Listeria monocytogenes EU listeriosis and food sampling data 2017-22 - PowerPoint Presentation

1. Listeria monocytogenesEU listeriosis and food sampling data 2017-22Karin Goodburn MBEListeria & 2073/2005 Rapporteur – European Chilled Food FederationDG - Chilled Food Association13/12/23CFA/09X/23

2. 2022* EU27 Top 5 Foodborne Diseases Morbidity & Mortality2018 EFSA/ECDC Data2020: Listeriosis death rate 260x Campylobacteriosis, 31x STEC2019: Listeriosis death rate 586x Campylobacteriosis, 84x STEC2018: Listeriosis death rate 520x Campylobacteriosis, 71x STEC2017: Listeriosis death rate 345x Campylobacteriosis, 28x STEC2016: Listeriosis death rate 540x Campylobacteriosis, 60x STEC* EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdf**EU One Health 2021 Zoonoses Report: https://www.efsa.europa.eu/en/efsajournal/pub/7666 *** EU One Health 2020 Zoonoses Report, https://www.efsa.europa.eu/sites/default/files/2021-12/6971.pdf **** EU One Health Zoonoses Report 2019. https://www.efsa.europa.eu/en/efsajournal/pub/6406***** EU summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2017. doi: 10.2903/j.efsa.2018.5500 ****** EU summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2016. EFSA Journal 2017. 10.2903/j.efsa.2017.5077 ‡ Not all countries observed cases for all diseasesEXCLUDES UK  HospitalisationsDeathsOutbreaks    Disease No. confirmedcasesStatus available (%)No reporting ‡countriesNo. hospitalised%hospitalisedOutcome available (%)No. reporting MSReportedDeathsCaseFatality (%)No.Related CasesCase rateLm Fatality Rate cf human casesDeathsFatality (%)Campylobacteriosis137,10744,8761610,55123.561.617340.042551,09745.1453Salmonellosis65,20829,0031711,28738.956.517810.221,0146,63215.382Yersiniosis7,9192,1131763630.147.5170014962.2 STEC infections7,1172,933171,13038.567.821280.58714082.131Listeriosis2,7381,386191,33096.057.62128618.1352960.62 

3. UK 2020 data: Food Security Report 2021. UK 2022 data provisionalSentinel system coverage:Belgium: 2016-21 80% pop (Surveillance not mandatory)Spain: 2016-21 no infoSwitz incs Liechtenstein data to 2020EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdfNon-EU rates:South Africa: 1.84 (2017-18)USA: 0.24Australia : 0.3 (2013)NZ: 0.6US rates: cdc.gov/listeria/technical.html Australia: https://www.health.vic.gov.au/infectious-diseases/listeriosis#public-health-significance-and-occurrence-of-listeriosis NZ: www.foodstandards.gov.au/publications/Documents/Listeria%20monocytogenes.pdf European Listeriosis Rates 2017-222018CasesRate2019CasesRate2020CasesRate2021CasesRate2022CasesRateEstonia272.05Spain505–Spain191–Spain224–Denmark861.5Finland801.45Estonia211.59Finland941.7Iceland51.4Finland701.3Spain3700.89Iceland41.12Slovenia261.2Finland701.3Sweden1251.2Sweden890.88Sweden1131.1Iceland41.1Denmark621.1Spain4370.95Denmark490.85Denmark611.05Malta50.97Sweden1071Slovenia200.95Lux50.83Malta51.01Sweden880.85Slovenia190.9Belgium870.94Germany6830.82Slovenia200.96Denmark440.76Belgium650.7Switz780.89Belgium740.81Finland500.91Norway370.69France4350.64Estonia110.83Latvia150.78Belgium660.72Switz580.67Germany5600.67Germany5480.66Lithuania200.71Germany5700.69Germany5440.65Lux40.63France4510.66Portugal640.62NL1030.6Lux40.64Latvia100.53Hungary640.66Switz520.61France3730.56Belgium540.59NL860.49EU 2727380.62Iceland20.57Portugal560.54NL900.52EU272,1830.49EU27+EFTA2848 France3380.51Norway270.51France3340.5EU27+EFTA2,2680.44Lux40.62Slovenia100.48Lux30.49Austria410.46Austria380.43Portugal630.61EU + EFTA2,5490.47EU + EFTA2,6210.46Portugal470.46Italy2410.41Italy3450.58Norway240.45Austria380.43Latvia80.42Estonia50.38Norway300.55Ireland210.43Switz360.42EU27+ EFTA1,8760.42Switz330.38NL940.53NL690.4Hungary390.4Hungary320.33Norway200.37Iceland20.53Poland1280.34Ireland170.35Italy1470.25Hungary350.36Austria470.52Austria270.31Italy2020.33Cyprus20.23Poland1200.32Czechia480.46Slovakia170.31Slovakia180.33Estonia30.23Ireland140.28Slovakia250.46Czechia310.29Poland1210.32UK1430.21UK1840.27Lithuania130.46Italy1780.29Latvia60.31Greece200.19Lithuania70.25Latvia80.43Hungary240.25Czechia270.25Poland620.16Slovakia130.24Poland1420.38UK1680.25UK1540.23Czechia160.15Czechia240.22Ireland170.34Malta10.21Lithuania60.21Slovakia70.13Greece210.2UK*1510.28Greece190.18Bulgaria130.19Croatia50.12Croatia80.2Malta10.19Romania280.14Croatia60.15Ireland60.12Cyprus10.11Croatia50.13Bulgaria90.13Cyprus10.11Bulgaria40.06Romania110.06Cyprus10.11Cyprus10.12Greece100.09Romania20.01Bulgaria30.04Bulgaria50.07Croatia40.1Romania170.09Lithuania00Malta00Greece70.07         Liecht00Romania140.07       Portugal00Liecht02

