南非与加工肉类相关的利斯特菌病疫情爆发。
Outbreak of Listeriosis in South Africa Associated with Processed Meat.
机构信息
From the Centre for Enteric Diseases (J.T., N.R., P.S., N.T., S.S., H.M.N., B.D., N.A.P., A.M.S.), the Division of Public Health Surveillance and Response (N.G., K.M.M., L.K.E., G.N., A.S., V.E., L.H.B.), the Sequencing Core Facility (M.A., A.I.), and the Centre for Healthcare-Associated Infections and Antimicrobial Resistance (N.P.G.), National Institute for Communicable Diseases, National Health Laboratory Service, the University of the Witwatersrand (K.M.M., N.P.G., A.G.D., T.T., A.M.S.), and the School of Pathology, National Health Laboratory Service (A.G.D., R.S., T.T.), Johannesburg, the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Pretoria (T.J.D.), the University of Pretoria, Tshwane (N.R., G.N., N.A.P.), and the University of Stellenbosch, Stellenbosch (L.H.B.) - all in South Africa; Deon Mahoney Consulting, Melbourne, VIC, Australia (D.M.); and Santé Publique France, the French Public Health Agency, Saint-Maurice (M.T.), and Institut Pasteur, Biology of Infection Unit, INSERM Unité 1117 and National Reference Center-WHO Collaborating Center for Listeria (O.D., P.T., M.M.M., A.L., M.L.), and Université de Paris, Division of Infectious Diseases and Tropical Medicine, Necker-Enfants Malades University Hospital, Assistance Publique-Hôpitaux de Paris, Institut Imagine (M.L.), Paris - all in France.
出版信息
N Engl J Med. 2020 Feb 13;382(7):632-643. doi: 10.1056/NEJMoa1907462.
BACKGROUND
An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown.
METHODS
We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type isolates. A case was defined as laboratory-confirmed infection during the period from June 11, 2017, to April 7, 2018.
RESULTS
A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case-control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of ST6 infections.
CONCLUSIONS
This investigation showed that in a middle-income country with a high prevalence of HIV infection, caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.
背景
2017 年，南非暴发了李斯特菌病疫情。但源头不明。
方法
我们开展了流行病学、溯源和环境调查，并使用全基因组测序对分离株进行分型。病例定义为 2017 年 6 月 11 日至 2018 年 4 月 7 日期间实验室确诊的 感染。
结果
共发现 937 例病例，其中 465 例（50%）与妊娠相关；妊娠相关病例中有 406 例（87%）发生在新生儿中。937 例病例中，229 例（24%）发生在 15 至 49 岁人群（不包括妊娠患者）。在已知人类免疫缺陷病毒（HIV）状态的患者中，妊娠相关病例中有 38%（77/204）和其余患者中有 46%（97/211）感染了 HIV。在 728 例已知结局的患者中，193 例（27%）死亡。对 609 例有临床分离株的患者进行了测序，其中 567 例（93%）鉴定为 6 型序列型（ST6）。在病例对照分析中，感染 ST6 的患者比感染非 ST6 的患者更有可能食用过 polony（一种即食加工肉类）（比值比，8.55；95%置信区间，1.66 至 43.35）。polony 和环境样本也分离出了 ST6 菌株，这些菌株与患者分离株一起，属于同一个核心基因组多位点序列分型聚类，仅有不超过 4 个等位基因差异；这些发现表明，来自单个工厂的 polony 是疫情的源头。召回来自该工厂的即食加工肉类产品与 ST6 感染病例的发病率迅速下降有关。
结论
本研究表明，在一个 HIV 感染率较高的中等收入国家，李斯特菌病疫情导致孕妇和 HIV 感染者中出现不成比例的疾病。全基因组测序有助于发现疫情，并指导溯源调查，从而确定了源头。
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