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 Products Implicated In E. coli O157:H7 Illnesses

Raw milk products from Organic Pastures (Fresno County, CA) are the probable source of five California cases of E. coli O157:H7 according to the California Department of Food and Agriculture. All five children became infected with the same strain of E. coli O157:H7 between August and October; three of the children were hospitalized with hemolytic uremic syndrome.

The five children live in four different California counties – Contra Costa, Kings, Sacramento and San Diego. While E. coli O157:H7 has not been recovered from lab samples of the company’s raw milk, the only food exposure they have in common is raw milk from the Organic Pastures dairy.

The California Department of Public Health has ordered a statewide recall of all raw milk products from Organic Pastures, except for cheese that has been aged a minimum of 60 days – the aging process is supposed to allow time for pathogens to die. In addition, Organic Pastures has been placed under a quarantine order; until further notice, the company may not produce raw milk products – including raw butter, raw cream, raw colostrum and Qephor – for the retail market.

This is the second time that raw milk products from Organic Pastures have been implicated in an outbreak of E. coli O157:H7 illnesses. In 2006, six children became infected with the pathogen after consuming raw milk or raw colostrum produced by Organic Pastures. On that occasion, too, the pathogen was not recovered from milk samples; however, the epidemiological evidence linking the illness to raw milk and colostrum from the dairy was strong.

State food safety experts are carrying out a complete inspection of the Organic Pastures operations. The present quarantine will not be lifted until the facility has been found to meet all sanitation requirements under state law and until lab tests confirm that the dairy’s raw milk products are in compliance with regulatory standards.

Individuals who have consumed raw milk products from Organic Pastures and who develop symptoms of E. coli O157:H7 infections – including abdominal cramps and diarrhea which is often bloody – should seek immediate medical attention. Young children and the elderly who become infected with this pathogen are at risk of developing hemolytic uremic syndrome, a life-threatening complication that is associated with this pathogen.