Raw is risky: ‘Not aware this was remotely possible’ Father of toddlers critically sickened by E. coli linked to raw milk in Tenn.

I started the Food Safety Network (the original FSN) as an incoming graduate student in 1993 in the wake of the Jack-in-the-Box outbreak, combining my science and journalism learnings, and because a constant refrain I observed was, I never knew foodborne illness could be so serious.

That’s why I continue to do it as a form of community service (I haven’t been paid since 2016).

There are now at least 15 children sick with E. coli in Tennessee that has now been linked to consumption of raw milk from French Broad Farm.

According to Kristi L Nelson of Knox News, Jordan and Stephanie Schiding wanted to give their children every health advantage.

That’s the reason the Schidings, two months ago, signed up for a local cow-share program after they read about the health benefits of unpasteurized milk.

Instead, 18-month-old Genevieve and 3-year-old Anthony contracted an illness caused by E. coli bacteria and ended up with kidney failure in the pediatric intensive care unit at East Tennessee Children’s Hospital — two of 12 local children hospitalized with E. coli since the end of May.

Knox County Health Department staff told the Schidings the E. coli infection was likely linked to the consumption of raw milk from French Broad Farm. On Thursday, the health department lifted its directive that requested French Broad Farm temporarily cease operations. But health department Director Dr. Martha Buchanan reiterated that consuming raw milk is always risky and health officials recommend the public consume only pasteurized milk and dairy products.

Jordan Schiding said he and his wife knew there was “potential” for food poisoning from unpasteurized milk, which both adults drank with seemingly no serious effects, but “we were definitely not aware that anything like this was remotely possible.”

The Schiding children seem to have turned a corner, he said, with Anthony discharged Friday afternoon and Genevieve still hospitalized but out of intensive care.

But what started as a supposed stomach bug May 31 turned into a terrifying experience that traumatized both the children and their parents, who had to watch them suffer.

Schiding said the family brought Genevieve to the emergency room at Children’s Hospital May 31 after she became seriously dehydrated with diarrhea and vomiting. As she was being admitted, Anthony also began vomiting.

The hospital rehydrated the children and discharged them a few hours later. Schiding believes they were among the first children related to the current cluster of E. coli cases to come to Children’s Hospital.

Two days later, after both children continued to get sicker, the Schidings brought them back to the hospital. This time, hospital staff took a stool sample from Genevieve, which tested positive for E. coli, and then from Anthony, who also tested positive. Both children were admitted, and Knox County Health Department contacted the couple the next day, he said.

The Schidings knew little about E. coli; certain strains produce a toxin, Shiga, that can cause a chain of reactions in the body — hemolytic uremic syndrome — resulting in clots in the small blood vessels in the kidneys that cause kidney failure. The very young, the very old and people whose immune systems are already compromised are more susceptible to HUS.

Four children admitted to Children’s so far have had HUS, including Genevieve and Anthony. Though Anthony wasn’t quite as sick as his sister, both had surgery to implant central lines so they could get fluids, dialysis and blood transfusions, Schiding said. Anthony had three days of dialysis, Genevieve seven.

In addition, Anthony’s central lines became infected with staph, Schiding said, but the antibiotics typically prescribed to treat staph are too hard on the kidneys to give a child with HUS, so doctors had to use a less common medication, which has seemed to work.

“Obviously, we were freaked out a little bit,” Schiding said. “It seemed like he had started turning the corner” until he spiked a fever of 104.9 and tested positive for staph.

Schiding said his family no longer will consume raw milk.

Raw is risky: Netherlands study finds STEC and Campylobacter in dairy goats and dairy sheep, shows importance of pasteurization

Researchers with the Dutch National Institute for Public Health and the Environment (RIVM) and the Dutch Food and Consumer Product Safety Authority (NVWA) shows that two types of bacteria that can cause diarrhea in humans ( STEC and Campylobacter) are common in dairy goat farms and dairy sheep farms, according to a RIVM press release (computer translated).

According to Outbreak News Today, in the animal study, 181 dairy goat farms and 24 dairy sheep farms were examined. STEC (Shiga-toxin-producing E. coli) and Campylobacter was found on most. STEC appeared on virtually all the farms studied. Campylobacter has been demonstrated in one out of three goat farms (33 percent) and almost all sheep farms (96 percent). These bacteria have found much less among cattle farmers and family members.

