Multistate Outbreak of Listeriosis --- United States, 2000

Since May 2000, 29 illnesses caused by a strain of Listeria monocytogenes (LM) have been identified in 10 states: New York (15 cases); Georgia (three); Connecticut, Ohio, and Michigan (two each); and California, Pennsylvania, Tennessee, Utah, and Wisconsin (one each). Dates of LM isolation ranged from May 17 through November 26 with 26 (90%) infections occurring since July 15. When subtyped, the LM isolates from these cases were indistinguishable by pulsed-field gel electrophoresis (PulseNet pattern numbers GX6A16.0014 by Asc1 and GX6A12.0017 by Apa1) and ribotyping (DUP-1053). This report summarizes the investigation, which linked these cases of listeriosis to eating deli turkey meat.

Eight perinatal and 21 nonperinatal cases were reported. Among the 21 nonperinatal case-patients, the median age was 65 years (range: 29--92 years); 13 (62%) were female. The 29 cases have been associated with four deaths and three miscarriages/stillbirths.

A case-control study conducted by five state and two local health departments and CDC implicated eating deli turkey meat as the probable source of infection. Thirteen (76%) of 17 case-patients and five (21%) of 24 controls ate deli turkey meat during the 30 days before illness onset (Mantel-Haenszel weighted odds ratio=8.0; 95% confidence interval=1.2--43.3). State health and agriculture departments investigated 13 stores and delicatessens where 11 patients reported purchasing turkey; these stores and deli-catessens carried turkey meat produced by at least 27 federally inspected establishments. Two establishments were linked to 10 of 11 patients; one of these establishments produced turkey meat for the second establishment.

On December 8, investigators from the Food Safety and Inspection Service, U.S. Department of Agriculture (USDA) began investigating the implicated establishments. On December 12, Cargill Turkey Products, Inc. (Waco, Texas) stopped shipping ready-to-eat foods and, on December 14, voluntarily recalled processed turkey and chicken deli meat that might have been contaminated.

Reported by: S Hurd, Q Phan, J Hadler, State Epidemiologist, Connecticut State Dept of Public Health. B Mackenzie, S Lance-Parker, P Blake, State Epidemiologist, Div of Public Health, Georgia Dept of Human Resources. M Deasy, J Rankin, State Epidemiologist, Pennsylvania Dept of Health. D Frye, I Lee, Los Angeles Dept of Health; B Werner, D Vugia, State Epidemiologist, California Dept of Health Svcs. S Bidol, G Stoltman, M Boulton, State Epidemiologist, Michigan Dept of Community Health. M Widemann, Cornell Univ, Ithaca; L Kornstein, S Reddy, B Mojica, New York City Dept of Health; F Guido, A Huang, Westchester County Dept of Health, New Rochelle; C Vincent, A Bugenhagen, J Corby, New York State Dept of Agriculture and Markets, Albany; E Carloni, M Holcomb, S Kondracki, R Woron, S Zansky, P Smith, State Epidemiologist, New York Dept of Health. G Dowdle, C Nichols, State Epidemiologist, Utah Dept of Health. F Smith, State Epidemiologist, Ohio Dept of Health. D Gerber, T Jones, W Moore, State Epidemiologist, Tennessee Dept of Health. S Ahrabi-Fard, J Davis, State Epidemiologist, Wisconsin Dept of Health. Human Health Sciences Div, Office of Public Health and Science, Food Safety and Inspection Svc, US Dept of Agriculture. Foodborne and Diarrheal Diseases Br, Div of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, CDC.

Editorial Note:

LM infection causes an estimated 2500 serious illnesses and 500 deaths in the United States each year. Infected pregnant women may experience only a mild, influenzalike illness; however, infections during pregnancy can lead to premature delivery, miscarriage, stillbirth, or serious infection of the newborn. Other persons at increased risk for infection are those aged >65 years, persons with cancer, diabetes, kidney disease, acquired immunodeficiency syndrome, or who take immunosuppressive medications. Manifestations of illness include meningitis and sepsis. Healthy persons aged <65 years rarely are affected.

The risk for a person developing Listeria infection after eating a contaminated product is very small. Persons who have eaten a recalled product but do not have symptoms do not require tests or treatment even if they are in a highrisk group. However, persons in a high-risk group who have eaten contaminated product and become ill within 2 months with fever or signs of serious illness should consult a physician.

Guidelines for preventing listeriosis are similar to those for preventing other foodborne illnesses. The general recommendations are 1) cook thoroughly raw food from animal sources (e.g., beef, pork, or poultry); 2) wash raw vegetables thoroughly before eating; 3) keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods; 4) avoid raw (unpasteurized) milk or foods made from raw milk; and 5) wash hands, knives, and cutting boards after each handling of uncooked foods. Persons at high risk for listeriosis may choose to 1) avoid soft cheeses (i.e., feta, Brie, Camembert, blue-veined, and Mexican-style cheese such as queso fresco). Hard cheeses, processed cheeses, cream cheese, cottage cheese, or yogurt need not be avoided; 2) cook leftover foods or ready-to-eat foods (e.g., hot dogs) until steaming hot; and 3) avoid foods from deli counters (e.g., prepared salads, meats, and cheeses) or thoroughly reheat cold cuts before eating.

Cases of listeriosis with onset since October 1, 2000, should be reported to state and local health departments; information about the recall is available at http://www.fsis.usda.gov/OA/recalls/rec_actv.htm*. Consumers who have recalled meat products, even if they have been stored in freezers, should discard or return them to the point of purchase. High-risk consumers who have processed turkey or chicken deli meat but are uncertain of the brand should call the place of purchase to find out if it might be a recalled product, or discard it. Answers to meat-safety questions are available at the USDA meat and poultry hotline, (800) 535-4555. Listeriosis information is available at http://www.cdc.gov/ncidod/dbmd/diseaseinfo/listeriosis_g.htm.

* References to sites of non-CDC organizations on the World-Wide Web are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites.

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