Raw milk and crypto in pools — policy choices and public health

Information about risk — specifically the microbiological risks in food and water — needs to be rapid, reliable, relevant and repeated. Often those with the most information and the most credibility in an outbreak situation are the local medical officers of health, or some other government-type.

And they often don’t say much.

But there are examples of officials doing their jobs and being accountable to the public they serve. In the aftermath of the first case of homegrown bovine spongiform encephalopathy in Canada in May, 2003, Brian Evans, the chief veterinarian for the government of Canada, did an excellent job of explaining here’s what we know, here’s what we don’t know, here’s what we’re doing to find out more, and whatever we find out, you’ll hear it from me first.

Two public health officials have stepped out in the past two days and offered their analysis on a couple of persistent health risks: raw milk and parasites in swimming pools.

Yesterday, Dr. Stephen Ostroff, director, Bureau of Epidemiology, Pennsylvania Department of Health, wrote in the Lebanon Daily News that,

"In light of recent discussions pertaining to raw-milk health issues, the Pennsylvania Department of Health continues to advise consumers that raw milk is an inherently unsafe product regardless of how it is produced. While the permitting process unquestionably enhances the safety margin of raw milk, and we strongly endorse this program, it is not a substitute for milk pasteurization.…

Last year, an outbreak of salmonellosis due to consumption of raw milk sold in south-central Pennsylvania produced 29 illnesses. Sadly, many of the victims were children who had no choice in the kind of milk their parents purchased for them. Indeed, the department is currently investigating another raw-milk-associated outbreak of campylobacter infections. So far, more than 54 illnesses have been reported.

While standard hygiene and production practices can reduce the risk from consuming raw milk, they simply cannot eliminate it. In a 2006 survey of Pennsylvania dairy farms, pathogens were found in 13 percent of bulk tank raw-milk samples. Therefore, the department believes it is necessary to warn consumers about the risks associated with raw milk and to urge persons with immune disorders, pregnant women and young children to avoid consuming this product in the interest of protecting the public’s health."

Today, David N. Sundwall, executive director of the Utah Department of Health, wrote in The Salt Lake Tribune that,

"The UDOH, along with our partners at Utah’s local health departments, carefully considered whether to restrict young children from pools. Young children are more likely to become ill from crypto and more likely to leave poop in the pool. While it might seem like common sense to ban them, we cannot say that they caused the outbreak or that banning them would prevent another one.
Children have been swimming in public pools in Utah in past years when outbreaks didn’t occur. To our knowledge, no state bans children from public pools. Older children and adults, who have control of their bowels when healthy, are also susceptible to "leaking" if they swim with diarrhea.

We chose to continue to allow children to swim with swim diapers and waterproof swim pants. We believe this will help prevent contamination of the pool, but it isn’t foolproof.

Parents of young children need to act responsibly and with common sense. They need to monitor their children and give them frequent potty breaks. Most important, they need to keep them out of the pools when they are ill with diarrhea and for two weeks afterward.

The UDOH takes seriously its responsibility to protect people from health threats like cryptosporidium. After last summer’s outbreak, we considered multiple measures to help prevent a recurrence this summer. Preventing crypto transmission will require a combination of changes at pools and changes in behavior."

Both Ostroff and Sundwall are too be commended. You may not agree with what they say, but at least you know why they came to the positions they advocate. Public health types, please speak out.