4. Distribution of European 2022 confirmed listeriosis cases by food, countryEU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdf UKHSA Oct 2022 report of 2020 data for England + Wales 2 outbreaks. 124 cases total, 17 deaths (non-pregnancy). 20% of all cases were pregnancy-related, 34.8% of which resulted in stillbirth or miscarriage

5. ECDC European Lm statistics related to invasive human infections 2018-22(a) Data on animal samples from the UK (NI) were taken into account for 2021. In accordance with the agreement on the withdrawal of the UK from the EU, and in particular with the Protocol on Ireland/NI, the EU requirements on data sampling are also applicable to NI.(b) Data from the UK were taken into account for the 2018–2019 period, since the UK was still an EU MS at that time. However, on 1 February 2020 it became a third country.EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdf 2022 a2021 a20202019 b2018 bTotal no. confirmed2,7382,3651,8872,6212,544Confirmed /100k0.620.530.430.460.47No. reporting MSs2727272828EU-acquired1,7781,5461,2861,8161,640Acquired outside EU1255148Unknown travel status/ country of infection948814596791896No. outbreak-related cases296104120349159Total no. outbreaks3523162114

6. Seasonality, Europe: Jan 2013-Oct 2022EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/en/publications-data/european-union-one-health-2022-zoonoses-report Covers: Austria, Belgium, Cyprus, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Romania, Slovakia, Slovenia, Spain, Sweden and UK. Bulgaria, Croatia, Luxembourg and Portugal did not report data to the level of detail required for the analysis.Source: Austria, Belgium, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Latvia, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovakia, Slovenia, Spain and Sweden. Excludes UK

7. Major RTE food categories sampled in EU, 2018–2022 (EFSA)EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdf No. sampling units tested (detect. or enum.)2022202120202019 2018Meat & meat productsNo. sampling units135,148107,19840,29164,97158,060No. reporting MSs2423222222 Fish & fishery products      No. sampling units25,00929,78311,21213,36614,031No. reporting MSs2424232222 Milk & milk products      No. sampling units97,15766,63349,13261,86659,313No. reporting MSs2423232323Products intended for infants or special medical purposesNo. sampling units2,6722,7642,3942,3462,433No. reporting MSs1919191918 Other productsNo. sampling units120,53094,84181,57580,16728,204No. reporting MSs25232424232018-2019inc UK

