LISTERIA

Listeria Monocytogenes bacteria cause the serious infection (Listeriosis). While disease caused by this organism is uncommon (usually less than 20 cases per year in New Zealand) the consequences are often serious with a fatality rate of around 25%. Two forms of the disease are recognised ~ a serious invasive disease and a non-invasive gastroenteritis. Listeria can grow at refrigeration temperatures and associated foods tend to be those with long shelf lives stored under refrigeration. The organism is widespread and while most people ingest small numbers on a daily basis without any problems, at-risk groups may become ill. What is Listeria? Listeria monocytogenes is a bacteria having the following characteristics. It grows best at 37C and can grow between -1.5 and 45C. It grows through a pH range of 4.4 to 9.4, has a minimum water activity level of 0.92 and can grow in the presence or absence of oxygen. Listeria are readily killed through heating to 70C for about 10 seconds. They can survive for hours at 50C and for up to 10 minutes at 60C. They are inactivated at pH levels under 4.4 with inactivation being faster at higher temperatures. They survive well and can grow in food held under refrigeration and survive freezing very well. The bacteria can grow in relatively high (30%) CO2 atmospheres. Bacterial cells can remain viable in dry environments for long periods. Recent evidence suggests that under adverse conditions Listeria can undergo a transition to a VNC state (Viable but Non-Culturable). What are the symptoms? There are two types of disease ~ Invasive and Non-invasive. Invasive ~ Symptoms begin 1 to 90 days, (but usually around 30 days) after ingesting the bacteria and consist of flu-like symptoms (fever and headache), diarrhoea, vomiting, meningitis, septicaemia, encephalitis and intrauterine or cervical infections in pregnant women, possibly resulting in spontaneous abortion or stillbirth. A fatality rate of around 25% is associated with this illness. Non-invasive ~ Symptoms begin 11 hours to 7 days, (but usually around 18 hours) after ingesting the bacteria and consist of diarrhoea, fever, muscle pain, headache and less frequently with abdominal cramps and vomiting. It is often called non-invasive febrile gastroenteritis. The diagnosis is confirmed by laboratory tests on blood, cerebrospinal fluid, or faeces. Non-invasive disease will affect anyone ingesting a high enough number of bacteria, while the invasive disease affects at-risk groups comprising pregnant women and their foetuses, new-born babies, the elderly and the immunocompromised. Where does it come from? It is commonly found in mammals both domestic and wild as well as birds and possibly some fish and shellfish. It is widespread in the environment including soil, vegetation, water and sewage. It is carried asymptomatically (without showing symptoms) by up to 10% of the human population. It should be considered to be present in all raw foods and ingredients and may be in cooked foods through post cooking contamination. Greatest risk is associated with readyto-eat foods with long shelf lives.

How long does it last? Duration of invasive illness depends on the condition and severity of complicating symptoms as up to 90% of cases can be hospitalised. Non-invasive illness is generally self-limiting with symptoms abating after 2 to 3 days. Long-term effects of invasive illness can include neurological problems (cranial nerve palsies). Pre-term infants may suffer from excess fluid in the brain, requiring surgery and partial paralysis. How is it treated? Listeria monocytogenes is susceptible to a number of antibiotics. Penicillin and Ampicillin possibly together with an amino-glycoside like Gentamicin or Trimethoprimsulfamethoxazole for those allergic to penicillin may be drugs of choice. Can I get this infection again? Yes, as there is little evidence for resistance or immunity being gained against re-infection. Can it spread to others? This disease can possibly be spread to others so strict attention to personal hygiene must be paid. Person-to-person transmission is usually between mother and foetus. What about work, school, pre-school and child-care? Everyone with this infection should stay off work or school while they have symptoms. Those in High Risk groups, occupations or institutions (infants or children in day-care, school pupils, students, food workers, child-care workers, teachers, and health/care workers) should only return to them after they have been completely free of symptoms for 2 days, and they must stay away again if any symptoms return. Listeria infection is a Notifiable disease in NZ and those employed in High Risk groups may be required to stay away from work until tested free from infection. How can it be prevented or the risk reduced? Study estimates on foodborne transmission vary from 30% to food being the primary source. Foods implicated Overseas in Invasive illness include ~ Coleslaw, Mexican-style fresh cheese and pork tongue jelly. Foods implicated Overseas in Non-invasive illness include ~ Corn salad, cold-smoked trout and chocolate milk. Preventive measures that can be taken to help avoid the illness include ~ At-risk groups (comprising pregnant women, the elderly and the immunocompromised) avoiding ~ eating high-risk foods if you are unsure about how they have been prepared, handled and stored, high-risk, perishable foods (needing refrigeration) that have been prepared in advance and are to be eaten without further cooking, refrigerated ready-to-eat foods of long shelf life, choosing and consuming foods well within their best before or use by dates, ready-to-eat foods from food establishments that may have been prepared and refrigerated some time before being put out on display, if eating out, order hot meals choose menu items that are cooked to order and are served hot, dont eat food that is served lukewarm and it is safer to avoid smorgasbords and salad bars.

At-risk groups eating only freshly cooked food and well-washed freshly prepared fruit and vegetables. Thorough hand washing ~ Before handling or preparing food, or eating, After handling raw meat, farm animals or pets, and after changing nappies and going to the toilet. Correctly storing raw meat in a separate area of a cool room or on the lowest shelf of a fridge to keep the juices from dripping onto other foods. Preventing cross-contamination from raw to cooked or ready-to-eat foods, by using separate preparation areas and equipment or sanitising between processes. Thorough cooking of meat products. Not keeping high-risk foods at room temperature but above 60C if served hot, 4C if cold. Reheating foods until they are steaming hot and if reheating in a microwave ensuring that the food is heated throughout. Not drinking untreated water supplies. Thoroughly washing fruit and vegetables with clean water of drinking standard before use. Ensuring food handlers have good personal hygiene and adequate food safety training.

Health Licensing Section, Inspections & Enforcement Unit, Christchurch City Council