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Between 1 July and 26 October 2019 in Andalusia, Spain, a large outbreak with 207 confirmed cases of listeriosis was identified. Confirmed cases had a median age of 44 years (range: 0–94) and 114 were women (55.1%). Most cases (n = 154) had mild gastroenteritis, 141 (68.1%) required hospitalisation and three died; five of 34 pregnant women had a miscarriage. The median incubation period was 1 day (range: 0–30), and was significantly shorter in cases presenting with gastroenteritis compared to those presenting without gastroenteritis (1 day vs. 3 days, respectively, p value < 0.001). Stuffed pork, a ready-to-eat product consumed unheated, from a single producer contaminated with ST388 was identified as the source of infection. The outbreak strain was identified in 189 human samples and 87 non-human (82 food and 5 environmental) samples. Notification of new cases declined abruptly after control measures were implemented. These included contaminated food recall, protocols for clinical management of suspected cases and for post-exposure prophylaxis in pregnant women and communication campaigns with concise messages to the population through social media. Given that there were 3,059 probable cases, this was the largest outbreak ever reported in Europe.


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  1. Schlech WF 3rd. Epidemiology and clinical manifestations of Listeria monocytogenes infection. Microbiol Spectr. 2019;7(3):7.3.3.  https://doi.org/10.1128/microbiolspec.GPP3-0014-2018  PMID: 31837132 
  2. World Health Organization (WHO). Listeriosis. Key facts. Geneva: WHO; 2018. Available from: https://www.who.int/en/news-room/fact-sheets/detail/listeriosis
  3. Wang Z, Tao X, Liu S, Zhao Y, Yang X. An update review on listeria infection in pregnancy. Infect Drug Resist. 2021;14:1967-78. . https://doi.org/10.2147/IDR.S313675  PMID: 34079306 
  4. European Centre for Disease Prevention and Control. Surveillance Atlas of Infectious Diseases. Listeriosis disease data. Stockholm: ECDC. [Accessed: 27 Nov 2021]. Available from: https://www.ecdc.europa.eu/en/surveillance-atlas-infectious-diseases
  5. Herrador Z, Gherasim A, López-Vélez R, Benito A. Listeriosis in Spain based on hospitalisation records, 1997 to 2015: need for greater awareness. Euro Surveill. 2019;24(21).  https://doi.org/10.2807/1560-7917.ES.2019.24.21.1800271  PMID: 31138365 
  6. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis. 2014;58(3):309-18.  https://doi.org/10.1093/cid/cit816  PMID: 24421306 
  7. R Core Team. R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2020. Available from: https://www.r-project.org/
  8. Doumith M, Buchrieser C, Glaser P, Jacquet C, Martin P. Differentiation of the major Listeria monocytogenes serovars by multiplex PCR. J Clin Microbiol. 2004;42(8):3819-22.  https://doi.org/10.1128/JCM.42.8.3819-3822.2004  PMID: 15297538 
  9. Doumith M, Jacquet C, Gerner-Smidt P, Graves LM, Loncarevic S, Mathisen T, et al. Multicenter validation of a multiplex PCR assay for differentiating the major Listeria monocytogenes serovars 1/2a, 1/2b, 1/2c, and 4b: toward an international standard. J Food Prot. 2005;68(12):2648-50.  https://doi.org/10.4315/0362-028X-68.12.2648  PMID: 16355837 
  10. Salcedo C, Arreaza L, Alcalá B, de la Fuente L, Vázquez JA. Development of a multilocus sequence typing method for analysis of Listeria monocytogenes clones. J Clin Microbiol. 2003;41(2):757-62.  https://doi.org/10.1128/JCM.41.2.757-762.2003  PMID: 12574278 
  11. Ruppitsch W, Pietzka A, Prior K, Bletz S, Fernandez HL, Allerberger F, et al. Defining and evaluating a core genome multilocus sequence typing scheme for whole-genome sequence-based typing of Listeria monocytogenes. J Clin Microbiol. 2015;53(9):2869-76.  https://doi.org/10.1128/JCM.01193-15  PMID: 26135865 
  12. Van Walle I, Björkman JT, Cormican M, Dallman T, Mossong J, Moura A, et al. Retrospective validation of whole genome sequencing-enhanced surveillance of listeriosis in Europe, 2010 to 2015. Euro Surveill. 2018;23(33):1-11.  https://doi.org/10.2807/1560-7917.ES.2018.23.33.1700798  PMID: 30131096 
  13. European Commission. Commission Regulation (EC) No 2073/2005 of 15 November 2005 on microbiological criteria for foodstuffs. Official Journal of the European Union. Luxembourg: Publications Office of the European Union. 22.12.2005:L 338. Available from: https://eur-lex.europa.eu/eli/reg/2005/2073/oj
  14. Halbedel S, Wilking H, Holzer A, Kleta S, Fischer MA, Lüth S, et al. Large nationwide outbreak of invasive listeriosis associated with blood sausage, Germany, 2018-2019. Emerg Infect Dis. 2020;26(7):1456-64.  https://doi.org/10.3201/eid2607.200225  PMID: 32568037 
