Listeria monocytogenes contamination of ready‐to‐eat foods and the risk for human health in the EU
2018; Wiley; Volume: 16; Issue: 1 Linguagem: Inglês
10.2903/j.efsa.2018.5134
ISSN1831-4732
AutoresAntonia Ricci, Ana Allende, Declan Bolton, Marianne Chemaly, Robert Davies, Pablo Salvador Fernández Escámez, Rosina Gironés, Lieve Herman, Konstantinos Koutsoumanis, Birgit Nørrung, Lucy J. Robertson, Giuseppe Ru, Moez Sanaa, Marion Simmons, Panagiotis Skandamis, Emma Snary, Niko Speybroeck, Benno Ter Kuile, John Threlfall, Helene Wahlström, Johanna Takkinen, Martin Wagner, Davide Arcella, Maria Teresa da Silva Felício, Marios Georgiadis, Winy Messens, Roland Lindqvist,
Tópico(s)Food Safety and Hygiene
ResumoEFSA JournalVolume 16, Issue 1 e05134 Scientific OpinionOpen Access Listeria monocytogenes contamination of ready-to-eat foods and the risk for human health in the EU EFSA Panel on Biological Hazards (BIOHAZ), EFSA Panel on Biological Hazards (BIOHAZ)Search for more papers by this authorAntonia Ricci, Antonia RicciSearch for more papers by this authorAna Allende, Ana AllendeSearch for more papers by this authorDeclan Bolton, Declan BoltonSearch for more papers by this authorMarianne Chemaly, Marianne ChemalySearch for more papers by this authorRobert Davies, Robert DaviesSearch for more papers by this authorPablo Salvador Fernández Escámez, Pablo Salvador Fernández EscámezSearch for more papers by this authorRosina Girones, Rosina GironesSearch for more papers by this authorLieve Herman, Lieve HermanSearch for more papers by this authorKonstantinos Koutsoumanis, Konstantinos KoutsoumanisSearch for more papers by this authorBirgit Nørrung, Birgit NørrungSearch for more papers by this authorLucy Robertson, Lucy RobertsonSearch for more papers by this authorGiuseppe Ru, Giuseppe RuSearch for more papers by this authorMoez Sanaa, Moez SanaaSearch for more papers by this authorMarion Simmons, Marion SimmonsSearch for more papers by this authorPanagiotis Skandamis, Panagiotis SkandamisSearch for more papers by this authorEmma Snary, Emma SnarySearch for more papers by this authorNiko Speybroeck, Niko SpeybroeckSearch for more papers by this authorBenno Ter Kuile, Benno Ter KuileSearch for more papers by this authorJohn Threlfall, John ThrelfallSearch for more papers by this authorHelene Wahlström, Helene WahlströmSearch for more papers by this authorJohanna Takkinen, Johanna TakkinenSearch for more papers by this authorMartin Wagner, Martin WagnerSearch for more papers by this authorDavide Arcella, Davide ArcellaSearch for more papers by this authorMaria Teresa Da Silva Felicio, Maria Teresa Da Silva FelicioSearch for more papers by this authorMarios Georgiadis, Marios GeorgiadisSearch for more papers by this authorWiny Messens, Winy MessensSearch for more papers by this authorRoland Lindqvist, Roland LindqvistSearch for more papers by this author EFSA Panel on Biological Hazards (BIOHAZ), EFSA Panel on Biological Hazards (BIOHAZ)Search for more papers by this authorAntonia Ricci, Antonia RicciSearch for more papers by this authorAna Allende, Ana AllendeSearch for more papers by this authorDeclan Bolton, Declan BoltonSearch for more papers by this authorMarianne Chemaly, Marianne ChemalySearch for more papers by this authorRobert Davies, Robert DaviesSearch for more papers by this authorPablo Salvador Fernández Escámez, Pablo Salvador Fernández EscámezSearch for more papers by this authorRosina Girones, Rosina GironesSearch for more papers by this authorLieve Herman, Lieve HermanSearch for more papers by this authorKonstantinos Koutsoumanis, Konstantinos KoutsoumanisSearch for more papers by this authorBirgit Nørrung, Birgit NørrungSearch for more papers by this authorLucy Robertson, Lucy RobertsonSearch for more papers by this authorGiuseppe Ru, Giuseppe RuSearch for more papers by this authorMoez Sanaa, Moez SanaaSearch for more papers by this authorMarion Simmons, Marion SimmonsSearch for more papers by this authorPanagiotis Skandamis, Panagiotis SkandamisSearch for more papers by this authorEmma Snary, Emma SnarySearch for more papers by this authorNiko Speybroeck, Niko SpeybroeckSearch for more papers by this authorBenno Ter Kuile, Benno Ter KuileSearch for more papers by this authorJohn Threlfall, John ThrelfallSearch for more papers by this authorHelene Wahlström, Helene WahlströmSearch for more papers by this authorJohanna Takkinen, Johanna TakkinenSearch for more papers by this authorMartin Wagner, Martin WagnerSearch for more papers by this authorDavide Arcella, Davide ArcellaSearch for more papers by this authorMaria Teresa Da Silva Felicio, Maria Teresa Da Silva FelicioSearch for more papers by this authorMarios Georgiadis, Marios GeorgiadisSearch for more papers by this authorWiny Messens, Winy MessensSearch for more papers by this authorRoland Lindqvist, Roland LindqvistSearch for more papers by this author First published: 24 January 2018 https://doi.org/10.2903/j.efsa.2018.5134Citations: 125 Correspondence: biohaz@efsa.europa.eu