Raw is risky and a drain on public health

A protracted outbreak of Escherichia coli O157:H7 infections was caused by consumption of unpasteurized (“raw”) milk sold at Oregon grocery stores. Although it never caused a noticeable increase in reported infections, the outbreak was recognized because of routine follow-up interviews.

Six of 16 Portland-area cases reported between December 1992 and April 1993 involved people who drank raw milk from dairy A. By pulsed-field gel electrophoresis (PFGE), E. coli O157:H7 isolates from these cases and from the dairy A herd were homologous (initially, 4 of 132 animals were E. coliO157:H7-positive).

Despite public warnings, new labeling requirements, and increased monitoring of dairy A, retail sales and dairy-associated infections continued until June 1994 (a total of 14 primary cases). Seven distinguishable PFGE patterns in 3 homology groups were identified among patient and dairy herd E. coli O157:H7 isolates. Without restrictions on distribution, E. coli O157:H7 outbreaks caused by raw milk consumption can continue indefinitely, with infections occurring intermittently and unpredictably.

A prolonged outbreak of Escherichia coli O157:H7 infections caused by commercially distributed raw milk

1.sep.2017

The Journal of Infectious Diseases

Keene et al.

https://academic.oup.com/jid/article/176/3/815/872141

Raw camel milk in US

Whenever someone writes, “frozen in Kansas” I think, that could have been me.

Ice storms and stuff.

And being a professor.

Making lots of money, going with the flow, and checking my brain at the door – on the few days I showed up.

So I decided to support my wife – although I’ve been a bit of a dick about it for the last 6 years – and move to Australia, eventually ending my career.

Although I do have a new job with the least amount of responsibility possible.

I’m having my American Beauty moment (but not chasing after younger girls, quite happy, and she noted it’s been 12 years since we first met).

So when raw milk advocate David Gumpert writes about raw camel milk and how the U.S. Food and Drug is asking the federal court to allow it to seize more than $70,000 worth of raw camel milk, some of it frozen, in storage in Kansas, and there’s some government conspiracy, I cast aspersions.

The agency had warned the owner of a small Missouri farm, which accounts for the bulk of raw camel milk production in the U.S., — of course it is in Missouri — to refrain from shipping it outside that state. The owner had reportedly agreed to the FDA’s order.

Now, a number of media are reporting that the FDA is asking a federal court to allow it to seize raw camel milk from the farm, known as Hump-Back Dairys, along with that of a national distributor of camel milk, Desert Farms.

Waste of time. Move on.Keep moving on.

Fancy food ain’t safe food: UK E. coli cheesemaker edition

Jane Bradley of the Scotsman reports an artisan cheesemaker which is embroiled in a court case with food hygiene authorities after being forced to withdraw its products amid an outbreak of E.coli which killed a three year old girl, has been named one of Britain’s top cheese producers in an industry awards ceremony.

Errington Cheeses, which is awaiting a court date against South Lanarkshire Council, which ordered the manufacturer to stop production of its raw milk cheeses amid an investigation following the outbreak of the food poisoning bug last summer, was given runner up in the Best Artisan Producer category at the Great British Cheese Awards. The Lanarkshire-based business also came runner up in the category of Best Blue Cheese for its Lanark Blue cheese, at the awards at Marcus Wareing’s Gilbert Scott restaurant in London, hosted by food website Great British Chefs.

The company is currently only making one type of cheese – made from ewe’s milk – pending its court case against South Lanarkshire Council. Owner Humphrey Errington, who launched the firm in 1985, has insisted that his cheese is not the source of the food poisoning outbreak – which saw 19 people hospitalised – and has claimed that the authorities, including Food Standards Scotland, are trying to curb production of raw milk cheese. A Just Giving campaign launched to help Errington cover its legal costs, raised £34,000 from supporters. Twitter user Artisan Food wrote: “Chefs vote of confidence @ErringtonCheese Resilience in face of harassment/bias/ignorance.” In March, an official report from Health Protection Scotland into the E.coli outbreak claimed that Errington’s Dunsyre Blue was the source of the bacteria.

3 with HUS linked to raw milk on Isle of Wight

Isle of Wight, known to most Western kids as the home of a groovy rock and jazz festival, is now home to three people have a potentially fatal kidney condition following an outbreak of E. coli which has been linked to unpasteurised milk from a farm.

