Published Date: 2010-07-09 09:00:04
Subject: PRO/AH/EDR> Salmonellosis, unpasteurized milk - USA (02): (UT) serotype Newport
Archive Number: 20100709.2287

SALMONELLOSIS, UNPASTEURIZED MILK - USA (02): (UTAH) SEROTYPE NEWPORT
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Date: Thu 8 Jul 2010
Source: CDC. MMWR Morb Mortal Wkly Rep 2010; 59(26): 817-8 [edited]
<http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a6.htm?s_cid=mm5926a6_e>


_Salmonella_ Newport infections associated with consumption of
unpasteurized Milk - Utah, April-June 2010
----------------------------------------------------------------------
On 29 Apr 2010, the Utah Department of Health (UDOH) was notified of
3 cases of _Salmonella enterica_ serotype Newport infection. The
patients recently had consumed unpasteurized milk purchased from a
store in northern Utah (store A). In Utah, unpasteurized milk can be
sold legally at licensed dairies or by licensed dairies at
dairy-owned retail stores meeting specific requirements (1). A
central Utah dairy licensed to sell unpasteurized milk (dairy A) owns
and sells unpasteurized milk at store A and a 2nd northern Utah store
(store B). By 3 May 2010, 3 additional patients with _S._ Newport
infections had been reported; all recently had consumed unpasteurized
milk purchased from store A. UDOH notified the Utah Department of
Agriculture and Food (UDAF) of the suspected association between
illness and unpasteurized milk consumption, and UDAF suspended sales
of unpasteurized milk at the 2 stores on 3 May 2010.

During 29 Apr through 3 Jun 2010, a total of 10 _S._ Newport cases
were reported to UDOH; all 10 patients had consumed unpasteurized
milk from store A (7 patients) or store B (3 patients). The patients
ranged in age from 2 to 56 years (median: 21 years); 6 were female.
One patient was hospitalized. Isolates from all 10 patients were
identified as indistinguishable by two-enzyme pulsed-field gel
electrophoresis (PFGE), with pattern combination
UTJJPX01.098/UTJJPA26.009, and were sensitive to routinely used
antibiotics. Cultures of frozen, unpasteurized milk samples stored at
dairy A from batches of milk sold during the outbreak period yielded
_S._ Newport isolates indistinguishable by PFGE from the outbreak
strain. An inspection of dairy A on 7 May 2010, did not reveal any
obvious sources of contamination.

On 12 May 2010, on the basis of coliform test results within legal
limits, the dairy was permitted to resume sales of unpasteurized
milk. Ongoing testing includes monthly screening for _Salmonella_
spp. in retail samples of unpasteurized milk. As of 21 Jun 2010, no
additional cases had been reported to UDOH. Consumption of
unpasteurized dairy products poses a risk for foodborne illness (2),
and consumers of unpasteurized milk should be aware of this risk.

[Reported by: Hall JM, Rolfs RT, Herlihy RK, et al]

References
----------
1. Utah Dairy Act. Utah Code sec 4-3-14. Available at
<http://le.utah.gov/~code/TITLE04/htm/04_03_001400.htm>. Accessed 1 Jul 2010.
2. Oliver SP, Boor KJ, Murphy SC, Murinda SE: Food safety hazards
associated with consumption of raw milk. Foodborne Path Dis 2009;
6(7): 793-806 [abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/19737059>]

--
Communicated by:
ProMED-mail
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[This is the brief CDC report of the cluster. Classical zoonotic
organisms such as _Brucella abortus_, _Brucella melitensis_,
_Mycobacterium bovis_, _Salmonella_ species, _Listeria
monocytogenes_, _Campylobacter_ species, _Yersinia_ species, Coxiella
burnetii, and _E. coli_ O157:H7 are associated with raw milk
ingestion.

Non-zoonotic organisms such as _Streptococcus pyogenes_, _Salmonella_
Typhi, _Corynebacterium diphtheriae_, _Shigella_ species,
_Salmonella_ Paratyphi A, _Salmonella_ Paratyphi B, enterotoxins from
_Staphylococcus aureus_, and hepatitis A have also been associated
with raw milk ingestion.

Other diseases that can be related to unpasteurized milk are
highlighted in these paragraphs extracted from Leedom JM: Milk and
Infectious Diseases in Humans. Clin Infect Dis 2006; 43: 610-5
(<http://www.journals.uchicago.edu/doi/full/10.1086/507035>) with the
citations renumbered to be consecutive starting from 1:

"In 1996 and 1998, there were 2 episodes involving rabid cows that
occurred in Massachusetts (1). Milk from rabid cows can contain
rabies virus, and transmission via unpasteurized milk is
theoretically possible. Temperatures reached during pasteurization
kill the virus. 80 persons consumed unpasteurized milk that was
collected from the 2 cows, and 9 more had contact with saliva from
the cows. All 89 persons received postexposure rabies prophylaxis,
and no human cases of rabies eventuated. A similar report in Oklahoma
of possible rabies exposure associated with the consumption of raw
milk or cream from a rabid cow was circulated in 2006 (2).

Tickborne encephalitis, a zoonotic arbovirus infection usually
transmitted to humans by the bite of an _Ixodes persulcatus_ or
_Ixodes ricinus_ tick, is endemic to Central Europe, Eastern Europe,
and Russia (3). However, the virus can be found in the milk of cows
and goats with tickborne encephalitis and was reported to be
transmissible to humans by the consumption of unpasteurized milk (4).
A case-control study failed to confirm oral transmission (5).