Listeria was less common, at about 9 percent of the goat and about 17 percent of the sheep farms. The bacteria was not found in the people studied. People run the risk of becoming infected with the listeria bacteria by eating raw milk soft cheese. The study also looked at Salmonella and ESBL-producing bacteria. These were not very common on the farms surveyed.

The results show that pasteurization of milk and hygiene after visiting a dairy goat farm or dairy sheep farm is important to prevent disease.

The bacteria found are in the intestines of the animals and thus enter the manure. A small amount of manure can contaminate raw milk or raw milk cheese. Contamination can be prevented by drinking only pasteurized milk or using it in other foods. In addition, people at a farm can become infected if they have contact with the animals or their environment. Visitors can reduce the risk of illness by washing their hands after contact with the animals or their environment.

In unrelated but related news, Brandon Macz of the Monroe Monitor reports that St. John Creamery in Monroe, Washington, announced on Thursday it is voluntarily recalling raw goat milk that may be contaminated with Escherichia coli (E.coli) bacteria.

A June 14 news release states the recall was initiated after “the presence of toxin-producing E.coli in retail raw goal milk dated 6/17” was discovered during routine sampling by the Washington State Department of Agriculture.

Included in the recall are half-gallon and one-pint containers of raw goat milk marked best by June 17-21.

‘Close to 10 children hospitalized for E. coli’ in Tennessee: raw milk, farm animals may be sources

Kristi Nelson of Knox News reports East Tennessee Children’s Hospital said Tuesday it’s treated “close to 10” children, all younger than 4, for a “serious outbreak” of E. coli-caused illness over the past 10 days. 

The Knox County Health Department has confirmed two likely sources of the outbreak are unpasteurized milk and farm animals.

Most of the ill children are known to have consumed raw milk from a local cow-share dairy, French Broad Farm in Knox County, the health department said in an alert issued Tuesday evening. The health department recommends consumers dispose of all raw milk or other unpasteurized products they may have from this farm.

“People need to be aware that if they choose to drink raw milk, they’re taking a risk,” said Dr. Martha Buchanan, health department director.

The health department is also investigating whether any of the affected children were exposed to E. coli after interacting with farm animals at a local child care facility. The facility, which officials declined to name, is not currently operating, Buchanan said.

Four of the children are in the Pediatric Intensive Care Unit with kidney failure, said the hospital’s chief medical officer, Dr. Joe Childs, who is director of the PICU. There have been no fatalities related to the outbreak, hospital staff said, but life-threatening infections can occur when the strain of E. coli releases a toxin, shiga, that harms small blood vessels, of which the kidneys have many. Childs said the damage to the blood vessels is usually “temporary,” but children can get very ill, require surgery to place catheters, and may have nonfunctioning kidneys for weeks. 

“We are concerned that some of these cases do have exposure to the consumption of raw milk,” or milk sold unpasteurized, Childs said. “Tennessee is a state where that’s legal, to obtain raw milk. … The FDA and the American Academy of Pediatrics strongly discourage the consumption of raw milk and raw milk products because there’s a lot of things that can be in milk and there’s no real good way to decontaminate it other than pasteurizing it.” 

We let our kids explore the world, they get raw milk and barf

Following a school ski-trip to Austria from 10-18/02/2017, nine of 25 participants of the group from Lower Saxony (Germany) developed gastroenteritis. The students and teachers (17-41 years) shared meals in a hotel. Active case finding revealed further cases among German school groups from North Rhine-Westphalia and Schleswig-Holstein, staying at the same hotel in February 2017.

We conducted two retrospective cohort studies using self-administered questionnaires on clinical symptoms and food consumption. We defined a case as a trip participant in February 2017, staying at the aforementioned hotel and developing diarrhoea, vomiting or abdominal pain during or within ten days after the trip and/or who had a stool sample tested positive for STEC within four weeks after the trip. During the outbreak investigation, Austrian authorities detected that unlabeled raw cow milk delivered by a dairy farm had been offered at the hotel for breakfast during January and February 2017. Stool samples of participants, samples of milk served in the hotel and fecal samples of various animals kept at the milk-delivering farm were examined by culture and polymerase chain reaction. STEC isolates were typed using Pulsed-field Gel Electrophoresis (PFGE) and Whole-Genome Sequencing (WGS).

