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.
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?
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.
I have been following this tragic tale since right after Christmas in a series of three posts (
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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).
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