  15. Jacquet C, Catimel B, Brosch R, Buchrieser C, Dehaumont P, Goulet V, et al. Investigations related to the epidemic strain involved in the French listeriosis outbreak in 1992. Appl Environ Microbiol. 1995;61(6):2242-6.  https://doi.org/10.1128/aem.61.6.2242-2246.1995  PMID: 7793944 
  16. Kvistholm Jensen A, Nielsen EM, Björkman JT, Jensen T, Müller L, Persson S, et al. Whole-genome sequencing used to investigate a nationwide outbreak of listeriosis caused by ready-to-eat delicatessen meat, Denmark, 2014. Clin Infect Dis. 2016;63(1):64-70.  https://doi.org/10.1093/cid/ciw192  PMID: 27025820 
  17. Graves LM, Hunter SB, Ong AR, Schoonmaker-Bopp D, Hise K, Kornstein L, et al. Microbiological aspects of the investigation that traced the 1998 outbreak of listeriosis in the United States to contaminated hot dogs and establishment of molecular subtyping-based surveillance for Listeria monocytogenes in the PulseNet network. J Clin Microbiol. 2005;43(5):2350-5.  https://doi.org/10.1128/JCM.43.5.2350-2355.2005  PMID: 15872265 
  18. Thomas J, Govender N, McCarthy KM, Erasmus LK, Doyle TJ, Allam M, et al. Outbreak of Listeriosis in South Africa associated with processed meat. N Engl J Med. 2020;382(7):632-43.  https://doi.org/10.1056/NEJMoa1907462  PMID: 32053299 
  19. Jacks A, Pihlajasaari A, Vahe M, Myntti A, Kaukoranta SS, Elomaa N, et al. Outbreak of hospital-acquired gastroenteritis and invasive infection caused by Listeria monocytogenes, Finland, 2012. Epidemiol Infect. 2016;144(13):2732-42.  https://doi.org/10.1017/S0950268815002563  PMID: 26493730 
  20. Johnsen BO, Lingaas E, Torfoss D, Strøm EH, Nordøy I. A large outbreak of Listeria monocytogenes infection with short incubation period in a tertiary care hospital. J Infect. 2010;61(6):465-70.  https://doi.org/10.1016/j.jinf.2010.08.007  PMID: 20813130 
  21. Aureli P, Fiorucci GC, Caroli D, Marchiaro G, Novara O, Leone L, et al. An outbreak of febrile gastroenteritis associated with corn contaminated by Listeria monocytogenes. N Engl J Med. 2000;342(17):1236-41.  https://doi.org/10.1056/NEJM200004273421702  PMID: 10781619 
  22. Angelo KM, Jackson KA, Wong KK, Hoekstra RM, Jackson BR. Assessment of the incubation period for invasive listeriosis. Clin Infect Dis. 2016;63(11):1487-9.  https://doi.org/10.1093/cid/ciw569  PMID: 27535950 
  23. Goulet V, King LA, Vaillant V, de Valk H. What is the incubation period for listeriosis? BMC Infect Dis. 2013;13(1):11.  https://doi.org/10.1186/1471-2334-13-11  PMID: 23305174 
  24. Ministerio de Agricultura Pesca y Alimentación. Informe del consumo de alimentación en España 2020. [Report on food consumption in Spain 2020]. Madrid; Spanish government. [Accessed: 14 Dec 2021]. Spanish. Available from: https://www.mapa.gob.es/es/alimentacion/temas/consumo-tendencias/informe-anual-consumo-2020-v2-nov2021-baja-res_tcm30-562704.pdf
  25. Mpundu P, Mbewe AR, Muma JB, Mwasinga W, Mukumbuta N, Munyeme M. A global perspective of antibiotic-resistant Listeria monocytogenes prevalence in assorted ready to eat foods: A systematic review. Vet World. 2021;14(8):2219-29.  https://doi.org/10.14202/vetworld.2021.2219-2229  PMID: 34566342 
  26. Archer DL. The evolution of FDA’s policy on Listeria monocytogenes in ready-to-eat foods in the United States. Curr Opin Food Sci. 2018;20:64-8. .  https://doi.org/10.1016/j.cofs.2018.03.007 
  27. Lee JC, Daraba A, Voidarou C, Rozos G, El Enshasy HA, Varzakas T. Implementation of food safety management systems along with other management tools (HAZOP, FMEA, Ishikawa, Pareto). The case study of Listeria monocytogenes and correlation with microbiological criteria. Foods (Basel, Switzerland). 2021;10(9):2169.
  28. Junta de Andalucía Consejería de Salud y Consumo. Plan extraordinario de Listeria Monocytogenes [Extraordinary plan of listeria monocytogenes]. Seville: Junta de Andalucía. [Accessed: 11 Aug 2022]. Spanish. Available from: https://juntadeandalucia.es/organismos/saludyconsumo/areas/seguridad-alimentaria/gestion-seguridad-alimentaria/paginas/plan-extraordinario-listeria.html
  29. European Parliament and of the Council of the European Union. Decision No 1082/2013/EU OF the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision No 2119/98/EC. Luxembourg: Official Journal of the European Union. 5 Nov 2013. Available from: https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32013D1082
  30. Moura A, Criscuolo A, Pouseele H, Maury MM, Leclercq A, Tarr C, et al. Whole genome-based population biology and epidemiological surveillance of Listeria monocytogenes. Nat Microbiol. 2016;2:16185.

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