Three Isle of Wight patients are being treated in hospital for hemolytic uremic syndrome, a complication of E. coli that can lead to kidney failure.

Another four people affected by the bacteria have made a good recovery, Public Health England said.

The source has been traced to Briddlesford Lodge Farm near Newport.

Dr Ishani Kar-Purkayastha from Public Health England said the raw milk had been removed from sale.

“We are asking anyone who has raw milk purchased from Briddlesford Farm on, or before Monday, 25 September 2017, to either return it to the farm or dispose of it,” he said.

In a statement, the farm said: “We are especially concerned about the well-being of those affected by this bug, and we wish them and their families every good fortune at this terrible time.”

The outbreak has been identified as the E. coli 0157 strain, which caused the death of a three-year-old child in Scotland in 2016.

 

Wash. raw milk dairy flips off FDA, says Salmonella isn’t reason for recall:

Cathy Siegner of Food Dive reports that the owners of Pride & Joy Creamery in Granger, Washington declined to voluntarily recall products produced between September 13-28, despite the Washington State Department of Agriculture finding salmonella bacteria in a raw milk sample from Sept. 18.

On Sept. 28, the department issued a public health notice advising people not to consume the dairy’s products.

The owners wrote in their Facebook post that they had contacted distribution points and asked them to pull any milk with an Oct. 4 date for a full credit. They also said they would be producing their organic, grass-fed milk as usual while continuing to investigate the situation.

Pride and Joy shut down for three months this past spring after issuing a voluntary recall. The state said two people who reported drinking the dairy’s products had contracted salmonellosis, although no definite link was established. The state also reported finding E. coli in samples from the dairy, which the owners disputed. During the shutdown, the owners said remediation measures were implemented at the facility to reduce the chance of contamination.

 

Raw milk sucks and is stupid: New Zealand edition

Batches of a brand of raw milk that is delivered in parts of the South Island is being recalled because it might contain Listeria monocytogenes.

The Government’s food safety regulator, the Ministry of Primary Industries, has issued the recall notice on Sept. 1, which applies to certain batches of Go Farming Ltd’s raw – unpasteurised – drinking milk.

The affected products are one litre bottles in baches 32, 33 and 34, with use-by markings of August 18, 20 and 21.

The ministry said the milk is sold online and is collected at the farm or delivered in the Southland and Queenstown regions.

Not Paradise: Brucellosis linked to raw milk consumption in Texas

The Texas Department of State Health Services reports in the course of diagnosing the cause of fever, muscle and joint pain, and fatigue in a Texas resident, blood culture results revealed that the patient was infected with Brucella. Through investigation by DSHS, the most probable source of the infection was determined to be raw cow’s milk which the person had been consuming. The source of the milk was K-Bar Dairy, a licensed raw milk dairy in Paradise, Texas.

DSHS is concerned that other people who consumed raw milk from K-Bar Dairy may also have been exposed to Brucella and became infected. Brucellosis may cause short-term and long-term disease. Without specific testing, this disease may elude correct diagnosis, and without appropriate antibiotic therapy, illness may persist.

Health care providers should consider Brucellosis among differential diagnoses when a patient presents with a clinically-compatible constellation of signs and symptoms. The patient should be asked about risk factors for Brucellosis. A key question affecting the level of suspicion of Brucellosis in this scenario is the patient’s consumption of raw milk or raw milk products from K-Bar Dairy in Paradise Texas in Wise County since June 1, 2017. These individuals are considered to be at high risk of contracting brucellosis. Consumers are advised not to consume any raw milk or raw milk products from K-Bar Dairy that are still in their possession and to discard it.

At this time, it is uncertain how long Brucella may have been present in the raw milk from this dairy. Testing is ongoing in an attempt to answer that question. If a patient seeks consultation because they consumed raw milk or raw milk products from this dairy between January and June, 2017 they should be advised to be watchful for signs of chronic Brucellosis and clinically evaluated as appropriate.

4 sick with campy linked to raw milk served at Royal Welsh Show

In 2013, at least 50 people, mainly children, became ill with E coli O157 at the Ekka, Queensland, Australia’s version of the state fair.

It starts again on Friday, and because organizers have done little except to encourage people to wash their hands, we won’t be going.

Handwashing is never enough.

