Chester County Medicine Winter 2021 - 19

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Spread and Transmission of listeria: Recalling how easily
E. coli can be spread throughout ground beef by a contaminated
meat grinder reminds us that a contaminated slicing machine
at the Deli Counter of a retail store, and/or secondarily
contaminated food preparation surfaces, can spread the organism
to everything that touches them during the multiple steps of
processing food products from farm/ocean to table. [See Figure
2.] In addition, the rapidity of international travel and of
commercial food transportation gives an idea of how quickly
contaminated products can be shipped around the globe and
reach consumers half a world away. Recall the fear of the threat
of bovine spongiform encephalopathy from 1986-2015, when
over 180,000 cattle were diagnosed with Mad Cow Disease in the
U.K. and 177 people died from it. Now recall that an estimated
60% of America's produce is imported from other nations. If
we add to that, reported U.K. studies showing the persistence
of listeria in refrigerated products and even, apparently, in some
cold-smoked salmon products, one can just imagine the impact of
any large scale outbreak on the U.S. economy, health care systems,
and (no doubt) the secondary " plague " of litigation initiated by
America's lawyers.

How bad could it get? As an example, a long-smoldering
listeria outbreak between 2013 - 2016 identified 9 cases in 4 states;
all were hospitalized and 3 died. The cases were associated with
consumption of frozen vegetables from a frozen food company in
Washington which then recalled 11 products due to " potential
contamination, " but later expanded the recall to involve " all
organic and traditional frozen vegetables and fruit products " from
its Washington facility. This involved more than 350 consumer food
products sold under 42 brand names, plus another hundred products of
other food companies using their products.
In 2017-2019, listeria outbreaks affecting U.K. hospitals were
linked to commercially prepared sandwiches and salads served
to hospital patients. But perhaps the ultimate (at least so far)
listeria CD " nightmare " (labeled by the WHO " the world's largest
listeriosis outbreak " ) occurred in South Africa in 2017-2018.
Related to poor refrigeration and bologna products, it involved
1,060 cases and 216 deaths before it was halted.
For those interested in greater details about this problem, food
safety regulations, outbreak investigations (including advanced
molecular detection), or in more information generally about the
topics such as PulseNet, Whole Genome Sequencing, or food
production, processing and preparation safety practices, you will
find the websites of the CDC and the USDA/FDA and FSIS of
great help.
Dr. Maher is a retired physician, former County Health
Director, and long term member of the CCMS Board of
Directors, and advises he has relied heavily on those
public agencies' websites for the information used in
this article.

Figure 2:
Examples of Multiple " Food Processing " steps
" Processing " means changing plants and animal tissues into what we, as consumers, recognize as " food. " It may involve any or
many of the following steps, depending on the different kinds of food. Further, at various points along the process, food additives and
seasonings may be added to the product.
For Produce it can involve harvesting, washing, sorting, trimming, slicing, peeling, squeezing or shredding, packing and transporting.
For Milk, following the milking and transportation to the plant, it usually involves Pasteurization and bottling, or it may be made into
cheese. Nuts can be roasted, shelled, sliced, salted, chopped or ground (e.g., peanut butter) before packaging.
For animals, it starts with the slaughtering, evisceration, cutting into pieces (large or small), or grinding up; it is then cooked,
smoked, cured, frozen, combined with other ingredients (sausage, pot pie, etc.). Fish must be caught (hooked, netted or farmed),
cleaned, iced, refrigerated, transported to the wholesaler where it may be filleted, sliced, canned, frozen, cooked, before transporting
again, to the retailer, to be further processed and displayed to the consumer (who must then do his/her own food preparation activities
before serving the food to the family).

WINTER 2021 | CHESTER COUNT Y Medicine 19



Chester County Medicine Winter 2021

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