Listeria monocytogenes in Retail Delicatessens: An Interagency Risk Assessment-Risk Mitigations

Developing an Agent-Based Model that Predicts Listeria spp. Transmission to Assess Listeria Control Strategies in Retail Stores

Contamination of fresh produce with Listeria monocytogenes can occur throughout the supply chain, including at retail, where Listeria spp., including L. monocytogenes, may be introduced and spread via various routes. However, limited tools are available for retailers to assess practices that can enhance control of Listeria transmission to fresh produce. Therefore, we developed an agent-based model that can simulate Listeria transmission in retail produce sections to optimize environmental sampling programs and evaluate control strategies. A single retail store was used as a model environment, in which various routes of Listeria introduction into and transmission between environmental surfaces were modeled. Model prediction (i.e., Listeria prevalence) was validated using a published longitudinal study for all surfaces that were included in both the model and the validation data. Sensitivity analysis using the Partial Rank Correlation Coefficient showed that (i) initial Listeria concentration from incoming produce, (ii) transfer coefficient from produce to employee's hands, and (iii) transfer coefficient from consumer to produce were the top three parameters that were significantly (p < 0.0018) associated with the mean Listeria prevalence across all agents, suggesting that the accuracy of these parameters are important for prediction of overall Listeria prevalence at retail. Cluster analysis grouped agents with similar contamination patterns into six unique clusters; this information can be used to optimize the sampling plans for retail environments. Scenario analysis suggested that (i) more stringent supplier control as well as (ii) practices reducing Listeria transmission via consumer's hands may have the largest impact on reducing finished product contamination. Overall, we show that an agent-based model can serve as a foundational tool to help with decision-making on Listeria control strategies at retail.

A Critical Review of Risk Assessment Models for Listeria monocytogenes in Meat and Meat Products

A review of the published quantitative risk assessment (QRA) models of L. monocytogenes in meat and meat products was performed, with the objective of appraising the intervention strategies deemed suitable for implementation along the food chain as well as their relative effectiveness. A systematic review retrieved 23 QRA models; most of them (87%) focused on ready-to-eat meat products and the majority (78%) also covered short supply chains (end processing/retail to consumption, or consumption only). The processing-to-table scope was the choice of models for processed meats such as chorizo, bulk-cooked meat, fermented sausage and dry-cured pork, in which the effects of processing were simulated. Sensitivity analysis demonstrated the importance of obtaining accurate estimates for lag time, growth rate and maximum microbial density, in particular when affected by growth inhibitors and lactic acid bacteria. In the case of deli meats, QRA models showed that delicatessen meats sliced at retail were associated with a higher risk of listeriosis than manufacture pre-packed deli meats. Many models converged on the fact that (1) controlling cold storage temperature led to greater reductions in the final risk than decreasing the time to consumption and, furthermore, that (2) lower numbers and less prevalence of L. monocytogenes at the end of processing were far more effective than keeping low temperatures and/or short times during retail and/or home storage. Therefore, future listeriosis QRA models for meat products should encompass a processing module in order to assess the intervention strategies that lead to lower numbers and prevalence, such as the use of bio-preservation and novel technologies. Future models should be built upon accurate microbial kinetic parameters, and should realistically represent cross-contamination events along the food chain.

Consumer attitudes and perceptions towards chilled ready-to-eat foods: a multi-national study

Understanding consumers' behavior and their handling of high-risk foods at home is essential for reducing the number of foodborne illnesses. This study shows the results of a cross-national analysis of consumers' perception from nine countries, and the identification of customers' clusters and its characteristics in order to understand customers' behavior, and to build safe chilled ready-to-eat (RTE) foods prevention strategies. The cluster analysis resulted in two clusters: (1) "Precautious consumers" characterized by the orientation towards pre-packed RTE foods, with consumers mainly coming from Bosnia and Herzegovina, India, Poland, Portugal, Spain, and Turkey. Their attitudes and self-reported practices may be categorized as less risky in terms of food-borne illnesses connected with the consumption of RTE foods; (2) "Unconcerned consumers" preferred cutting and slicing RTE foods freshly at the point of purchase, usually sold at the delicatessen department in a supermarket or at open markets. Those consumers mostly came from Croatia, Serbia and Slovenia and their attitudes and self-reported practices were riskier. These results allow a better understating of what characterizes consumers of RTE foods in different countries.

