Brucellosis and raw milk, again

In December 2018, the Pennsylvania Department of Agriculture (PDA) and Pennsylvania Department of Health (PADOH) were notified of a New York patient with brucellosis caused by infection with Brucella abortus RB51, the live attenuated vaccine strain of B. abortus used to prevent brucellosis in cattle (1). Brucellosis is a serious zoonotic infection caused by the bacteria Brucella spp. The most common sign is fever, followed by osteoarticular symptoms, sweating, and constitutional symptoms (2). Without proper treatment, infection can become chronic and potentially life-threatening (2).

The patient had consumed raw (unpasteurized) milk from dairy A in Pennsylvania.* In July 2017, Texas health officials documented the first human case of domestically acquired RB51 infection associated with raw milk consumption from a Texas dairy (3). In October 2017, a second RB51 case associated with raw milk consumption was documented in New Jersey; the milk source was not identified at the time.

To determine the RB51 source for the New York case, PDA conducted an environmental investigation at dairy A in December 2018. PDA collected individual milk samples from all cows, excluding those known not to have been vaccinated against B. abortus, and from the bulk milk tank, which included milk pooled from all cows. All milk samples underwent polymerase chain reaction (PCR) testing and culture; whole-genome sequencing (WGS) was performed on patient and milk sample isolates. PDA conducted a traceback investigation of any cow with a milk sample that tested positive for RB51. PADOH worked with the raw milk cooperative that distributed dairy A’s milk to notify potentially exposed consumers and distributed notifications through Epi-X§ to identify cases.

Dairy A sold only raw milk and did not provide RB51 vaccination to cows born there (16 of the 30-cow herd). The remaining 14 cows were born outside the dairy and had inadequate vaccination records to determine whether they had received RB51. Because these cows might have been vaccinated, milk samples were collected from them. RB51 was detected by PCR and isolated in milk samples collected from the bulk tank and a single cow (cow 122). WGS identified two distinct RB51 strains shed by cow 122: one matched the 2018 New York patient’s isolate (3 single nucleotide polymorphisms [SNPs] different) and one, unexpectedly, matched the 2017 New Jersey patient’s isolate (1 SNP different). The two different RB51 strains were also shed from different quarters of cow 122’s udder.

Traceback revealed that cow 122 had received RB51 in 2011 and was purchased by dairy A in 2016. During 2016–2018, dairy A distributed raw milk potentially contaminated with RB51 to 19 states; PADOH notified those states’ public health veterinarians. PADOH provided a letter with RB51 information and brucellosis prophylaxis recommendations to the cooperative, which they distributed to dairy A customers. No additional cases were identified. Cow 122 was excluded from milk production, and serial PCR testing of bulk milk samples were subsequently negative for RB51.

Isolation of two different RB51 strains from different quarters of a cow’s udder has not previously been reported. These infections highlight the need to prevent RB51 infections. Raw milk consumption is also associated with serious illnesses caused by other pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella spp. (4). During 2007–2012, the number of raw milk outbreaks in the United States increased; 66 (81%) of 81 reported outbreaks occurred in states where raw milk sale is legal (5). Pregnant women, children, older adults, and persons with immunocompromising conditions are at greatest risk for infection.

To eliminate infection risk from milkborne pathogens, including RB51, all milk should be pasteurized. Because limited information is available about intermittent or continuous RB51 shedding among dairy cows, more research is needed to more fully understand this emerging public health threat for milk consumers. States can also consider the United States Animal Health Associations’ recommendations regarding the need for RB51 vaccination in areas where B. abortus is not endemic in wildlife.

Notes from the field: Brucella abortus RB51 infections associated with consumption of raw milk from Pennsylvania—2017 and 2018, 17 April 2020

Morbidity and Mortality Weekly Report

Joann F. Gruber, PhD1,2; Alexandra Newman, DVM3; Christina Egan, PhD3; Colin Campbell, DVM4; Kristin Garafalo, MPH4; David R. Wolfgang, VMD5; Andre Weltman, MD2; Kelly E. Kline, MPH2; Sharon M. Watkins, PhD2; Suelee Robbe-Austerman, DVM, PhD6; Christine Quance6; Tyler Thacker, PhD6; Grishma Kharod, MPH1; Maria E. Negron, DVM, PhD1; Betsy Schroeder, DVM2

https://www.cdc.gov/mmwr/volumes/69/wr/mm6915a4.htm

More Tragically Hip, with fellow Kingston, Ontario (that’s in Canada) native Dan Aykroyd blowing the harp.

