Outbreak of Listeriosis in South Africa Associated with Processed Meat.
Adolescent
Adult
Aged
Bacterial Typing Techniques
Case-Control Studies
Disease Outbreaks
Female
Foodborne Diseases
/ epidemiology
HIV Infections
/ complications
HIV-1
Humans
Infant, Newborn
Listeria monocytogenes
/ genetics
Listeriosis
/ epidemiology
Male
Meat Products
/ adverse effects
Middle Aged
Pregnancy
Pregnancy Complications, Infectious
/ epidemiology
Product Recalls and Withdrawals
Sex Distribution
South Africa
/ epidemiology
Whole Genome Sequencing
Young Adult
Journal
The New England journal of medicine
ISSN: 1533-4406
Titre abrégé: N Engl J Med
Pays: United States
ID NLM: 0255562
Informations de publication
Date de publication:
13 02 2020
13 02 2020
Historique:
entrez:
14
2
2020
pubmed:
14
2
2020
medline:
27
2
2020
Statut:
ppublish
Résumé
An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown. We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of This investigation showed that in a middle-income country with a high prevalence of HIV infection,
Sections du résumé
BACKGROUND
An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.
METHODS
We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type
RESULTS
A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of
CONCLUSIONS
This investigation showed that in a middle-income country with a high prevalence of HIV infection,
Identifiants
pubmed: 32053299
doi: 10.1056/NEJMoa1907462
pmc: PMC7301195
mid: NIHMS1578751
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
632-643Subventions
Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States
Informations de copyright
Copyright © 2020 Massachusetts Medical Society.
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