The first international case of listeriosis linked to an outbreak in Spain that has sickened almost 200 people and killed two is being investigated by British public health officials.

The outbreak has been traced to contaminated chilled pork products under the brand “La Mechá” made by Magrudis, based in Seville. The potential infection is in a man from England who ate the product in Seville in mid-August. He was treated at a hospital in France before returning to the United Kingdom.

A Public Health England spokeswoman told Food Safety News the agency does not disclose patient details so she was not able to provide information on the age of the man or wher in England he lives.

Almost 200 ill and nearly 80 hospitalized
A total of 193 cases have been confirmed in the outbreak. Most are in Seville with 158, but 10 infections have been found in Cádiz, four in Granada and Málaga and 17 in Huelva.

In Aragón there is one confirmed and six probable infections, Asturias has six probable cases in the same family including a pregnant woman. There are nine probable and suspected cases under investigation in Castilla-La Mancha and one probable infection with 16 suspected in Castilla y León. Ten people from Madrid, two in Melilla and five from Valencia are suspected of being part of the outbreak. Extremadura has reported 22 cases with one confirmed and 21 being investigated.

A 90-year-old woman and a 72-year-old man who had terminal cancer have died due to listeriosis. FACUA-Consumers in Action, a consumer group, is reporting two women have lost their babies as part of the outbreak.

The number of hospitalized patients is 77, of which 28 are pregnant women and three people are in the intensive care unit.

Affected product list
Most of the product was distributed in Andalusia, according to the Spanish Agency for Food Safety and Nutrition (AESAN). Around 225 kilograms was sent to Madrid and redistributed in small quantities to Castilla-La Mancha, Castilla y León, Badajoz and Adeje (Tenerife).

Listeria was isolated in the product on Aug. 14 and following a visit by Andalusian authorities to the company’s factory, all food produced since May 1 was withdrawn and production suspended.

The alert has also been extended to other products made by the firm that were distributed mostly to Andalusia and in smaller quantities to Madrid, Catalonia and Extremadura. These items include 250-gram and 465-gram pack sizes of ‘Crema de carne mechada, Manteca colorá, Pringá estilo casero, Zurrapa de hígado, Zurrapa lomo blanca and Zurrapa lomo roja’.

It also covers products distributed by the firm Comercial Martínez León, which sells meat manufactured by Magrudis.

ECDC and INFOSAN on Listeria plus 2 other outbreaks
Normally there are about 300 infections from Listeria in Spain every year. The country has also been hit by a suspected foodborne botulism outbreak caused by canned tuna in sunflower oil or grated carrots and an outbreak of norovirus in frozen seaweed salad from China, via Germany. The Ministry of Health, Consumer Affairs and Social Welfare (MSCBS) has yet to respond to a request for comment.

The European Centre for Disease Prevention and Control (ECDC) reported it is monitoring the Listeria incident and was not aware of any other international cases at this stage.

“Given the incubation period of listeriosis, the long expiration date of the implicated product and its consumption and distribution, the appearance of new cases in the following weeks seems probable despite the product recall.

“Additionally, due to the high numbers of tourists to Andalusia and the other regions wher the product was distributed, the identification of additional cases linked to this outbreak in other countries cannot be ruled out.”

The International Food Safety Authorities Network (INFOSAN) is also involved due to the outbreak’s scale.

“Early last week we shared information about the outbreak with INFOSAN members through the INFOSAN community website. At that time we indicated that the Listeria monocytogenes isolates from outbreak cases and implicated food were in the process of being sequenced and that we would share the results of the whole genome sequencing with INFOSAN members as soon as they are available,” said Carmen Savelli, technical officer at the INFOSAN Secretariat, department of Food Safety and Zoonoses at the World Health Organization.

This information would aid confirmation of travel-related cases identified outside Spain.

“In this case, even though the recalled products are produced in Spain and have reportedly not been exported, the INFOSAN secretariat has been included on the alert given the scale of the outbreak in Spain and to ensure we’re able to keep other inquiring INFOSAN members up to date with the latest information provided by the Spanish authorities. We have requested that authorities report such cases to the INFOSAN secretariat. No international cases have been reported to us at this time,” added Savelli.

Listeria infection information for consumers
Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause serious and sometimes life-threatening infections. Anyone who has eaten any of the implicated product and developed symptoms of Listeria infection should seek medical treatment and tell their doctors about the possible Listeria exposure.

Also, anyone who has eaten any of the recalled product should monitor themselves for symptoms during the coming weeks because it can take up to 70 days after exposure to Listeria for symptoms of listeriosis to develop. 

Symptoms of Listeria infection can include vomiting, nausea, persistent fever, muscle aches, severe headache and neck stiffness. Specific laboratory tests are required to diagnose Listeria infections, which can mimic other illnesses. 

Pregnant women, the elderly, young children, and people such as cancer patients who have weakened immune systems are particularly at risk of serious illnesses, life-threatening infections and other complications. Although infected pregnant women may experience only mild, flu-like symptoms, their infections can lead to premature delivery, infection of the newborn or even stillbirth.