Zeigler 1

Courtney Zeigler
FN 3350
Term Paper
October 30, 2014
Listeriosis during Pregnancy
Listeriosis is a type of foodborne bacteria that can cause very serious infections. It mainly
effects the elderly, pregnant women and newborns, and also people that have a disease or
condition that may cause their immune system to be weak. Among all major pathogens that are
transmitted by food, listeriosis is the third leading cause for death. Listeria can be transmitted
several different ways, but food is the major route of transmission for this bacteria. Listeriosis
has a reputation for being particularly deadly, especially because it can continue to grow in
refrigeration temperatures, which as a result, can make it difficult to kill and/or prevent its
growth in some cases. Seven species of listeria have been identified, but Listeria monocytogenes
is the principle pathogen in human and animals that is responsible for more than 90% of human
infections (1). Although listeriosis is a mild illness among pregnant women, it can be very fatal
for the fetus or for the newborn. Severe outcomes that can be caused by listeriosis include fetal
loss, meningitis, neonatal sepsis, and even death. Sadly, the newborns are the ones that suffer the
serious effects of the infection, rather than the pregnant women. Listeria is an intracellular
organism, so the response to treatment may be slow due to relatively poor cell penetration.
When it comes to contracting listeriosis, pregnant women are twenty times more likely
than the general population to get it, according to the Center for Disease Control and Prevention
(2). People with weak immune systems are also at a much higher risk than the rest of the
population as a whole, along with the elderly and pregnant women, but especially Hispanic
pregnant women. Pregnant women of Hispanic ethnicities have considerably higher listeriosis
rates in the United States than among pregnant women who do not have a Hispanic ethnic
background. The chances at risk for listeriosis are up to ten times higher for pregnant women, but
are twenty-four times higher for pregnant Hispanic women when compared with the rest of the
population. An estimated 800 cases occur every year in pregnant women and fetuses in the U.S.
alone (1). In Europe, the annual incidence for listeriosis is approximately 0.3 per 100,000 in the

Zeigler 2

general population; compared with a much larger rate of 12 per 100,000 in pregnancy (3). In a
study conducted by the Foodborne Diseases Active Surveillance Network, results provide
crucial insights for risk assessment efforts. They demonstrate that a significant increase in
listeriosis incidence begins among persons as young as 45 years, and the incidence rate increases
steadily as one ages (4).
The main cause of this infection is the consumption of contaminated food, such as milk,
soft cheese, coleslaw, undercooked meat, and/or unwashed raw vegetables. It is rather easy for
vegetables to become contaminated. This can happen from coming in contact with soil that is
contaminated, or from manure that hay have been used as a fertilizer. It is also possible for
animals to be a source for contamination, also. Animals may carry the bacteria that in turn
contaminates certain meat or dairy products. It is possible for listeria to be killed by cooking and
pasteurization processes, however, some ready-to-eat meats may be contaminated in the factory
after cooking, but before the packaging process. This can make it especially hard to determine
the exact site of contamination. Pregnant women are advised to steer clear of hot dogs and deli
meats, as these are some of the most common ways to contract listeria. Listeria is a facultative
anaerobe, meaning that it can grow with or without oxygen, making it very hard to prevent
considering it can still grow and multiply in refrigeration temperatures unlike most other
bacteria. The incubation period for this bacteria is anywhere from three to seventy days.
Listeriosis can lead to severe disease and infection if it is contracted during important growing
stages of life. Onset of disease usually appears hours after birth or within a few days of life; the
average onset time for neonatal symptoms is about 1 days after birth. Late-onset disease
occurs around 2-3 weeks after birth, with the average onset of symptoms being 14 days after
birth. Late-onset disease usually affects full-term infants of mothers with a history of normal
pregnancy (1). In a small study done on women who had contracted listeriosis, 36.3% of them
had to give birth via a cesarean section for fetal distress, compared to the 15% cesarean rate in
the general population (1). Four had premature labor, which was about four times the rate in the
U.S. population. In 2009-2011, 1,651 cases of severe listeriosis were reported across the United
States; of these cases, 292 of them were deaths or fetal losses (5). Fourteen percent of these cases
were pregnancy related. Among these pregnancy-related cases, Hispanic mothers made up 43%
of them. Preterm labor was also reported in 64% of the listeriosis cases that were pregnancyrelated.

