Deli-meat sandwiches should be no-go for elderly patients
Sept. 5, 2008

So I’ve done my due diligence this week and read through several dozen news items, reports and public-health warnings about the listeriosis outbreak that’s killing Canadians. I’m afraid I have to fall back on that old cliché about being left with more questions than answers, particularly around why old, sick people are still being fed deli meats.
Like most of the bacteria that cause food poisoning, listeria monocytogenes is found everywhere: In our soil and water; in almost 40 species of mammals (including humans); in fish; crustaceans; ticks; sewage waste; sickrooms. Healthy farm animals and humans alike can harbour it quite comfortably with no symptoms.
For a healthy adult under age 50, a bout of listeriosis is unpleasant but generally manageable. Still, the overall fatality rate is 20 to 30 per cent. And for those whose health issues put them at greater risk, the fatality rate is 40 per cent or more.
Pregnant women and their fetuses have a 20-fold higher risk of developing listeriosis. Almost all of the victims in Canada’s only other major listeria outbreak 27 years ago were unborn and newborn babies. Fatality rates are extremely high for fetuses infected in the womb.
People with AIDS are 300 times more at risk of infection. Anyone with suppressed immune systems - whether from chemotherapy, chronic illness, alcoholism or old age - is at significantly higher risk.
The health recommendations for those high-risk groups have been clear for years: Those who are elderly, seriously ill or pregnant should avoid eating foods known to carry the risk of listeria contamination - particularly soft, unpasteurized cheeses and “non-dry” deli meats (sliced ham, roast beef, chicken and turkey, for instance, as opposed to dried meats like salami and pepperoni).
Personal details aren’t available yet on the 13 deaths so far in this latest outbreak, or on another 25 confirmed cases of illness. But it’s known that most of the fatalities so far involved elderly patients at hospitals and seniors’ care facilities.
They died from eating infected sandwich meats from a single Toronto meat-processing plant, which produces some of Canada’s most popular brands. What has yet to be ascertained is whether anyone in authority gave even a second thought to the wisdom of serving frail seniors food that isn’t recommended for them.
I get that we consume untold tonnes of deli meat in Canada every year without incident - $1.2 billion worth, in fact. I get that most people will spend a lifetime eating deli meats and never get listeriosis. Coleslaw was the culprit in the 1981 listeriosis outbreak in Nova Scotia and New Brunswick that killed 18 people, so it’s not like it’s all about sandwich meats anyway.
But my research this week nonetheless turned up U.S. health warnings dating back 16 years that advised people in high-risk groups to avoid soft cheeses and deli meats that hadn’t been dried. Health Canada made a similar recommendation in 2005. BC Children’s and Women’s Hospital quit serving deli meats to its patients last year.
But the deli-meat sandwiches clearly never stopped coming in facilities serving old, sick people.
How does contamination happen? In the 1981 outbreak, the problem turned out to be a farm that used contaminated sheep manure on its cabbage patch. A small outbreak on Vancouver Island six years ago was traced to problems with decontamination measures at a Parksville plant making soft cheese with unpasteurized milk.
For the latest outbreak, we know the contamination occurred at the Maple Leaf plant in Toronto, but are still waiting for the rest of the story. It will likely involve the waste of one animal or another, as that’s the primary way listeria is spread.
Health professionals are not of one mind around dealing with listeriosis. Canada records some 13 million cases of food poisoning of one kind or another every year, and the incidence of listeriosis remains blessedly rare. A nationwide ban of listeria-prone foods in all hospitals and care homes has perhaps seemed unnecessarily extreme.
But the world is changing. The sheer coast-to-coast, shelf-emptying scope of a modern-day food recall is proof of that, and the latest incident yet another telling example of the downside of a consolidated, mechanized, multi-national food industry that’s about as far from the farm gate as you can get.
Miraculously, most foods we eat will continue to be safe even so. Most of us will neither fall ill nor die from listeriosis. But if all it takes to save a few more lives is to switch the sandwich fixings in our care facilities, surely we can take that one small step.