Brucellosis linked with raw milk

In December 2018, the Pennsylvania Department of Agriculture (PDA) and Pennsylvania Department of Health (PADOH) were notified of a New York patient with brucellosis caused by infection with Brucella abortus RB51, the live attenuated vaccine strain of B. abortus used to prevent brucellosis in cattle (1). Brucellosis is a serious zoonotic infection caused by the bacteria Brucella spp. The most common sign is fever, followed by osteoarticular symptoms, sweating, and constitutional symptoms (2). Without proper treatment, infection can become chronic and potentially life-threatening (2). The patient had consumed raw (unpasteurized) milk from dairy A in Pennsylvania.*

In July 2017, Texas health officials documented the first human case of domestically acquired RB51 infection associated with raw milk consumption from a Texas dairy (3). In October 2017, a second RB51 case associated with raw milk consumption was documented in New Jersey; the milk source was not identified at the time.

To determine the RB51 source for the New York case, PDA conducted an environmental investigation at dairy A in December 2018. PDA collected individual milk samples from all cows, excluding those known not to have been vaccinated against B. abortus, and from the bulk milk tank, which included milk pooled from all cows. All milk samples underwent polymerase chain reaction (PCR) testing and culture; whole-genome sequencing (WGS) was performed on patient and milk sample isolates. PDA conducted a traceback investigation of any cow with a milk sample that tested positive for RB51. PADOH worked with the raw milk cooperative that distributed dairy A’s milk to notify potentially exposed consumers and distributed notifications through Epi-X§ to identify cases.

Dairy A sold only raw milk and did not provide RB51 vaccination to cows born there (16 of the 30-cow herd). The remaining 14 cows were born outside the dairy and had inadequate vaccination records to determine whether they had received RB51. Because these cows might have been vaccinated, milk samples were collected from them. RB51 was detected by PCR and isolated in milk samples collected from the bulk tank and a single cow (cow 122). WGS identified two distinct RB51 strains shed by cow 122: one matched the 2018 New York patient’s isolate (3 single nucleotide polymorphisms [SNPs] different) and one, unexpectedly, matched the 2017 New Jersey patient’s isolate (1 SNP different). The two different RB51 strains were also shed from different quarters of cow 122’s udder. (It’s an old disease that won’t go away, like hockey players. This pic, left, is from about 2001 that my hockey pal Norm unearthed — he’s the coach in the middle, Bill and I were assistant coaches, daughter 2-of-4 beside me.)

Traceback revealed that cow 122 had received RB51 in 2011 and was purchased by dairy A in 2016. During 2016–2018, dairy A distributed raw milk potentially contaminated with RB51 to 19 states; PADOH notified those states’ public health veterinarians. PADOH provided a letter with RB51 information and brucellosis prophylaxis recommendations to the cooperative, which they distributed to dairy A customers. No additional cases were identified. Cow 122 was excluded from milk production, and serial PCR testing of bulk milk samples were subsequently negative for RB51.

Isolation of two different RB51 strains from different quarters of a cow’s udder has not previously been reported. These infections highlight the need to prevent RB51 infections. Raw milk consumption is also associated with serious illnesses caused by other pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella spp. (4). During 2007–2012, the number of raw milk outbreaks in the United States increased; 66 (81%) of 81 reported outbreaks occurred in states where raw milk sale is legal (5). Pregnant women, children, older adults, and persons with immunocompromising conditions are at greatest risk for infection.

To eliminate infection risk from milkborne pathogens, including RB51, all milk should be pasteurized. Because limited information is available about intermittent or continuous RB51 shedding among dairy cows, more research is needed to more fully understand this emerging public health threat for milk consumers. States can also consider the United States Animal Health Associations’ recommendations regarding the need for RB51 vaccination in areas where B. abortus is not endemic in wildlife.**

Notes from the field: Brucella abortus RB51 infections associated with consumption of raw milk from Pennsylvania—2017 and 2018, 17 April 2020

Morbidity and Mortality Weekly Report pp.482-483

Joann F. Gruber, PhD1,2; Alexandra Newman, DVM3; Christina Egan, PhD3; Colin Campbell, DVM4; Kristin Garafalo, MPH4; David R. Wolfgang, VMD5; Andre Weltman, MD2; Kelly E. Kline, MPH2; Sharon M. Watkins, PhD2; Suelee Robbe-Austerman, DVM, PhD6; Christine Quance6; Tyler Thacker, PhD6; Grishma Kharod, MPH1; Maria E. Negron, DVM, PhD1; Betsy Schroeder, DVM2

https://www.cdc.gov/mmwr/volumes/69/wr/mm6915a4.htm

Raw is risky: Two more deaths from brucellosis in Africa

The current human brucellosis epidemic in Ath Mansour has again
claimed new victims. These are 2 citizens of Ath Vouali, hospitalized
Wednesday [28 Aug 2019] at the EPH Kaci Yahia M’Chedallah. The
affected subjects are a 40-year-old father and his 15-month-old son.
Met in the halls of the hospital, the father indicated that he and his
family have consumed raw milk from the farmer whose goats were
infected almost 2 months ago.

