UNC Public health school serves raw milk cheese at welcome reception

Although North Carolina is largely seen as a basketball-first state, college football is definitely king during the fall months. Despite a current top-25 ranking for Carolina, and a less-than-stellar start of the season for N.C. State (a last minute one-point win over Georgia Southern) the two schools are gearing up for the all-important rivalry game in November. The rivalry often spills over into other areas; including public health and food safety.

Liz Rogawski, a student at UNC Chapel Hill’s Gillings School of Public Health writes in a letter to The Daily Tarheel,

raw-milk-cheese-940x626Students, faculty, and staff in the School of Public Health today were welcomed to the fall semester with a large selection of local delicacies as part of the welcome-back social. The spread included raw milk cheese — cheese that is made from unpasteurized milk. The irony of serving raw milk cheese in a school of public health is hard to miss. Pasteurization, which kills harmful bacteria, is one of public health’s finest achievements in disease prevention.

Raw milk is “150 times more likely to cause foodborne illness and results in 13 times more hospitalizations than illnesses involving pasteurized dairy products,” according to the Food and Drug Administration website (this is from a CDC-authored paper -ben).

The serving of raw milk cheese puts our students and staff at unnecessary risk of diseases that have been prevented by pasteurization since the mid-19th century. Luckily, we have plenty of epidemiologists around to investigate any disease outbreaks if needed.

The CDC-authored paper that Rogawski cites reports that between 1993-2006, “of the 65 outbreaks involving cheese, 27 (42%) involved cheese made from nonpasteurized milk. Of the 56 outbreaks involving fluid milk, an even higher percentage (82%) involved nonpasteurized milk.”

The raw data shows more outbreaks related to pasteurized-milk cheeses compared to unpasteurized-milk the relative risk tells a different story.

The authors go on to say:

Because consumption of nonpasteurized dairy products is uncommon in the United States, the high incidence of outbreaks and outbreak-associated illness involving nonpasteurized dairy products is remarkable and greatly disproportionate to the incidence involving dairy products that were marketed, labeled, or otherwise presented as pasteurized.

A 2013  joint FDA/Health Canada risk assessment detailed the relative risks.

While there are foodborne illness risk differences between soft and hard unpasteuized cheeses due to the influence of water activity, raw milk cheeses, regardless of aging carry increased risk (see this 2013 outbreak and others as well as D’Amico and colleagues, 60-day aging requirement does not ensure safety of surface-mold-ripened soft cheeses manufactured from raw or pasteurized milk when Listeria monocytogenes is introduced as a post processing contaminant).

Communicating the risk to the eaters is important, I’m all about informed choice.

Quantitative risk assessment of hemolytic and uremic syndrome linked to O157:H7 and non-O157:H7 shiga-toxin producing Escherichia coli strains in raw milk soft cheeses

Shiga-toxin producing Escherichia coli (STEC) strains may cause human infections ranging from simple diarrhea to Haemolytic Uremic Syndrome (HUS). The five main pathogenic serotypes of STEC (MPS-STEC) identified thus far in Europe are O157:H7, O26:H11, O103:H2, O111:H8, and O145:H28.

raw.milk.cheeseBecause STEC strains can survive or grow during cheese making, particularly in soft cheeses, a stochastic quantitative microbial risk assessment model was developed to assess the risk of HUS associated with the five MPS-STEC in raw milk soft cheeses. A baseline scenario represents a theoretical worst-case scenario where no intervention was considered throughout the farm-to-fork continuum. The risk level assessed with this baseline scenario is the risk-based level. The impact of seven preharvest scenarios (vaccines, probiotic, milk farm sorting) on the risk-based level was expressed in terms of risk reduction. Impact of the preharvest intervention ranges from 76% to 98% of risk reduction with highest values predicted with scenarios combining a decrease of the number of cow shedding STEC and of the STEC concentration in feces. The impact of postharvest interventions on the risk-based level was also tested by applying five microbiological criteria (MC) at the end of ripening.

The five MCs differ in terms of sample size, the number of samples that may yield a value larger than the microbiological limit, and the analysis methods. The risk reduction predicted varies from 25% to 96% by applying MCs without preharvest interventions and from 1% to 96% with combination of pre- and postharvest interventions.

