Listeria monocytogenes in Cooked Chicken: Detection of an Outbreak in the United Kingdom (2016 to 2017) and Analysis of L. monocytogenes from Unrelated Monitoring of Foods (2013 to 2017)

ABSTRACT

In England and Wales, Public Health England applies whole genome sequencing to cultures of Listeria monocytogenes recovered from human cases of listeriosis, foods, and food production environments. Following the routine inspection of a small retailer in February and March 2016, two unopened packs of cooked chicken produced by the same manufacturer were found to be contaminated with L. monocytogenes at levels of 340 and 20 CFU/g. A public recall of this product was issued in March 2016. Early in 2017, a less than five single-nucleotide polymorphism single-linkage cluster was detected between the L. monocytogenes isolates from the two cooked chicken products and cultures from five cases of human listeriosis in England and Scotland with onsets of illness between March 2016 and February 2017. Epidemiological data provided further supportive evidence that this cluster was an outbreak linked to a manufacturer of cooked chicken whose products were supplied to the small retailer that initiated the outbreak investigation. Unrelated to this outbreak, 34 L. monocytogenes isolates recovered from routine food monitoring of 2,007 samples of cooked chicken during 2013 to 2017 were analyzed by whole genome sequencing. Previously undetected fewer than five single-nucleotide polymorphism single-linkage clusters were identified between cultures from cooked chicken and with those from two clusters and two sporadic cases of human listeriosis that were consistent with foodborne transmission. This analysis identified linkage of L. monocytogenes clusters within specific food chains more readily than traditional manual tracing. Linking of data associated with L. monocytogenes cultures from cases of listeriosis with those from unrelated food testing is a unique source of information for communicable disease risk assessment, epidemiological studies, and disease prevention and control. This report provides further evidence that should act as a reminder of the association between cooked chicken consumption and human listeriosis.

HIGHLIGHTS

Outbreak of Salmonella enteritidis PT14b gastroenteritis at a restaurant in England: the use of molecular typing to achieve a successful prosecution

OBJECTIVES

To describe an outbreak of Salmonella enteritidis phage type (PT) 14b in people who had eaten at a restaurant, and the investigation and subsequent prosecution of the food business operator (FBO).

STUDY DESIGN

The local health protection team and environmental health department formed an outbreak control team to investigate the outbreak.

METHODS

Epidemiological, microbiological, and environmental investigations were undertaken. Epidemiological investigations involved case finding and interviews. Microbiological investigation: stool samples from the suspected cases and environmental samples from the implicated food business were investigated. Salmonella isolates obtained were subjected to multiple locus variable-number tandem repeat analysis (MLVA) profiling and whole genome sequencing. In addition, adenosine triphosphate (ATP) hygiene swab tests were used to verify the quality of cleaning procedures and data loggers were used to determine the water temperature of the mechanical dishwasher.

RESULTS

Fifteen cases of illness where the causative agent was shown to be S. enteritidis PT14b were identified, all of whom had eaten at the same restaurant. S. enteritidis PT14b was also identified from three of the 11 food and environmental samples taken at the restaurant and found to have the same MLVA profile as the cases. A case for prosecution was built and the FBO was successfully prosecuted in July 2015.

CONCLUSIONS

This investigation highlighted that the use of molecular typing as part of thorough epidemiological, microbiological, and environmental investigations can present a robust case for prosecution against restaurants which pose a risk to public health.

An Outbreak of Human Listeriosis in England between 2010 and 2012 Associated with the Consumption of Pork Pies

An outbreak of listeriosis in England affecting 14 people between 2010 and 2012 and linked to the consumption of pork pies was investigated. All 14 individuals were older than 55 years, 12 were men, and 10 reported the presence of an underlying condition. All were resident in or had visited either of two English regions and were infected with the same strain of Listeria monocytogenes. In interviews with 12 patients, 9 reported eating pork pies, and individuals that consumed pork pies were significantly more likely to be infected with an outbreak strain than were individuals with sporadic cases of listeriosis infections in England from 2010 to 2012. Pork pies were purchased from seven retailers in South Yorkshire or the East Midlands, and the outbreak strain was recovered from pork pies supplied by only the producer in South Yorkshire. The outbreak strain was also recovered from samples of finished product and from environmental samples collected from the manufacturer. The likely source of contamination was environmental sites within the manufacturing environment, and the contamination was associated with the process of adding gelatin to the pies after cooking. Inadequate temperature control and poor hygienic practices at one of the retailers were also identified as possible contributory factors allowing growth of the pathogen. Following improvements in manufacturing practices and implementation of additional control measures at the retailers' premises, L. monocytogenes was not recovered from subsequent food and environmental samples, and the outbreak strain was not detected in further individuals with listeriosis in England.