All 25 participants from Lower Saxony completed the questionnaire on symptoms and milk consumption; 14 were cases (56%). Thirteen of 20 participants who had consumed cold milk fell ill (risk ratio (RR): 3.25; 95%-confidence interval (CI): 0.55-19.32). Of 159 trip participants from North Rhine-Westphalia, 81 completed the questionnaire (51%), 25 were cases (31%); RR for cold milk was 2.11 (CI: 0.89-5.03). The combined RR for cold milk in both groups was 2.49 (CI: 1.16-5.35). Shiga toxin 1a-gene and eaeA-gene positive STEC O103:H2 were detected in nine of 32 patients’ stool samples and in two of 18 dairy farm cattle. Nine isolates from human stool samples and two isolates from cattle fecal samples yielded the same strain with an almost identical PFGE-pattern and WGS-profile.

Microbiological and epidemiological evidence identified raw cow milk as the vehicle. Results may have been compromised by misclassification of cases due to a recall bias and mild symptoms. As a result of this outbreak investigation, the Austrian authorities enforced Austrian law in the hotel, to provide milk only when pasteurized. We recommend re-emphasizing the risk of raw milk consumption to providers.

Shiga toxin-producing Escherichia coli O103:H2 outbreak in Germany after school trip to Austria due to raw cow milk, 2017-The important role of international collaboration for outbreak investigations, 29 May 2018

International Journal of Medical Microbiology

Maren Myliusabc, , Johannes Dreesmana, Matthias PulzaGerhard Pallaschd, Konrad Beyrera, Katja ClaußenaFranz AllerbergereAngelika FruthfChristina LangfRita PragerfAntje FliegerfSabine SchlagereDaniela KalhöfergElke Mertensa

https://doi.org/10.1016/j.ijmm.2018.05.005

https://www.sciencedirect.com/science/article/pii/S1438422118301905

1 child dead, 14 sick from E. coli O26 in French ‘Our regions have talent’ raw milk cheese

Outbreak News Today reports on a statement from the French abouthe Escherichia coli ( E. coli ) O26 outbreak linked to the consumption of raw milk reblochons produced at the Cruseilles (Haute-Savoie) site of Chabert. French health officials are now reporting 14 children aged one to five years included in the investigation.

As of May 31, 6 children with HUS were infected with the same strain of E. coli O26, for which the consumption or reblochon incriminated is documented. These six children are domiciled in several regions of metropolitan France (Center-Val de Loire, PACA, Ile-de-France, Auverhne-Rhone-Aples, Pays-de-la-Loire); and for 8 other children, investigations are in progress. Of these, two had signs of gastroenteritis and six had HUS. One of the children with HUS died; the investigation around this case is in progress. To date, it cannot be dismissed or affirmed that these cases of HUS are linked to the consumption of reblochon: non-isolated and characterized strain, or consumption of reblochon incriminated not yet documented.

Going public, Salmonella-in-French-cheese-style: Morbier and Mont d’Or cheese behind 10 deaths in France, 2015-16

In a country where reporting foodborne illness is deemed unpatriotic an investigation by France Inter radio revealed that at least 10 people died in the Franche-Comté region in the east of France linked to two cheeses made from unpasteurized milk  in late 2015 and early 2016.

The investigation produced a document which showed that in January 2016 national health authorities had discovered an unusually high number of salmonella contaminations in France that was centred on Franche-Comté.

Five cheese making companies in the region, between them making 60 different brands, were later identified as being at the source of the contaminations that began in November 2015 and continued until April the following year.

In a way that is truly French in its description, those who died in the outbreak were old people who were physically weak or who suffered from another illness.

Jean-Yves Mano, the president of the CLCV consumer association, said he was surprised that a product recall had not been ordered of products that might have been infected with salmonella.

“We do not understand why a general alert was not issued by state officials, or at least information given on what precautions to take,” he told France Inter.

The state food agency, the Direction générale de l’alimentation (DGAL), said there were two reasons why a recall was not ordered.

The first was that it would have allegedly been very difficult to identify which exact brand of the cheeses were contaminated because there were a total of 60 that were produced in the cheese-making firms where the outbreak originated.

The second was that by the time the authorities found out where the outbreak had come from, the contaminated cheeses had already been consumed and the new batches in the cheesemakers’ premises were not infected.

“It is perhaps due to these two factors that this contamination was not in the media, even though all the data was public nothing was hidden,” said Fany Molin of the DGAL food agency.

That’s French-bureau-speak.

Go public: Further illnesses may be prevented; others learn; citizens may not come with torches demanding change; and it’s the right thing to do.