After these 2 new victims, 6 cases of human brucellosis have been
detected since last week [18-24 Aug 2019] in this commune and
hospitalized at M’Chedallah hospital. In this context, we learned that
a Daira commission, composed of a member of the APC executive of Ath
Mansour, the subdivisionary of agriculture of Ahnif, a member of the
prevention of the Ahnif EPSP and the M’Chedallah Civil Protection
Unit, was set up on the instructions of the Daira Chief.’

Raw is risky: Drug-resistant brucellosis linked to raw milk

The U.S. Centers for Disease Control and Prevention and state health officials are investigating potential exposures to Brucella strain RB51 (RB51) in 19 states, connected to consuming raw (unpasteurized) milk from Miller’s Biodiversity Farm in Quarryville, Pennsylvania. One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm. This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.­

The New York case is the third known instance of an infection with RB51 associated with consuming raw milk or raw milk products produced in the United States. The other two human cases occurred in October 2017 in New Jersey and in August 2017 in Texas. Those cases reported drinking raw milk from an online retailer and a Texas farm, respectively. In addition to these three confirmed cases, hundreds of others were potentially exposed to RB51 during these three incidents.

RB51 is a live, weakened strain used in a vaccine to protect cows against a more severe form of Brucella infection that can cause abortions in cows and severe illness in people. On rare occasions, cows vaccinated with RB51 vaccine can shed the bacteria in their milk. People who drink raw milk from cows that are shedding RB51 can develop brucellosis.

People who consumed raw milk or raw milk products from this dairy farm since January 2016 may have been exposed and should talk to their doctor.

People who are still within six months of the date they last consumed the raw milk are at an increased risk for brucellosis and should receive antibiotics to prevent an infection and symptoms, and should monitor their health for possible symptoms for six months. If symptoms develop, they should see their doctor immediately for testing.

Milk samples from Miller’s Biodiversity tested positive for RB51. A cow that tested positive for RB51 has been removed from the milking herd.

Brucellosis in a dog, raw meat origin

My friend Scott Weese wrote this up in his Worms and Germs Blog so I don’t have to.

˙(I still miss Sadie, who we had to relo˙cate before we moved to Australia).

A recent report from the Netherlands in Emerging Infectious Diseases (van Dijk et al 2018) describes a new twist on raw feeding concerns, Brucella suis infection. For the full details, you can read the whole paper here, but the short version of the story is outlined below.

The dog had fever, ascites (fluid free in the abdomen) and inflammation of the testicles, and after failing to respond to antibiotics, it was taken to surgery. At surgery, culture samples were collected from the epididymis (tissue adjacent to the testicle). Brucella suis was identified, which presumably caused a bit stir in the lab and clinic since that bacterium is a rarely identified, poses risks to people and is notifiable (the government has to be contacted when it’s found). Ultimately, the dog was euthanized after failing to respond to further treatment.

Because this is a notifiable disease, there was an investigation. The dog’s raw, rabbit-based diet became the leading potential source and Brucella suis was identified in samples from a 30,000 kg batch of raw rabbit imported from Argentina, a country where B. suis is present.

It’s a single case report so we can’t get too worked up about it, but it’s noteworthy for a couple reasons.

One is the disease…brucellosis is a nasty disease. It can be hard to treat, is potentially zoonotic and sometimes results in public health-mandated euthanasia of the dog.

Another is the importation aspect. The dog wasn’t imported but the bacterium was, via food. We’re trying to get increasing awareness of the need to query travel and importation history, since that can impact disease risks. Querying diet origins is tougher, since, while most people would know where their dog has been in the past few weeks, they may not know much about where their dog’s diet has been. With commercial processed food, it’s not a big deal but with a higher risk food like raw meat, importing food can be similar to the dog visiting the country of origin, from a disease standpoint. With raw meat, knowing where the meat came from and the disease risks in those areas may be important, but that’s not often easy to find.

The incidence of disease in dogs and cats associated with raw meat feeding ins’t clear and is probably low. Nevertheless, I recommend avoiding raw meat feeding, especially in  high risk households (e.g. with elderly individuals, kids <5 yrs of age, pregnant women or immunocompromised individuals). However, if raw meat is to be fed, some basic practices can be taken to reduce the risk, as we outline in the info sheet in our Resources section.