8. Commentary on Major RTE food categories sampled in EU 2022EU One Health 2022 Zoonoses Report: https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_8442.pdf 26 MSs reported a total of 312,489 samples from different RTE food categories from distribution or manufacturing stages - an increase of 26.3% over 2021. Focus was on POAO. At distribution, proportion Lm +ves was <0.1% to 1.0% except for ‘fish’ (2.3%). At manufacture the proportion of +ves was higher for all categories except ‘milk’ where there were no detections at either stage. Highest +ve categories were ‘fish’ (2.6%), ‘fishery products’ (2.5%) & products of meat origin other than fermented sausages’ (2.5%)Lm occurrence results varied according to the RTE food category and the sampling stage. Including all samplers and sampling units occurrences remained generally rare (<1%) to low (1% to 10%) in these categories, except ‘fish/fishery products’, ‘meat products from bovines or pigs’, fruits & vegetables’& ‘cheeses from sheep milk’.11 MS took 22,370 samples from primary production (not crops). +ves in pigs were (0.35%) & in cattle (1.2%)

9. Major RTE food categories sampled by EU Competent Authorities at manufacturer, 2022NB: https://www.efsa.europa.eu/en/microstrategy/listeria-dashboard https://www.arcgis.com/apps/dashboards/a5e5fd9ce37a4802b4f34ff2bcd9ed1a

10. Major RTE food categories sampled by Competent Authorities at point of sale in EU, 2022NB: https://www.efsa.europa.eu/en/microstrategy/listeria-dashboard https://www.arcgis.com/apps/dashboards/a5e5fd9ce37a4802b4f34ff2bcd9ed1a

11. From CFA Members’ Lm Database: Jan 2011-Dec 2022

12. Proposed 2022 EURegs change(s): Challenge testing to set shelf life?**, or ND before leaving control of the producing FBO or ND throughout life?… OR SOMETHING ELSE?CODEX/EU 2008EU REG 2073/2005INCONSISTENT IMPLEMENTATIONEU Listeria legislation: Origins, Ethos & DirectionDiffering MS/CA 1.2b interpretationsInconsistent commercial enforcement CFA food + envt test results database (>4m since 2004)Dec 2005: 100 cfu/g max*EURL guidance: EC brief to focus on DOP/EOL data usage, but did not (challenge testing)CCFH Dec 2008: agreed on basis of epi data (EU/US) that 100/g gave acceptable level of protection cf zero toleranceInconsistent FBO implementation/ resourcingEuropean listeriosis rates increase beyond 2008 levelsWith evidence of compliance throughout shelf life (criterion 1.2a), otherwise CA can specify not detected at point of production (criterion 1.2b)** for RTE food supporting the growth of Lm LABS FOCUS ON CHALLENGE TESTINGEURL 4th ed July 2021 shelf life (challenge testing)Campden Guideline 81 (Feb 2022) food challenge testing prioritised, 2073/2005 misinterpretedJune 2022 ECJ/Estonian fish court case re 1.2b interpretation: not applicable on market, but Art 14(8) 178/2002 appliesEU FBO guidance (DOP, EOL emphasis)FSA/CFA/BRC 2073/2005 implementation guidanceFSA/CFA/BRC Lm & shelf life guidance2003ISO 20976-1: 2019 food + feed challenge testing

13. What is happening with the Regs?Pieces of the JigsawEU Micro Criteria for Foodstuffs Reg 2073/2005 currentlySets 100 cfu/g default max whether food supports Lm growth or not Based on storage trials to set shelf life + Day of Production (DOP) and End of Life (EOL) sampling, trending and taking corrective actionCriterion 1.2a/b (food supporting Lm growth)100/g limit if the FBO can show the Competent Authority (CA) it has data to support thisCA can require Lm ‘not detected at the point of production’ if data are lacking or insufficientRequires environmental sampling, trending and corrective action but lacks detail/guidance (also referred to in 852/2004)

