No amount of money can compensate for the loss of a child or another family member. I recall the Jensen Farms Listeria outbreak in 2011 that sickened 147, killing more than 33, and the impact it had on the families. All the deaths were horribly memorable, but I recall two WWII vets who survived years of war only to be killed by a cantaloupe. An outbreak nearly 10 times the size is sobering.
- For the 204 dead $265 to $525 Million U.S. – Mortality cases were assigned compensation values of U.S. $1,244,747 and U.S. $2,524,312 per fatality for minimum and maximum human life valuation adjusted for South Africa which was 15 percent to 80 percent of U.S. values. The total valuation of mortalities over the 16 months of the outbreak ranged from U.S. $265 million using the low valuation for a fatality to U.S. $525 million using the high valuation.
- For those who survived – Hospitalization costs associated with one-month recovery from listeriosis were estimated at U.S. $10.4 million. Note, however, the direct costs that were not estimated consisted of: current and future value of outpatient care and medication costs to treat chronic and acute cases, future cost of human suffering and lost productivity.
Here is my summarization of a well-done article:
According to a recent report in “Food Control,” in 2017-2018, Listeria was reported on polony (processed deli meat similar to baloney) and listeriosis was observed in South Africa (L. monocytogenes sequence type 6 (ST-6) was identified as the causal agent for listeriosis). Due to its potential effects, we conducted cost estimates to assess the implications of listeriosis outbreak with respect to illnesses, hospitalizations and deaths, and productivity losses. Cost estimates were computed on publicly available data by using USDA-ERS cost computation model for Listeria. Listeriosis had significant impacts, as mortality of 204 individuals with confirmed listeriosis cases was reported, with infants having the highest percent of fatalities (42 percent). The cost valuation of fatality cases was over U.S. $260 million. Hospitalization costs associated with one-month recovery from listeriosis were estimated at U.S. $10.4 million . According to the authors, the objective of this research was to determine the cost implications of the 2017 listeriosis outbreaks in South Africa on morbidity and hospitalization costs, mortality, and productivity losses to affected individuals.
The cost calculator of Listeria foodborne illness produced by the USDA’s Economic Research Service (ERS) was used to compute costs associated with listeriosis outbreaks in South Africa. The computation had low, average, and high cost listeriosis-case outbreak scenarios. The components of listeriosis losses were estimated as direct and indirect costs. The direct costs were computed from:
- Valuation of human life (value of statistical life ($/person) × deaths from outbreak);
- Hospitalization costs (mean cost of regular or internal care unit ($/person) × number of hospital cases);
- Work losses from Listeria-affected individuals was computed as mean productivity loss ($/person × number of cases missing work). 
The human impact and health outcomes associated with the listeriosis outbreaks were derived from the listeriosis situation report. These included sick individuals but those who did not go to the doctor (costs can’t be quantified); sick and went to the doctor, and hospitalized with final outcomes within time periods (costs measured); sick and hospitalized without a final outcome (costs could not be measured). Data for hospitalization consisted of adolescents, mothers, children, infants (newborn to less than 28 days old). The hospitalized outcomes for infants, children, and adolescents were based on age groups with morbidity and mortality records for cost analyses.
In order to calibrate the ERS model for South African conditions, we evaluated mortality compensation values from Miller which were estimated for all countries in the world through meta-analysis of available global data to derive ranges of multipliers (global average ~120) required to convert per capita GDP to the estimated value of a human life. These multipliers estimated for South Africa were used to derive the minimum to maximum range of life valuation for the analysis. Therefore, mortality cases were assigned compensation values of U.S. $ 1,244,747 and U.S. $ 2,524,312 per fatality for minimum and maximum human life valuation adjusted for South Africa which was 15 percent to 80 percent of U.S. values. Compensation values for mortality were derived by adjusting current South African per capita GDP by estimated multipliers. These values were then multiplied by the average percent (64.94 percent) of South African life expectancy remaining for all age-classes specific to the 204 outbreak fatalities.
In this computation, the South African hospital costs per patient were assumed to be 12.1 percent of U.S. hospital costs. The medical cost estimates included the average costs per care of regular hospitalization due to listeriosis for intensive care units (ICU) based on South African conditions. We excluded the cost computations for chronic cases of listeriosis, as data on disability attributed to listeriosis were not readily available and chronic conditions have yet to manifest themselves. In some instances, the outcomes of hospitalization were still pending (have not yet been determined).
Productivity losses (the average number of work days) due to listeriosis outbreak was assessed, on the assumption that able-bodied working age (15 to 64 years old) individuals were gainfully employed. The productivity losses per case were computed for a duration of one month, as this was the estimated duration of hospitalization and medical recovery from listeriosis for acute or non-fatal cases and pending in which case outcomes have not yet been determined (185 cases of 15-49 years old and 34 cases of 50-64 years old) as well as 89 (15-49 years old) and 26 (50-64 years old) cases discharged from hospitalization. Lost income during hospitalization was computed using the average monthly income in South Africa.
