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Delaware Health Alert Network #452

July 5, 2021 10:33 am


Health Alert
OUTBREAK OF LISTERIA MONOCYTOGENES INFECTIONS LINKED TO TYSON FOODS

The Delaware Division of Public Health (DPH) is issuing this health alert to provide the health care community with information regarding a multistate outbreak of Listeria monocytogenes infections linked to recalled Tyson Foods ready-to-eat chicken products.

Summary

The Delaware Department of Health and Social Services (DHSS), Division of Public Health (DPH), announced today that the State has confirmed one case of Listeria associated with a multistate outbreak of Listeria monocytogenes infections linked to recalled Tyson Foods ready-to-eat chicken products. Two other cases are confirmed in Texas.

Background

The frozen, fully cooked chicken products were produced between December 26, 2020 and April 13, 2021. The products that are subject to recall are listed on the U.S. Department of Agriculture’s website: Tyson's Product List Final.pdf (usda.gov). Labels can be seen here: Labels for FSIS Recall Notification Report 023-2021 (usda.gov).       

The products subject to recall bear establishment number “EST. P-7089” on the product bag or inside the USDA mark of inspection. Products include frozen, fully cooked chicken strips, diced chicken, chicken wing sections, and fully cooked pizza with chicken and were sold under many brands including Tyson, Jet’s Pizza, Casey’s General Store, Marco’s Pizza, and Little Caesars. These items were shipped nationwide to retailers and institutions, including hospitals, nursing facilities, restaurants, schools and Department of Defense locations. There is also concern that some product may be in both consumer and institutional freezers. 

The Centers for Disease Control and Prevention issued a Food Safety Alert on July 3, after an epidemiologic investigation identified three listeriosis illnesses, including one death (in Texas), between April 6, 2021 and June 5, 2021. This outbreak may be much larger than the current number of known patients. The products were served all over the country. In addition, some people who contract Listeria infections do not seek medical care and recover on their own, so are not tested.

Listeriosis:

Listeria monocytogenes is a facultatively anaerobic, rod-shaped, gram-positive bacterium that can be readily isolated in standard bacterial culture of normally sterile body sites. It is widespread in the environment and can be isolated from soil, water, and decaying vegetation. It is a hardy organism that can withstand a wide range of conditions including freezing, drying, heat, and relatively high levels of acid, salinity, and alcohol. Unlike most foodborne pathogens, it can grow at standard refrigerator temperature (40°F), which makes it a particular problem in ready-to-eat foods that are not cooked before eating.

Listeriosis is usually acquired through foodborne transmission, except for fetal and neonatal infection, which is usually acquired in utero. Cutaneous infections have been reported very rarely among veterinarians and farmers following direct animal contact, particularly involving livestock products of conception.

Clinical Features:

In older adults and people with immunocompromising conditions, the most common clinical presentations are invasive infections, such as sepsis, meningitis, and meningoencephalitis. People can also experience focal infections, including septic arthritis, osteomyelitis, prosthetic graft infections, and infections of sites inside the chest and abdomen or of the skin and eye. Less commonly, otherwise healthy young people may also develop invasive listeriosis.

Listeriosis during pregnancy is typically a relatively mild “flu-like” illness. Some pregnant women with Listeria infection have no symptoms. Although severe disease in the mother is rare, infection during pregnancy can result in miscarriage, stillbirth, preterm labor, and sepsis or meningitis in the neonate.

  • Some neonates with listeriosis develop granulomatosis infantiseptica, a severe disorder involving the internal organs and skin.
  • Neonatal listeriosis is classified as early (within 6 days of birth) or late onset (7­–28 days after birth).
    • Early-onset neonatal listeriosis is usually acquired through transplacental transmission.
    • The sources of late-onset listeriosis are less clear; they may involve exposure during delivery or nosocomial exposure.

People with normal immune systems rarely develop invasive infection. However, they may experience a self-limited acute febrile gastroenteritis following high-dose Listeria exposure. Because Listeria cannot be detected by routine stool culture, febrile gastroenteritis from Listeria infection is rarely diagnosed outside of outbreak settings.