Quantitative risk assessment model to investigate the public health impact of varying Listeria monocytogenes allowable levels in different food commodities: A retrospective analysis

Invasive listeriosis is a potentially fatal foodborne disease that according to this study may affect up to 32.9 % of the US population considered as increased risk and including people with underlying conditions and co-morbidities. Listeria monocytogenes has been scrutinized in research and surveillance programs worldwide in Ready-to-Eat (RTE) food commodities (RTE salads, deli meats, soft/semi-soft cheese, seafood) and frozen vegetables in the last 30 years with an estimated overall prevalence of 1.4-9.9 % worldwide (WD) and 0.5-3.8 % in the United States (US). Current L. monocytogenes control efforts have led to a prevalence reduction in the last 5 years of 4.9-62.9 % (WD) and 12.4-92.7 % (US). A quantitative risk assessment model was developed, estimating the probability of infection in the US susceptible population to be 10-10,000× higher than general population and the total number of estimated cases in the US was 1044 and 2089 cases by using the FAO/WHO and Pouillot dose-response models. Most cases were attributed to deli meats (>90 % of cases) followed by RTE salads (3.9-4.5 %), soft and semi-soft cheese and RTE seafood (0.5-1.0 %) and frozen vegetables (0.2-0.3 %). Cases attributed to the increased risk population corresponded to 96.6-98.0 % of the total cases with the highly susceptible population responsible for 46.9-80.1 % of the cases. Removing product lots with a concentration higher than 1 CFU/g reduced the prevalence of contamination by 15.7-88.3 % and number of cases by 55.9-100 %. Introducing lot-by-lot testing and defining allowable quantitative regulatory limits for low-risk RTE commodities may reduce the public health impact of L. monocytogenes and improve the availability of enumeration data.

Development of a Modeling Tool To Assess and Reduce Regulatory and Recall Risks for Cold-Smoked Salmon Due to Listeria monocytogenes Contamination

ABSTRACT

Although public health risk assessments for Listeria monocytogenes (Lm) have been published for various foods, firm-level decision making on interventions targeting Lm involves considerations of both public health and enterprise risks. Smoked seafood is a ready-to-eat product with a high incidence of Lm contamination and has been associated with several recalls. We used cold-smoked salmon as a model product to develop a decision support tool (the regulatory and recall risk [3R] model) to estimate (i) baseline regulatory and recall (RR) risks (i.e., overall risks of a lot sampled and found positive for Lm, e.g., by food regulatory agencies) due to Lm contamination and (ii) the RR risk reduction that can be achieved through interventions with underlying mechanisms such as reducing the prevalence and/or level of Lm and retarding or preventing Lm growth. Given that a set number of samples (e.g., 10) are tested for a given lot, the RR risk equals the likelihood of detecting Lm in at least one sample. Under the baseline scenario, which assumes a 4% Lm prevalence and no interventions, the median predicted RR risk for a given production lot was 0.333 (95% credible interval: 0.288, 0.384) when 10 25-g samples were tested. Nisin treatments, which reduce both the prevalence and initial level of Lm, reduced RR risks in a concentration-dependent manner to 0.109 (0.074, 0.146) with 5 ppm, 0.049 (0.024, 0.083) with 10 ppm, and 0.017 (0.007, 0.033) with 20 ppm. In general, more effective reduction in RR risks can be achieved by reducing Lm prevalence than by retarding Lm growth; the RR risk was reduced to 0.182 (0.153, 0.213) by a 50% prevalence reduction but to only 0.313 (0.268, 0.367) by bacteriostatic growth inhibitors. Sensitivity analysis indicated that prevalence and initial level of Lm and storage temperature have the greatest impact on predicting RR risks, suggesting that reliable data for these parameters will improve model performance.

