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MAJOR ARTICLE – Outbreak of Escherichia coli O157 Associated with Raw Milk, Connecticut, 2008

Alice Guh,1,2 Quyen Phan,2 Randall Nelson,2 Katherine Purviance,2 Elaine Milardo,4 Stacey Kinney,2 Patricia Mshar,2 Wayne Kasacek,3 and Matthew Cartter2

1Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia; 2Connecticut Department of Public Health and 3Connecticut Department of Agriculture, Hartford, and 4Farmington Valley Health District, Avon, Connecticut

Background. In Connecticut, despite hazards of raw milk consumption, attempts to ban raw milk sales have been unsuccessful. In July 2008, 2 children experienced Escherichia coli O157–associated hemolytic uremic syndrome (HUS) after consuming raw milk purchased at a retail market and a farm (farm X). We investigated to determine the outbreak source and control measures.

Methods. Confirmed cases were HUS diagnosis or E. coli O157:NM infections with isolates matching outbreak strains among patients during June to July 2008. Probable cases were diarrheal illness among farm X customers during the same period. We conducted case-control studies to determine the source of E. coli O157 exposure and assess for dose-response relation between illness and frequency of raw milk consumption. Farm X dairy practices were evaluated; stool specimens of humans and animals were cultured for E. coli O157. Staff time and laboratory and medical costs were calculated.

Screen shot 2010-11-12 at 9.55.24 AM.pngResults. We identified 14 cases (7 confirmed). Five (36%) case patients required hospitalization; 3 (21%) experienced HUS. No deaths were reported. Raw milk consumption was associated with illness (P p .008); a dose- response relation was demonstrated (Pp.01). Dairy practices reflected industry standards. E. coli O157:NM outbreak strains were isolated from stool specimens of 6 case patients and 1 milking cow. The total estimated outbreak cost was $413,402.

Conclusions. Farm X’s raw milk was the outbreak source despite no violations of current raw milk regulatory standards. This outbreak resulted in substantial costs and proposed legislation to prohibit nonfarm retail sale, strengthen advisory labels, and increase raw milk testing for pathogens.

Clinical Infectious Diseases 2010;51:000–000, 1058-4838/2010/5112-00XX, DOI: 10.1086/657304 – See also:

Raw (Unpasteurized) Milk: Are Health-Conscious Consumers Making an Unhealthy Choice?

Michele T. Jay-Russell, Western Institute for Food Safety and Security, University of California, Davis