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

Raw is risky: Brucellosis from unpasteurized milk in Texas

In July 2017, the Texas Department of State Health Services (DSHS) Region 2/3 office reported a human case of brucellosis associated with the consumption of raw (unpasteurized) cow’s milk purchased from a dairy in Paradise, Texas. CDC’s Bacterial Special Pathogens Branch (BSPB) confirmed the isolate as Brucella abortus vaccine strain RB51 (RB51).

Brucellosis is a zoonotic bacterial disease that affects humans and many animal species. In humans, the disease is characterized by fever and nonspecific influenza-like symptoms that frequently include myalgia, arthralgia, and night sweats. Without appropriate treatment, brucellosis can become chronic, and life-threatening complications can arise. Human brucellosis transmitted by cattle was once common in the United States. Control strategies have focused on elimination of brucellosis through vaccination and surveillance of cattle herds, in addition to milk pasteurization. Because of these measures, domestically acquired human cases are now rare (1).

RB51, a live-attenuated vaccine used to prevent B. abortus infection in cattle, has been documented to cause human disease, most commonly through occupational exposures such as needle sticks (2). Importantly, unlike wild strains of B. abortus, RB51 does not stimulate an antibody response detectable by routine serological assays, requiring culture for confirmation. Additionally, RB51 is resistant to rifampin, a common treatment choice for human brucellosis (2,3). This case represents the first documented instance of human brucellosis caused by RB51 through consumption of raw milk acquired in the United States.

Following isolation of RB51 from the patient’s blood, bulk milk tank samples from the farm tested positive for RB51 by polymerase chain reaction and bacterial culture. Culture of individual milk samples from all 43 cows in the herd identified two RB51 culture-positive cows. Subsequent whole genome sequencing indicated genetic relatedness between the cow and human isolate.

In Texas, farm sales of raw milk products to the public are legal with a “Grade ‘A’ Raw for Retail” license, regulated by the DSHS Milk and Dairy Group. By the end of August, through correspondence with the dairy, DSHS had identified approximately 800 persons who might have visited the farm during June 1–August 7. On September 1, Texas DSHS and BSPB began notification calls to these households, recommending that all exposed persons (i.e., those who consumed raw milk products from the farm during June 1–August 7) seek medical attention and begin 3 weeks of postexposure prophylaxis, even if asymptomatic (4).

Contact information was available for 582 households. The notification was issued successfully to 397 (68.2%) households. Among these notified households, 324 (81.6%) identified at least one exposed household member. Contacted persons referred 34 additional potentially exposed households, including households from seven other states.* A nationwide press release and Health Alert Network Health Advisory were issued in September to facilitate further identification of exposed persons (5).

To date, there are no other confirmed cases associated with this investigation. CDC and Texas DSHS continue measures to increase awareness among health care providers and the public regarding unique challenges associated with treatment and diagnosis of RB51 in humans and the risks of consuming raw milk.

Notes from the Field: Brucella abortus vaccine strain RB51 infection and exposures associated with raw milk consumption

09.mar.18

CDC

Caitlin Cossaboom

https://www.cdc.gov/mmwr/volumes/67/wr/mm6709a4.htm?s_cid=mm6709a4_w

60 days don’t mean shit: 1 dead, 28 sick from E. coli O157:H7 in raw milk cheese, Canada, 2013

Between 12 July and 29 September 2013, 29 individuals in five Canadian provinces became ill following infection with the same strain of Escherichia coli O157:H7 as defined by molecular typing results. Five case patients were hospitalized, and one died.

Twenty-six case patients (90%) reported eating Gouda cheese originating from a dairy plant in British Columbia. All of the 22 case patients with sufficient product details available reported consuming Gouda cheese made with raw milk; this cheese had been produced between March and July 2013 and was aged for a minimum of 60 days. The outbreak strain was isolated from the implicated Gouda cheese, including one core sample obtained from an intact cheese wheel 83 days after production.

The findings indicate that raw milk was the primary source of the E. coli O157:H7, which persisted through production and the minimum 60-day aging period. This outbreak is the third caused by E. coli O157:H7 traced to Gouda cheese made with raw milk in North America.

These findings provide further evidence that a 60-day ripening period cannot ensure die-off of pathogens that might be present in raw milk Gouda cheese after production and have triggered an evaluation of processing conditions, physicochemical parameters, and options to mitigate the risk of E. coli O157:H7 infection associated with raw milk Gouda cheese produced in Canada.