Characterization of an emergent clone of enteroinvasive Escherichia coli circulating in Europe

Enteroinvasive Escherichia coli (EIEC) cause intestinal illness indistinguishable from that caused by Shigella, mainly in developing countries. Recently an upsurge of cases of EIEC infections has been observed in Europe, with two large outbreaks occurring in Italy and in the United Kingdom. We have characterized phenotypically and genotypically the strains responsible for these epidemics together with an additional isolate from a sporadic case isolated in Spain. The three isolates belonged to the same rare serotype O96:H19 and were of sequence type ST-99, never reported before in EIEC or Shigella. The EIEC strains investigated possessed all the virulence genes harboured on the large plasmid conferring the invasive phenotype to EIEC and Shigella while showing only some of the known chromosomal virulence genes and none of the described pathoadaptative mutations. At the same time, they displayed motility abilities and biochemical requirements resembling more closely those of the non-pathogenic E. coli rather than the EIEC and Shigella strains used as reference. Our observations suggested that the O96:H19 strains belong to an emerging EIEC clone, which could be the result of a recent event of acquisition of the invasion plasmid by commensal E. coli.

A multi-country Salmonella Enteritidis phage type 14b outbreak associated with eggs from a German producer: ‘near real-time’ application of whole genome sequencing and food chain investigations, United Kingdom, May to September 2014

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Application of multilocus variable number tandem repeat analysis to monitor Verocytotoxin-producing Escherichia coli O157 phage type 8 in England and Wales: emergence of a profile associated with a national outbreak

AIMS

Evaluation of multilocus variable number tandem repeat analysis (MLVA) to subtype all isolates of Vero cytotoxin-producing Escherichia coli O157 phage type 8 in England and Wales.

METHODS AND RESULTS

Over a 13 month period from December 2010, 483 isolates of VTEC O157 PT8 were tested by MLVA; 39% were received in the first 4 months of 2011, when infections are generally low. One profile, or single locus variants of it, was present in 249 (52%) isolates but was not common previously. These cases represented a national increase in PT8, associated epidemiologically with soil-contaminated vegetables. Most of the 177 other MLVA profiles were unique to a single isolate. Profiles shared by >1 isolate included cases from two small community, food-borne outbreaks and 11 households. Several shared profiles were found among 23 isolates without known links. Apart from one group, isolates linked to travel abroad had very diverse profiles.

CONCLUSIONS

Multilocus variable number tandem repeat analysis discriminated apparent sporadic isolates of the same PT and assisted in detection of cases in an emerging national outbreak.

SIGNIFICANCE AND IMPACT OF THE STUDY

Multilocus variable number tandem repeat analysis is an epidemiologically valid complement to surveillance and applicable as a rapid, practical test for large numbers of isolates.

Development of an online database for diphtheria molecular epidemiology under the remit of the DIPNET project

The Diphtheria Surveillance Network (DIPNET), launched on 1 November 2006, is a 38-month programme bringing together 25 European Union partner countries (24 Member States and Turkey) and collaborating countries beyond Europe in a global dedicated surveillance network for diphtheria and related infections caused by Corynebacterium diphtheriae and C. ulcerans [1].

Cholesterol versus alpha-tocopherol: effects on properties of bilayers made from heteroacid phosphatidylcholines

The techniques of differential scanning calorimetry, fluorescence of merocyanine 540, fluorescence polarization of 1,6-diphenyl-1,3,5-hexatriene, proton permeability, and lipid peroxidation are used to compare the perturbations of cholesterol and alpha-tocopherol on lipid bilayer membranes composed of different phosphatidylcholines containing stearic acid in the sn-1 position and an unsaturated fatty acid (either oleic, alpha-linolenic, gamma-linolenic, or docosahexaenoic acid) in the sn-2 position. It is concluded that the structural roles of cholesterol and alpha-tocopherol may be similar with membranes composed of some phosphatidylcholines but are clearly different with membranes composed of other related phosphatidylcholines. alpha-Tocopherol exerts a much larger effect than cholesterol on membranes rich in polyunsaturated fatty acids that have their initial double bond before the delta 9 position. Cholesterol interacts more favorably with fatty acids that do not have an double bond before the delta 9 position. The membrane structural effects are explained in terms of the larger size of the sterol ring structure of cholesterol compared to the smaller chromanol ring of the alpha-tocopherol.

Analysis of transcription during the cell cycle in toluenized Chlamydomonas reinhardi cells

A toluene-permeabilized cell system was established to examine the transcription of certain RNAs regulated during the cell cycle in Chlamydomonas reinhardi. The incorporation of [alpha-32P]UTP into RNA which hybridizes to specific cloned cDNA, such as beta-tubulin, indicates that the cell cycle pattern of RNA accumulation may be controlled, in part, by differential transcription.