Last week I posted “Two Raw Milks – one for the Pasteurizer and one in the Raw.” The idea behind the post was to recognize that several of the outbreaks linked to raw milk in the past few years were from milk that had been intended to be pasteurized – presumably from a CAFO, and therefore suspect. However, for several of the outbreaks that I have been involved in over the last years, the milk consumed by my clients came from the other milk – that is raw milk intended to be consumed that way. It did not work out too well for that milk, or my clients, either.
On July 16, 2008, the Connecticut Department of Public Health (CDPH) was investigating two cases of HUS as part of its routine surveillance. Interviews conducted in these investigations revealed that both children had consumed raw milk in the week before the onset of their illnesses. Both children had consumed raw milk produced by the Simsbury Town Farm Dairy. CDPH notified the Connecticut Department of Agriculture (CDA), and opened an investigation. In the following two weeks five additional confirmed and seven additional probable cases of E. coli O157:NM infection, each associated with consumption of raw milk from the Simsbury Town Farm Dairy.
As part of the investigation of the outbreak, CDA conducted an environmental inspection of the Simsbury Town Farm Dairy. CDA found a number of troubling practices at the dairy. These included: manual bottling of raw milk directly from the bulk tank; failure to cap valves; an improper seal around the shaft of the transport tank; and a biofilm protein residue found inside the transport tank. In addition, investigators found a number of “poor hygienic practices” at the dairy. Among these was the storage of a stainless steel milk tank in an exposed unsanitary bucket. In addition, investigators found a lack of hand soap, a lack of hot water and the hand-washing sink, and soiled floors. Flies were observed in the bulk milk storage tank room. The dairy workers were unable to identify the dairy’s sanitization process for glass milk bottles that were re-used. It was also noted that the glass bottles from the dairy did not feature the statutorily required consumer advisory language.
A laboratory study was also conducted. Of the six patients that cultured positive for E. coli O157:NM, 5 had a “genetic fingerprint” that was indistinguishable. The sixth varied very slightly on one test. Samples of feces from the cows at the dairy were also tested. One of the tests was positive for E. coli O157:NM of a strain matching that of the group of five patients. The CDPH concluded that “several findings from this investigation indicated that consumption of raw milk from Farm X [Simsbury] was the cause of the outbreak.” Three of the consumers developed HUS.
On October 2, 2008, the California Department of Public Health (CDPH) issued a report linking an outbreak of Campylobacter illnesses to unpasteurized milk from Alexandre Eco Farms Dairy. The report was the result of an investigation commenced on July 14, 2008, when Dr. Thomas Martinelli, the County Health Officer for Del Norte County, California reported four cases of laboratory confirmed Campylobacter infections and five additional cases of diarrhea in Del Norte County residents. Eight of the original nine sick individuals were members of the Alexandre Eco Farms “cow-leasing” program. Eight of these individuals had consumed milk produced on the farm. The ninth sick individual worked with cattle on the Alexandre Eco Farms Dairy. One of the eight individuals who were sick, Mari Tardiff, had already been hospitalized with GBS, following the onset of acute gastroenteritis after consumption of the milk.
As part of the investigation, health department officials retrieved a refrigerated carton of partially consumed Alexandre Eco Farms milk from Mari Tardiff’s home. Mari had consumed a portion of the milk before her illness. The specimen tested positive for Campylobacter jejuni DNA using a test called polymerase chain reaction (PCR). Testing indicated that multiple strains of Campylobacter jejuni were present in the milk. Del Norte County officials eventually identified 16 cases of Campylobacter jejuni associated with the outbreak. Fifteen of those were persons who consumed milk from Alexandre Eco Farms Dairy. The 16th case was the farm employee. CDPH and Del Norte county officials concluded that “the available epidemiologic and laboratory data support the conclusion that this cluster of acute diarrheal illness in Del Norte County was an outbreak of C. jejuni infections caused by consumption of unpasteurized milk from [Alexandre Eco Farms Dairy.]”
On May 12, 2008 the Lawrence County Health Department (LCHD) was notified of a case of HUS in a child with a history of bloody diarrhea. The health care provider reported that the child had consumed unpasteurized goat’s milk obtained from a local store, the Herb Depot, in Barry County, Missouri. The milk had been purchased on April 29, 2008. It was quickly learned that an additional Barry County child that had cultured positive for E. coli O157:H7 had also consumed unpasteurized goat’s milk from the same store. As a result, the LCHD contacted the Missouri Department of Health and Senior Services (DHSS) who began a full epidemiological and environmental investigation of the illnesses. The investigation revealed that the milk consumed by both ill children had been produced at Autumn Olive Farms.
At the conclusion of its investigation, the DHSS ultimately announced that there were four cases of E. coli O157:H7 associated with the outbreak. Of these, three were laboratory confirmed, and one was identified as a probable case. Each of these individuals resided in different counties in Southwest Missouri, and were not known to have any relation to each other. Nonetheless, each shared a common exposure to milk from Autumn Olive Farms. In addition, the three culture-confirmed cases shared a common, indistinguishable genetic strain of E. coli O157:H7. The strain was identified as a unique subtype of E. coli O157:H7, never before reported in Missouri. Each of the four cases had consumed milk from Autumn Olive Farms within 3-4 days of onset of illness. The DHSS reported: “no other plausible sources of exposure common to all four cases were identified [other than the milk.]” The final outbreak report ultimately concluded: “the epidemiological findings strongly suggest the unpasteurized goat’s milk from Farm A [Autumn Olive] was the likely source of infection for each of the cases associated with this outbreak.”