Risk Analysis
Frédérique Perrin, Fanny Tenenhaus-Aziza, Valérie Michel, Stéphane Miszczycha, Nadège Bel, and Moez Sanaa

http://onlinelibrary.wiley.com/doi/10.1111/risa.12267/abstract;jsessionid=74BD9124E68BA3CAA0FCD6112D55BB0C.f02t01

Is 60 days enough for safety? FDA launching pilot testing program for raw milk cheese

In January, the U.S. Food and Drug Administration will launch a pilot program to sample and test domestic and imported raw milk cheese aged at least 60 days for Salmonella, L. monocytogenes, and E. coli O157:H7. On December 19, members of the American Cheese Society (ACS) Regulatory & Academic Committee attended a conference call held by FDA to share information about the program.

This program will test a new microbiological sampling surveillance model, which should help to fill knowledge gaps on the prevalence of microbiological hazards in commodities raw-milk-cheeseand increase FDA’s understanding of risks, contamination rates, and mitigation strategies.

Along with raw milk cheese, the pilot program will include domestic and imported sprouts and raw almonds.

Sampling will begin in January 2014 (an exact date has not been provided) and will last for approximately 12 months. Sampling may take place at any point in the supply chain for domestic cheeses, including at the cheesemaking plant. For imported cheeses, sampling will occur at locations where the cheese normally enters the U.S.

22 sick, 1 dead from E. coli; Canadian media focuses on alleged benefits of raw milk

With 22 people sick and 1 dead from E. coli O157 linked to raw milk cheese produced by Gort’s Gouda Cheese Farm in Salmon Arm, British Columbia, Canadian media have chosen to focus on the alleged benefits of raw milk cheese.

Citing Michael Pollan as an influence, one writer says “there is magic in traditional methods … It has been known for some time that excessive hygiene can cause more colbert.raw.milktrouble than it prevents.”

Another says my cows are clean so the milk is clean, and another says “Raw milk has all the enzymes still in it and a lot of immunoglobulin in it which helps the immune system of the baby to be developed and it helps the growth factors.”

Magical food, hmmm, where have I heard that before? Oh yeah, that would be when 140 people got sick with Salmonella from sprouts on Jimmy John’s sandwiches beginning in Dec. 2010.

Shouldn’t the focus be on the sick people? And using science to evaluate risk, not magic?

20 sick, 1 dead from E. coli O157 in raw milk organic goat’s milk cheese; columnist says don’t overreact

As the number of people sick with E. coli O157:H7 linked to Gort’s Gouda Cheese Farm in Salmon Arm, British Columbia, climbs to 20 sick and one dead, an Edmonton Journal columnist writes that any suggestions of risk are an overreaction.

“In light of such a tragedy, it’s easy to panic, and to view cheese made from unpasteurized milk — which is legal to sell in Canada — with a jaundiced eye. Ban it! Bring on irradiation! This sort of fear-based attitude is a mistake.

“Foodborne pathogens exist. They are a fact of life — always have been, always will be. But to blame, or move to eliminate, an entire gort's.cheese.O157food culture, in existence for thousands of years, stimulating both the palate and the economy, would be an overreaction.”

Kevin Allen, a microbiologist at the University of British Columbia and aging hockey player, had some sensible comments, such as,  “We can’t keep saying that, historically, there is a 60-day aging period. It’s not necessarily based on E. coli O157, which we didn’t recognize as a foodborne pathogen until 1982. … The longer the cheese is aged, the more inactivation you will have. But it’s hard to put an exact (time) on that. We don’t have the data.”

One solution, says Allen, is to conduct research into how long it takes for a pathogen to be rendered inactive. Or he says you could just pasteurize the milk used in the cheese, a heating process which, properly done, kills pathogens.

Well, that sounds simple enough. Heat the bejezus out of the stuff, and eliminate the worry, the risk, right?

The owner of a cheese shop says, “Anyone working with raw milk products has safety systems and precautions, and a system of vigilance against the proliferation of bad bacteria … and that is regulated at a federal and provincial level.”

And so are the bacteria-seeing goggles.

As usual, the Public Health Agency of Canada provides completely irrelevant information to this outbreak, and wants “to remind Canadians to follow proper hygiene and safe food handling and preparation practices to prevent the spread of all food-borne illness including E. coli. For example:

Wash your hands before and after cooking;

Keep knives, counters and cutting boards clean;

Keep raw meats separate from other foods when you store them; and

Refrigerate or freeze left-overs promptly.”

Going public fail: E. coli cheese outbreak suspected days before recall issued

My friend and hockey goon Kevin Allen at the University of British Columbia makes some good points about policy after one person died and 16 others were sickened with E. coli O157:H7 via raw Kevin-Allen-lab-horiz-284x188milk cheese in Canada.

Dr. Robert Parker, the chief medical officer for the B.C. Interior Health Authority, makes some lousy points about policy and when to go public.

