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Health Requirements and Recommendations for Travellers to Saudi Arabia for Hajj and Umrah 9 June 2019 Editorial note Th
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WHO recommendations for international travel and trade in relation to the Listeriosis outbreak in Spain 28 August 2019 On 21 August 2019, an outbreak of listeriosis in Andalusia, Spain, linked to the consumption of domestically produced chilled pork roast from a single manufacturer in the municipality of Sevilla, was notified by Spanish authorities. Implicated food products that are suspected to be linked to the outbreak have tested positive for the presence of Listeria monocytogenes. Production has since been suspended. The responsible manufacturer has been ordered to recall all implicated products from the market, investigate the causes, and undertake full traceability of the product. Spanish authorities are conducting an outbreak investigation. Due to the high number of tourists visiting this region, if any cases of listeriosis with history of consumption of chilled pork roast in Andalusia have been reported outside of Spain during the previous 3 months, Member States should kindly inform the International Network of Food Safety Authorities (INFOSAN) Secretariat. The epidemiological link between suspected cases abroad and the current outbreak in Spain, Andalusia, can only be confirmed by comparing the whole-genome sequence with Listeria monocytogenes isolates associated with this outbreak.
International travellers: increased vigilance for high risk group Risk for travellers is generally low. However, during an outbreak this risk is increased. This is a reminder that people at higher risk for severe Listeria infection should increase vigilance to avoid exposure to the pathogen. To minimize the risk of infection, travellers in areas affected by Listeriosis, should take similar precautions for the prevention of other types of foodborne diseases:
All precautions should be taken to avoid consumption of potentially contaminated food, by only consuming food from known safe sources. L. monocytogenes in food are killed by pasteurization and cooking. Persons in high risk groups should avoid consuming dairy products made of unpasteurized milk; deli meats and ready-to-eat meat products such as sausages, hams, pâtés and meat spreads, as well as cold-smoked seafood (such as smoked salmon). Read and carefully follow the shelf life period and storage temperatures indicated on the product labels. Follow the five keys for safe food: wash hands often and always before handling and consuming food; make sure the food is cooked thoroughly; peel all fruits and vegetables if eaten raw; drink bottled water if available, or if the source of water is doubtful, bring it to a vigorous boil; separate cooked food from raw food, avoid uncooked food, and keep food at safe temperatures.
Returning at-risk travellers with travel history in Andalusia since June 2019 who present listeriosis-like symptoms, should seek immediate medical attention and report their travel history to their medical doctor.
International traffic: no restrictions recommended Listeriosis is a food-borne disease, not transmissible from person to person. The continuous recall and safe disposal of the implicated processed products is on-going, as indicated by the Spanish Government. As of 23 August 2019, Spain confirmed that known distribution of implicated products is limited to domestic market. Therefore, WHO recommends against the application of any travel or trade restrictions in relation to this outbreak. States Parties to the International Health Regulations (2005) are reminded not to take actions that significantly interfere with international travel and trade, which are not based on scientific principles, and which may be viewed as excessive. Indeed, such measures contravene the spirit and purpose of the IHR (2005) and can impede public health objectives.
Listeriosis: causes, symptoms and treatment Listeriosis is a serious, but preventable and treatable infectious disease. It is caused by eating food contaminated with the bacterium Listeria monocytogenes. High risk foods include deli meat and readyto-eat meat products (such as cooked, cured and/or fermented meats and sausages), dairy products made of unpasteurized milk, soft cheeses and cold smoked fishery products. Transmission is also possible from mother to fetus or from mother to child during birth. There are two main forms of listeriosis: a non-invasive and an invasive form. The non-invasive form occurs in otherwise healthy individuals and is a mild form of disease. Symptoms include diarrhoea, fever, headache and muscle pain. The incubation period is short (a few days). Outbreaks of this disease have generally involved the ingestion of foods containing high doses of Listeria monocytogenes. Invasive listeriosis is a more severe form of the disease and affects certain high-risk groups of the population. These include pregnant women, patients undergoing treatment for cancer, HIV/AIDS and organ transplants, elderly people and infants. This form of disease is characterized by severe symptoms and a high mortality rate (20%–30%). The symptoms include fever, muscle pain, septicaemia, meningitis. The incubation period is usually one to two weeks but can vary between a few days and up to 70 days. Listeriosis can be treated if diagnosed early. Antibiotics are used to treat severe symptoms such as meningitis. When infection occurs during pregnancy, prompt administration of antibiotics prevents infection of the foetus or newborn. Further information International Health Regulations (2005), 3rd edition WHO Guide on Safe Food for Travellers WHO 5 Keys for Safer Food WHO Manual to Strengthen Surveillance of and Response to Foodborne Diseases WHO fact sheet