On September 18, 2006, the California Department of Health Services (CDHS) opened an investigation of a possible outbreak of E. coli O157:H7 infections after receiving reports of two patients who had been hospitalized with HUS. One was culture confirmed as infected with E. coli O157:H7. Interviews revealed that both patients had consumed unpasteurized cow milk sold by Organic Pastures in the week prior to the onset of illness.
In the following days, four additional cases of E. coli O157:H7 were identified. All of the additional cases had consumed raw milk or raw cow product sold by Organic Pastures. Isolates of the E. coli O157:H7 cultured from the five culture-positive patients had indistinguishable “genetic fingerprints” as determined by pulsed-field gel electrophoresis (PFGE) testing. These PFGE patterns were new to the national PulseNet database. In other words, the pattern associated with all of these children was unique, and had not been seen before in conjunction with any other outbreaks of E. coli O157:H7. In addition, the PFGE pattern differed markedly from the patterns associated with the outbreak of E. coli O157:H7 associated with Dole fresh-bagged baby spinach that had peaked a few weeks prior to these illnesses.
CDHS conducted an epidemiological and environmental investigation of the cluster of illnesses. A review of 50 consecutive E. coli O157:H7 cases reported to CDHS from October 2004 to June 2006 revealed that 46 of 47 cases asked about raw milk consumption reported consuming no raw milk. In contrast, five of the six patients in the cluster being investigated reported definite consumption of Organic Pastures raw dairy products. The sixth denied consuming the raw milk, but his family routinely consumed Organic Pastures raw milk during the suspected time frame. Two of the children developed Hemolytic Uremic Syndrome.
Two children became ill due to an E. coli outbreak associated with unpasteurized milk. The milk came from Grace Harbor Farms, a dairy operation in Whatcom County. Testing conducted by the Washington Department of Health confirmed the two cases were caused by the same strain of the bacteria, E. coli O157:H7. Both children drank milk from the dairy. Grace Harbor sells its products in several counties through health food stores, PCC Natural Markets and Whole Foods Market. The children are identified as a King County boy and a Snohomish County girl. The boy remains hospitalized at a Seattle hospital recovering from the E. coli infection (HUS).
“We’re very concerned, very sorry it happened,” Tim Lukens, president and general manager of Grace Harbor Farms in Lynden, said in a telephone interview. He stressed that the problem involved raw milk, not the dairy’s pasteurized milk. While he said he has not yet seen “an absolute test on our milk that shows it is the same E. coli,” he said he totally agreed with the recall.
During the week of December 5, 2005, public health officials in Clark County, Washington, were notified of four county residents with laboratory-confirmed Escherichia coli O157:H7 infection. All four residents reported having consumed raw (i.e., unpasteurized) milk obtained from a farm (Dee Creek) in neighboring Cowlitz County, Washington. The farm participated in a cow- share program, in which persons purchase interests in, or shares of, dairy cows in return for a portion of the milk produced. The farm had five dairy cows and regularly provided raw milk to shareholders. Although the sale of raw milk and cow-share agreements are illegal in certain states, they are legal in Washington; however, Washington farms that provide raw milk to consumers must be licensed, meet state milk-production and processing standards, and pass health and sanitation inspections by the state department of agriculture (1). The Cowlitz County farm was not licensed.
Eighteen cases were identified among the 43 families who were interviewed, and eight (44%) of these were laboratory confirmed. Dates of illness onset ranged from November 29 to December 13, 2005 (Figure). Patients were residents of two southwest Washington counties and one northwest Oregon county. The median age was 9 years (range: 1–47 years); nine (50%) were female. Among the 18 patients, 17 (94%) reported diarrhea, 13 (72%) bloody diarrhea, and 13 (72%) abdominal cramps. Five patients (28%), aged 1–13 years, were hospitalized; four of these had hemolytic uremic syndrome (HUS). Seventeen patients were farm shareholders or children of shareholders; one patient, a child aged 10 years, was a friend of a shareholder.
Although some in public health and many in the raw milk mooovement disagree with some of my ideas, I posted this several months ago – “What I’d Recommend: Raw vs Pasteurized Milk.” Here are the highlights:
In lieu of banning raw milk products, some states have adopted regulations that attempt to protect public health and allow for consumer choice. This is an approach I would suggest the following:
- Raw milk should be sold only on farms that are certified by the state and inspected and tested regularly. Make ambiguous black market milk/cheese sales and “pet food sales” meant for human consumption clearly illegal
- Raw milk should not be sold in grocery stores or across state lines–the risks of mass production and transportation are too great; the risk of a casual purchase by someone misunderstanding the risks is too great, as well
- Farms should be required to have insurance coverage sufficient to cover reasonable damages to their customers
- Practices such as outsourcing (buying raw milk from farms not licensed for raw milk production) should be illegal
- Colostrum should be regulated as a dairy product, not a nutritional supplement
- Warning signs on the bottles and at point-of-purchase should be mandatory. An example:
“WARNING: This product has not been pasteurized and may contain harmful bacteria (not limited to E. coli O157:H7, Campylobacter, Listeria and Salmonella). Pregnant women, infants, children, the elderly and persons with lowered resistance to disease (immune compromised) have the highest risk of harm, which includes Diarrhea, Vomiting, Fever, Dehydration, Hemolytic Uremic Syndrome, Guillain-Barre Syndrome, Reactive Arthritis, Irritable Bowel Syndrome, Miscarriage, or Death, from use of this product.”
One or two raw milks? I am not sure. I do know that people get sick, and my concern, and the concern of people in public health, is to prevent that. For more information on raw milk, visit www.realrawmilkfacts.com.