HIGHLIGHTS

Evaluation of the Impact of Compliance with Mitigation Strategies and Frequency of Restaurant Surface Cleaning and Sanitizing on Control of Norovirus Transmission from Ill Food Employees Using an Existing Quantitative Risk Assessment Model

ABSTRACT

Reduction of foodborne illness caused by norovirus (NoV) continues to be a focus for the food safety community. Using a previously published quantitative risk assessment model, we evaluated more than 60 scenarios examining the impact of implementation of and compliance with risk management strategies identified in the U.S. Food and Drug Administration Food Code for (a) surface cleaning and sanitizing, (b) hand hygiene, (c) exclusion, or (d) restriction of ill employees. Implementation of and compliance with hand hygiene and ill food employee exclusion strategies had the largest impact on the predicted number of highly contaminated food servings and associated consumer illnesses. In scenarios in which gloves were always worn and hand washing compliance was 90%, the model estimated reductions in the number of highly contaminated food servings and ill consumers to 39 and 43% of baseline estimates (i.e., typical practice), respectively. Reductions were smaller when gloves were never worn. Hand washing compliance after using the restroom strongly impacted predicted numbers of highly contaminated servings and consumer illnesses. Ten percent compliance with removing or excluding ill food employees was predicted to increase the number of highly contaminated food servings and ill consumers to 221 and 213% of baseline estimates, respectively. Ninety-four percent compliance with exclusion of ill food employees was predicted to decrease these numbers to 69 and 71% of baseline estimates, respectively. Surface cleaning in food establishments had a relatively small impact on these measures. Restriction of food employees (removed from contact with food and food contact equipment and utensils) was not effective for reducing NoV illness unless this restriction included additional provisions. The results from this study can help risk managers prioritize mitigation strategies and their implementation for controlling the transmission of NoV and subsequent consumer foodborne illness.

HIGHLIGHTS

Assessment of Sanitation Practices for the Control of Listeria monocytogenes at Small and Very Small Ready-to-Eat Meat and Poultry Processors

ABSTRACT

Science-based guidance was used at eight small and very small state and federally inspected ready-to-eat meat and poultry processors across Michigan. Data were collected to determine the current level of sanitary control methods used for reducing Listeria in the processing environment and compared interactions with the facility microbial results. A checklist was created to assess the current recommended sanitary control methods from the U.S. Department of Agriculture, U.S. Food and Drug Administration, and the Michigan Department of Agriculture and Rural Development. The checklist, composed of 178 items divided into 10 general content domains, was used to assess which of the recommended controls were being used in the facilities to prevent postlethality contamination of ready-to-eat products. Effectiveness of preoperational and operational sanitation was assessed through sampling 12 nonfood contact surfaces by using an ATP reader and amplified nucleic single temperature reaction test for Listeria spp., including L. monocytogenes, at each facility. In total, 288 samples were taken collectively from the eight facilities (96 ATP, 96 preoperational Listeria spp., and 96 operational Listeria spp.). Microbial outcomes did not differ (P > 0.05) based on the overall number of recommended sanitary control methods used and the type of facility inspection. There was a greater content domain compliance overall in operational sanitation (P = 0.0005), sanitation (P = 0.0030), facility (P = 0.0397), and personal hygiene (P = 0.0033) than for segregation procedures regardless of the regulating body. Findings suggest that regardless of the regulating body, the quality of sanitary control measures used is more impactful for microbial control than simply the quantity implemented. Pathogen control may be obtained without implementing all of the sanitary control methods within the guidance documents.

HIGHLIGHTS

Listeria monocytogenes Occurrence and Adherence to Recommendations: Small and Large Retail Delicatessens in Iowa

The goal of this research was to determine the prevalence of Listeria monocytogenes in Iowa retail delicatessens and assess environmental aspects that mitigate L. monocytogenes. Fifty-seven small and large retail delicatessens in Iowa were selected randomly. More small operations (n = 43) were included as compared with larger stores, given the higher frequency of violations. An environmental assessment instrument was used to determine environmental factors and practices. At least five microbial samples were collected per site. We collected 286 (74.3%) of 385 microbial samples from small deli operations and 99 (25.7%) of 385 samples from large deli operations. Samples were taken from various zone 1 and 2 areas, such as the slicer, deli case, and meat scale; three (0.08%) samples were positive for L. monocytogenes. Regarding environmental aspects, not preparing, holding or storing ready-to-eat products near raw products (n = 30, 53%) was practiced by the fewest delis. The majority of establishments were observed covering, wrapping, or protecting ready-to-eat products when not in use to prevent contamination (n = 56, 98.2%). Comparisons were made to the U.S. Department of Agriculture Food Safety and Inspection Service Guidance on environmental practices, and 60% of the operations surveyed were in adherence with at least seven of the eight recommendations.

