E. coli Raw Milk Strikes Again - Report from Connecticut Department of Agriculture

On July 16th, 2008 the Connecticut Department of Agriculture began an investigation of a possible link between several reported illnesses and the consumption of Retail Raw Milk (unpasteurized milk).  Recently we concluded that investigation. The investigation was prompted when the Department was notified by Connecticut Department of Public Health (DPH) Epidemiologists of 2 reported illnesses in which both patients had consumed Retail Raw Milk from a dairy licensed to produce Retail Raw Milk and pasteurized milk and milk products. The patients were aged 2 and 7, one was on dialysis. After notifying the dairy of the investigation, the dairy voluntarily stopped sale of all milk. Soon after the initial 2 reported illnesses, DPH reported 2 additional cases linked to the dairy. By the time we concluded our investigation a total of 7 known individuals were sickened from consuming Retail Raw Milk and several were hospitalized. The Retail Raw Milk implicated in this incident was purchased from 2 separate national, natural food, chain store locations and directly from the farm. None of the reported illnesses were linked to pasteurized milk and milk products produced at this dairy.

The individuals sickened had acquired a condition known as Hemolytic Uremic Syndrome (HUS) and one case of Thrombotic Thrombocytopenic Purpura (TTP). HUS is a disorder that occurs when an infection in the digestive system produces toxic substances that destroy red blood cells. It often effects the kidneys. This disorder is most common in children. It often occurs after a gastrointestinal (enteric) infection, often caused by a type of Escherichia coli (E. coli) bacteria, O157:H7.  Unpasteurized (Raw) milk has been associated with several outbreaks of E. coli O157:H7 infections in the U.S. Other outbreaks of E. coli O157:H7 have been associated with undercooked or raw hamburger (ground beef), unpasteurized fruit juices, alfalfa sprouts, dry-cured salami, lettuce, game meats and from transmission from animals to humans from contact with infected animals. HUS also can be caused by other enteric infections, including Shigella and Salmonella, and some non-enteric infections. Patients with TTP have clinical and pathologic features similar to patients with HUS.

In addition to Department of Agriculture staff, the investigation involved the Connecticut Department of Public Health and local health departments. After extensive testing of milk, milk contact surfaces, water sources, the environment in and around the farm and processing plant and, analysis of feces from each milking aged animal, the department obtained a genetic fingerprint match between E. coli O157:H7 recovered from the feces of 1 cow and E. coli O157:H7 isolated from 3 patients.

Approximately 170 separate samples and specimens of milk, water, feces and swabs of milk contact surfaces were analyzed by the DPH Public Health Laboratory in a 3 week period. A review of scientific literature reveals that E. coli O157:H7 as well as other food borne pathogens most likely are introduced into milk by contamination from animals shedding the organism in their feces. Direct introduction of pathogens into the milk from the bloodstream is unlikely but can not be ruled out. The department has concluded that the most likely cause of this food borne illness outbreak was the consumption of Retail Raw Milk contaminated with E. coli O157:H7. While good sanitation and management practices can lower the incidence of pathogens in raw milk we believe and studies support the position that pasteurization is the only proven way to eliminate pathogens from raw milk.

The Connecticut Department of Public Health and the Food and Drug Administration, and other public health authorities such as the American Medical Association, the American Academy of Pediatrics, the National Conference on Interstate Milk Shipments, the National Association of State Departments of Agriculture, the Association of Food and Drug Officials, and National Association of State Public Health Veterinarians all oppose the consumption of unpasteurized milk because of the health risks.

4 People Dead After Drinking Listeria-Laden Pasteurized Milk From Massachusetts

Three elderly men have died and at least one pregnant woman has miscarried since last June after drinking listeria-contaminated pasteurized milk from Whittier Farms in Shrewsbury, Massachusetts. At least two others have been sickened as well. According to the Massachusetts Department of Health, tests have found no problems with the pasteurization process at the Whittier Farms plant, so investigators have turned their attention to the cooling and bottling machinery. So, the question really becomes where in the process did the milk become contaminated? Assuming that it really was not a problem in under-pasteurization, where, after heating, was the listeria bacteria introduced?

