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Published Date: 2011-11-16 10:11:32
Subject: PRO/AH/EDR> E. coli O157 - USA (09): (CA) unpasteurized milk, recall
Archive Number: 20111116.3374

E. COLI O157 - USA (09): (CALIFORNIA), UNPASTEURIZED MILK, RECALL
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A ProMED-mail post
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International Society for Infectious Diseases
http://www.isid.org

Date: Tue 15 Nov 2011
Source: California Department of Food and Agriculture (CDFA) News
Release [edited]
http://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=11-064

Raw milk products produced by Organic Pastures of Fresno County are
the subject of a statewide recall and quarantine order announced by
California State Veterinarian Dr Annette Whiteford. Under the recall,
all Organic Pastures raw dairy products with the exception of cheese
aged a minimum of 60 days are to be pulled immediately from retail
shelves and consumers are strongly urged to dispose of any products
remaining in their refrigerators. Until further notice, Organic
Pastures may not produce raw milk products for the retail market. The
order also affects Organic Pastures raw butter, raw cream, raw
colostrum, and a raw product labeled "Qephor."

The quarantine order came following a notification from the California
Department of Public Health of a cluster of 5 children who were
infected, from August 2011 through October 2011, with the same strain
of _E. coli_ O157:H7. These children are residents of Contra Costa,
Kings, Sacramento, and San Diego counties. Interviews with the
families indicate that the only common reported food exposure is
unpasteurized (raw) milk from Organic Pastures dairy. 3 of the 5
children were hospitalized with hemolytic uremic syndrome, a serious
condition that may lead to kidney failure. There have been no deaths.
Surveys indicate that only about 3 percent of the public report
drinking raw milk in any given week so finding 100 percent of these
children drank raw milk and the absence of other common foods or
animal exposures indicates the Organic Pastures raw milk is the likely
source of their infection. While laboratory samples of Organic
Pastures raw milk have not detected _E. coli_ 0157:H7 contamination,
epidemiologic data collected by the California Department of Public
Health link the illnesses with Organic Pastures raw milk.

The great majority of milk consumed in California is pasteurized. Raw
milk is not pasteurized. Pasteurization is a process that kills
harmful bacteria. In California, state law requires that raw milk and
raw milk products shall bear the following warning on the label:
"Warning -- raw (unpasteurized) milk and raw milk dairy products may
contain disease-causing micro-organisms. Persons at highest risk of
disease from these organisms include newborns and infants; the
elderly; pregnant women; those taking corticosteroids, antibiotics or
antacids; and those having chronic illnesses or other conditions that
weaken their immunity."

CDFA [California Department of Food and Agriculture] milk and dairy
foods safety experts have begun a complete inspection at Organic
Pastures dairy, of all facets of operations, from the cows to the
bottling plant. Before the quarantine may be lifted, the facility must
meet all sanitation requirements under state law. Additionally, raw
milk products will be tested to ensure compliance with regulatory
standards.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[The state of California can be located on the HealthMap/ProMED-mail
interactive map at http://healthmap.org/r/1r3f. The counties
mentioned can be seen in the map at
http://www.digital-topo-maps.com/county-map/california.shtml. -
Sr.Tech.Ed.MJ]

A 2006 outbreak of _E. coli_ O157:H7 in California was also associated
with unpasteurized milk from the same dairy (see ProMED-mail E. coli
O157, unpasteurized milk - USA (CA) 20060922.2706).

The following is extracted from the 8 Nov 2007 ProMED-mail post of a
CDC reported outbreak related to unpasteurized dairy products with the
references renumbered:

"Raw milk is a well-documented source of infections from _Salmonella_,
_E. coli_ O157:H7, _Campylobacter_, _Listeria_, _Mycobacterium bovis_,
and other pathogens (1-5). In 1938, before widespread adoption of milk
pasteurization in the USA, an estimated 25 percent of all foodborne
and waterborne outbreaks of disease were associated with milk (6). By
2001, the percentage of such outbreaks associated with milk was
estimated at less than one percent (6). During 1998-2005, a total of
45 outbreaks of foodborne illness were reported to CDC in which
unpasteurized milk (or cheese suspected to have been made from
unpasteurized milk) was implicated. These outbreaks accounted for 1007
illnesses, 104 hospitalizations, and 2 deaths (CDC, unpublished data,
2007). Because not all cases of foodborne illness are recognized and
reported, the actual number of illnesses associated with unpasteurized
milk likely is greater.