Quantitative versus qualitative risk assessment of meat and its products: what is feasible for Sub-Saharan African countries?

Prevalent risks in meat value-chains of sub-Saharan African (SSA) countries are increasingly attributed to microbial rather than chemical hazards. Resource constraints and lack of capacity has limited the utilization of risk assessment tools in the instituting of food controls to mitigate the risks. The review sought to bring to light the focus of risk assessment studies in SSA while generating evidence of feasible options to further the contribution of this component in risk mitigation. The informal street vending sector emerges as a priority in the meat value chain with a vendor population that are unwilling to abandon it. Campylobacter and Staphylococcus aureus are prevalent risks that have bedeviled this sector. However, limited risk assessment studies with capacity to inform proper food controls for the sector have been done. Evidence in place indicate that the incorporation of qualitative aspects in quantitative approaches serve as less-costly and effective ways of generating risk estimates. Limitations of capacity and gaps in epidemiological data are also circumvented. Considering that the street-vending sector is robust and its dynamics of operation are not fully in the picture of policy actors; incorporation of a participatory approach that combines qualitative and quantitative aspects of risk assessment is highly recommended.

Toward a Better Understanding of Listeriosis Risk among Older Adults in the United States: Characterizing Dietary Patterns and the Sociodemographic and Economic Attributes of Consumers with These Patterns

ABSTRACT

Older adults are at higher risk of invasive listeriosis compared with the general population. Some foods are more likely than others to be contaminated with or to contain high levels of Listeria monocytogenes. The objectives of this study were to (i) determine dietary consumption patterns among older adults in the United States; (ii) evaluate sociodemographic and economic characteristics of older adults associated with each pattern; (iii) determine intake of foods associated with larger relative risk of listeriosis within these patterns; and (iv) rank these patterns based on risk. Data related to older adults (age 60 and older) participating in the cross-sectional National Health and Nutrition Examination Surveys (NHANES) 2009 to 2010, 2011 to 2012, and 2013 to 2014 (n = 4,967) were included in these analyses. Cluster analysis was used to define dietary patterns based on 24-h dietary recalls from day 1 and day 2. Mean intake of foods associated with higher risk of listeriosis was examined within each pattern, and analysis of variance with Dunnett's method of adjustment was used to evaluate significant differences in mean intake of foods. Patterns were ranked based on relative risk of listeriosis, using outbreak illness attribution data. Five distinct dietary patterns were identified. Patterns ranked at highest relative risk of listeriosis, based on U.S. outbreak illness attribution data, were characterized by relatively higher intakes of fruits, vegetables, and cheeses (∼13% respondents) or cereal, milk, and yogurt (∼14% respondents). Individuals consuming these dietary patterns differed in sex, race, food security, self-rated diet quality, and self-rated health. Cluster analysis, despite methodological limitations, provides new information on consumption, sociodemographic, and economic characteristics of subgroups within susceptible populations, which may be used to target educational messages.

HIGHLIGHTS

Multisite survey of bacterial contamination in ready-to-eat meat products throughout the cooking and selling processes in urban supermarket, Nanjing, China

OBJECTIVE

Ready-to-eat (RTE) meat is a kind of popular instant food easily contaminated by microbes, which is one of the causes of foodborne diseases. This study analyzes the possible sources of RTE food bacterial contamination during processing and subsequent selling.

METHOD

Samples of eight kinds of RTE meat were collected from four supermarkets in Nanjing, China. The knives, chopping boards, trays(containers of food), clamps, air, water, and hands of the sales staff were sampled, and the enumeration of aerobic plate count and total coliforms and pathogenic bacteria was performed.