The families of victims of this outbreak have recently contacted us. One of the questions asked is how listeria survived pasteurization or how it was contaminated after pasteurization. Historically, there have been bacteria outbreaks tied to pasteurized milk, but the outbreaks seem tied to under-pasteurization or post-pasteurization contamination.

Date - Location - Species - Cases

1966 - Florida - Shigella flexneri - 97

1975 - Louisiana - Salmonella Newport - 49

1976 - New York - Y. enterocolitica - 38

1978 - Arizona - S. Typhimurium - 23

1979 - UK - Campylobacter jejuni - 3,500

1982 - Tenn., Ark., Miss. - Y. enterocolitica - 172

1983 - Massachusetts - Listeria monocytogenes - 49

1984 - Kentucky - S. Typhimurium - 16

1985 - Illinois - S. Typhimurium - >150,000

1986 - Vermont - Campylobacter jejuni - 35

1992 - UK - Campylobacter jejuni - 23

1992 - UK - Campylobacter sp. - 110

1994 - Illinois - L. monocytogenes - 45

1995 - UK - Campylobacter sp. - 12

1995 - Vermont, New Hampshire - Y. enterocolitica - 10

1999 - UK - E. coli O157:H7 - 114

2000 - Pennsylvania, New Jersey - S. Typhimurium - 93

2004 - Denmark - E. coli O157:H7 - 25

2005 - Colorado - Campylobacter jejuni - 40

2006 - California - Campylobacter jejuni - 1,644

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

Whittier Recalls Listeria Laden Milk

I have been following this tragic tale since right after Christmas in a series of three posts (1, 2, 3). I was somewhat surprised when Linda Bock of the Worcester Telegram wrote in yesterdays paper that Whittier Farms “voluntarily” stopped production of milk after it had learned that two men over 70 had died, one 87 year old man was still hospitalized and one young woman lost her baby. One wonders how “voluntary” the recall really was? Listeria monocytogenes is a very nasty bug in milk - it clearly can be deadly.

Cornell University, speaking specifically about milk, reported that Listeria monocytogenes can be found in soil and water and has been isolated from a large number of environmental sources. Listeria monocytogenes is destroyed by pasteurization, but if food products are contaminated after pasteurization, Listeria monocytogenes, can grow at refrigerator temperatures.

According to the FDA, Listeria typically causes illness in pregnant adults, newborns, the elderly, and patients with compromised immune systems, but healthy adults and children may also become infected. Symptoms of Listeriosis include flu-like symptoms, fever, muscle aches, stiff neck, headache, septicemia, meningitis, miscarriage, stillbirth, premature delivery, abortion, or death. The CDC reports that in the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die. Unfortunatley, is doubtful that fetal deaths are counted in that number.

In June of 2006 researchers at the University of California at Berkeley published disturbing data on “Listeriosis's path to miscarriage traced to placental infection.” Their research showed that the bacteria may invade the placenta, where - protected from the body's immune system - they proliferate rapidly before pouring out to infect organs such as the liver and spleen. The illness they cause often results in miscarriage or infection of the fetus.

Listeria infections in the elderly are also common and can be deadly as well. Not surprisingly, inflammation and atrophy of the gastric mucosa escalates with age. Because stomach acids play an important role in limiting the number of bacteria that enter the small intestine, the low gastric acidity common in the elderly, especially those with gastric ulcer disease, increases the likelihood of infection when bacteria is ingested in food or drink. In addition, underlying (co-morbid) conditions contribute to the morbidity and mortality of infection in the elderly. These conditions make the elderly susceptible to certain complications of an infectious diarrheal illness like electrolyte imbalance, dehydration, and shock. And, finally, as people age the immune system is compromised. It leads to an inappropriate, inefficient, and sometimes detrimental immune response, and its effect on health often manifests most apparently during intense stress (e.g., surgery, sepsis, multiple organ failure, malnutrition, dehydration).

More News on Massachusetts Listeria Deaths Related to Whittier Farms' Pasteurized Milk.