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

Brucella Free Villages: India says raw (milk) is risky

Neetu Chandra Sharma of DNA India reports the government has geared up following new outbreaks down South India. In a bid to curb cases of Brucellosis, a bacterial disease affecting cattle like cow and buffalo and causing undulant fever in humans, Department of Biotechnology, Ministry of Science & Technology has come up with a pilot project called “Brucella Free Villages”.

brucellosis-cattle-indiaBrucellosis is an infectious disease caused by bacteria belonging to the genus Brucella. Brucellosis is also an important zoonotic disease of worldwide importance; people acquire the infection by consuming unpasteurized milk and other dairy products, and by coming in contact with the contaminated animal secretions and tissues.

According to the World Health Organization (WHO), brucellosis is transmitted to humans from animals through direct contact with infected materials like afterbirth or indirectly by ingestion of animal products and by inhalation of airborne agents. Consumption of raw milk and cheese made from raw milk is the major source of infection in humans.

In humans, brucellosis can cause range of symptoms that are similar to the flu and may include fever, sweats, headache, back pain and physical weakness. Severe infections of the central nervous system or lining of the heart may also occur.

Doctors say that often brucellosis is diagnosed after ruling out all other fevers such as those caused by malaria, typhoid, dengue etc. Therefore, the disease is under reported and many medical professionals are not even aware of the problem. It is estimated that the disease causes economic losses of about Rs 28,000 crores.

“There is an urgent need for addressing this important issue of not only livestock health and production, but also public health. India is the world’s largest milk producer and hosts around 20 per cent of the world’s livestock population,” said Sudarshan Bhagat, Minister of State, Agriculture and Farmers Welfare.

Unpasteurized cheese making record number sick in Texas

Claire Z. Cardona of The Dallas Morning News reports a record number of people in Dallas County have been sickened from an infection caused by consuming unpasteurized cheese, health officials said. 

brucellosisThere have been 13 brucellosis infections in residents so far this year, affecting patients between 6 and 80 years old, according to a health advisory released Thursday

All of the patients reported eating the cheese brought into the U.S. from Mexico by friends or relatives, consuming the cheese while traveling in Mexico or eating unidentified cheese products from local street vendors, officials said. 

The county typically sees two to six cases a year, though 11 were recorded in 2004. 

Health officials confirmed all the Dallas County cases by blood culture. In two instances, hospital lab personnel were exposed while handling the samples. 

The Brucella bacteria can infect livestock and is most commonly transmitted to humans who consume the unpasteurized dairy products. Some areas, such as Mexico and Central and South America, are considered high-risk, according to the Centers for Disease Control and Prevention. 

10 sick: Unpasteurized, this time ‘green for life’ camel milk in Israel

Ten additional people have come down with brucellosis after consuming camel milk, it was revealed today (Thursday, 8 Sep 2016) when the Ministry of Health extended the administrative closure of a business dealing with this product. A month ago, it was reported that 2 children were hospitalized in mild to moderate condition at the Ichilov Hospital [Tel-Aviv] with brucellosis resulting of drinking the said milk.

camel-milkConcurrently, the Be’er Sheva Magistrate indicted E.L., the manager of an enterprise engaged with the storage and marketing of milk and milk products “Green for Life” or “Genesis Milk” in Moshav Sitria, Shefela district. Prof. Shmuel Rishpon, Acting District Medical Officer [DMO] – Center District, signed today the extension of the closure order of the business, issued by the DMO/Center, Dr. Ofra Havkin, on 11 Aug 2016, for 30 additional days.

The Acting DMO’s decision stated that the closure order was extended because during an inspection/control visit to the enterprise, performed about 2 weeks ago, it was found that — in breach with the previous order — camel milk was encountered in the premises. Even worse, since the decree was issued last month, information on 10 additional brucellosis patients, infected by the consumption of the milk, has been obtained. “This situation is indicative of continued immediate danger to public health from the consumption of the camel milk,” Prof Rishpon stated in the issued order.

Brucellosis linked to unpasteurized camel milk in Israel

Two patients have been hospitalized at Meir Medical and another patient at Schneider Hospital in Petach Tikvah, suffering from brucellosis linked to the consumption of unpasteurized camel milk produced by the dairy company “Genesis.”

camel.milkLast week, two children were hospitalized for mild to moderate condition at Ichilov Hospital, following a drinking camel’s milk marketed by the company. Following the admission office ordered destroyed four tons of camel milk.

Amir Shreibman (64) and his wife, Kfar Sava have suffered in recent weeks from a high fever. “Four months ago we started to drink camel’s milk of Genesis, after we were convinced that it had medicinal properties,” he said. “They told us that many people drink this milk, and everything was fine. We did not think anything would happen to us, even if unpasteurized milk.”