Outbreak of Escherichia coli O157:H7 infections linked to aged raw milk gouda cheese, Canada, 2013

Andrea Currie, Eleni Galanis, Pedro Chacon, Regan Murray, Lynn Wilcott, Paul Kirkby, Lance Honish, Kristyn Franklin, Jeff Farber, Rob Parker, Sion Shyng, Davendra Sharma, Lorelee Tschetter, Linda Hoang, Linda Chui, Ana Pacagnella, Julie Wong, Jane Pritchard, Ashley Kerr, Marsha Taylor, Victor Mah, and James Flint

Journal of Food Protection, vol. 81, No. 2, 2018, pg. 325-331

doi:10.4315/0362-028X.JFP-17-283

https://www.ncbi.nlm.nih.gov/pubmed/29369688

Raw is risky: 17 sick with Campylobacter from raw milk in Colorado, 2016

In August 2016, a local public health agency (LPHA) notified the Colorado Department of Public Health and Environment (CDPHE) of two culture-confirmed cases of Campylobacter infection among persons who consumed raw (unpasteurized) milk from the same herdshare dairy.

In Colorado, the sale of raw milk is illegal; however, herdshare programs, in which a member can purchase a share of a herd of cows or goats, are legal and are not regulated by state or local authorities. In coordination with LPHAs, CDPHE conducted an outbreak investigation that identified 12 confirmed and five probable cases of Campylobacter jejuni infection. Pulsed-field gel electrophoresis (PFGE) patterns for the 10 cases with available isolates were identical using the enzyme Sma. In addition, two milk samples (one from the dairy and one obtained from an ill shareholder) also tested positive for the outbreak strain. Five C. jejuni isolates sent to CDC for antimicrobial susceptibility testing were resistant to ciprofloxacin, tetracycline, and nalidixic acid (1).

Although shareholders were notified of the outbreak and cautioned against drinking the milk on multiple occasions, milk distribution was not discontinued. Although its distribution is legal through herdshare programs, drinking raw milk is inherently risky (2). The role of public health in implementing control measures associated with a product that is known to be unsafe remains undefined.

Investigation and Results

On August 23, 2016, El Paso County Public Health notified CDPHE of two culture-confirmed cases of C. jejuni infection; campylobacteriosis is a reportable disease in Colorado. Both patients reported drinking unpasteurized milk from the same herdshare dairy in Pueblo County. Since 2005, obtaining raw milk by joining a herdshare program has been legal for Colorado residents, but selling raw milk is illegal. By purchasing a share of a herd (cows or goats), shareholders are entitled to a portion of the raw milk.

Because the prevalence of consuming unpasteurized milk is low (2.4% in Colorado, 2006–2007 FoodNet Population Survey; 3.1%, 2009 Colorado Behavioral Risk Factor Surveillance System), two cases of enteric illness with a common exposure to raw milk are unlikely to occur by chance (3,4). In this outbreak, a confirmed case was defined as diarrheal illness with onset on or after August 1, 2016, in a person with known consumption of unpasteurized milk from the same herdshare dairy and culture-confirmed C. jejuni infection. A probable case was defined as diarrhea onset on or after August 1, lasting 1 or more days, in a person with either known consumption of milk from the same herdshare dairy or with an epidemiologic link to a confirmed case.

Cases were identified through routine passive reporting with follow-up interviews, a Health Alert Network broadcast to area providers, and attempts to contact all shareholders. A public health order was issued to obtain a list of shareholders with their contact information after it was not provided by the dairy within 5 days of the initial request. CDPHE attempted to contact shareholders to inform them about the outbreak and assess possible illness. Up to three calls were made to each shareholder household. Epidemiologists contacted laboratories to request that isolates from potential outbreak-associated cases be forwarded to the state public health laboratory.

Among 91 (53%) of 171 shareholder households that responded to requests for follow-up interviews, representing 207 persons in five or more Colorado counties, 12 confirmed and five probable cases were identified (Figure). Among confirmed cases, patients ranged in age from 12 to 68 years (median = 58 years); nine were male. Duration of illness ranged from 3 to >10 days. One hospitalization occurred; there were no deaths. In addition to diarrhea, among the 12 confirmed cases, the majority of patients also experienced fever (10), abdominal pain or cramps (eight), headache (eight), and myalgia (seven); vomiting and bloody diarrhea were reported less frequently (in five and four persons, respectively).

