A review of Listeria monocytogenes: An update on outbreaks, virulence, dose-response, ecology, and risk assessments

Improved control measures starting in the 1990s have greatly reduced the prevalence of L. monocytogenes in many food categories, particularly in meats and meat products. However, the rate of listeriosis has remained constant during the last decade and the more severe, systemic (invasive) form of listeriosis is now recognized as occurring more frequently in small outbreaks than previously recognized. This review addresses the recent advances in epidemiology and virulence, in growth and modelling, and insights from the risk assessments. Recognition of recent outbreaks from food vehicles not traditionally associated with L. monocytogenes (celery, cantaloupe, mung bean sprouts, stone fruits, caramel apples and ice cream) was facilitated by PFGE and, increasingly, whole genome sequencing. The Key Events framework, an understanding of the key individual biochemical steps from ingestion to infection, provides a structure for relating new knowledge on strain variability, mutations, and host susceptibility to the probability of illness. Guidance for determination of the growth/no growth potential of a food has been issued by several regulatory authorities and the risk assessments indicate that prevention of growth remains a principle control element. The recognition of biofilm formation and the possible existence of dormant, non-dividing persister cells will require additional attention. The recent outbreaks underscored the individual characteristics of specific foods (melons vs all fruit; microenvironments in the caramel apples) and raised questions about the current understanding of infectivity of lower doses and the susceptibility of specific individuals. Advances have been made in these areas, but further research is clearly necessary to control this pathogen.