According to press reports this morning, the pasteurization process at Whittier Farms, the central Massachusetts dairy connected to a deadly outbreak of a bacterial illness, appears to be working properly. Dr. Alfred DeMaria, the state director of communicable disease control, said that could mean the listeria bacteria that sickened four people, killing 2 adults and an unborn child in Massachusetts, entered Whittier Farms' milk supply after it was pasteurized. DeMaria said the Massachusetts outbreak is believed to be just the third ever in pasteurized milk in the United States.

Three seemed low to me, so I spent a few hours today surfing the web looking for other outbreaks of bacterial or viral illnesses that have been tied to pasteurized milk or milk products. What I was able to find from other sources and a CDC chart summarizing Pasteurized Milk Outbreaks by State and pathogen - 1966 – 2000. I did not find any other outbreaks tied to pasteurized milk or milk products (although lots from unpasteurized).  So, if anyone has some, I will add them to the chart.

What is evident from the below chart (and reading the literature on each outbreak) is that in each instance the cause of the outbreak was either inadequate pasteurization, post-pasteurization contamination or unknown. So, I suppose in some ways these are all really unpasteurized milk outbreaks?

Date -  Location   -   Species   -   Cases

1966 - Florida - Shigella flexneri - 97

1975 - Louisiana - Salmonella Newport - 49

1976 - New York - Y. enterocolitica - 38

1978 - Arizona - S. Typhimurium - 23

1979 - UK - Campylobacter jejuni - 3,500

1982 - Tenn., Ark., Miss. - Y. enterocolitica - 172

1983 - Massachusetts - Listeria monocytogenes - 49

1984 - Kentucky - S. Typhimurium - 16

1985 - Illinois - S. Typhimurium - >150,000

1986 - Vermont - Campylobacter jejuni - 35

1992 - UK - Campylobacter jejuni - 23

1992 - UK - Campylobacter sp. - 110

1994 - Illinois - L. monocytogenes - 45

1995 - UK - Campylobacter sp. - 12

1995 - Vermont, New Hampshire - Y. enterocolitica - 10

1999 - UK - E. coli O157:H7 - 114

2000 - Pennsylvania, New Jersey - S. Typhimurium - 93

2004 - Denmark - E. coli O157:H7 - 25

2005 - Colorado - Campylobacter jejuni - 40

2006 - California - Campylobacter jejuni - 1,644


Foodsnark sent me this interestingly, disturbing find:

Fatal Bacteria May Have Survived Pasteurization
from the Los Angeles Times from 1985:
The bacteria found in Mexican-style cheese and linked to 31 deaths in Southern California possess an unusual ability to live as parasites inside the white blood cells of animals and humans where they may be protected from the heat of the pasteurization process, scientists at the federal Centers for Disease Control believe.
Mycobacterium avium Subspecies paratuberculosis has been shown to survive in retail milk that had been pasteurized in the United Kingdom and the United States and shows that humans are being exposed to this chronic enteric pathogen by this route. There appears, however, to be insufficient scientific evidence to prove a link between Johne’s disease (or MAP) in animals and Crohn’s disease in humans.
Any more articles on bacteria and viruses surviving pasteurization?

Two dead from Listeria from Whittier Farms milk contamination in Shrewsbury, Massachusetts

According to the Milford Daily News, the Massachusetts Department of Public Health (DPH) issued a warning today warning consumers not to drink any milk products from Whittier Farms in Shrewsbury because of listeria bacteria contamination, which has contributed to the death of two people. Four cases of listeriosis infection have been identified by DPH, according to a statement released by the state department late this afternoon. The cases occurred in June, October and two in November. The four cases involved three elderly residents and a pregnant woman from Worcester County. Two of the people have died. They have not been identified. DNA fingerprinting conducted by the State Laboratory Institute showed that the bacteria causing these infections came from a common source. Samples collected showed product contamination.

According the its website:
Whittier Farms is located in the historic and picturesque town of Sutton, Massachusetts. The farm is presently owned and operated by the fourth and fifth generation of the Whittier Family. The farm consists of two locations, which oversee each other from the tops of two hills with rolling fields nestled between them, depicting a true New England countryside.
Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.