RESULTS

The survey revealed that poor hygienic levels was the causes that RTE meat products were contaminated by bacteria at different levels. With regard to pathogen, the incidences of Salmonella spp. and Staphylococcus aureus were 4.2% and 2.1%, respectively. These results also revealed that the bacterial contamination of RTE food was caused by the air, as well as clamps, chopping boards, knives, trays, and hands of the operators. The total number of aerobic colonies were positively correlated with the amount of RTE food in one pot (r = .87728, p = .0217), and negatively correlated with the maximum temperature in the center of the meat (r = -.81633, p = .0475).

CONCLUSION

The high number of bacteria in RTE foods indicates potential food safety risks and the need to improve the health of supermarket sales staff. The most important thing is to determine how to raise hygiene awareness of employees through food safety education. Meanwhile, a comprehensive set of regulations on hand cleaning and disinfection should be developed to facilitate public health and reduce foodborne illness caused by the consumption of RTE food.

Genetic diversity and profiles of genes associated with virulence and stress resistance among isolates from the 2010-2013 interagency Listeria monocytogenes market basket survey

Whole genome sequencing (WGS) was performed on 201 Listeria monocytogenes isolates recovered from 102 of 27,389 refrigerated ready-to-eat (RTE) food samples purchased at retail in U.S. FoodNet sites as part of the 2010-2013 interagency L. monocytogenes Market Basket Survey (Lm MBS). Core genome multi-locus sequence typing (cgMLST) and in-silico analyses were conducted, and these data were analyzed with metadata for isolates from five food groups: produce, seafood, dairy, meat, and combination foods. Six of 201 isolates, from 3 samples, were subsequently confirmed as L. welshimeri. Three samples contained one isolate per sample; mmong the 96 samples that contained two isolates per sample, 3 samples each contained two different strains and 93 samples each contained duplicate isolates. After 93 duplicate isolates were removed, the remaining 102 isolates were delineated into 29 clonal complexes (CCs) or singletons based on their sequence type. The five most prevalent CCs were CC155, CC1, CC5, CC87, and CC321. The Shannon's diversity index for clones per food group ranged from 1.49 for dairy to 2.32 for produce isolates, which were not significantly different in pairwise comparisons. The most common molecular serogroup as determined by in-silico analysis was IIa (45.6%), followed by IIb (27.2%), IVb (20.4%), and IIc (4.9%). The proportions of isolates within lineages I, II, and III were 48.0%, 50.0% and 2.0%, respectively. Full-length inlA was present in 89.3% of isolates. Listeria pathogenicity island 3 (LIPI-3) and LIPI-4 were found in 51% and 30.6% of lineage I isolates, respectively. Stress survival islet 1 (SSI-1) was present in 34.7% of lineage I isolates, 80.4% of lineage II isolates and the 2 lineage III isolates; SSI-2 was present only in the CC121 isolate. Plasmids were found in 48% of isolates, including 24.5% of lineage I isolates and 72.5% of lineage II isolates. Among the plasmid-carrying isolates, 100% contained at least one cadmium resistance cassette and 89.8% contained bcrABC, involved in quaternary ammonium compound tolerance. Multiple clusters of isolates from different food samples were identified by cgMLST which, along with available metadata, could aid in the investigation of possible cross-contamination and persistence events.

An Assessment of Listeriosis Risk Associated with a Contaminated Production Lot of Frozen Vegetables Consumed under Alternative Consumer Handling Scenarios