Manure from ruminants is easily aerosolized in these environments, and I’ve been to many human-animal interaction events for research, and there is shit everywhere.

Although ostensibly designed to promote understanding of food production, these agricultural celebrations rarely discuss risk – until an outbreak happens.

The motto seems to be: It’d be better for us if you don’t understand.

Now, four people have been sickened with Campylobacter linked to unpasteurised or raw cow’s milk from Penlan y Môr farm near New Quay, Ceredigion and sold at the Royal Welsh Show.

Public Health Wales says the four cases all consumed or bought the milk at Aberystwyth Farmer’s Market after June 1.

But visitors to the Royal Welsh Show in Builth Wells may also have sampled or bought the milk which was available there on Wednesday, 26 July.

A table of animal-human-interaction outbreaks is available at http://www.barfblog.com/wp-content/uploads/2017/08/Petting-Zoo-Outbreaks-Table-7-26-17.xlsx

Erdozain G, Kukanich K, Chapman B, Powell D. 2012. Observation of public health risk behaviours, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011. Zoonoses Public Health. 2012 Jul 30. doi: 10.1111/j.1863-2378.2012.01531.x. [Epub ahead of print]

Observation of public health risk behaviors, risk communication and hand hygiene at Kansas and Missouri petting zoos – 2010-2011Outbreaks of human illness have been linked to visiting settings with animal contact throughout developed countries. This paper details an observational study of hand hygiene tool availability and recommendations; frequency of risky behavior; and, handwashing attempts by visitors in Kansas (9) and Missouri (4), U.S., petting zoos. Handwashing signs and hand hygiene stations were available at the exit of animal-contact areas in 10/13 and 8/13 petting zoos respectively. Risky behaviors were observed being performed at all petting zoos by at least one visitor. Frequently observed behaviors were: children (10/13 petting zoos) and adults (9/13 petting zoos) touching hands to face within animal-contact areas; animals licking children’s and adults’ hands (7/13 and 4/13 petting zoos, respectively); and children and adults drinking within animal-contact areas (5/13 petting zoos each). Of 574 visitors observed for hand hygiene when exiting animal-contact areas, 37% (n=214) of individuals attempted some type of hand hygiene, with male adults, female adults, and children attempting at similar rates (32%, 40%, and 37% respectively). Visitors were 4.8x more likely to wash their hands when a staff member was present within or at the exit to the animal-contact area (136/231, 59%) than when no staff member was present (78/343, 23%; p<0.001, OR=4.863, 95% C.I.=3.380-6.998). Visitors at zoos with a fence as a partial barrier to human-animal contact were 2.3x more likely to wash their hands (188/460, 40.9%) than visitors allowed to enter the animals’ yard for contact (26/114, 22.8%; p<0.001, OR= 2.339, 95% CI= 1.454-3.763). Inconsistencies existed in tool availability, signage, and supervision of animal-contact. Risk communication was poor, with few petting zoos outlining risks associated with animal-contact, or providing recommendations for precautions to be taken to reduce these risks.

Best practices for planning events encouraging human-animal interactions

Zoonoses and Public Health

G. Erdozain , K. KuKanich , B. Chapman  and D. Powell

http://onlinelibrary.wiley.com/doi/10.1111/zph.12117/abstract?deniedAccess

Educational events encouraging human–animal interaction include the risk of zoonotic disease transmission. It is estimated that 14% of all disease in the US caused by Campylobacter spp., Cryptosporidium spp., Shiga toxin-producing Escherichia coli (STEC) O157, non-O157 STECs, Listeria monocytogenes, nontyphoidal Salmonella enterica and Yersinia enterocolitica were attributable to animal contact. This article reviews best practices for organizing events where human–animal interactions are encouraged, with the objective of lowering the risk of zoonotic disease transmission.

The Australian Institute of Food Safety identifies five high risk food items for poisoning

In the UK each year roughly 20,000 people are hospitalised with food poisoning and 500 people die.
Symptoms are unpleasant and include vomiting, diarrhoea and a high temperature, according to the NHS.
There are a number of causes, including chemicals, toxins and bacteria.
While it’s almost always an accident, food poisoning tends to affect people after they’ve eaten particular foods.
According to the Australian Institute of Food Safety, this is because certain foods are more at risk of bacterial growth than others.
Poultry
Raw and undercooked poultry can be contaminated with campylobacter bacteria and salmonella.
According to the Australian Institute of Food Safety, the bacteria can survive up until cooking kills them – so make sure you cook it thoroughly and don’t contaminate surfaces with raw chicken.