Requestor: EFSA Question number: EFSA-Q-2015-00597 Panel members: Ana Allende, Declan Bolton, Marianne Chemaly, Robert Davies, Pablo Salvador Fernández Escámez, Rosina Girones, Lieve Herman, Kostas Koutsoumanis, Roland Lindqvist, Birgit Nørrung, Antonia Ricci, Lucy Robertson, Giuseppe Ru, Moez Sanaa, Marion Simmons, Panagiotis Skandamis, Emma Snary, Niko Speybroeck, Benno Ter Kuile, John Threlfall and Helene Wahlström. Acknowledgements: The Panel wishes to thank the hearing experts: Andrew Hart and Sophie Roussel for the support provided to this scientific output. The Panel also wishes to thank the consortia of the three outsourcing activities under 'Closing gaps for performing a risk assessment on L. monocytogenes in RTE foods' for their collaboration. In addition, Régis Pouillot is thanked for sharing the dose response model as described in Pouillot et al. (2015). Also the epidemiologists and microbiologists of the nominated public health contact points for listeriosis and Listeria isolates in the European Food- and Waterborne Diseases and Zoonoses network (FWD-Net) are thanked for replying to the questionnaire related to the surveillance of listeriosis. Adopted: 6 December 2017 Reproduction of the images listed below is prohibited and permission must be sought directly from the copyright holder: Figure 14: © Emerald Group Publishing Limited all rights reserved. Marklinder I and Eriksson MK, British Food Journal, 117, 6, 1764–1776. This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2018.EN-1352/full AboutSectionsPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Food safety criteria for Listeria monocytogenes in ready-to-eat (RTE) foods have been applied from 2006 onwards (Commission Regulation (EC) 2073/2005). Still, human invasive listeriosis was reported to increase over the period 2009–2013 in the European Union and European Economic Area (EU/EEA). Time series analysis for the 2008–2015 period in the EU/EEA indicated an increasing trend of the monthly notified incidence rate of confirmed human invasive listeriosis of the over 75 age groups and female age group between 25 and 44 years old (probably related to pregnancies). A conceptual model was used to identify factors in the food chain as potential drivers for L. monocytogenes contamination of RTE foods and listeriosis. Factors were related to the host (i. population size of the elderly and/or susceptible people; ii. underlying condition rate), the food (iii. L. monocytogenes prevalence in RTE food at retail; iv. L. monocytogenes concentration in RTE food at retail; v. storage conditions after retail; vi. consumption), the national surveillance systems (vii. improved surveillance), and/or the bacterium (viii. virulence). Factors considered likely to be responsible for the increasing trend in cases are the increased population size of the elderly and susceptible population except for the 25–44 female age group. For the increased incidence rates and cases, the likely factor is the increased proportion of susceptible persons in the age groups over 45 years old for both genders. Quantitative modelling suggests that more than 90% of invasive listeriosis is caused by ingestion of RTE food containing > 2,000 colony forming units (CFU)/g, and that one-third of cases are due to growth in the consumer phase. Awareness should be increased among stakeholders, especially in relation to susceptible risk groups. Innovative methodologies including whole genome sequencing (WGS) for strain identification and monitoring of trends are recommended. Summary Despite the application of the food safety criteria (FSC) for Listeria monocytogenes in ready-to-eat (RTE) foods from 2006 onwards (Commission Regulation (EC) 2073/20051), a statistically significant increasing trend of human invasive listeriosis was reported in the European Union and European Economic Area (EU/EEA) over the period 2009–2013 (EFSA and ECDC, 2015). In 2010–2011, an EU-wide baseline survey (BLS) estimated the prevalence and concentration of L. monocytogenes in RTE foods at retail: packaged (not frozen) smoked or gravad fish, packaged heat-treated meat products and soft or semi-soft cheese. The EU-level estimate of the proportion of samples with L. monocytogenes counts > 100 colony forming units (CFU) per gram at the end of shelf life was 1.7% for 'RTE fish,' 0.43% for 'RTE meat' and 0.06% for 'RTE cheese.' Therefore, the Panel on Biological Hazards of the European Food Safety Authority (EFSA) initiated a self-tasking mandate to deliver a Scientific Opinion on L. monocytogenes contamination of RTE foods and the risk for human health in the EU. The Opinion draws conclusions on the two terms of reference (ToR): (1) to summarise and critically evaluate the most recent information on L. monocytogenes in RTE foods and (2) to discuss and evaluate the factors related to contamination in the food chain and the consumption patterns that may contribute to the reported trend of listeriosis incidence rates in the EU. The focus