Patient Management:

The risk of invasive listeriosis after exposure to L. monocytogenes is very low; exposure is common, but disease is rare.

Management of pregnant women: The American College of Obstetrics and Gynecology has issued a committee opinion on the Management of Pregnant Women with Presumptive Exposure to Listeria monocytogenes. If the patient has a presumptive exposure with symptoms including fever, simultaneous testing with blood cultures and treatment with IV ampicillin (trimethoprim with sulfamethoxazole if patient is allergic to penicillin) may be indicated.

Management of people other than pregnant women with elevated risk of invasive listeriosis: Clinicians may consider using the framework provided by CDC at Information for Health Professionals and Laboratories | Listeria | CDC. Patient management decisions for asymptomatic or mildly symptomatic people are appropriately made on a case-by-case basis, informed by clinical judgment and the likelihood of exposure of the patient. Consultation with a specialist in infectious disease may be considered.

Reporting

Listeriosis is a reportable disease in Delaware. All Delaware physicians, laboratories and other health care providers are required by regulations to report patients with the following conditions, either based on clinical diagnosis or laboratory confirmation, to the Office of Infectious Disease Epidemiology (OIDE) as listed at Reportable Diseases in Delaware - Delaware Health and Social Services - State of Delaware. Reporting enables appropriate public health follow-up for your patients, helps identify outbreaks, and provides a better understanding of disease trends in Delaware. Cases can be reported to the DPH Office of Infectious Disease Epidemiology (OIDE) by calling 302-744-4990 (normal business hours) or 1-888-295-5156 (outside of normal business hours). You may also complete a Notifiable Disease Report PDF Form and mail the form as directed, fax the form to DPH at 302-223-1540, or email to reportdisease@delaware.gov. The form can be found online at https://dhss.delaware.gov/dhss/dph/dpc/rptdisease.html.

The annual incidence of laboratory-confirmed listeriosis in the United States is about 0.24 cases per 100,000 population, based on active surveillance in 10 FoodNet sites. The U.S. Healthy People 2020 target for listeriosis is 0.2 cases per 100,000. Approximately 800 laboratory-confirmed cases are reported annually to CDC’s National Notifiable Disease Surveillance System. However, many cases are not detected or reported, and CDC’s 2011 Estimates of Foodborne Illness, which includes estimates of cases not diagnosed or reported, indicates that approximately 1,600 cases occur annually in the United States. CDC estimates that listeriosis is the third leading cause of death from foodborne illness with about 260 deaths per year. Nearly everyone with listeriosis is hospitalized. The case-fatality rate is about 20%. Nearly one-quarter of pregnancy-associated cases result in fetal loss or death of the newborn.

 

Additional Information/Resources

For more information, visit the CDC: Listeria (Listeriosis) | Listeria | CDC.

Consumers with food safety questions can call the toll-free USDA Meat and Poultry Hotline at 1-888-MPHotline (1-888-674-6854) or live chat via Ask USDA from 10 a.m. to 6 p.m. (Eastern Time) Monday through Friday. Consumers can also browse food safety messages at Ask USDA or send a question via email to MPHotline@usda.gov

 

Tyson also has a hotline that consumers can call or text, 1-855-382-3101. Customer service representatives will be available beginning Sunday July 4 through Friday July 9, from 9:00 a.m. to 6:00 p.m. EDT. 

 

For more information about the CDC’s multi-state outbreak investigation, visit: https://www.cdc.gov/listeria/outbreaks/precooked-chicken-07-21/index.html. For more information about the Tyson Foods recall, visit: https://www.fsis.usda.gov/recalls-alerts/tyson-foods-inc.-recalls-ready-eat-chicken-products-due-possible-listeria.

Categories of Health Alert messages:

  • Health Alert: Conveys the highest level of importance; warrants immediate action or attention.
  • Health Advisory: Provides important information for a specific incident or situation; may not require immediate action.
  • Health Update: Provides updated information regarding an incident or situation; unlikely to require immediate action.
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