Zeigler 3

If a listeriosis case occurs in a pregnant woman, fetus, or an infant that is younger than 31
days old then it is considered a pregnancy related case.There are a few methods that are
commonly used to locate cases of listeriosis. Blood cultures performed by radiometric methods,
and later by calorimetric methods can be used. Laboratory tests are then performed to test the
severity of the infection (1). Blood testing to find listeriosis is the most effective method that is
used. There are also other laboratory tests that can be done to locate this bacteria. Urine samples
can be taken and tested, along with spinal fluid. Identification from these cultures usually takes
thirty-six hours. It is very important if symptoms are shown, that the listeria gets taken care of as
soon as possible because it can become very severe, very quickly. Prompt antibiotic treatment
given to a pregnant woman as soon as the bacteria is found, can keep from infecting the baby.
Early treatment and induction of delivery helps to reduce the risk of vertical transmission. Mild
symptoms sometimes require no treatment. Listeriosis symptoms usually resolve after delivery,
with or without antibiotic therapy. Yet severe symptoms of listeria almost always result in
hospitalization, so the chances of one being treated properly by medical professionals is very
high. Some of these symptoms include fever, muscle aches, and chills. It is most commonly
mistaken for the flu, so many individuals just wait it out rather than seeking medical attention.
This is a large part as to why the fatality rate for this illness is so high.
With pregnant women being such an at-risk group for listeriosis, education methods and
information that will target their specific circumstances and nutritional needs are necessary. Food
safety improvements and knowledge of these possible outcomes can greatly help to decrease the
occurrence of listeriosis in pregnancy. The main factor that can help to decrease the incidence of
this illness is simply education. Being educated on how one can contract listeria, what causes it,
and knowing to get immediate attention once symptoms are shown, could make all of the
difference to a pregnant woman and her fetus. Taking simple precautions to prevent listeriosis
might be all that one needs to ensure the highest quality of health during pregnancy. There are
many basic food safety measures that can be used to not only reduce the risk for listeriosis, but
also for other potentially severe foodborne infections. Some of these methods include the
knowledge of the steps clean, separate, cook, and chill. Scrubbing raw vegetables and making
sure to keep things clean is always a top priority, but especially when one is pregnant, it needs to
be done with extra care. Cooking foods thoroughly will ensure that the food is cooked to the
minimum internal temperature and does not pose a threat to certain bacteria. Keeping foods

Zeigler 4

separated when cooking or storing, can help to prevent cross contamination. Taking additional
precaution with hazardous foods while one is pregnant can greatly improve ones knowledge of
food safety for references in the future. According to the Food Safety and Inspection Service
(FSIS), it is recommended that anybody at risk should reheat foods until they are steaming before
eating them. This is especially important with deli meats and hot dogs, so that way any listeria
that may be present is then destroyed (2). There are also many precautions that the general
population along with people at higher risk need to follow. Avoiding all unpasteurized milk and
dairy products that are made from or with unpasteurized milk, such as some types of cheeses,
should be kept in mind. Prevention and control however, are difficult due to the fact that listeria
organisms are ubiquitous and most infections are sporadic. The most effective strategy to help
prevent the incidence of infection, is to stay away from contaminated foods. According to the
Foodborne Diseases Active Surveillance Network, risk assessments are being made in order to
get educational messages and preventive strategies out to higher-risk population subgroups,
specifically targeting Hispanic populations, including women of all ages, but mainly directed
towards women of reproductive age (4). Targeting a variety of different age and population
groups on food safety and preventive measures can also help to greatly decrease their risk for
other foodborne illnesses. Federal food safety agencies are now using risk analysis framework to
address the problem of listeriosis by describing problems with food safety and strategies that can
be used to help prevent these problems. There are three different parts to the risk analysis
framework that is being used. These three parts are assessment, management, and
communication. All three of these steps are formed once all of the risks that are present are
addressed. Using these three steps can help to identify what the problems are, and solutions that
can help to reduce the risks for listeriosis (2).
In conclusion, new methods of educational practices are needed to inform women about
the risks of listeriosis during pregnancy and ways that they can possibly reduce these risks. Many
food safety organizations have already begun the process to work to help educate pregnant
women on what they can do to prevent listeriosis and ensure a healthy pregnancy. Education is
the key component needed when it comes to developing a risk management plan that can help
inform others how to reduce the risks for contracting listeriosis. However, listeriosis still remains
an uncommon infection, with a much greater incidence during pregnancy. Listeriosis infections
almost always lead to hospitalization or meningitis, with the possibility of fetal loss and even

Zeigler 5

death. Early treatment and knowledge of this infection can greatly decrease the risks associated
with listeriosis, which is why so many educational and risk management initiatives are being put
into place. Education and knowledge of this infection and food safety practices that can be done
to reduce the risks of contracting it are the key points that women need to continuously prevent
it. Once pregnant women are adequately educated about the causes and prevention methods that
can be done, individuals that contract this infection can substantially decline as a result.

Zeigler 6

Works Cited
1. Benshushan A, Tsafir A, Arbel R. Listeria infection during pregnancy: a 10 year
experience. ACOG. 2002 Oct;4:776-780.
2. Cates S, Carter-Young H, Conley S, OBrien B. Pregnant women and listeriosis:
preferred educational messages and delivery mechanisms. JNEB. 2004
Jun;36(3):121-127.
3. Bubonja-Sonje M, Mustac E, Brunn A, Deckert M. Listeriosis in pregnancy: case
report and retrospective study. J Matern Fetal Neonatal Med. 2013;26(3):321-323.
4. Pouillot R, Hoelzer K, Jackson K, Silk B. Relative risk of listeriosis in foodborne
diseases active surveillance network (FoodNet) sites according to age, pregnancy, and
ethnicity. CID. 2012;54(5):S405-410.
5. Silk B. Vital signs: listeria illnesses, deaths, and outbreaks-United States, 2009-2011.
MMWR. 2013 Jun 7;62(22):448-452.