Published Date: 2012-06-27 15:51:36
Subject: PRO/AH/EDR> E. coli EHEC - Finland: (southwest), unpasteurized milk
Archive Number: 20120627.1182388
E. COLI EHEC - FINLAND: (SOUTHWEST), UNPASTEURIZED MILK
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Tue 26 Jun 2012
Source: Finnish Food Safety Authority (Evira) [in Finnish, machine trans., edited]
A 4 year old child was brought on Mon 18 Jun 2012, to a physician and was diagnosed with EHEC (enterohemorrhagic _E. coli_)-induced severe symptomatic infection. The child needed ICU care, but is already recovering. The infectious source is suspected to be non-pasteurized milk (raw or tinkimaito) directly purchased from a Finish farm in southwestern Finland.
On Mon 25 Jun 2012, a 1 year old child was diagnosed with EHEC infection. This child also ingested non-pasteurized milk. The illness did not require hospitalization.
Today, 26 Jun 2012, 3 additional people are suspected of being infected after drinking unpasteurized milk.
Sales of milk from the farm were suspended immediately after suspicions that it was the source of infection arose on 19 Jun 2012. All persons who bought raw milk from the farm have been reached and informed of the situation. Visitor contact with farm animals is being blocked.
[The specter of human infection acquired from unpasteurized milk or other dairy product continues to raise its head. Illnesses linked to raw milk include those caused by 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. 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(5): 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)."
1. CDC: Mass treatment of humans who drank unpasteurized milk from rabid cows -- Massachusetts, 1996-1998. MMWR; 48(11); 228-9 [available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00056759.htm].
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://cid.oxfordjournals.org/content/28/4/882.full.pdf+html].
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 in English 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. [in German]. Gesundheitswesen 1998; 60(6): 348-56 [abstract in English 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.jamanetwork.com/data/Journals/JAMA/8815/jama_256_4_029.pdf].
7. Mintz ED, Parsonnet J, Osterholm MT: Chronic idiopathic diarrhea [letter]. N Engl J Med 1993; 328(23): 1713-4 [available at http://www.nejm.org/doi/full/10.1056/NEJM199306103282314].
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://jid.oxfordjournals.org/content/177/4/1041.full.pdf+html]. - Mod.LL
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