14. L. monocytogenes EU LegislationEU Microbiological Criteria for Foodstuffs 2073/2005Criterion numberFood category Sampling plan Limits Analytical reference method Stage where the criterion applies nc1.2 (a and b)Ready-to-eat foods able to support the growth of L. monocytogenes, other than those intended for *infants and for special medical purposes 5 0100 cfu/g: applies if the manufacturer is able to demonstrate, to the satisfaction of the competent authority, that the product will not exceed the limit 100 cfu/g throughout the shelf-life. The FBO may fix intermediate limits during the process that must be low enough to guarantee that the limit of 100 cfu/g is not exceeded at the end of shelf-lifeEN/ISO 11290-2 Products placed on the market during their shelf-life 5 0Not detected in 25g: applies before products have left the immediate control of the producing FBO when he is NOT able to demonstrate to the satisfaction of the competent authority that the product will not exceed the limit of 100cfu/g throughout the shelf lifeEN/ISO 11290-1 Before the food has left the immediate control of the food business operator, who has produced it 1.3Ready-to-eat foods *unable to support the growth of L. monocytogenes, other than those intended for **infants and for special medical purposes 50100 cfu/gEN/ISO 11290-2Products placed on the market during their shelf-life* Shelf life <5 days (P+4): food ‘automatically considered’ not to support growth. NB: P=0 (EU Lm Ref Lab Shelf Life Guidance)** EU Reg 609/2013 on Food for Specific Groups (FSG), i.e. food for infants & young children (infant formula, follow-on formula and weaning foods), food for specific medical purposes, and total diet replacement for weight control. Limit of 0 cfu/g in 25g sample, n=10, c=0Consolidated Reg https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX:02005R2073-20200308

15. Pieces of the Jigsaw (2)Differing criteria 1.2a/b (food supporting Lm growth) interpretations by various EU MS Estonia fish company (MV Wool) court case determined:No ND criterion applies on the market178/2002 general food safety requirements allow MS to act when they believe there is a riskEC Micro WG May 2020 agreed proposals to change 1.2 a/b toChallenge testing to set shelf life (~EUR15000/test)If challenge testing not done then the CA can require Lm ‘not detected throughout shelf life’, i.e. zero tolerance, reformulation, post-pack processing, shorter shelf livesEC to consult (Q1 2023?) on changes to criteria for foods supporting the growth of LmExpect 4 week consultation periodTechnical Lobbying Dossier drawn up summarising info and arguments with respect to:Disadvantages of challenge testingDisadvantages of setting Not Detected in 25g as a blanket approachGuidance on environmental sampling and use of dataIndustry consortium of being built: UK Ind Listeria Group, ECFF, CLITRAVI [+ ESSA]

16. Evidence & ConclusionsEpidemiology shows that 100/g limit drives sampling/monitoring, compliance with best practice and when enforced commercially achieves high levels of consumer protectionUK (and IE) listeriosis rates are consistently well below European (EU + EFTA) mean. Note ECDC/EFSA figures inc UK as EU MS to end 2019:Day of Production (DOP) and End of Life (EOL) sampling, trending and analysis works as a means of demonstrating control and shelf life appropriatenessAggressive continuous environmental sampling to find Listeria spp, attacking with hygiene and is an effective strategy for factory hygiene control* provisionalRate per 100k2010201120122013201420152016201720182019202020212022Europe inc UK0.370.330.410.440.520.460.480.480.470.46UK0.280.260.290.300.310.290.310.240.250.230.220.270.28*Europe exc UK0.390.340.430.460.560.490.500.520.500.490.420.490.62

17. Example of US experience with Zero Tolerance/Not Detected17ZT/ND policy (law or commercial)Reduced Lm testing (food contact, product)Lack of food safety assurance dataUndetected eventual loss of controlLack of evidence of control/ safety data for B2BEventual illness / discovery of Lm in foodsWidespread long term product contamination by ingredientsMass recalls and potential widespread outbreaks