was on the time period after the adoption of the previous Scientific Opinion of the BIOHAZ Panel at the end of 2007, i.e. 2008–2015 (EFSA BIOHAZ Panel, 2008). The steps of a common risk assessment were used to structure the evidence in response to ToR 1. For the ToR 1 in particular, the following sources were to be considered: (a) the above-mentioned BLS and the monitoring data and (b) the three EFSA outsourcing activities under 'Closing gaps for performing a risk assessment on L. monocytogenes in RTE foods,' i.e. (i) the presence of, and risk factors for, L. monocytogenes in RTE foods in the EU, (ii) the estimation of the public health risks from consumption of various RTE food categories contaminated with L. monocytogenes and (iii) the comparison of L. monocytogenes isolates from different compartments along the food chain, and in humans using whole genome sequencing (WGS). It is concluded that the overall pattern of listeriosis epidemiology has not changed since the previous Scientific Opinion. Despite an increase in confirmed invasive listeriosis cases during 2008–2015, fewer than 2,300 cases per year were reported in the EU/EEA. The notification rates of invasive listeriosis in the EU/EEA generally increased with increasing age, and were highest in the age groups over 65 years and in children below 1 year of age (i.e. mainly pregnancy-related cases). In addition to age/susceptibility, medical practices for other ailments have been associated with increased risk factors for human listeriosis, such as treatments with proton pump inhibitors (PPI). Bloodstream infections were the most commonly reported clinical forms of invasive L. monocytogenes infections (71.8% of confirmed cases), followed by meningitis (19.4% of cerebrospinal fluid samples), and the overall annual case fatality rates (CFR) ranged from 12.7 to 20.5%. There is ample evidence for a high variability regarding the virulence potential and pathogenicity of L. monocytogenes isolates. Epidemiological data combined with genetic sequencing information and results from animal models (> 6,000 isolates from clinical specimens and food items) indicate that 12 clonal complexes (CC) make up almost 80% of all isolates, and that different levels of virulence may be associated with these. Listeriosis is a food-borne illness, but CCs have been termed, according to one study, 'infection-associated,' 'food-associated' or 'intermediate' depending on the relative proportion of isolates from clinical cases, food or both. Uncertainty may be associated with this classification due to knowledge gaps about factors influencing the isolation and detectability of different strains from different matrices. 'Infection-associated' CCs are most commonly associated with central nervous system (CNS) and maternal–neonatal (MN) infections as opposed to bacteraemia alone, while 'food-associated' CCs are rarely isolated from invasive form clinical samples but, when recovered from clinical specimens, usually isolated from blood. In addition, 'food-associated' CCs are more frequently associated with highly immunocompromised patients or patients showing a higher number of severe comorbidities. Based on humanised mouse models, it appears that these predominately 'food-associated' CCs are less invasive (hypovirulent) than the 'infection-associated' CCs. However, despite the observed variability in their virulence potential, almost every L. monocytogenes strain has the ability to result in human listeriosis because of the complex interaction between the pathogen, food and host. When more data become available, e.g. on occurrence, virulence and dose response, it may be considered appropriate to carry out a risk assessment for different CCs of L. monocytogenes. As most listeriosis cases appear to be sporadic, and reported outbreaks are usually small, it is difficult to establish links between human cases and causative foods. However, it has been shown that WGS techniques, when combined with epidemiological information, have the potential to attribute relatedness among L. monocytogenes strains and thus establish stronger links between human listeriosis cases and causative foods. Results from the outsourced study to attribute human cases to different animal sources are limited, as for source attribution in general, by the representativeness of isolates from all relevant sources but also by difficulties of identifying their origin, since contamination during processing is so important. Persistence of L. monocytogenes in food processing environments is still considered to be the major source of RTE food contamination. Persistence appears to be the result both of improper hygiene conditions and the high adaptive capacity of these bacteria against physical–chemical factors, for example, biofilm-forming capacity. The RTE food categories typically associated with human listeriosis, i.e. 