Chester County Medicine Winter 2021 - 16

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a Growing, But
Often Underrated,
Problem
BY JOHN P. MAHER, MD, MPH

F

or most of calendar year 2020, the continuous media
hype, the politicization of the pandemic response, and the
information overload coming at us from all directions, have
pretty much totally absorbed our attention. As a result, public
attention has been almost completely focused on only two things:
the national election campaign, and the COVID-19 pandemic.
That fixation has also, at least to some extent, distracted
some physicians from other aspects of communicable disease
transmission and epidemiology, despite the fact that Norovirus,
Lyme Disease, influenza, and other disease entities continue to
cause scattered cases, while the CDC, FDA, and other health
related agencies try to hold the line against infectious diseases
causing clusters, or outbreaks, of infections associated with
exposures to contaminated food, water, and other aspects of our
common environments.
Generally speaking, when we mention such outbreaks, most
of us call up a mental image of well-reported outbreaks such as E.
coli (EHEC) outbreaks related to petting zoos or contaminated
produce (vegetables, fruits), Norovirus outbreaks on cruise
ships, or perhaps hepatitis A (HAV) outbreaks associated with an
infected food handler at a restaurant.

16 CHESTER COUNT Y Medicine | WINTER 2021

Information available from the CDC and/or FDA websites
indicate that foodborne outbreaks do continue to occur here in the
USA. From 2009 to 2018, the CDC reports there have been 8,544
recorded foodborne outbreaks nationwide, resulting in 150,830
illnesses, 9336 hospitalizations, and 242 deaths.
Those of us, especially if we do not generally deal with
communicable disease issues, would immediately think of the
better known causative agents: Salmonella, E. coli, Shigella,
Norovirus, and HAV, while those with more CD experience may
add Cyclospora, Brucella, Campylobacter, Clostridium, and others
to the list.
But there is another " malefactor " lurking in the wings, which
has been gradually sneaking its way up on the list of " the usual
suspects, " and which needs to be given more consideration in the
differential diagnosis of foodborne diseases, namely the organism
Listeria monocytogenes, which is a Gram+, facultative, anaerobic
bacterium capable of surviving in the presence or the absence of
oxygen.
In the ten-year period, 2009-2018, the CDC documents
69 listeria outbreaks here in the U.S. These have accounted
for 731 known (reported) illnesses, 635 hospitalizations, and
118 deaths. Some older works consider listeria outbreaks



Chester County Medicine Winter 2021

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