More than 220 people are sick and three have died as part of a listeriosis outbreak in Spain, according to the World Health Organization (WHO).

From July 7 to September 13, 222 confirmed cases have been reported in five regions of Spain: 214 patients in Andalusia, four in Aragon, two in Extremadura and one each in Castilla y Leon and Madrid.

Most Andalusian cases have been registered in Seville with 175 but 17 people are sick in Huelva, 11 in Cádiz, six in Málaga and five in Granada. This past Friday only 21 people remained in hospital.

The outbreak has been traced to a chilled roasted pork meat product made in Spain by Magrudis and sold under the brand name “La Mechá”. Usually, there are about 300 infections from Listeria in Spain every year.

A total of 66 probable and 80 suspected cases are under investigation in Aragón, Canary Islands, Castilla y León, Castilla La Mancha, Cataluña, Valencia, Extremadura, Madrid, and Melilla, according to Spanish authorities.

Potential international cases

Graph showing confirmed Listeria outbreak cases from July 15 to September 11

WHO recommended against any travel or trade restrictions in relation to the outbreak. The European Centre for Disease Prevention and Control (ECDC) is also monitoring the incident.

It was reported by Spanish authorities to the World Health Organization, via the International Food Safety Authorities Network (INFOSAN), on August 20. Three days later, a food safety alert by Spanish authorities advised consumers to avoid any product sold under the Magrudis brand and that a small amount of implicated chilled roasted pork was also sold non-branded by another company, Commercial Martínez León.

France notified a related case in a citizen of the United Kingdom with travel history to Andalusia. Spanish media reported infections in Germany but authorities in Spain said there are none from Germany included in the outbreak as yet.

Only three cases of listeriosis have been recorded with a date of consumption after August 17, but they all bought the product before the food alert. The maximum incubation period in the outbreak is 30 days but listeriosis can have an incubation period of up to 70 days.

Fifty-seven percent of those ill are female including 38 pregnant women and 24 percent are 65 years old or above. Three deaths have been reported in two people over 70 years old and one person over 90 years old who were ill with listeriosis at the time of death. Six women had miscarriages linked to the outbreak.

“Although the implicated products have been recalled, given the long incubation period of listeriosis (up to 70 days), the shelf life of the implicated products (three months), and the popularity of this brand of meat served in many restaurants, additional cases are expected in the coming weeks,” said WHO officials.

“Additionally, given the high number of tourists to Spain, and Andalusia, in particular during the summer months, international travelers may have been exposed while the product was in the market; although the risk for any international disease spread is low given that the products have been recalled and have not been exported outside of Spain.”

WGS analysis of outbreak strain

Authorities in Andalusia suspended production of the implicated pork at Magrudis and ordered the withdrawal of all batches from the market. The company recalled all products manufactured since May 1, 2019.

During investigations at the plant by authorities in Spain, Listeria monocytogenes was isolated in other products commercialized under the same brand. Whole Genome Sequencing (WGS) of isolates at the Instituto de Salud Carlos III in Spain revealed that human and food strains share the same sequence. The strain has been characterized as serovar IVb, sequence type 388, clonal complex 388 and core genome-multilocus sequence typing (cgMLST) CT8466.

In other developments, the Spanish Agency for Food Safety and Nutrition (AESAN) has informed a sample of chilled roasted pork meat under the brand “Sabores de Paterna” tested positive for Listeria and the alert was later extended to include all items produced by Sabores de Paterna S.C.A. Products were mainly distributed in Andalucía but no infections associated with the alert have been confirmed.

AESAN also alerted the public about Listeria in products of the “La Montanera Del Sur” brand, which is produced by Incarybe SL, based in Benaoján (Málaga). As a precaution, Andalusian authorities ordered the withdrawal of all products made by the company but no illnesses have been recorded.

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