (SA Medical Journal 12 May 1965)
   1st outbreak 1978 – 14 persons high mortality rate – type 4b – before known
    that food is the source of listeria – confirmed in 1984 in Canada
   Next report 6 patients in Cape Town 2012
   2015 Genome Announcements – ST 6 – not epidemiologically linked

Time line of outbreak 2017 and 2018
                                                                            Recall

Epidemic curve of laboratory-confirmed listeriosis cases by date of clinical specimen collection (N=1 060) and sequence type (ST)
(n=636), South Africa, 01 January 2017 to 17 July 2018 (Source: www.nicd.ac.za)

Demographics of the outbreak

Age distribution and outcome* of laboratory-confirmed listeriosis cases, South Africa, 01 January
2017 to 10 July 2018 (N = 1 060) (Source: www.nicd.ac.za)

Geographic reach of the outbreak
               Outcome available    Number of deaths
                                                         # cases (% of
  Province       (as a % of total    (% of those with
                                                            total cases)
                  cases in RSA)     outcome available)
  Gauteng            393 (64.0)         108 (27.5)        614 (57.9)
Western Cape         134 (98.5)          32 (23.9)        136 (12.8)
  Kwa-Zulu            76 (91.6)          21 (27.6)         83 (7.8)
     Natal
  Limpopo            51 (92.7)           11 (21.6)          55 (5.2)
Eastern Cape         40 (75.5)           13 (32.5)          53 (5.0)
Mpumalanga           47 (97.9)           11 (23.4)          48 (4.5)
 Free State          32 (88.9)            9 (28.1)          36 (3.4)
 North West          27 (93.1)            8 (29.6)          29 (2.7)
  Northern           6 (100.0)            3 (50.0)           6 (0.6)
     Cape
    Total           806 (76.0)          216 (26.8)           1 060         (Source:www.nicd.ac.za)

Confirmation of sequencing type

   Public Sector (65%, 649/995), Private Sector (35%, 346/995)
   Sequencing unit at NICD – collect isolates from public and private health sector as well as
    from NHLS – food and environmental sample testing
   636 clinical isolates – WGS & 91% =ST6
   Clinical cases 20 ST identified
   Other sequence types isolates: ST1, ST2, ST3, ST5, ST8, ST54, ST101, ST204, ST219,
    ST224, ST876
   Non-clinical: 24 ST’s identified
   10 representative ST6 sequence types in GenBank-NCBI database

Juno Thomas NICD January 2018

9 Sick Kids from Soweto Broke the World’s
Largest Listeria Outbreak
– WGS Links Kids to Tiger Brands Enterprise Polony
   L. monocytogenes isolated: stool collected from one of the ill
    children & from both of the polony specimens collected from
    the crèche
   EHPs conducted an extensive food product and environmental
    sampling
   L. monocytogenes was isolated >30% of environmental
    samples collected from Enterprise factory in Polokwane

International concern

Foods implicated
        Reduced Food
       options for lower
       income groups?

                           Source:www.sachefs.com)

What is this polony?

   RTE processed meat products are significant in South Africa
        Low cost, versality, shelf-life and availability on the market
        Street food vendors or fast food/take-away shops often add vienna’s, polony or Russian
         sausage to dishes such as the “kota” and “gatsby” which are often very affordable and filling
   A ‘kota’?
        quarter loaf of bread that has been hollowed out and then filled with a combination of slap
         chips, eggs, cheese or atchar and topped with Vienna, polony or Russian sausage
         (Ndabezitha, 2016)
   A ‘gatsby’
        foot long roll that is cut open, filled with slap chips, sauce/atchar and topped with polony,
         Vienna or Russian sausage (other meats may also be used), this is usually cut and divided
         between 2- 4 people (Morris, 2017).

Companies implicated

                                                   Local and continental
                                                      conglomerates

www.tigerbrands.com

                                www.rclfoods.com

Hits on business: Share price

Hits on business: Sales after recall

Parameter Estimates for Recall Variables and Sales Recovery Pattern
Ratios in parentheses

Hits on business: Trade

Recall

 4 162 tons of recalled products was destroyed by thermal
  treatment or landfill
 Includes products destroyed at exported destinations

Hits on business: Litigation

Hits on business: Effect of politics?

Management of the outbreak
                       (Emergency Management Approach)
     Phase 1                              Phase 2                       Phase 3

 -Development of the Emergency            -Inspection of at-risk food   -Reporting and
         Response Plan                    processing plant              consolidation of health
                                                                        system strengthening
   -Communication of plan with            -Strengthening the            activities
provincial and district stakeholders      capacity of district
                                          environmental health          -After action review
   -Development of material and           practitioners
     training of staff to support
inspections of facilities identified as
    at-risk food processing plants

                                                                                    Source: www.nicd.ac.za)

Public Health action/Response Interventions

                                                              Food Safety
                                           Training
                                                           Legislation Review
                         Co-ordination

                                             Recall
                         Surveillance       Process       Risk Communcation,
                                                         Community Engagment,
                                                           Social Mobilization

                                         Environmental
                          Laboratory     Health & Food
                                             Safety
                                                          Recommendations &
                                                              Follow up
Source: www.nicd.ac.za

In the wake of the outbreak: What has been done?

Challenges/Gaps

   Turn-around of testing of environmental swabs from facility inspections
   Volume of samples received
   Test result interpretation
   Addressed through appropriate interventions

In the wake of the outbreak: What has been done?

                Surveillance system to find and test all Listeria isolates from
                 human cases to identify clusters (groups) of cases that may
                 represent outbreaks
                Food Safety laws have been updated. Food Safety management
                 systems should be in place for all meat and poultry processing
                 industries according to Regulation R607 published on 14 June
                 2018
                Sharing of food safety information between Department of
                 Health (DoH), NICD and other partners

Source: www.nicd.ac.za

Wake up call
            and food safety
              lessons to be
             learnt by both
              Government

Thank You     and industry

             Risk based
              approach
             needed not
              knee jerk
              reaction

Thank You