Raw Milk Consumption A Risky Proposition – CDC

“Consumption of nonpasteurized dairy products cannot be considered safe under any circumstances.”

– US Centers for Disease Control and Prevention

Less than 1% of dairy products consumed in the USA is unpasteurized. Yet consumption of unpasteurized dairy products – mainly milk and cheese – accounted for 60% of dairy-associated disease outbreaks between 1993 and 2006, according to a report released today by the CDC.

The risk of illness linked specifically to drinking raw milk was even more glaring; 80% of fluid milk-related disease outbreaks were associated with unpasteurized milk.

Disease outbreaks traced to unpasteurized dairy products also were more likely to result in hospitalization (13% of victims hospitalized) versus those associated with pasteurized dairy products (1% hospitalization rate).

Campylobacter, one of the two most common causes of bacterial foodborne disease, was responsible for more than 54% of the outbreaks involving unpasteurized milk and cheese. Only 13% of the outbreaks associated with pasteurized dairy products involved Campylobacter.

Of the 4,413 confirmed dairy-product associated illnesses reported during the 1993-2006 period, 1,571 (~36%) were linked to unpasteurized milk and cheese consumption, even though less than 1% of milk drinkers who responded to a 2005-2006 survey reported that they usually consumed raw milk.

And legalizing the sale or distribution of raw milk is not the answer to improving its safety. States in which the sale and distribution of raw milk was permitted experienced higher rates of unpasteurized dairy product-associated disease than states where its distribution was illegal.

The risk of illness that is assumed – often unwittingly – by those who choose to drink unpasteurized milk is underscored by the recent 4-state outbreak of Campylobacter illnesses that were traced unequivocally to raw milk produced and supplied by The Family Cow dairy farm in Pennsylvania. Seventy-seven people were sickened in that outbreak at last report.

The final paragraph of the CDC report says it all:

“Our analysis shows that legal intrastate sale of nonpasteurized dairy products is associated with a higher risk for dairy-related outbreaks and implies that restricting sale of nonpasteurized dairy products reduces the risk for dairy-related outbreaks within that state. Pasteurization is the most reliable and feasible way to render dairy products safe for consumption. Although warning labels and signs or government-issued permits are prudent where the sale of nonpasteurized dairy products is legal, they have not been shown to be effective and, given the results of this analysis, do not seem to reduce the incidence of outbreaks involving nonpasteurized dairy products to the degree that pasteurization does. Whether certain types of warnings or more explicit health advisories might be more effective than others is unknown. Public health officials at all levels should continue to develop innovative methods to educate consumers and caregivers about the dangers associated with nonpasteurized dairy products. State officials should consider further restricting or prohibiting the sale or distribution of nonpasteurized dairy products within their states. Federal and state regulators should continue to enforce existing regulations to prevent distribution of nonpasteurized dairy products to consumers. Consumption of nonpasteurized dairy products cannot be considered safe under any circumstances.”

Organic Pastures and E. coli O157:H7

Raw milk is a touchy subject in the food safety community, and nowhere more so than in California – the home state of Organic Pastures.

Yesterday, the California Department of Food and Agriculture (CDFA) and the California Department of Public Health (CDPH) announced that the State had imposed a recall and quarantine on raw milk products from Organic Pastures (Fresno County, CA). The action resulted from reports of five E. coli O157:H7 illnesses among children in the state.

The five children live in four California counties: San Diego, Contra Costa, King and Sacramento. They became ill during the months of August through October. Three of the children developed hemolytic uremic syndrome (HUS) and were hospitalized. The San Diego area victim is a five-year old boy, who became ill in late August. He was not hospitalized. All five children were infected with a single genetic strain of E. coli O157:H7.

CDPH says that the children had only a single food exposure in common – raw milk produced by Organic Pastures. According to Dr. Debra Gilliss, Chief of the CDPH Disease Investigations Section, all five children were reported by their parents to have consumed raw whole milk.

I’m told by Steve Lyle, Director of Public Affairs for CDFA, that there were no investigative product samples collected and tested by the state. The decision to recall and quarantine Organic Pastures products was based on epidemiological evidence. This, presumably, was because the milk consumed by the five children was long gone by the time the outbreak was identified.