18. Examples of Fatal Listeriosis Outbreaks & Root Causeslisteriosis outbreaks where a root cause has been identified (79/88) have been caused by cross contamination post-processFAO/WHO (2022) Lm in RTE food: attribution, characterization & monitoring. https://www.who.int/publications/i/item/9789240034969 18Country (year)Outcomes and Root CausesUK (1987-9) >17 dead, 200+ cases. Pâté imported from Belgium. Post-process contaminationFrance (1992) 92 dead, 272 cases. Jellied pork tongue. Post-process contaminationUSA (1998-9) 17 dead, 4 miscarriages/stillbirths, 101 cases. Cooked meat. Air filtration maintenance contamination Canada (2008) 22 dead, 57 cases. CAD 27m. Cooked sliced meat. Dirty slicer. Post-process contaminationUSA (2010-15)3 dead, 10 cases. Ice cream used by hospital to make milkshake. Equipment contaminationUSA (2011)33 dead, 147 cases. Cantaloupes. Contaminated production. Washing process validated?Denmark (2014)17 dead, 41 cases. Cooked meat (rullepølse). Post-process contamination USA (2014)7 dead, 35 cases. Caramel apples. Contaminated production. Washing process validated?Europe (2015-18)6 dead, 32 cases. Frozen sweetcorn eaten raw (non-RTE) but not High Care grown or handledSouth Africa (2017-18)216 dead, 455 miscarriages, 1060 cases. Cooked RTE meat products. Post-process contaminationNetherlands, Belgium (2017-19)3 dead, 21 cases. Cooked meat product. Post-process contaminationAustralia (2018)6 dead, 19 cases. Cantaloupes. Field contamination, processing contaminationGermany (2019)7 dead, 1 miscarriage, 112 cases. Cooked meat product. Post-process contaminationSpain (2019)3 dead, 38 miscarriages, 222 cases. Cooked meat product. Post-process contamination

19. Examples of Major Fatal Listeriosis Outbreaks & Root CausesCountry (year)Outcomes and Root CausesUK (1987-9) >17 dead, 200+ cases. Pâté imported from Belgium. Post-process hygieneFrance (1992) 92 dead, 272 cases. Jellied pork tongue. Post-process hygieneUSA (1998-9) 17 dead, 4 miscarriages/stillbirths, 101 cases. Cooked meat. Contamination from air filtration unit maintenance.Canada (2008) 22 dead, 57 cases. CAD 27m. Cooked sliced meat. Dirty slicer. Post-process hygieneDenmark (2014)17 dead, 41 cases. Cooked meat (rullepølse). Post-process contamination South Africa (2017-18)216 dead, 1060 cases. Cooked RTE meat products. Post-process contaminationNetherlands, Belgium (2017-19)3 dead, 21 cases. Cooked meat product. Post-process contaminationSpain (2019)3 dead, 7 miscarriages, 200+ cases. Cooked meat product. Post-process contaminationAlso: EU frozen sweetcorn (2015-18) – not produced to RTE (High Care) standards but consumed uncooked by some

20. Industry (ECFF + CLITRAVI + ESmSA + ESpSA) PositionThese data demonstrate that DOP and EOL sampling, trending and analysis and environmental hygiene monitoring and control as specified in 2073/2005 works as a means of demonstrating control and shelf life appropriateness, hygiene management and give a high level of consumer health protection.It is not possible to make clean food in an unclean production environment, nor to assemble a final RTE food from chilled RTE ingredients that are microbiologically not of the appropriate standard. The production environment, the ingredients and final product shelf life must be demonstrated continuously to be well-controlled, which is what DOP, EOL and environmental monitoring do.CODEX allows for data from naturally contaminated foods to be used in shelf life setting, setting precedent

21. Industry (ECFF + CLITRAVI + ESmSA + ESpSA) PositionChallenge testing of foods:Does not reflect actual control of the supply chain or of a production plant’s environmental hygieneArtificially shortens shelf lives leading to waste. Particularly likely to be affected are Continental products and potentially UK foodsUses high numbers of log phase rapid growth strains not reflecting real life contamination or the stressed nature of organisms in food plants (effect of cold, biocides etc)Results only apply to that particular formulationHas insufficient laboratory capacity to test the myriad of foods in questionIs highly costly and therefore not viable for SMEs in particular Diverts companies’ and authorities’ money away from implementing meaningful everyday hygiene controlsChallenge Testing should remain voluntary and not required by law

22. The voice of the European chilled food industrywww.ecff.eu