title: Multistate outbreak of Listeriosis linked to turkey deli meat and subsequent changes in US regulatory policy.
abstract: BACKGROUND
  Listeriosis, a life-threatening foodborne illness caused by Listeria monocytogenes, affects approximately 2500 Americans annually. Between July and October 2002, an uncommon strain of L. monocytogenes caused an outbreak of listeriosis in 9 states.
  
  
  METHODS
  We conducted case finding, a case-control study, and traceback and microbiological investigations to determine the extent and source of the outbreak and to propose control measures. Case patients were infected with the outbreak strain of L. monocytogenes between July and November 2002 in 9 states, and control patients were infected with different L. monocytogenes strains. Outcome measures included food exposure associated with outbreak strain infection and source of the implicated food.
  
  
  RESULTS
  Fifty-four case patients were identified; 8 died, and 3 pregnant women had fetal deaths. The case-control study included 38 case patients and 53 control patients. Case patients consumed turkey deli meat much more frequently than did control patients (P = .008, by Wilcoxon rank-sum test). In the 4 weeks before illness, 55% of case patients had eaten deli turkey breast more than 1-2 times, compared with 28% of control patients (odds ratio, 4.5; 95% confidence interval, 1.3-17.1). Investigation of turkey deli meat eaten by case patients led to several turkey processing plants. The outbreak strain was found in the environment of 1 processing plant and in turkey products from a second. Together, the processing plants recalled > 30 million pounds of products. Following the outbreak, the US Department of Agriculture's Food Safety and Inspection Service issued new regulations outlining a L. monocytogenes control and testing program for ready-to-eat meat and poultry processing plants.
  
  
  CONCLUSIONS
  Turkey deli meat was the source of a large multistate outbreak of listeriosis. Investigation of this outbreak helped guide policy changes designed to prevent future L. monocytogenes contamination of ready-to-eat meat and poultry products.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. stg8@cdc.gov
authors.forename: Sami L
authors.initials: SL
authors.lastname: Gottlieb
authors.forename: E Claire
authors.initials: EC
authors.lastname: Newbern
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Griffin
authors.forename: Lewis M
authors.initials: LM
authors.lastname: Graves
authors.forename: R Michael
authors.initials: RM
authors.lastname: Hoekstra
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Baker
authors.forename: Susan B
authors.initials: SB
authors.lastname: Hunter
authors.forename: Kristin G
authors.initials: KG
authors.lastname: Holt
authors.forename: Fred
authors.initials: F
authors.lastname: Ramsey
authors.forename: Marcus
authors.initials: M
authors.lastname: Head
authors.forename: Priscilla
authors.initials: P
authors.lastname: Levine
authors.forename: Geraldine
authors.initials: G
authors.lastname: Johnson
authors.forename: Dianna
authors.initials: D
authors.lastname: Schoonmaker-Bopp
authors.forename: Vasudha
authors.initials: V
authors.lastname: Reddy
authors.forename: Laura
authors.initials: L
authors.lastname: Kornstein
authors.forename: Michal
authors.initials: M
authors.lastname: Gerwel
authors.forename: Johnson
authors.initials: J
authors.lastname: Nsubuga
authors.forename: Leslie
authors.initials: L
authors.lastname: Edwards
authors.forename: Shelley
authors.initials: S
authors.lastname: Stonecipher
authors.forename: Sharon
authors.initials: S
authors.lastname: Hurd
authors.forename: Deri
authors.initials: D
authors.lastname: Austin
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Jefferson
authors.forename: Suzanne D
authors.initials: SD
authors.lastname: Young
authors.forename: Kelley
authors.initials: K
authors.lastname: Hise
authors.forename: Esther D
authors.initials: ED
authors.lastname: Chernak
authors.forename: Jeremy
authors.initials: J
authors.lastname: Sobel
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D005516:Food Microbiology / Q000331:legislation & jurisprudence*; D006801:Humans; D007223:Infant; D008089:Listeria monocytogenes / Q000302:isolation & purification*; D008088:Listeriosis / Q000453:epidemiology* / Q000382:microbiology*; D008297:Male; D008460:Meat / Q000382:microbiology*; D008875:Middle Aged; D014422:Turkeys; D014481:United States / Q000453:epidemiology