#ClinicSpeak: behavioural change is need to reduce listeria risk

There is an expert for everything; including preventing post-alemtuzumab listeriosis #ClinicSpeak #MSBlog 

In the modern era you can find an expert for everything. Fortunately, I found Ellen Evans, an expert, who works on preventing food-borne Listeriosis; she is based in Cardiff. In just 15-20 minutes and a few email exchanges has taught me a lot. Fortunately, she has kindly agreed to work with us on a Listeria prevention programme for Alemtuzumabers. She has done a lot of research on Listeriosis and informed me that by simply providing patients with an information sheet about Listeriosis is unlikely to make much difference. What we need is a formal education and engagement programme with the whole MS community, pwMS, their families and carers, to make a difference. We need a much more intensive education programme about Listeriosis for our patients and staff, that should begin long before we treat them with alemtuzumab. 

In the next week or so we are planning to pull together relevant stakeholders to make this happen and hopefully prevent anymore post-alemtuzumab listeria cases. The good news is that we can adopt, adapt and use material and systems developed for oncology (chemotherapy) patients. They have had a similar problem to us and seem to be on top of the problem. 

Another thing I learnt is that we should not refer to the diet as the ‘Pregnancy Diet’; some people might find this term offensive, particularly if they can’t have children. This was a particular issue with cancer patients. I was also surprised to find that the advice in relation to preventing listerial infection in at-risk individuals is highly variable across the country. On the positive side listeria prevention programmes work, we just need to make sure we implement the best programme and do it well and more importantly ASAP. I will keep you posted via the blog as this initiative evolves.

Evans & Redmond. Older Adult Consumer Knowledge, Attitudes, and Self-Reported Storage Practices of Ready-to-Eat Food Products and Risks Associated with Listeriosis. J Food Prot. 2016 Feb;79(2):263-72. doi: 10.4315/0362-028X.JFP-15-312.

Consumer implementation of recommended food safety practices, specifically relating to time and temperature control of ready-to-eat (RTE) food products associated with listeriosis are crucial. This is particularly the case for at-risk consumers such as older adults, given the increased listeriosis incidence reported internationally among adults aged ≥60 years. However, data detailing older adults’ cognitive risk factors associated with listeriosis are lacking. Combining data about knowledge, self-reported practices, and attitudes can achieve a cumulative multilayered in-depth understanding of consumer food safety behavior and cognition. This study aims to ascertain older adults’ cognition and behavior in relation to domestic food handling and storage practices that may increase the risks associated with L. monocytogenes. Older adults (≥60 years) (n = 100) participated in an interview and questionnaire to determine knowledge, self-reported practices, and attitudes toward recommended practices. Although the majority (79%) had positive attitudes toward refrigeration, 84% were unaware of recommended temperatures (5°C) and 65% self-reported “never” checking their refrigerator temperature. Although most (72%) knew that “use-by” dates indicate food safety and 62% reported “always” taking note, neutral attitudes were held, with 67% believing it was safe to eat food beyond use-by dates and 57% reporting doing so. Attitudes toward consuming foods within the recommended 2 days of opening were neutral, with 55% aware of recommendations and , 84% reporting that they consume RTE foods beyond recommendations. Although knowledgeable of some key practices, older adults self-reported potentially unsafe practices when storing RTE foods at home, which may increase risks associated with L. monocytogenes. This study has determined that older adults’ food safety cognition may affect their behaviors; understanding consumer food safety cognition is essential for developing targeted food safety education.

5 thoughts on “#ClinicSpeak: behavioural change is need to reduce listeria risk”

  1. Reading about listeria on the Food Standards Agency website it states 'Who can it affect? Those at increased risk include people with weakened immune systems.' So this would be all pwMS?

    1. not all people with ms.. but i think those people whose lymphocyte counts (including some subsets) drop significantly are… whether the lymphocyte count drops due to DMT or some unexplained reason.

    2. In the general population the over 60's need to be aware of listeria and not take risks with foods.

  2. I have asked this before. What is considered a low lymphocyte count? After my second lemtrada in 2014 my lymphocyte count is now 0.9 thanks

    1. Less than 0.8 (grade 2 or worse) is low. The risk of Listeria is mainly linked to low monocyte, and neutrophil, counts in the first few weeks after alemtuzumab treatment. This is similar to that which happens after chemotherapy.

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