Listeria monocytogenes (LM), the main causative agent of human listeriosis, a highly pathogenic intracellular bacterium that demonstrates the characteristics of psychrotrophic growth and flagellum-mediated motility (1). Individuals with compromised immune systems are particularly susceptible to infection (2). Elevated progesterone levels and reduced cellular immunity increase the risk of invasive LM infection during pregnancy. Pregnant women have a 10–20 times higher risk of contracting listeriosis from consuming LM-contaminated food compared to the general population (3), and more than 100 times higher risk than non-pregnant women of reproductive age (4). According to the World Health Organization (WHO), 43% of all reported listeriosis cases occur during pregnancy, with 14% occurring in the third trimester (5). LM can cross the placental barrier, leading to bacteremia in pregnant women and potentially causing severe adverse pregnancy outcomes such as miscarriage, stillbirth, and neonatal infection. From 1964 to 2010, 46 pregnancy-related listeriosis cases were documented in literature in China, while from 2010 to 2023, 482 cases were reported, with neonatal mortality rates of 46 and 27.1%, respectively (6). Despite being a notifiable disease in countries like the United States, Canada, and some EU nations, listeriosis remains non-notifiable in China. Notably, an estimated 99% of listeriosis cases in China are transmitted through food (7). The clinical presentation of listeriosis lacks specificity (8), and blood cultures are positive in only 36% of symptomatic pregnant patients (9), making diagnosis challenging and increasing the likelihood of missed or misdiagnosed cases (10, 11). Therefore, enhancing clinicians’ vigilance of listeriosis, initiating early antimicrobial coverage for LM, and promoting timely detection and treatment are crucial for preventing adverse pregnancy outcomes. Additionally, health education targeting pregnant women plays a vital role in disease prevention. The investigation aims to assess the clinical vigilance for listeriosis and evaluate pregnant women’s knowledge, attitudes, and practices (KAP) in Gansu Province, with the ultimate goal of informing and enhancing listeriosis surveillance and public prevention education. The study integrates on-site survey administration with targeted health education delivered to pregnant women after completing the questionnaire.

China launched a nationwide pilot surveillance program for listeriosis across six provinces /municipalities in 2013. Data from the National Risk Assessment Center (2013–2019) revealed 211 confirmed listeriosis cases across 64 sentinel hospitals in 11 provinces, with notable inter-provincial variation in reported case numbers. Between 2015 and 2020, Henan Province reported 71 listeriosis cases from 16 sentinel hospitals, including 38 perinatal infections (12). Research reports suggest that listeriosis in mainland China is underestimated, with perinatal cases likely being significantly higher than reported (13). Gansu Province incorporated listeriosis into its public health surveillance system in 2022. Since then, a pilot surveillance program has been implemented across five medical institutions in the province. In 2023, Qinyang People’s Hospital identified two pregnancy-associated cases, including one miscarriage and one preterm delivery. Wuwei Liangzhou Hospital reported one pregnancy-associated case involving a live birth at 27 weeks of gestation. The remaining three participating institutions did not report any pregnancy-related cases during the same period. No pregnancy-associated cases of listeriosis were detected in Gansu Province between 2024 and 2025. In certain cases, the reporting of listeriosis is contingent upon the diagnostic vigilance of clinicians. Among 207 surveyed tertiary hospital physicians in current study, only 14.98% had prior experience treating listeriosis, 26.57% were familiar with common LM-contaminated foods, 24.15% could recognize listeriosis symptoms, and 27.54% knew the appropriate treatment drugs. However, medical staff in Gansu Province demonstrated a relatively higher awareness of susceptible populations (46.86%) compared to Beijing’s foodborne disease surveillance personnel (38.78%) in 2016 (14). He et al. identified nonspecific clinical presentations, limited physician experience, and insufficient laboratory diagnostics as key factors contributing to underreporting and misdiagnosis of notifiable infectious diseases (15). Similarly, this study found that missed listeriosis diagnoses primarily resulted from lack of clinical suspicion and inadequate hospital testing capacity. Furthermore, most physicians had not received any listeriosis related training or continuing education in the past 2 years, which may contribute to underdiagnosis and underreporting of listeriosis cases in Gansu Province. Like many foodborne illnesses, Listeriosis often presents with nonspecific symptoms—vomiting, diarrhea, fever, abdominal pain—necessitating thorough clinical and epidemiological evaluation alongside laboratory confirmation (16). Overall, to effectively improve the efficiency of listeriosis surveillance in Gansu Province, it is essential to strengthen training for clinicians on listeriosis, enhance their diagnostic vigilance, and expand the current surveillance network to include more healthcare facilities. Furthermore, The standard treatment for listeriosis in humans involves β-lactams, particularly aminopenicillins like ampicillin or amoxicillin, typically combined with an aminoglycoside, most often gentamicin, to enhance the synergistic bactericidal effect (17), Notably, cephalosporins—frequently used as empirical broad-spectrum antibiotics—are ineffective against LM due to intrinsic resistance (8). Therefore, improving the vigilance of clinicians for listeriosis and ensuring adequate empirical antimicrobial coverage for LM is critically important for preventing adverse pregnancy outcomes among affected pregnant women.