Organic Pastures appealed the recall and quarantine order, according to a report carried today in The Sacramento Bee, on the grounds that the outbreak cluster happened two to three months ago and that the microbe was not found in the dairy’s milk. CDFA heard the appeal, but reaffirmed their order.

Samples will be taken and analyzed as part of the state’s inspection of Organic Pasture’s facility and operations. Lyle didn’t know how long it would take for the dairy to be permitted to resume distribution of its quarantined products. That will depend, according to Mr. Lyle, “…on completion of any needed corrections to sanitary conditions of equipment, good manufacturing practices, and outcome of laboratory tests demonstrating food contact surfaces are properly cleaned and products meet applicable microbial standards.”

This is the second E. coli O157:H7 outbreak that has been linked to raw milk produced and distributed by Organic Pastures. A similar situation arose in 2006, when six children developed E. coli O157:H7 infections after they consumed Organic Pastures raw milk or raw colostrum. The follow-up inspection carried out by the state recovered E. coli O157:H7 – not the outbreak strain – from five fecal samples taken from cows at the dairy. The E. coli O157:H7 strains found in 2006 are genetically different from the strain that has been recovered from the five victims of the current outbreak, according to Dr. Gilliss of CDPH.

California health officials offer the following information and advice to California residents who purchase and consume Organic Pastures raw milk products:

Symptoms of E. coli O157:H7 infection may include abdominal cramps and diarrhea which is often bloody. Most infected people recover within a week; however, some may develop complications that require hospitalization. Young children and the elderly are at highest risk for a potentially life-threatening complication known as hemolytic uremic syndrome (HUS), which includes kidney failure. People who develop symptoms of E. coli O157:H7 infection after consuming unpasteurized milk or milk products should consult their health care provider. Physicians who have patients suspected of having HUS or E. coli O157:H7 infections should report them to the local health department.

Raw Milk – The Inconvenient Truth

Our next door neighbor, on learning yesterday that I’m a food safety microbiologist, asked me whether there were any foods I avoided. “I don’t eat raw sprouts,” I replied,”And I don’t drink raw milk.

One month ago today, the Wisconsin Department of Health Services reported that raw milk supplied to a school event by a local farm infected 16 people with Campylobacter jejuni. The identical strain of Campylobacter was recovered from stool samples obtained from the 16 victims and from milk samples collected from the farm’s bulk milk tank.

According to a July 15th report in Food Safety News, a parent of one of the Wisconsin school children went to a relative’s farm and collected raw milk from the farm’s bulk milk tank to bring to the event. The farm does not sell raw milk to consumers; it supplies milk to a licensed dairy for pasteurization.

On June 27th, the Alaska Division of Public Health reported on a cluster of 4 cases of Campylobacter; all four victims were infected with the same strain of Campylobacter jejuni. All four people reported drinking raw milk from the same cow-share farm in the Matanuska-Susitna Valley – the only common element. Two of the 4 victims reported that a total of three family members also had experienced symptoms of acute gastroenteritis, but had not sought medical treatment. The three unreported victims also had consumed raw milk from the same farm.

Yesterday, FDA announced that it was investigating – in conjunction with officials in North Carolina and South Carolina – three confirmed cases and an additional five probable cases of campylobacteriosis in people who drank raw milk from Tucker Adkins Dairy in York, SC. One of the three confirmed victims was hospitalized. The eight confirmed and probable victims all report having consumed raw milk obtained from the dairy on June 14, 2011. The victims come from three different households.

Most Campylobacter infections are relatively mild and short-lived. Nevertheless, Campylobacter, which is one of the most common causes of diarrhea in the USA, sometims produces severe illness – including bloody diarrhea – and is estimated to cause approximately 124 deaths annually in the United States. Campylobacter also is responsible for as many as 40% of the cases of Guillain-Barré syndrome reported annually in the US. Guillain-Barré is an autoimmune disease typified by paralysis that lasts for several weeks, and usually requiring intensive care.

FDA is urging consumers not to drink raw milk from Tucker Adkins Dairy. In my opinion, that warning doesn’t go far enough. To understand the risks, please check out Real Raw Milk Facts.

When you’re done, perhaps you will appreciate why I don’t drink raw milk.