'meat and meat products,' 'fish and fish products,' and 'milk and milk products' continue to be of significance from a food safety perspective. In addition, food of plant-derived origin or even frozen foods have been implicated in outbreaks (e.g. cantaloupe, caramel apples, ice cream) illustrating that almost all RTE foods under certain conditions may support growth and/or that when consumed by highly susceptible people, have the potential to contribute to the burden of disease. During the period 2008–2015, reported annual non-compliance of L. monocytogenes in RTE foods at processing sites was highest in 'RTE fishery products' (3–10%), followed by 'RTE products of meat origin other than fermented sausage' (1–7%). Non-compliance in the remaining RTE food subcategories was 2% or less. The lower level of annual non-compliance at retail (below 1% for most years) than at processing is at least partly explained by the application of different limits of FSC at retail and processing. According to the BLS, as presented above, L. monocytogenes was more prevalent in 'RTE fish': 10.3% (1.7% above 100 CFU/g) than in 'RTE meat': 2.07% (0.43% above 100 CFU/g) and 'RTE cheese': 0.47% (0.06% above 100 CFU/g) at the end of their shelf life. Cooked meat and heat-treated sausages were the RTE food subcategories with most consumed servings per person and per year in the EU/EEA. Combining the BLS data with consumption data indicates that approximately 55 million servings of RTE meat and meat products contaminated with more than 100 CFU/g may be consumed per year by the population over 75 years old in the EU/EEA. It was noted that unsafe practices (including storage time and temperatures) are not uncommon within the elderly group (> 10% of persons studied), and have a potential impact on the human listeriosis risk. There is a wide variation within the broadly defined consumer groups and it is thus problematic to generalise about the food handling behaviours of these groups and in different Member States and on how this may contribute to trends of human listeriosis. In addition, the temperature of domestic refrigerators is highly variable as shown through a review of 23 available survey studies from 1991 to 2016. The mean, minimum and maximum temperatures ranged from < 5 to 8.1°C, −7.9 to 3.8°C and 11.4 to 20.7°C, respectively. The extent of different behaviours among risk groups between Member States may vary to the same extent that socioeconomic factors, traditions and types of food vary. There is uncertainty on the actual distribution in the EU because the studies were developed in a few countries only. The average probability of a single L. monocytogenes CFU to cause illness in a specific host (the r value), reflects the strain virulence and host susceptibility, and ranges three orders of magnitude, from the least (i.e. under 65 years old without underlying condition) to the most susceptible (i.e. haematological cancer) subpopulations. Reported r values for specific outbreaks with highly susceptible populations increase the range by another five orders of magnitude. This means that the probability of a single CFU to cause illness may range 100 million times depending on variability in host susceptibility and L. monocytogenes virulence. This suggests that the impact of the health status of a consumer is equally important to consider as the level of L. monocytogenes in the ingested food. A US study applying a lognormal-Poisson extension of the exponential dose–response (DR) model, incorporating the virulence and susceptibility variability for 11 population groups, suggests that most cases are. expected to be caused by highly contaminated food items (Pouillot et al., 2015b). Most risk characterisations considered three risk populations (i.e. pregnant women/perinatals, the elderly (> 60 or > 65 years old), and the intermediate population that does not belong to either of these categories) and have not addressed gender differences. This limitation can be addressed in future EU/EEA risk assessments with DR data and other input data developed at a finer resolution in recent publications and in this Scientific Opinion. Developments to improve the capability to provide realistic predictions for growth initiation and changes in levels of L. monocytogenes growth in RTE foods include validated growth models, progress on cardinal growth, probability of growth, and non-thermal inactivation models, together with data on strain variability and stochastic modelling. Based on the quantitative risk characterisation of L. monocytogenes in various RTE food categories (heat-treated meat; smoked and gravad fish; and soft and semi-soft cheese) in the EU (outsourcing activity 2), it was concluded that most of the cases were predicted to occur in the elderly population (≥ 65 years old) (48% of cases) followed by the pregnant population (41%) and the healthy population < 65 years old (11%). The attribution of cases to the pregnant population appears to be an overestimation compared to the distribution of cases during the period, where about 8% of reported cases were related to the 25–44 year female age