Cook poultry to an internal temperature of 74C (165F) to ensure safety, forget the jargon “cook thoroughly,”doesn’t tell me anything.

Eggs
Last week it was revealed that Dutch eggs contaminated with insecticide may have entered the UK.
They can also sometimes be contaminated with salmonella.
You can avoid being affected by cooking eggs thoroughly, and avoiding foods that purposely contain undercooked eggs, like mayonnaises and salad dressings, according to the Australian Institute of Food Safety.

Leafy greens
Because they are often eaten raw with no cooking process, bacteria like E.coli can easily affect you.
However, according to the Australian Institute of Food Safety, washing them can reduce risk of harmful bacteria as well as chemical pesticides.

Well this all depends if the salad is pre-washed and labelled accordingly, if so, washing lettuce at home will only increase the risk of cross-contamination. Reducing the food safety risk with leafy greens begins well before it arrives in your home.

Raw milk
This is where milk is unpasteurised, meaning it has not been heated up to kill harmful bacteria.
It leaves you at a higher risk than regular milk of consuming bacteria like E.coli, salmonella and listeria.

Raw milk has always left an impression on me ever since I was a food tech in Alberta. The health department submitted a sample of raw milk from a community in Alberta where a significant number of kids became ill. I was responsible in analyzing the milk to determine the etiologic agent and I remember vividly looking at this black, overgrown agar plate, completely taken over by Campylobacter jejuni, poor kids.

Cheese
A bacteria commonly found in cheese is staphylococcus aureus.
It’s heat resistant, so the best way of avoiding cheese becoming contaminated is to store it at or under 5 degrees.

 

Going public fail: 14 sick with E. coli linked to raw milk in Virginia, 2016

The general public didn’t have access to the suspect food, so there was no point in unnecessarily alarming the public.

I’ve heard that paternalistic crap for 30 years now, and it never turns out well.

Coral Beach of Food Safety News reports that Virginia officials did not alert the general public to an E. coli outbreak in March 2016 that sickened at least 14 people — a dozen of them children.

This week, 17 months after the outbreak, public health officials expect to complete their report on the incident, according to a spokesman for the Virginia Department of Health. The implicated milk was from Golden Valley Guernseys (free samples delivered for $4) dairy, which sent a letter to members of its herd-share operation alerting them to the illnesses at the time.

Of the 14 confirmed E. coli victims, half had symptoms so severe that they required hospitalization. Three developed hemolytic uremic syndrome.

The state health department’s Rappahannock-Rapidan Health District office did not make a public announcement about the outbreak at the time because the general public did not have access to the milk, District Director Dr. Wade Kartchner told Food Safety News.

“Consideration was given to putting out a broad public notice, but the nature of the herd-share programs are such that we were confident that we would be able to effectively reach those who were truly at risk of illness,” Kartchner said. “… it is not quite the same situation as a restaurant outbreak where the public at large may be exposed.”

This is so wrong.

Others, even mere mortals, learn from outbreaks: How did this happen? How dangerous was the outbreak? And what kind of foods to avoid, like raw fucking milk.

In the absence of public announcements, it also makes it harder for mere scientists to make a case that a certain food may be risky.

Going public is the new normal for foodborne outbreaks, and some day, admin-types may catch up.

Facebook, tweets, calls to lawyers like Marler, going public is any agency’s best defense.

And it’s the right thing to do.

We’ve published about this before, and as I said at the time, I’ve had different versions of this paper running through my head for 25 years.

It started as a rebel-without-a-clue teenager, and led to questions about mad cow disease in 1995 (or earlier) when the UK government knew there were human victims but said nothing until March 1996.

Yet the job of public health, no matter how many political assholes, no matter how many impediments, and no matter how many dog bites you have to investigate, is to protect public health.

If people are barfing, it’s time to go public.

That doesn’t always happen.

Anyone can search barfblog.com under the phrase “going public” and find hundreds of incidents of people acting like shits.

But this is important shit, because credibility depends on transparency and trust and truthiness (at least in my idyllic world-view).

Public health is under siege.

The science is there, the outbreaks are there. Go public.

Or at least explain the process so the rest of us can understand.

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.