Listeriosis, the most deadly food-borne disease has claimed over 100 lives in South Africa. The source of the outbreak has been traced, according to Dr Aaron Motsoaledi, the Minister of Health, to three Enterprise processing plants in Polokwane, Germiston and also in Pretoria. Retailers consequently withdrew from the shelves all ready to eat uncooked foods from Enterprise, Rainbow Chickens and other products contaminated with the bacteria known as Listeria monocytogenes.
Most fast foods sellers, in the townships, who use Polony, as one of the ingredients in their Khothas (a quarter slice of bread hollowed out and filled with Polony, eggs, chips etc) have experienced a marked decline in the sales of their fast -foods, as consumers fear contracting this deadly disease from ready to eat uncooked foods.
Listeriosis is a bacterial disease-caused by a bacteria known as Listeria monocytogenes. Whilst many people do not know about this deadly disease, it is not a new emerging disease. This bacteria has been a cause of human disease for a long time worldwide. It commonly causes Meningitis or Blood Stream infection in new-born babies. It is widely distributed in nature, in soil, in vegetation etc. It is also found in about 5% of pregnant women who are not ill (a colonizer of maternal gastrointestinal tract and the genital tract-hence leading to infection of the new-born during delivery). It is also one of the causes of Meningitis in the elderly above the age of 65 years.
When looking at the statistics from National Institute for Communicable Disease (NICD) from 2013 to end of 2016 countrywide, there has been about 60-80 cases per year – that is sporadic cases. The outbreak was first noticed between July and August 2017 by two academic hospital laboratories in Gauteng. These laboratories were noticing higher than usual numbers of laboratory confirmed cases of Listerioses in their centres. The laboratories reported their observations to NICD and laboratories and clinics were placed on a heightened sense of alert.
By October 2017, NICD had reported 129 culture confirmed cases since January 2017 – which was higher than the usual numbers. Laboratories and clinicians were on high alert and the outbreak was declared in December 2017 by the Health Ministry. By then, 557 cases were reported country wide – with Gauteng having the most cases. By 3 March 2018, there were 967 laboratory confirmed cases.
Of these there had been 218 deaths (where outcome was known – because there are cases where the patient outcome was not known).These numbers are very dynamic as new data is received by the NICD on daily basis, so the numbers may be different, today.
In adults, Listeriosis is a food-borne disease which is contracted from eating contaminated foods. Of note Listeria can survive in temperatures of 4°C, hence its ability to survive and contaminate refrigerated foods such as cold meats and other ready to eat uncooked foods. On 4 March 2018, the Minister of Health, Dr Aron Motsoaledi, announced to the nation the discovery of the source, which was traced to Enterprise manufacturing plants in Polokwane, Germiston and in Pretoria. As a consequence, stringent control measures were put in place since then.
This disease can be prevented by not drinking unpasteurized Milk. Wash vegetables thoroughly before eating. Keep the refrigerator at 4.4°C or lower. Eat pre-cooked, perishable or ready to eat food as soon as possible. Keep raw meat, fish and poultry separate from other food.
The symptoms of Listeriosis, (broken down into age categories/or clinical scenarios to make it easy to read)
(1) Adults and children
Mild febrile diarrhoea after eating contaminated food. Symptoms may occur long after eating the suspected foods – several days to weeks. Outbreaks of diarrhoea and vomiting in 2 or more people who have shared a common meal (Food poisoning). Severe disease: Meningitis /Bloodstream infection in people above 65 years of age or those with a compromised immune system( Body defence system) for one reason or another e.g.- HIV/AIDS, Cancer therapy, diabetes etc.(NB: Symptoms may occur long after exposure, up to 90 days).
(2) Pregnant women
May be asymptomatic or may have mild flu-like symptoms with fever. These women in the setting of the outbreak must be asked about these symptoms when they come for routine antenatal care even though they have mild disease, because of the danger of passing it to the new-born.
(3) New-borns (babies day 0-day 30 of life)
Severe disease-Meningitis or Bloodstream infection. From laboratory statistics from January 2017 to 26 March 2018 in Dr George Mukhari Academic Hospital (DGMAH) there were 32 Cases, 8 of which were from surrounding district hospitals and data could not be confirmed for them. Majority were new-borns just as it is nationally. There were 9 confirmed deaths.
The disease is treated with antibiotics, administered timeously, even before laboratory confirmation. As long as there is suspicion or differential diagnosis of Listerioses. Recommended antibiotics – Ampicillin + Gentamycin. For patients with Penicillin allergy there are affordable easy to get alternative antibiotics. In addition – other supportive care, in severe disease.