HEALTH ADVISORY # 318
July 24, 2014
MANAGEMENT OF PERSONS POSSIBLY EXPOSED TO LISTERIA MONOCYTOGENES ASSOCIATED WITH WAWONA PACKING COMPANY’S FRESH WHOLE PEACHES, PLUMS, NECTARINES, AND PLUOTS
Please distribute to Healthcare Providers, Infection Control Departments, Emergency Departments, Employee Health Services, Infectious Disease Departments, Pediatrics, Directors of Nursing, Medical Directors, and all patient care areas.
SUMMARY
- On July 19, 2014, Wawona Packing Company of Cutler, California voluntarily recalled certain lots of whole peaches (white and yellow), nectarines (white and yellow), plums and pluots packed between June 1, 2014 and July 12, 2014 due to the potential for contamination of the products with Listeria monocytogenes.
- To date, no illnesses have been linked to this recall.
- Providers should consider L. monocytogenes in the differential diagnosis of patients presenting with symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, particularly those patients with an exposure history of Wawona Packing Co.’s fresh whole peaches, plums, nectarines, and pluots.
- Routine screening or treatment of asymptomatic persons possibly exposed to recalled products is not recommended.
- For patients with illness suggestive of invasive listeriosis, testing should include blood culture and other tests, such as culture of cerebrospinal fluid, as indicated by the clinical presentation.
- Stool testing for Listeria has not been evaluated as a screening tool for listeriosis and, in general, is not recommended for the diagnosis of listeriosis.
- Suspect or confirmed cases should be reported promptly to the LHD where the patient lives. Erie County residents should be reported to Epidemiology and Surveillance at (716) 858-7697 during normal business hours and (716) 961-7898 after hours.
BACKGROUND
On July 19, 2014, Wawona Packing Company of Cutler, California voluntarily recalled certain lots of whole peaches (white and yellow), nectarines (white and yellow), plums and pluots packed between June 1, 2014 and July 12 , 2014 due to the potential for contamination of the products with L. monocytogenes. The recall was initiated based on the results of internal company testing. Prior to the recall, products were shipped directly to retailers and wholesalers who resell the products. The company issued a nationwide recall because they do not know the locations of the companies that purchased the products from their direct customers. Several retailers, including ALDI, Costco, Kroger, Trader Joe’s, Walmart and Wegmans, have announced a connection to the recall. To date, no illnesses have been linked to the recalled fruits. Information about the recall is available at: http://www.fda.gov/Safety/Recalls/ucm405943.htm.
EPIDEMIOLOGY AND CLINICAL PRESENTATION
Invasive listeriosis — illness with isolation of L. monocytogenes from a normally sterile site, typically blood or cerebrospinal fluid — is a serious infection, usually caused by eating food contaminated with the bacterium. The disease primarily affects older adults, pregnant women, newborns, and adults with immunocompromising conditions. Risk increases with increasing age over 50 years. Although exposure to L. monocytogenes is common, the risk of invasive listeriosis after exposure is very low, with an incidence rate of ~0.3/100,000 in the general population and ~3/100,000 in population subgroups at elevated risk.
Symptoms typically begin within a month after exposure but can range from three to 70 days. Listeriosis can present in different ways. In older adults and people with immunocompromising conditions, septicemia and meningitis are the most common clinical presentations. In older adults and immunocompromised persons, symptoms of listeriosis may include headache, stiff neck, confusion, loss of balance, and/or convulsions. Pregnant women may experience a fever and other non-specific symptoms, such as fatigue and aches, followed by miscarriage, still birth, or bacteremia and meningitis in their newborns. Immunocompetent people may experience acute febrile gastroenteritis or no symptoms.
Physicians evaluating patients presenting with flu-like symptoms, high fever, severe headache, stiffness, nausea, abdominal pain, vomiting or diarrhea and exposure to fresh whole peaches, plums, nectarines, and pluots, should include L. monocytogenes in their differential diagnosis.
MEDICAL MANAGEMENT OF PERSONS EXPOSED TO L. monocytogenes
In 2011, the Centers for Disease Control and Prevention (CDC) convened an expert panel to discuss medical management of persons at elevated risk for invasive listeriosis may seek medical care because of concern that they have been exposed to L. monocytogenes. A suggested frame work for medical management of such individuals was released on September 19, 2011. CDC redistributed these recommendations on July 22, 2014 in response to inquiries from health care providers and concerned members of the public about the Wawona Packing Company of peaches, plums, nectarines, and pluots related to possible L. monocytogenes contamination. It was the consensus of an expert panel that no testing or treatment is indicated for an asymptomatic person with elevated risk of invasive listeriosis who ate a product recalled because of L. monocytogenes contamination. NYSDOH does not recommend routine screening or treatment of asymptomatic persons exposed to recalled products. The CDC recommendations are attached.
DIAGNOSIS AND TESTING
For patients with illness suggestive of invasive listeriosis, testing should include blood culture and other tests, such as culture of cerebrospinal fluid, as indicated by the clinical presentation. Primary specimen testing should be performed following routine laboratory protocols and primary specimens should not be sent to New York State Wadsworth Center Laboratory; however Listeria isolates cultured from primary specimens should be submitted as per the 2010 Laboratory Reporting of Communicable Diseases.
Stool testing for Listeria has not been evaluated as a screening tool for listeriosis and, in general, is not recommended for the diagnosis of listeriosis. Ingestion of Listeria occurs frequently because the bacterium is commonly present in the environment. Therefore, intermittent fecal carriage and shedding of Listeria is frequent (about 5% in unselected populations, but substantial variation exists) and rarely indicative of infection. Stool culture for Listeria may also have low sensitivity.
REPORTING
All suspect and laboratory L. monocytogenes cases should be reported promptly by telephone for Erie County residents to the Erie County Department (ECDOH) of Health Epidemiology and Surveillance Office at (716) 858-7697 during normal business hours and (716) 961-7898 after hours.
CONTACT PHONE NUMBER
ECDOH Epidemiology and Surveillance Office: (716)858-7697 during normal business hours and (716)961-7898 after hours.
ADDITIONAL INFORMATION:
- Recall information: http://www.fda.gov/Safety/Recalls/ucm405943.htm.
- CDC General Listeria information: http://www.cdc.gov/listeria/index.html
Health Category Definitions:
Health Alert FLASH: conveys the highest level of importance due to a large-scale, catastrophic public health emergency; warrants immediate action or attention
Health Alert Priority: conveys the highest level of importance; warrants immediate action or attention to a health problem or situation
Health Advisory: provides important information for a specific incident or situation; may not require immediate action
Health Update: provides updated information regarding an incident or situation; no immediate action necessary
The Erie County Department of Health does not provide medical advice. The information provided on the Erie County Department of Health website is not an attempt to practice medicine and is not intended as a substitute for professional medical advice, diagnosis,or treatment. It is for informational purposes only. Always seek the advice of your personal physician or other qualified health provider with any questions you may have regarding a medical condition or issue. Never disregard professional medical advice or delay in seeking it because of the content found on the Erie County Department of Health website or this correspondence.
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