According to CBC, health officials suspected an E. coli outbreak was linked to a B.C. cheese farm as early as last Friday, but waited until Tuesday to warn the public because they had to be certain of the source. The Canadian Food Inspection Agency confirmed one person has died and 10 people are ill from consuming raw milk cheese products from B.C. Gort’s Gouda has been linked to an outbreak of E. coli in B.C. and Alberta

Parker says media attention can destroy a business, and authorities wanted to be certain. He says people do not need to stop eating cheese made from raw milk, since there have not been several outbreaks. “I think if we start seeing repeated outbreaks in unpasteurized cheese products, it might be worthwhile to review again,” said Parker.

There have been endless and a disproportionately high number of outbreaks associated with raw milk cheese. Parker should know that.

Publicly available guidelines for when to go public with health information that are consistently followed by health types, would gort's.cheese.O157remove many conspiratorial elements.

Edmonton’s Annemarie McCrie ate at Gort’s Farm on Sept. 1 on her way back home from vacation in B.C. with a friend. “We wanted to stop and there’s a little sign that said ‘cheese farm’ – so I thought ‘oh, let’s go to the cheese farm,’ because everybody wants to visit a cheese farm.”

I don’t.

Kevin Allen, a University of British Columbia microbiologist, says this recall highlights the problems associated with consuming raw milk and its products. “Obviously we have a failure here,” says Allen. Allen says currently Canadian law requires raw milk cheese to be aged for 60 days in order to eliminate pathogens and make it safe, but E. coli O157 can survive well past that time and aging is not a guarantee of safety. “The problem is we have a modern-day food chain with modern-day pathogens that seem tolerant to these cheese.sample.braunwynn.05conditions that we use to render it safe,” says Allen. “I think it’s maybe time to look at our policy and maybe amend it.”

A Calgary cheesemaker whose family has been in the cheese business for roughly 300 years wants to see unpasteurized cheese banned in Canada.

1 dead, 10 sick from E. coli O157 in Canadian raw milk cheese; govt says wash hands

One person has died and 10 have become ill in B.C. and Alberta after eating E. coli tainted products from Gort’s Gouda Cheese Farm of Salmon Arm, B.C.

A statement from Health Canada said there were four cases of illness in B.C. and seven in Alberta.

“One of the cases in British Columbia has died, and the cause of death is currently under investigation,” said the Health Canada gort's.cheese.O157statement.

One person is still recovering in hospital and several cases remain under investigation, said B.C. Centre for Disease Control epidemiologist Dr. Eleni Galanis.

The illnesses began in July, with the majority of infected people displaying symptoms in late August to early September. 

Farm owner and operator Kathy Wikkerink said she was devastated by the news.

“We feel like we … we have hurt these people and it’s totally unintentionally … we were totally unaware of this bacteria being in any of our products,” she said.

“We only have raw milk cheese sales … people come here for raw milk cheese,” adding the farm will only make pasteurized cheese for the time being. 

It is illegal to sell unpasteurized milk, but cheese made from unpasteurized milk is legal for sale in Canada.

Officials advise that if you have eaten this cheese and feel well, there is no need to do anything further.

All sizes of the raw milk cheeses listed below are affected by the recall:

  • Medium Gouda Cheese Quaso de Prato.
  • Aged Quaso de Prato.
  • X Aged Quaso de Prato.
  • Cumin Quaso de Prato.
  • Greek Blend: Onion, Paprika, Parsley, Pepper, Thyme, Oregano Quaso de Prato.
  • Gouda Cheese with Jalapeno Peppers Quaso de Prato.
  • Smoked Gouda Cheese Quaso de Prato.
  • Gouda Cheese with Red Peppers, Ginger, Onions & Garlic Quaso de Prato.
  • Peppercorn, Ginger, Paprika, Onion & Garlic Quaso de Prato.
  • Parsley, Celery, Onion, Garlic, Dill & Chives Quaso de Prato.
  • Maasdammer.
  • Beaufort.
  • Parmesan.
  • Mazouda.

​An alert from the Canadian Food Inspection Agency states the affected products have lot codes 122 to 138 and were sold at the manufacturer’s outlet, at retail stores in Alberta and B.C, and through Internet sales from May 27 to Sept. 14, 2013, inclusive.

Some product packages may not bear a lot code or indicate that the cheese was made with raw milk, and CFIA advises consumers who are unsure if they have purchased the affected product to contact their retailer.

