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You Can’t Ignore the Cantaloupe Listeria Issue…Especially During Pregnancy  

By Sonia Alvarado, CTIS Pregnancy Health Information Line Counselor

Pregnant women are typically told to avoid raw milk, unpasteurized cheese, and deli meats to avoid exposure to Listeria monocytogenes, a mycobacteria. Listeria infection in pregnancy can cause neonatal infection, stillbirth, miscarriage or prematurity.

While we recommend that everyone wash fruits and vegetables before eating, we had not been specifically concerned about listeria contaminating fruit and possibly infecting pregnant women, until now. At the time this is being written, there is a large investigation being conducted by the Centers for Disease Control and other federal authorities, along with the support and cooperation of local health departments, on an extensive listeria outbreak resulting from contaminated cantaloupes. The contaminated cantaloupes originated from a Colorado producer, Jensen Farms, who distributed to vendors in 25 states, who then trucked the cantaloupes to stores and supermarkets.

According to the CDC, at this time there are at least 72 people who have been sickened, including 13 deaths. It is expected that the number of infected people will rise since illness may not occur until 2 to 3 weeks after infection, and cases would still have to be reported to the appropriate authorities to be counted. The ages of infected individuals so far ranges from 35 to 96, including two pregnant women, according to media reports. Listeria infection causes listeriosis and this disease is most dangerous to pregnant women, immunocompromised individuals, children, and senior citizens.

Pregnant women are reported to be 20 times more likely to get listeriosis. The symptoms of listeriosis are different in the various sensitive groups: Pregnant women may experience a mild, flu-like illness; seniors may suffer septicemia and meningitis. Pregnant women may not realize what’s happened until after they’ve suffered a pregnancy loss, one of the risks associated with listeria infection in pregnancy.

Most worrisome at this time is that we do not know how the cantaloupes were infected. Was the listeria in the soil or in the water that irrigated the cantaloupes? This critical piece of information is necessary to prevent this outbreak from occurring again. This outbreak is yet another warning about the importance of having evidence-based and enforced regulations on food handling, production and inspection. However, since no system is perfect, we all need to take steps to reduce the chance that we’ll be infected from listeria or other bacteria and parasites.

The following are recommendations from the CDC, in combination with other sources, to reduce your chance of exposure, recognizing that no recommendations are going to be 100-percent effective.

1. Wash your hands before handling any food (meat, fruits, vegetables, canned, prepared, not prepared, etc.). Wash hands for 20 seconds with soapy, warm water.

2. Wash all homegrown and store-bought produce before eating it. You can use water, a 1-percent vinegar solution, soapy water or a commercial vegetable-cleaning product. Use a vegetable brush if possible.

3. Wash knives, counter tops, and cutting boards after handling and preparing uncooked foods.

4. Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature. What’s the appropriate temperature? From the USDA (using a food thermometer):

o All whole cuts of meat (ground beef, veal, lamb, and pork) to 145 °F as measured with a food thermometer placed in the thickest part of the meat (rest time of 3 minutes before eating)
o Ground meats, (ground beef, veal, lamb, and pork): 160 °F (no rest time recommended)
o All poultry products (ground beef, veal, lamb, and pork); 160 °F (no rest time recommended)

5. Separate uncooked meats and poultry from vegetables.

6. Separate uncooked meats from cooked foods and ready-to-eat foods.

7. Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.

8. Consume perishable and ready-to-eat foods as soon as possible.

9. Clean dishes with soap water in the hottest temperature that is safe and comfortable for you. The FDA requires restaurants clean dishes with a minimum temperature of 110 degrees F, so if you have a dishwasher, you may be able to get the water to this recommended temperature.

10. When possible, choose irradiated foods. Cleaning foods on the surface may not get to all of the bacteria. For example, cleaning lettuce with water may not get to bugs that get between nooks in the leaves. Irradiation exposes food to a source of electron beams, and destroys bacteria and parasites.

