Outbreak of Listeriosis in South Africa Associated with Processed Meat.


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
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

632-643

Subventions

Organisme : Intramural CDC HHS
ID : CC999999
Pays : United States

Informations de copyright

Copyright © 2020 Massachusetts Medical Society.

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Auteurs

Juno Thomas (J)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Nevashan Govender (N)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Kerrigan M McCarthy (KM)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Linda K Erasmus (LK)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Timothy J Doyle (TJ)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Mushal Allam (M)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Arshad Ismail (A)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Ntsieni Ramalwa (N)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Phuti Sekwadi (P)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Genevie Ntshoe (G)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Andronica Shonhiwa (A)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Vivien Essel (V)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Nomsa Tau (N)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Shannon Smouse (S)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Hlengiwe M Ngomane (HM)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Bolele Disenyeng (B)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Nicola A Page (NA)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Nelesh P Govender (NP)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Adriano G Duse (AG)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Rob Stewart (R)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Teena Thomas (T)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Deon Mahoney (D)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Mathieu Tourdjman (M)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Olivier Disson (O)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Pierre Thouvenot (P)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Mylène M Maury (MM)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Alexandre Leclercq (A)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Marc Lecuit (M)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Anthony M Smith (AM)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

Lucille H Blumberg (LH)

From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.

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