Frozen foods do not support the growth of Listeria monocytogenes (LM) and should be handled appropriately for safety. However, consumer trends regarding preparation of some frozen foods may contribute to the risk of foodborne listeriosis, specifically when cooking instructions are not followed and frozen products are instead added directly to smoothies or salads. A quantitative microbial risk assessment model FFLLoRA (Frozen Food Listeria Lot Risk Assessment) was developed to assess the lot-level listeriosis risk due to LM contamination in frozen vegetables consumed as a ready-to-eat food. The model was designed to estimate listeriosis risk per serving and the number of illnesses per production lot of frozen vegetables contaminated with LM, considering individual facility factors such as lot size, prevalence of LM contamination, and consumer handling prior to consumption. A production lot of 1 million packages with 10 servings each was assumed. When at least half of the servings were cooked prior to consumption, the median risk of invasive listeriosis per serving in both the general and susceptible population was <1.0 × 10^-16 with the median (5th, 95th percentiles) predicted number of illnesses per lot as 0 (0, 0) and 0 (0, 1) under the exponential and Weibull-gamma dose-response functions, respectively. In scenarios in which all servings are consumed as ready-to-eat, the median predicted risk per serving was 1.8 × 10^-13 and 7.8 × 10^-12 in the general and susceptible populations, respectively. The median (5th, 95th percentile) number of illnesses was 0 (0, 0) and 0 (0, 6) for the exponential and Weibull-Gamma models, respectively. Classification tree analysis highlighted initial concentration of LM in the lot, temperature at which the product is thawed, and whether a serving is cooked as main predictors for illness from a lot. Overall, the FFLLoRA provides frozen food manufacturers with a tool to assess LM contamination and consumer behavior when managing rare and/or minimal contamination events in frozen foods.

Retail Deli Slicer Inspection Practices: An EHS-Net Study

The Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die in the United States each year from foodborne illness, and Listeria monocytogenes causes the third highest number of deaths. Risk assessment data indicate that L. monocytogenes contamination of particularly delicatessen meats sliced at retail is a significant contributor to human listeriosis. Mechanical deli slicers are a major source of L. monocytogenes cross-contamination and growth. In an attempt to prevent pathogen cross-contamination and growth, the U.S. Food and Drug Administration (FDA) created guidance to promote good slicer cleaning and inspection practices. The CDC's Environmental Health Specialists Network conducted a study to learn more about retail deli practices concerning these prevention strategies. The present article includes data from this study on the frequency with which retail delis met the FDA recommendation that slicers should be inspected each time they are properly cleaned (defined as disassembling, cleaning, and sanitizing the slicer every 4 h). Data from food worker interviews in 197 randomly selected delis indicate that only 26.9% of workers ( n = 53) cleaned and inspected their slicers at this frequency. Chain delis and delis that serve more than 300 customers on their busiest day were more likely to have properly cleaned and inspected slicers. Data also were collected on the frequency with which delis met the FDA Food Code provision that slicers should be undamaged. Data from observations of 685 slicers in 298 delis indicate that only 37.9% of delis ( n = 113) had slicers that were undamaged. Chain delis and delis that provide worker training were more likely to have slicers with no damage. To improve slicer practices, food safety programs and the retail food industry may wish to focus on worker training and to focus interventions on independent and smaller delis, given that these delis were less likely to properly inspect their slicers and to have undamaged slicers.

Food Safety Practices Linked with Proper Refrigerator Temperatures in Retail Delis

Listeria monocytogenes (L. monocytogenes) causes the third highest number of foodborne illness deaths annually. L. monocytogenes contamination of sliced deli meats at the retail level is a significant contributing factor to L. monocytogenes illness. The Centers for Disease Control and Prevention's Environmental Health Specialists Network (EHS-Net) conducted a study to learn more about retail delis' practices concerning L. monocytogenes growth and cross-contamination prevention. This article presents data from this study on the frequency with which retail deli refrigerator temperatures exceed 41°F, the Food and Drug Administration (FDA)-recommended maximum temperature for ready-to-eat food requiring time and temperature control for safety (TCS) (such as retail deli meat). This provision was designed to control bacterial growth in TCS foods. This article also presents data on deli and staff characteristics related to the frequency with which retail delis refrigerator temperatures exceed 41°F. Data from observations of 445 refrigerators in 245 delis showed that in 17.1% of delis, at least one refrigerator was >41°F. We also found that refrigeration temperatures reported in this study were lower than those reported in a related 2007 study. Delis with more than one refrigerator, that lacked refrigerator temperature recording, and had a manager who had never been food safety certified had greater odds of having a refrigerator temperature >41°F. The data from this study suggest that retail temperature control is improving over time. They also identify a food safety gap: some delis have refrigerator temperatures that exceed 41°F. We also found that two food safety interventions were related to better refrigerated storage practices: kitchen manager certification and recording refrigerated storage temperatures. Regulatory food safety programs and the retail industry may wish to consider encouraging or requiring kitchen manager certification and recording refrigerated storage temperatures.