11. Clean your refrigerator! You won’t get all the listeria out, but most of it and slow its growth.

12. Keep your refrigerator at 40 degrees F or below. This temperature slows the growth of listeria in refrigerators.

Sonia Alvarado is a bilingual (Spanish/English) Teratogen Information Specialist with the California Teratogen Information Service (CTIS) Pregnancy Health Information Line, a statewide service that aims to educate women about exposures during pregnancy and breastfeeding. Along with answering women’s and health professionals’ questions regarding exposures during pregnancy/lactation via CTIS’ toll-free hotline and e-mail service, she’s provided educational talks regarding pregnancy health in community clinics and high schools over the past decade.

CTIS Pregnancy Health Information Line is part of the Organization of Teratology Information Specialists (OTIS), a non-profit with affiliates across North America. California women with questions or concerns about pregnancy exposures can be directed to (800) 532-3749 or by visiting CTISPregnancy.org. Outside of California, please call OTIS counselors at (866) 626-OTIS (6847).

ARTICLE ARCHIVE  

VACCINES DURING PREGNANCY: ARE THEY SAFE?  

By Nadia Mohamedi, OTIS Teratogen Information Specialist

Although going back to school means the end of summer fun, I have always looked forward to the newness that September brings like the first day of school outfits and the smell of unused books. During this hectic time, some may forget an important requirement for the start of school: vaccines. In fact, some colleges or schools may not let you enroll in classes unless you have received certain vaccines. Recently, I received a counseling call at the Organization of Teratology Information Specialists from a young woman concerned about the meningitis vaccine, which her college required before she could move into the dormitory. The one problem was that she was pregnant. What should she do?

Two of the most common vaccines required by schools are the HPV vaccine and the meningitis vaccine. Both of these vaccines are non-infectious, meaning that they can’t give you the disease that they are preventing against. Non-infectious vaccines are generally thought to be a low risk in pregnancy. HPV is the most common infection transmitted by sexual contact and can sometimes cause genital warts and cervical cancer. Although it has not been well studied in pregnancy, having HPV during pregnancy usually does not cause harm to the pregnancy or the baby. Generally, the HPV vaccine is not recommended in pregnancy because it is best to receive the vaccine before sexual contact and it has not been well studied in pregnancy. One study reported that Cervarix®, one of the brands of the HPV vaccine, was linked to a higher risk of miscarriage when given close to the date that the women got pregnant, however, the rate of miscarriages that happened in the study was similar to the rate expected in the general population, about 15 to 20 percent.

Meningitis is a more serious infection and affects the brain and spinal cord. Unlike HPV, meningitis is contagious through saliva, so a simple kiss with an infected person can result in life-long disability and even death. There are two versions of the Meningitis vaccine: MPSV4 (Menomune®) and MCV4 (Menveo® and Menactra®). The MPSV4 vaccine has been studied in a few small studies and has not been shown to be harmful to the pregnancy or the developing baby, however larger studies are needed to confirm these results. The MCV4 vaccine is newer and has not been well studied in pregnancy. Since meningitis is a serious condition, if you have not received the meningitis vaccine and are starting school, they may require that you receive this vaccine, especially if you plan on living in the dorms.

Given all of this information, the caller had her school nurse call OTIS and talk to me about what they should do about giving her the meningitis vaccine. The nurse had talked to the school administration and they were confident that the requirement of having a meningitis vaccine before moving into the dorm would still apply to a woman who was pregnant. The nurse was reassured that the MPSV4 vaccine had been studied in pregnancy and decided to give the pregnant student the MPSV4 vaccine over the MCV4 vaccine. That way the student could be protected against this potential life-threatening illness in an environment that would put her at greater risk of contracting it, while making sure they were taking safety precautions given her pregnancy.

You can always call OTIS at 1-866-626-6847 or go to www.OTISPregnancy.org to get free information about vaccines in pregnancy.


Nadia Mohamedi is a teratogen information specialist and also serves as a research assistant/interviewer for OTIS studies in San Diego, CA. She holds a BA in neurobiology and a minor in psychology from Harvard College. She is currently working toward her MD at the University of California, San Diego. In addition to her work with OTIS, Nadia has worked for the Alcohol and Drug Abuse Treatment Program at McLean Hospital as well as served as a teacher’s assistant at a school for children with disabilities in Lima, Peru.

OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and lactation. Questions or concerns about medications and other exposures during pregnancy or breastfeeding can be directed to OTIS counselors at (866) 626-OTIS (6847) or online at OTISPregnancy.org.