Symptoms of Listeria all right it's time now for our weekly update with Dr Isaac bogos infectious diseases specialist at Toronto General Hospital good morning doctor we really appreciate you taking the time to speak with us once a week thank you sir my pleasure let's start with this uh recent development involving outbreaks with leria new updates suggesting a third person has died as a result of this it's very very concerning to so many people and we're reading the symptoms can last for a really long time as many as or for as long as 70 days how long or or when is it likely that the symptoms could show up here yeah so for starters we know that there's several products in Canada that had a leria that were contaminated with leria there's been a recall and a lot of communication for to the general public to that if they have any of these products that you can see up on your screen to just throw them out or if there's any concern at all that you may have one of these products you're not sure throw them out as well now the incubation period for leria can be as little as 7even days but it actually can also be much longer and measured in weeks and weeks and weeks that's an incubation period meaning you're not going to have any symptoms during that time but then people can get uh the infection after that incubation period and have symptoms of an infection the real concern here is in the extremes of age so the very oldest the very youngest uh also in pregnant women and people who are imuno compromised that's where leria can cause more invasive disease it can cause a bloodstream infection and it has a predilection for going to the brain and causing a menitis and it can be very serious readily treated with antibiotics not hard to diagnose but of course prevention is key so if you have any of those products available in your house it's best to throw them out so if What to do if you have symptoms somebody consumed one of these products that's now part of the recall and they notice some of the symptoms say even a week a two weeks up to 70 days later what should they do now if anyone's concerned that they're ill with this infection or quite frankly any other infection you've got to go chat with a health care provider and you know it's this is one of those things where most people who have a leria infection will just will get a gastroenteritis a diarrhea it's not pleasant but it's usually self-resolving on the mild to moderate end of the spectrum but for people who are on the older end of the spectrum the younger end of the spectrum immunal compromised or pregnant that it certainly can cause more severe infection including sepsis from a bloodstream infection and and menitis and of course if anyone has any symptoms or feels unwell and they've had contact with that product uh it's important to speak with a healthcare provider to let them know because this these are readily treatable um moving on to another topic we're following really closely this week uh the latest with maox we know the World Health Organization watching this closely they're having a meeting tomorrow to talk about this can we talk about how this strain has changed a little bit since the original one that was discovered in in 2022 yeah so there's uh you know for for millennium empo has been in in primarily in Africa in parts of West Africa that's called just to use the technical technical term that's clay to and then in central Africa mostly in the Democratic Republic of Congo that's Cay one and more recently they've identified a substrain of Cay one so basically an offshoot of the type of empo that was found in central Africa I think it's people are chatting about whether or not this may or may not be more severe or cause more severe illness or may be more readily transmitted I think it's fair to say that it's premature to have any conclusive statements on the virulence of this particular strain what is clear regardless uh is that it is spreading there are many more infections right now in Democratic Republic of Congo and in neighboring countries and countries in the region including uh Uganda Kenya Rwanda Burundi uh so empo is a much bigger growing a growing issue in on the African continent and of course we know from many other infections including Co including empo in 2022 that we live in a very interconnected world we saw a very large empo outbreak in Canada in 2022 and it has not gone away we still have it here and given the the outbreak Is Canada at risk situation that we are seeing in African countries is Canada at risk of seeing an outbreak here what do you think well you know we already had this outbreak in 2022 and it hasn't gone away it's grumbling along so for example as of July 13th 2024 if we're just looking at the 2024 calendar year Ontario had 102 cases of empo most of them were locally acquired not brought in from another part of the world and if you compare that to with all of 2023 we only had 33 cases so we have locally acquired empo in Ontario now of course said with with love respect uh no moralization no value judgments whatsoever but our outbreak in Ontario has predominantly been in the men who have sex with men community in fact over 96% of all of our cases in Ontario have been in men uh so you know risk is not equal and of course we've had a very large Public Health response and with leadership from the men who have sex with men Community to make sure people are aware of this infection make sure people know what the risk factors are uh lower barriers to vaccines get the vaccines out there lower barriers to treatment and huge kudos to leadership in the men who have sex with men Community for informing the community and and providing better safety to the community but again this is an issue that is grumbling along in Ontario and Canada and many places that were previously thought to not be endemic and it doesn't seem like it's going away unfortunately and you Vaccine effectiveness mentioned vaccines vaccines are available for people who would like to protect themselves against empo how do you know how effective the vaccine would be against this this changing strain so it's unclear uh with this particular strain that's a really good point and all of this is really under investigation here's what's likely the likely scenario is that these vaccines still provide pretty reasonable protection against infection and severe infection if you do have a breakthrough infection and quite frankly in Ontario you know myself and other people who work in infectious diseases primary care emergency medicine you know we do see an occasional case of empo and uh and and sometimes these individuals who are infected have been vaccinated so these are breakthrough infections but again what you're going to see is the the Breakthrough infections in a vaccinated individual are far less severe than ones than the infections that we saw for example before the vaccines were rolled out uh we saw some you know really sad cases where people were were miserable and in pain and some individuals were even hospitalized with this I think that's far less common and in fact in the um 2024 calendar year of in Ontario at least with the 102 cases that have been seen to date there have been zero hospitalizations and zero deaths with those you know obviously I think we can improve the vaccine roll out in the those who are at most risk for empo but many of those have many people have received one preferably two doses of That vaccine and it does go a long way in preventing infection but really also mitigating severity of infection if there is a breakthrough Dr Isaac bogos thank you so much for sharing your time with us this morning we certainly covered a lot so we appreciate uh everything you're able to share with our viewers my pleasure have a great day thank you you too