A diarrhea syndrome (later named Brainerd diarrhea) occurred among
122 residents of Brainerd, Minnesota, during the period December
1983-July 1984 (6). It was characterized by acute onset, marked
urgency, lack of systemic symptoms, failure to respond to
conventional antimicrobial agents, and a long median duration of
illness (median duration, 16.5 months). The syndrome was linked to
consumption of raw milk from a single dairy (6). No etiologic agent
was ever isolated. The outbreak of Brainerd diarrhea stopped when all
of the dairy's output was diverted and pasteurized (6, MT Osterholm,
personal communication).

Subsequent outbreaks in Illinois and Texas were not directly
associated with milk, although cattle had been in the vicinity of an
Illinois well that had its water implicated as a vehicle of
transmission (7). Another outbreak of Brainerd-like diarrhea,
although not associated with raw milk, affected 58 (15 percent) of
394 passengers aboard a cruise ship visiting the Galapagos Islands in
Ecuador (8).

References
----------
1. CDC: Mass treatment of humans who drank unpasteurized milk from
rabid cows -- Massachusetts, 1996-1998. JAMA 1999; 281: 1371-2
[available at
<http://jama.ama-assn.org/cgi/content/full/281/15/1371>].
2. Rabies, bovine, human exposure - USA (OK). 2006 [ProMED-mail
archive no. 20060101.0005. Accessed 26 Jul 2006].
3. Dumpis U, Crook D, Oksi J: Tick-borne encephalitis. Clin Infect
Dis 1999; 28(4): 882-90 [available at
<http://www.journals.uchicago.edu/doi/pdf/10.1086/515195>].
4. Matuszczyk I, Tarnowska H, Zabica J, Gut W: The outbreak of an
epidemic of tick-borne encephalitis in Kielec province induced by
milk ingestion [in Polish]. Przegl Epidemiol 1997; 51(4): 381-8
[abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/9562785>].
5. Rieger MA, Nubling M, Kaiser R, et al: Tick-borne encephalitis
transmitted by raw milk -- what is the significance of this route of
infection? Studies in the epidemic region of Southwest Germany.
Gesundheitswesen 1998; 60(6): 348-56 [abstract available at
<http://www.ncbi.nlm.nih.gov/pubmed/9697358>].
6. Osterholm MT, MacDonald KL, White KE, et al: An outbreak of a
newly recognized chronic diarrhea syndrome associated with raw milk
production. JAMA 1986; 256(4): 484-90 [available at
<http://jama.ama-assn.org/cgi/reprint/256/4/484>].
7. Mintz ED, Parsonnet J, Osterholm MT: Chronic idiopathic diarrhea
[letter]. N Engl J Med 1993; 328(23): 1713-4.8. Mintz ED, Weber JT,
Guris D, et al: An outbreak of Brainerd diarrhea among travelers to
the Galapagos Islands. J Infect Dis 1998; 177: 1041-5 [available at
<http://www.journals.uchicago.edu/doi/pdf/10.1086/515237>]. - Mod.LL]

[The state of Utah can be located on the HealthMap/ProMED-mail
interactive map of the US at
<http://healthmap.org/r/016l>. - Sr.Tech.Ed.MJ]

See Also

Salmonellosis, unpasteurized milk - USA: (UT) 20100517.1616
Campylobacteriosis, unpasteurized milk - USA: (MI ex IN) 20100329.0981
2009
----
Campylobacteriosis, unpasteurized milk - USA (02): (WI) 20090917.3264
Campylobacteriosis, unpasteurized milk - USA: (CO) 20090415.1430
2008
----
Campylobacteriosis, unpasteurized milk - USA (CA) 20080817.2557
2007
----
Campylobacteriosis, unpasteurized milk - USA (KS) 20071205.3922
Salmonellosis, serotype Typhimurium, raw milk - USA (02): (PA), CDC
report 20071108.3629
Salmonellosis, free unpasteurized milk - USA (PA) (03) 20070815.2667
Campylobacteriosis, unpasteurized milk - USA (GA) 20070803.2520
Salmonellosis, free unpasteurized milk - USA (PA) 20070722.2354
Listeriosis, unpasteurized cheese - USA (IN) 20070425.1351
Campylobacteriosis, unpasteurized milk - USA (UT) (02) 20070324.1033
Campylobacteriosis, unpasteurized milk - USA (UT) 20070322.1004
Salmonellosis, serotype Typhimurium, raw milk - USA (PA) 20070303.0748
E. coli O157, unpasteurized milk, 2005 - USA (WA) 20070302.0741
2006
----
Foodborne illness, unpasteurized milk - USA (OH) 20060929.2794
E. coli O157, unpasteurized milk - USA (CA) (03) 20060929.2791
E. coli O157, unpasteurized milk - USA (WA): recall 20060929.2790
E. coli O157, unpasteurized milk - USA (CA) (02): background 20060927.2761
E. coli O157, unpasteurized milk - USA (CA) 20060922.2706
E. coli O157, unpasteurized milk - USA (OR, WA) (04) 20060121.0199
2005
----
E. coli O157, unpasteurized milk - USA (OR, WA) 20051216.3622
2003
----
Salmonellosis, raw milk - USA (Ohio) (03) 20030204.0308
Salmonellosis, raw milk - USA (Ohio) 20030105.0033
...................................ll/mj/lm

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