group. The overestimation is partially a result of the scope of the risk assessment and the application of a DR model considering only these three populations. Of the foods considered, the food subcategory associated with the largest number of cases per year was cooked meat (863 cases), followed by sausage (541 cases), gravad fish (370 cases), cold-smoked fish (358 cases), pâté (158 cases), soft and semi-soft cheese (19 cases) and hot-smoked fish (7 cases). Estimated risks expressed as the median number of cases per 106 servings was in general highest for the pregnant population, followed by the elderly and last the healthy (< 65 years) population. Cases due to other food categories were not considered. To address ToR 2, for the time period 2008–2015, time series analyses (TSA) of 14,002 confirmed human invasive listeriosis cases in the EU/EEA were carried out at different levels of aggregation, i.e. aggregated by total confirmed cases, and disaggregated by 14 age–gender groups. The aggregated TSA did not show an increasing trend while trends were shown in the disaggregated analyses (by age and gender). The discrepancy is partly a consequence of the presence of changing dynamics, autocorrelation and seasonality in the aggregated analysis. For females, the incidence rate of confirmed human invasive listeriosis significantly increased for the 25–44 and ≥ 75 age groups in this time period with a monthly increase estimated at 0.64% and 0.70%, respectively. For the female age groups 45–64 and 65–74, the increasing trend was borderline significant with a monthly increase estimated at 0.43% and 0.30%, respectively. For males, the incidence rate of confirmed human invasive listeriosis cases increased significantly for the ≥ 75 age group only with a monthly increase estimated at 0.50%. In 2015, the invasive listeriosis incidence rate was higher for males than for females in the age groups over 45 years old. The opposite was true for the female age groups 15–24 and 25–44 believed to largely reflect pregnancy-related listeriosis. The highest incidence rate was seen in the ≥ 75 age group in 2015, resulting in an incidence rate of 2.20 and 1.30 cases per month per million persons for males and females, respectively. There are several sources of uncertainty, which can lead to under- or overestimation of the observed trends. Because of the limitations of the available data, the analysis and understanding of trends were carried out using age and gender as proxies for susceptible populations or pregnant women and did not include countries as a covariate. This is a limitation and means that the observed trends may hide different trends among subgroups or be true for only a subset of the age–gender–country population. Potential factors related to the human host, the food, the national surveillance systems, or the bacterium, to be addressed in ToR 2 to explain the epidemiological trend were identified via a conceptual model. The selected factors were evaluated as assessment questions (AQs) in three steps. First, an importance analysis was used to evaluate the most important factors and their potential impact on the number of predicted cases using a developed L. monocytogenes generic quantitative microbiological risk assessment (gQMRA) model. Second, the empirical evidence, i.e. the indicator data, was evaluated to investigate the support for a change in the factor during the time period. Third, an evidence synthesis of the TSA, the importance analysis, indicator data and the uncertainty analyses was made. The gQMRA model was developed to reflect a generic RTE food consumed in the EU/EEA. Contamination of the RTE food at the moment of consumption was based on consumption data, growth properties, packaging, and empirical data on initial L. monocytogenes concentrations of the considered foods 'RTE smoked and gravad fish,' 'RTE heat-treated meat' and 'RTE soft and semi-soft cheese'. The gQMRA model can be updated with additional food categories when data become available. Based on this gQMRA model, 92% of invasive listeriosis cases for all age–gender groups are attributable to doses above 105 CFU per serving. Assuming an average serving size of 50 g, this would correspond to an average L. monocytogenes concentration in RTE foods above 2,000 CFU/g at the time of consumption. Still, a smaller proportion of cases are associated with the more frequently occurring RTE foods having a higher L. monocytogenes prevalence and lower L. monocytogenes levels. The frequency of exposure (i.e. the prevalence of L. monocytogenes in RTE food) over 25 years old appears to increase with age for both genders, due to differences in consumption patterns. Based on predictions of the gQMRA model, the expected number of invasive listeriosis cases per year is reduced by 37% (from 1,523 to 953) in the absence of growth after retail (i.e. at the consumer phase). This points to the possibility to control 63% of listeriosis cases via control prior to the retail phase. Factors that may have