The Public Health Agency of Canada said in a release, “We want to remind Canadians to follow proper hygiene and safe food handling and preparation practices to prevent the spread of all foodborne illness including E. coli for example:

• wash your hands before and after cooking;

• keep knives, counters and cutting boards clean;

• keep raw meats separate from other foods when you store them; and,

• refrigerate or freeze left-overs promptly.      

The best they can do, for a raw milk cheese outbreak.

Raw milk cheese? Maine bistro probed as possible source of foodborne illness

A popular Portland restaurant was investigated this month as a possible source of foodborne illness, the second such investigation of the restaurant in 18 months.

The Portland Press Herald reports health officials zeroed in on Petite Jacqueline after a food handler and a patron were stricken by the same bacterial illness on June 1, but they could not prove the restaurant’s food Petite-Jacqueline-Bistro-Burgerwas the cause – or that it wasn’t – because too much time had passed since the people who became sick were exposed.

Liz Koenigsberg, the restaurant’s part owner and general manager, said the restaurant is fully cooperating with state health inspectors and the Maine Center for Disease Control.

“It has not been concluded by any means that the source of illness was from Petite Jacqueline,” Koenigsberg said. “All of our food-handling practices are safe.”

The French bistro is a popular West End spot that has been nominated for a coveted James Beard Award.

Michael Russell, the manager of Portland’s Environmental Health and Safety program and the certified state health inspector who followed up on the illness complaint, said in an email Wednesday that the restaurant needed to change some of its food-handling practices.

“I observed some risk factors and made recommendations to correct (them),” he said.

Russell’s report said the restaurant should stop selling raw, aged cheese. State law prohibits eating establishments from selling raw, or unpasteurized, cheese unless it has been aged at a temperature of 35 degrees or higher for at least 60 days and is appropriately labeled.

Koenigsberg contends that the restaurant was selling appropriately aged cheese and is still working with health officials to clarify the rules. Russell said the eatery can resume selling the cheese as long as the “raw milk” labels are changed to “non-pasteurized.”

Russell also noted in his report that the restaurant uses the same color cutting boards for both meat and produce, which could result in accidental cross-contamination even though the boards were being sterilized. And he called on the restaurant to cover food items in the refrigerator to protect against contamination.

Raw milk cheeses face new 60-day scrutiny in US

William Herkewitz of Science Liner writes that in the United States some raw-milk cheeses are as illegal to buy and sell as Cuban cigars or imported ivory. Their crime? They haven’t been shelved for long enough. By federal law, all cheeses aged less than 60 days — usually soft cheeses like mozzarella or brie — have to be pasteurized (heated for sterility) in order to be sold.

The idea is that at 60 days, the fermentation processes taking place within the cheese will have naturally eradicated any harmful bacteria. raw-milk-cheeseBut the U.S. Food and Drug Administration (FDA) is currently reviewing its restrictions on unpasteurized, raw-milk cheeses, with the intent of elongating this time-period.

“Recent scientific literature has raised doubts about the efficacy of 60-day aging as an alternative to pasteurization,” says Marianna Naum, a policy analyst at the FDA.

Enacted in 1950, the 60-day rule was a compromise between cheese lovers and food safety experts, with the former concerned that pasteurization altered both the flavor and traditional methods of cheese making. But much has changed since 1950.

But recent multi-state fatal food-illness outbreaks of even older unpasteurized cheeses have convinced many food scientists that 60 days may simply not be long enough.

13 sick; Salmonella from raw-milk cheese outbreak in Minn

Thirteen people have become ill with salmonellosis linked to eating a raw Mexican-style cheese, queso fresco, and state health officials are warning consumers about the risks of consuming unpasteurized dairy products.

The Minnesota Department of Health (MDH), the Minnesota Department of Agriculture (MDA) and the City of Minneapolis are queso-blanco-440investigating the outbreak and the source of the raw milk used to make the cheese.

MDH has confirmed 11 cases of infection with the same strain of Salmonella Typhimurium. Eight were hospitalized. Additional illnesses have been reported in family members of the cases, including two hospitalizations. All have recovered. Many cases reported eating unpasteurized queso fresco purchased or received from an individual who made the product in a private home. Investigators have determined that the individual made home deliveries and also may have sold the product on a street corner near the East Lake Street area of Minneapolis.

Anyone who may have purchased or received this product recently should not eat it but should throw it away.

“While our immediate concern is that there might be additional illnesses associated with consumption of this particular product, we also want to remind people of the inherent risk of consuming any raw dairy product,” said Dr. Carlota Medus, foodborne illness epidemiologist with MDH. “We encourage people to think carefully about those risks before consuming raw dairy products from any source and know that the risks are especially high for young children, pregnant women, the elderly and those with weakened immune systems.”