This survey revealed that 23.09% of the surveyed pregnant women were aware of or had heard about listeriosis, a rate higher than that reported in Beijing (18), yet significantly lower compared to findings from countries such as the Netherlands (19, 20). The willingness of pregnant women to acquire knowledge about listeriosis and to seek timely medical attention upon experiencing symptoms indicates a positive attitude, which facilitates the implementation of health education initiatives related to listeriosis among pregnant women. LM is capable of growth and reproduction at lower refrigeration temperatures (21), suggesting that refrigeration does not completely prevent food contamination. The results indicated that over 60% of pregnant women cleaned their refrigerators no more than twice per year, particularly among those with higher educational attainment, higher household income, and those who were not primigravid. Additionally, 17.83% of the surveyed pregnant women reported consuming leftover meals from the refrigerator without adequate reheating, predominantly among those with lower household income and primigravid women. Therefore, while promoting comprehensive listeriosis related health education for all pregnant women, targeted interventions should be emphasized for these specific subgroups. Efforts should focus on encouraging regular refrigerator cleaning and maintaining hygiene to prevent prolonged neglect, which may lead to LM proliferation and subsequent contamination of food, thereby posing potential risks to human health.

Machine-made ice cream, Chinese cold dishes, and ready-to-eat cooked meat products are recognized as high-risk food items for LM contamination (22). According to national surveillance data from 2021, the detection rate of LM in ready-to-eat cooked meat products across China was 2.49% (23). In Changchun City, between 2010 and 2023, the reported detection rate of LM in commercially available cold dishes reached 9.49% (24). This study found that more than half of the participants had consumed these high-risk foods within the past 4 weeks, with a higher proportion among those with higher educational attainment and first-time pregnant women. Given the relatively low incidence of listeriosis and its non-specific clinical presentation upon infection, public awareness of LM remains limited. Therefore, implementing targeted health education initiatives focusing on pregnant women is of critical importance.

Listeriosis is a preventable foodborne illness that can be mitigated through standard food safety practices, such as separating raw and cooked foods and ensuring thorough heating of food before consumption. In this survey, over half of the participating pregnant women did not maintain separate cutting boards for raw and cooked ingredients, and some failed to practice proper hand hygiene after handling raw meat during food preparation. Given that raw meat and processed meat products are recognized as high-risk vehicles for LM contamination, adherence to basic food safety principles is essential. A systematic review conducted by Zhang et al. revealed that the prevalence of LM in livestock and poultry meat in northern China was consistently higher than in southern regions (25). The positive detection rates of LM in ice cream and Chinese cold mixed dishes in Gansu Province from 2007 to 2011 were 8.33 and 3.14%, respectively (26). In 2022, the detection rate of LM in processed meat products—such as chicken and duck meat links, chicken fillets, and restructured beef steaks—was 9.16%, while raw poultry meat showed a detection rate of 12.11%, indicated raw meat and processed meat products may be susceptible to contamination by LM. Inadequate hygiene practices, such as improper separation of raw and cooked foods or failure to wash hands after handling raw meat, may lead to cross-contamination of cooked or ready-to-eat foods, thereby increasing the risk of human infection. Therefore, cultivating good food hygiene habits is critical for the prevention of listeriosis and other foodborne diseases. Moreover, the study found that a relatively small but notable proportion of pregnant women consume at least one daily meal from roadside stalls or mobile food vendors. While such food sources offer convenience and accessibility, they often lack adequate food safety controls. As a vulnerable population group, the nutritional and health status of pregnant women significantly influences both maternal and fetal well-being. Therefore, targeted interventions to guide pregnant women in making scientifically informed food choices and selecting appropriate dining venues are essential for preventing foodborne disease occurrence.

The Knowledge-Attitude-Practice (KAP) theory describes a sequential process in which individuals acquire knowledge, develop attitudes or beliefs, and ultimately form corresponding behaviors, with a positive interrelationship among these components. This study revealed a significant positive correlation between knowledge and attitude regarding listeriosis among pregnant women; however, no significant association was observed between attitude and behavior. These findings suggest that pregnant women in Gansu Province demonstrate coherence in acquiring listeriosis related knowledge and forming preventive beliefs. Although they tend to develop favorable attitudes toward listeriosis prevention after gaining relevant knowledge, this attitudinal shift does not appear to translate into consistent preventive actions. This discrepancy may stem from a mismatch between the knowledge acquired and the specific preventive measures required for listeriosis, or from an inadequate understanding of high-risk behaviors associated with the disease. Therefore, future health education initiatives on listeriosis should emphasize clear communication of actionable preventive strategies to enhance recipients’ comprehension and promote behavior change. Additionally, our survey found that older pregnant women with higher education levels, better family incomes, and those who are further along in their pregnancies—or experiencing their first pregnancy—tend to have better knowledge, attitudes, and behaviors when it comes to listeriosis. That means while we should keep providing health education to all pregnant women, we should especially focus on younger moms-to-be, those with less education, lower income, those in their early pregnancy, and those who have been pregnant before. Guiding the population to establish good hygiene habits and abandon high-risk behaviors of listeriosis is of great significance for avoiding adverse pregnancy outcomes.

Ongoing attention will be given to the surveillance and reporting of listeriosis cases in Gansu Province.