contributed to the trends of human invasive listeriosis cases/incidence rates in the EU/EEA during 2008–2015 were classified, based on the potential impact when changing the factor according to modelling or other information, the degree of support from indicator data, and expert opinion, into probability scales as defined in the draft EFSA guidance on uncertainty (EFSA Scientific Committee, 2016). The first likely (66–90%) factor was an increased proportion of susceptible persons in age groups over 45 years for both genders. The increasing trend in the female 25–44 age group (mainly pregnancy-related) suggests that a factor other than susceptibility must have contributed since susceptibility is not expected to have changed in this population during the time period. The additional factor may be any of those evaluated and would likely contribute to the trend in all age groups but possibly to a varying degree. The second likely factor is an increased population size of the elderly and susceptible population (except in the female 25–44 age group which has decreased). This factor would only contribute to the number of invasive listeriosis cases but not the increase in incidence rates. The factors considered as likely as not (33–66%) were an increased consumption (number of servings per person) of RTE foods in the EU/EEA as there is some support in the indicator data for an increase in the consumption frequency of RTE foods, e.g. cooked RTE foods and smoked salmon, but this is based on limited data and an improved surveillance of human invasive listeriosis in the EU/EEA as there have been some changes in the surveillance systems, in particular for some countries with a relatively high level of reporting. Inconclusive factors were: (1) L. monocytogenes concentration in the three considered RTE food categories at retail; (2) L. monocytogenes prevalence in the three considered RTE food categories at retail; (3) L. monocytogenes virulence potential; (4) storage conditions (time and temperature) after retail of the three considered RTE food categories. Thus, the increasing trend of listeriosis for some population groups may potentially be attributed to numerous factors which not only include the contamination levels in food, but also other factors, such as consumption, strain virulence, health status of consumer and demographic changes. This indicates the need for continuous review of the food safety management system in EU to achieve the appropriate level of protection. Due to data limitations, the present evaluation of contributing factors was based on only three RTE categories which is a limitation of the assessment. The impact of this depends on the degree that the non-considered foods would differ in terms of prevalence, initial contamination, growth, storage, consumption, etc., to those considered. Furthermore, since the analysis is carried out at EU/EEA level, and because there are many data gaps and wide variations between countries, the outcome at EU/EEA level may not be representative for all countries. Thus, MS are encouraged to apply the gQMRA model with their specific data. Uncertainty is associated with the gQMRA model because of data and knowledge gaps. An important source of uncertainty is the DR relationship since it is dependent on the same data as used in the exposure assessment and the epidemiological data. However, the impact of uncertainty is expected to be lower for the importance analysis when the relative effects of factors were evaluated than for the absolute number predictions. Data gaps to conclude on contributing factors include representative data collected across the EU/EEA using a harmonised sampling strategy suitable for surveillance over time on: (1) prevalence and concentration of L. monocytogenes in RTE foods; (2) consumption of RTE foods; (3) prevalence of underlying conditions in different risk groups by age and gender; (4) retail and home storage temperatures and (5) L. monocytogenes virulence. It was recommended that awareness be raised among all stakeholders in the food chain, including vulnerable groups, people supplying food to vulnerable groups, caterers, RTE producers and authorities, about the potentially increasing problem of L. monocytogenes in RTE foods since the proportion of citizens in high-risk groups is expected to increase in the EU/EEA. The implementation of innovative programmes to generate data (i.e. prevalence and concentration, preferably coupled with sequencing) on L. monocytogenes in RTE foods (not only the classical food categories) that are comparable across Member States and time in the EU was also recommended; existing monitoring has other objectives and is not appropriate for evaluating trends over time. To enable a better assessment of compliance by food business operators (FBO) with the FSC for L. monocytogenes of RTE food categories according to Commission Regulation (EC) No 2073/2005, it is recommended to improve the m
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