Four milk samples were tested for C. jejuni; pathogen identification and PFGE were performed on available isolates from persons epidemiologically linked to the outbreak. C. jejuni with one of two outbreak PFGE patterns (PulseNet DBRS16.0008 using the enzyme Sma and PulseNet DBRK02.1272 or DBRK02.0028 using the enzyme Kpn) was confirmed in 10 isolates that were available at the public health laboratory and two of the four raw milk samples. The National Antimicrobial Resistance Monitoring System performed antimicrobial susceptibility tests on five representative isolates; all were resistant to ciprofloxacin, tetracycline, and nalidixic acid (1).

Public health responses to this outbreak consisted of notifying shareholders about the outbreak on three occasions and requiring the dairy to provide additional written notification about the outbreak at milk distribution points. A press release was issued by two LPHAs in response to detecting at least one infection in a person who was not a shareholder but was given milk by shareholders. In addition, a number of shareholders reported sharing milk with nonshareholders who might have been unaware of the outbreak. Although milk sample results were positive for C. jejuni, CDPHE did not close the dairy or stop distribution of its milk because without pasteurization CDPHE could not create standards for safely reopening the dairy (5). Shareholders were, however, urged to discard raw milk distributed since August 1 and were reminded that Colorado statute prohibits redistribution of raw milk.

Discussion

Raw milk from a herdshare dairy was the source of this outbreak of C. jejuni infections, and the investigation highlighted the difficulties inherent in addressing an outbreak related to unpasteurized milk from a herdshare dairy. During three previous herdshare-associated outbreaks in Colorado, public health authorities temporarily took action to stop milk distribution until a series of negative tests were obtained from the milk (Alicia Cronquist, CDPHE, personal communication, December 2017). However, because CDPHE could not ensure that unpasteurized milk would be safe in the future, the decision was made not to close the dairy during this outbreak. In addition, CDPHE’s Division of Environmental Health and Sustainability chose not to make formal recommendations on the dairy’s processes because no protocol improvements short of pasteurization could ensure the product’s safety, even with improved sanitation (5).

All tested isolates’ resistance to three antibiotics was concerning, particularly as fluoroquinolones are frequently used to treat Campylobacter infections in those cases where treatment is indicated. Treatment of antibiotic-resistant Campylobacter infections might be more difficult, of longer duration, and possibly lead to more severe illness than treatment of nonresistant Campylobacter infections (6–8). In 2015, approximately 25.3% of U.S. C. jejuni isolates were resistant to ciprofloxacin, an increase from 21.6% a decade earlier (1).

In collaboration with LPHAs, CDPHE is creating guidelines to address future outbreaks related to raw milk from herdshares. As more states legalize the sale or other distribution of unpasteurized milk, the number of associated outbreaks will likely increase (9,10). The role of public health in responding to raw milk–related outbreaks should be further defined. State-level guidelines might assist with this process.

 

Corresponding author: Alexis Burakoff, aburakoff@cdc.gov, 303-692-2745.

1Epidemic Intelligence Service, Division of Scientific Education and Professional Development, CDC; 2Colorado Department of Public Health and Environment, Denver, Colorado; 3Pueblo City-County Health Department, Pueblo, Colorado; 4El Paso County Public Health, Colorado Springs, Colorado; 5Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC.

References

CDC. National Antimicrobial Resistance Monitoring System for Enteric Bacteria (NARMS): human isolates surveillance report for 2015 (final report). Atlanta, Georgia: US Department of Health and Human Services, CDC; 2018.

CDC. Food safety: raw milk. Atlanta, GA: US Department of Health and Human Services, CDC; 2016. https://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html

CDC. Foodborne diseases active surveillance network (FoodNet) population survey atlas of exposures, 2006–2007. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. https://www.cdc.gov/foodnet/PDFs/FNExpAtl03022011.pdf

Colorado Department of Public Health and Environment. Colorado Behavioral Risk Factor Surveillance System, 2009. [Data on raw milk]. Denver, CO: Colorado Department of Public Health and Environment; 2009. http://www.chd.dphe.state.co.us/Resources/brfss/BRFSS2009results_raw%20milk.pdf

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Outbreak of Fluoroquinolone-Resistant Campylobacter jejuni Infections Associated with Raw Milk Consumption from a Herdshare Dairy — Colorado, 2016

Morbidity and Mortality Weekly Report; February 9, 2018; 67(5);146–148

Alexis Burakoff, MD; Kerri Brown, MSPH; Joyce Knutsen; Christina Hopewell; Shannon Rowe, MPH; Christy Bennett; Alicia Cronquist, MPH

https://www.cdc.gov/mmwr/volumes/67/wr/mm6705a2.htm