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Listeria caused the highest proportion of hospitalizations and deaths of any foodborne illness across the EU in 2024, according to a new report by the European Food Safety Authority (EFSA).
The report recorded 3041 cases in 2024. Of these, 72% were hospitalized and 8% died. Case numbers have risen significantly since 2020.
“After a drop in 2020 linked to the COVID-19 pandemic, case numbers returned to pre-pandemic levels by 2022 and have continued to rise each year since. By 2024, both the number of cases and the notification rate reached the highest levels since 2007,” Áine Collins, PhD, expert in foodborne, vector-borne, and zoonotic diseases at the European Centre for Disease Prevention and Control (ECDC), told Medscape News Europe.
Listeria monocytogenes, which causes listeriosis, is a foodborne organism and a common veterinary pathogen. It is considered one of the most serious foodborne diseases under EU surveillance because of its high rates of hospitalization and substantial morbidity and mortality. Infection is uncommon in the general population, but pregnant women, neonates, older adults, and immunocompromised individuals are at higher risk.
Belgium, Denmark, Germany, and Italy recorded the highest number of outbreaks, ranging from five to eight each in 2024. The top food vehicles included vegetables and juices, mixed foods, and fish and fish products.
Analyses of more than 350,000 samples from across the region revealed that fermented sausages of meat origin were the ready-to-eat foods most likely to test positive for L monocytogenes, at a rate of 6.6%. In comparison, 2.9% of fish, 2.2% of meat products other than fermented sausages, and 1.6% of hard cheeses tested positive.
Why Are Infections Rising?
“Europe’s ageing population — 21.6% of the European population is over 65 — is one factor that may contribute to higher numbers of reported cases,” Mirko Rossi, DVM, PhD, veterinarian and microbiologist at EFSA, told Medscape News Europe.
In 2024, 301 deaths were attributed to listeriosis across the EU, more than 81% of which occurred in people older than 65 years, the report noted.
Matthias Marschal, MD, of the Institute of Medical Microbiology and Hygiene at Tübingen University Hospital, Tübingen, Germany, noted that advances in modern medicine mean people are living longer, but more patients are now immunosuppressed than in the past, increasing their risk for invasive infection.
Rossi added that changing dietary habits in vulnerable populations may also play a role, especially in relation to higher consumption of ready-to-eat foods.
“These foods, if contaminated, are not safe, as there is no cooking process that eliminates the bacteria,” he said.
Improved surveillance is likely another factor. The report noted that all member states now have comprehensive surveillance systems for listeriosis that cover the whole population, with the exception of Belgium, where estimated coverage of the surveillance system is 80%.
“The increased use of whole-genome sequencing improved the sensitivity of surveillance, enhancing the ability to detect outbreaks,” explained Rossi, adding that while the report shows increased incidence, it remains unknown whether the rise is directly linked to trends in food contamination.
What are the symptoms?
- Symptoms resemble a gastrointestinal illness, with nausea, vomiting, mild fever, and diarrhea.
- Bacteremia and meningitis are more serious manifestations that can affect high-risk individuals.
- Unless recognized and treated, infections can lead to significant morbidity and mortality.
Diagnosis:
- Blood cultures should be performed. They are positive in 60%-75% of patients with central nervous system infections.
- Cerebrospinal fluid cultures can also be done but are positive less frequently than blood cultures.
- Rapid testing with monoclonal antibodies can detect the bacteria.
- Synovial fluid should be cultured in cases of septic arthritis.
- Serologic testing is not reliable.
What’s Happening on the Ground?
Rises in listeriosis have also not been uniform across the EU. Marschal said that despite EU-wide increases in listeria infection, cases have remained relatively “rare” at Tübingen University Hospital. Still, cases there increased from zero in 2020 to four in 2023 and seven in 2025. The small numbers, he said, do not allow for statistically robust analyses.
A spokesperson from the Austrian Agency for Health and Food Safety told Medscape News Europe that Austria has not seen a clear upward trend; case numbers typically fluctuate between 30 and 50 per year. However, almost all cases are hospitalized, and, out of 44 lab-confirmed cases in 2024, 27% died within 28 days of diagnosis.
The ECDC spokesperson told Medscape News Europe that, “among cases of invasive listeriosis, hospitalization and mortality patterns have remained largely stable over the past 5 years, with nearly all cases requiring hospital care and deaths occurring predominantly among older adults.”
What Can Be Done?
Marschal stressed that education about listeriosis and its prevention is necessary for high-risk patient groups. He added that clinicians should consider listeriosis early and take blood cultures promptly if patients at risk present with compatible symptoms such as fever.
Collins said that at the policy level, strong surveillance systems and food safety standards, alongside support for prevention measures across the food chain, are critical. Clinicians also play a role by reporting confirmed cases quickly.
“It is difficult to predict future numbers with certainty, but if these underlying drivers continue, cases could remain high or increase further. However, strong surveillance, strict food safety controls all along the food supply chain, and clear advice to vulnerable groups about avoiding high‑risk foods can help prevent infections. So trends in the coming years will also depend on how effectively these measures are implemented and maintained,” Collins emphasized.
Collins, Rossi, and Marschal reported having no relevant financial relationships.
Annie Lennon is a medical journalist. Her writing appears on Medscape Medical News, WebMD, and Medical News Today, among other outlets.