The outbreak of listeriosis contamination of polony and associated deli meat products led to serious health consequences for consumers in South Africa. Listeriosis occurrences were recorded in all nine provinces in South Africa. Among the provinces, confirmed listeriosis ranged from 6 to 606 cases with mortality of 3 to 106 cases. Overall, there were 1,034 total confirmed listeriosis cases with 204 fatalities. Listeriosis was recorded on babies (≤ 28 days old) to adults over 65 years old. The total cases varied among age groups as 441 cases were babies and 83 cases were > 65 years old. The number of fatalities was lowest for those > 65 years old, and highest for infants. No data were available on the exact ages of listeriosis-affected individuals due to confidentiality regulations. Reports indicated that all individuals diagnosed with listeriosis had consumed polony or deli meat contaminated with L. monocytogenes.
The total valuation of mortalities over the 16 months of the outbreak ranged from U.S. $265 million using the low valuation for a fatality to U.S. $525 million using the high valuation. At both one year (52 weeks) and at the recall for contaminated product at 62 weeks of listeriosis, the cumulative costs of listeriosis were already approaching values similar to the total estimated cost for listeriosis for both minimum and maximum estimates. The South African Rand (ZAR) equivalent cost estimates are also presented.
There was a total of 544 adults, where hospitalized cases consisted of 338 adults and 92 mothers, while mortality totaled 114 cases. Hospitalized newborn recovery from listeriosis totaled 400 cases with 90 mortalities. For adolescents and adults greater than 15 years of age or those in unknown age groups, there were 285 cases. The hospitalized adolescents and adults over 15 years old or those with unknown ages and with pending outcome of hospitalization from foodborne listeriosis had 145 cases. There were 255 hospitalized newborns that recovered, while newborns with pending outcome comprised 145 listeriosis cases. The total mortality costs for 204 individuals was at least U.S. $265 million. The hospitalization costs for babies born with listeriosis were estimated at U.S. $15,840 per case with a total estimated cost of over U.S. $6 million. The mortality cases of babies born with listeriosis computed based on standards amounted to U.S. $1.28 million/case for a total cost of U.S. $115 million. For the adults, the medical costs for maternal hospitalization cases amounted to over U.S. $364,000, while for other adults and deceased adults, hospitalization costs were over U.S. $1.3 million and U.S. $902,000, respectively. The costs associated with the mortality of 114 adults attributed to listeriosis amounted to over U.S. $145 million. The total costs associated with the projected hospitalization were U.S. $10,367,280. Hospitalization costs per case varied at U.S. $15,840/case for babies, U.S. $7,920/case for hospitalized older individuals that died, and U.S. $3,960/case for being hospitalized. 
The total losses in one month of lost productivity for maternal, adult cases was computed as U.S. $184,276 at U.S. $2,003 per case. For other adults with moderate cases (no mortality recorded) of listeriosis, lost productivity was computed at U.S. $1,230 per case totaling U.S. $415,740. Productivity losses were only 0.22 percent of listeria outbreak costs.
And, if anyone ever questions why surveillance and prevention of foodborne illness makes economic sense:
 According to the authors, in Sub-Saharan Africa (South Africa inclusive), costs associated with foodborne pathogens and illnesses are not precisely known, as many cases go unreported or have incomplete diagnosis (De Noordhout et al., 2014).
 The direct costs that were not estimated consisted of: current and future value of outpatient care and medication costs to treat chronic and acute cases, future cost of human suffering and lost productivity.
 The drawbacks for this study are that there were some direct and indirect costs that could not be quantified due to medical confidentiality issues that were excluded from the analyses. These include medication costs, sampling, laboratory/diagnosis costs, administrative costs, surveillance costs, the long-term effects of listeriosis on affected individuals in South Africa and possibly other countries.
 According to the authors, no attempt was made to quantify disability-adjusted life years (DALY, where one DALY equals one year of healthy life lost, that was attributed to listeriosis), due to lack of specific data (exact ages, case severity, and duration) of affected individuals. Therefore, hospitalization costs were assumed to be the same for all cases.
Editor’s note: For up-close and personal coverage of some of the victims, please see these stories by Joe Whitworth who was recently on assignment in South Africa for Food Safety News:
- Parents describe their baby’s ongoing treatment and their fears for his future
- Mother describes uncertain future for her daughter after listeriosis infection
- Uncertainty after the outbreak — ‘My niece may not know her father has died’
For information about a lawsuit, certified for class action, seeking to secure financial reimbursement for victims and their families, please click here for a Food Safety News story by Editor Dan Flynn.
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