Consumers have reported consuming raw milk for convenience, taste
preference, or perceived health benefits. Although some advocates
claim health benefits from raw milk compared with pasteurized milk,
including decreased risks for atherosclerosis, arthritis, and lactose
intolerance, such claims are not supported by scientific evidence (7).
Unsubstantiated claims of health benefits of raw milk for infants and
children are particularly concerning for care givers, because infants
and children are dependent on their care givers to make safe dietary
decisions for them. 16 of the 29 ill persons in this outbreak were
aged less than 7 years.

Pathogens that infect humans are shed in the feces of cows, can be
present in or on the udders of cows, and can contaminate their milk.
Standard hygiene practices during milking can reduce but not eliminate
the risk for milk contamination. In a 2001-2002 survey of Pennsylvania
dairy farms, pathogenic bacteria, including _Salmonella_, were
isolated from 13 percent of samples from raw milk bulk tanks (8).
Pasteurization decreases the number of pathogenic organisms, prevents
transmission of pathogens, and has been determined to improve the
safety of milk more than other measures, including certification of
raw milk (3,4).

As of 2004, at least 27 states permitted some form of raw milk sales
to the public, including sales at dairies, farmers' markets, or
through purchase of "cow shares." Certain states also allow public
sales of raw milk but for pet food only (9).

Given the continued interest in raw milk production, policy makers,
parents, and the public need to be informed regarding the potential
health risks posed by raw-milk consumption. The only sure way for
consumers to prevent raw milk-associated infection from _Salmonella_
or other pathogens is to refrain from consuming raw milk.

References
----------
1. Gillespie IA, Adak GK, O'Brien SJ, Bolton FJ: Milkborne general
outbreaks of infectious intestinal disease, England and Wales,
1992-2000. Epidemiol Infect 2003; 130(30): 461-8. Available at
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2869982/pdf/12825730.pdf.
2. Leedom JM: Milk of nonhuman origin and infectious disease in
humans. Clin Infect Dis 2006; 43(5): 610-5. Available at
http://www.journals.uchicago.edu/doi/full/10.1086/507035.
3. Currier RW: Raw milk and human gastrointestinal disease: problems
resulting from legalized sale of "certified raw milk." J Public Health
Policy 1981; 2(3): 226-34.
4. Potter ME, Blaser MJ, Sikes RK, et al: Human _Campylobacter
infection_ associated with certified raw milk. Am J Epidemiol 1983;
117(4): 475-83. Abstract available at
http://aje.oxfordjournals.org/cgi/content/abstract/117/4/475.
5. CDC: Human tuberculosis caused by _Mycobacterium bovis_ -- New York
City, 2001-2004. MMWR 2005; 54(24): 605-8. Available at
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5424a4.htm.
6. Center for Food Safety and Applied Nutrition: Grade "A" pasteurized
milk ordinance: 2001 revision. US Department of Health and Human
Services, Food and Drug Administration, Center for Food Safety and
Applied Nutrition; 2002.
7. Leonard C: On the safety of raw milk (with a word about
pasteurization). Presented at the National Conference on Interstate
Milk Shipments, Columbus, Ohio, 12-17 May 2005. Available at
http://www.fda.gov/Food/FoodSafety/Product-SpecificInformation/MilkSafety/ConsumerInformationAboutMilkSafety/ucm165105.htm.
8. Jayarao BM, Donaldson SC, Straley BA, et al: A survey of foodborne
pathogens in bulk tank milk and raw milk consumption among farm
families in Pennsylvania. J Dairy Sci 2006; 89: 2451-8. Available at
http://www.journalofdairyscience.org/article/S0022-0302(06)72318-9/fulltext.
9. Dairy Division of National Association of State Departments of
Agriculture. Raw milk survey: November 2004. Available at
http://www.nasda.org/file.aspx?id=11160." - Mod.LL]

See Also