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Multistate Outbreak of Listeria monocytogenes Associated with Mexican-Style Cheese Made from Pasteurized Milk among Pregnant, Hispanic Women

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Abstract:

Listeriosis is a severe infection caused by Listeria monocytogenes. Since 2004, the Centers for Disease Control and Prevention has requested that listeriosis patients be interviewed using a standardized Listeria Initiative (LI) questionnaire. In January 2009, states and the Centers for Disease Control and Prevention began investigating a multistate outbreak of listeriosis among pregnant, Hispanic women. We defined a case as an illness occurring between October 2008 and March 2009 with an L. monocytogenes isolate indistinguishable from the outbreak strain by pulsed-field gel electrophoresis. We conducted a multistate case-control study using controls that were selected from L. monocytogenes illnesses in non–outbreak-related pregnant, Hispanic women that were reported to the LI during 2004 to 2008. Eight cases in five states were identified. Seven of these were pregnant, Hispanic females aged 21 to 43 years, and one was a 3-year-old Hispanic girl, who was excluded from the study. Seven (100%) cases but only 26 (60%) of 43 controls had consumed Mexican-style cheese in the month before illness (odds ratio, 5.89; 95% confidence interval, 1.07 to ∞; P = 0.04). Cultures of asadero cheese made from pasteurized milk collected at a manufacturing facility during routine sampling by the Michigan Department of Agriculture on 23 February 2009 yielded the outbreak strain, leading to a recall of cheeses produced in the plant. Recalled product was traced to stores where at least three of the women had purchased cheese. This investigation highlights the usefulness of routine product sampling for identifying contaminated foods, of pulsed-field gel electrophoresis analysis to detect multistate outbreaks, and of the LI for providing timely exposure information for case-control analyses. Recalls of contaminated cheeses likely prevented additional illnesses.

Document Type: Research Article

DOI: http://dx.doi.org/10.4315/0362-028X.JFP-10-536

Affiliations: 1: Enteric Diseases Epidemiology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. gqv8@cdc.gov 2: Enteric Diseases Epidemiology Branch, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA 3: Georgia Department of Community Health, Division of Public Health, Atlanta, Georgia 30303, USA 4: North Carolina Division of Public Health, Raleigh, North Carolina 27699, USA 5: Wisconsin Department of Health Services, Madison, Wisconsin 53703, USA 6: Illinois Department of Public Health, Division of Food, Drugs and Dairies, Springfield, Illinois 62761, USA 7: Georgia Department of Agriculture, Consumer Protection Division, Atlanta, Georgia 30334, USA 8: Tennessee Department of Health, Nashville, Tennessee 37243, USA 9: Illinois Department of Public Health, Communicable Disease Control Section, Springfield, Illinois 62761, USA 10: Michigan Department of Agriculture, Lansing, Michigan 48909, USA

Publication date: June 1, 2011

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