E. coli O157:H7 in raw milk cheese, Quebec, 2008, 16 sickened

Although nominally about epidemiological basics and evaluative techniques during an outbreak of foodborne illness, a new paper also provides some details – and investigative uncertainty — during a 2008 outbreak of E. coli O157:H7 linked to raw milk cheese in Quebec (that’s in Canada).

The authors write in the Journal of Food Protection that on 4 December 2008, the Bureau de surveillance et de vigie at the Ministe`re de la Sante´ et des Services sociaux in the Province of Quebec, Canada, was notified by the Laboratoire de sante´ publique du Que´bec (LSPQ) of a cluster of three E. coli O157:H7 cases with the same pulsed-field gel electrophoresis (PFGE) profile, 849.

This PFGE profile was designated EC849 according to the Quebec nomenclature and ECXAI.2091/ECBNI.0570 according to the PulseNet Canada database.

During the same period, public health authorities from Ontario notified the Bureau de surveillance et de vigie in Quebec about an Ontario case who acquired an E. coli O157:H7 infection with the same PFGE profile, and who had traveled to Quebec 2 to 10 days before his onset of symptoms. This specific PFGE profile was not found in other Canadian provinces or in the United States.

On 15 January 2009, a cumulative total of 16 EC849 cases had been reported to Quebec and Ontario public health authorities. Fourteen cases lived in Quebec. Two lived in Ontario, but visited the Province of Quebec within 10 days preceding the onset of their symptoms. Of the 16 cases, 62.5% were female and 87.5% were older than 20 years (median, 38.5 years; range, 7 to 76 years). All the cases had diarrhea and blood in their stools. Fifty percent were hospitalized; one of them had thrombocytopenic thrombotic purpura and was hospitalized
for 32 days. If we exclude Ontario cases, no Quebec cases had traveled outside the province in the 10 days preceding their symptoms. The first case (an Ontario case) had onset of symptoms on 26 October, 7 or 8 days after having visited the cheese plant that produces cheese A, where he had eaten the cheese directly. The last case had his onset of symptoms on 26 December 2008. The majority of the cases had their onset of symptoms between 16 November and 7 December 2008. The epidemic curve suggested an exposure span over 2 months.

Escherichia coli O157:H7 outbreak linked to raw milk cheese in Quebec, Canada: Use of exact probability calculation and case study approaches to foodborne outbreak investigation
02.may.12
Journal of Food Protection®, Volume 75, Number 5, May 2012 , pp. 812-818(7)
Gaulin, Colette; Levac, Eric; Ramsay, Danielle; Dion, Réjean; Ismaïl, Johanne; Gingras, Suzanne; Lacroix, Christine
http://www.ingentaconnect.com/content/iafp/jfp/2012/00000075/00000005/art00001
Abstract:
The analytical studies used to investigate foodborne outbreak are mostly case-control or retrospective cohort studies. However, these studies can be complex to perform and susceptible to biases. This article addresses basic principles of epidemiology, probability, and the use of case-case design to identify the source of an Escherichia coli O157:H7 outbreak linked to raw milk cheese consumption in Quebec, Canada; a small number of cases with the same pulsed-field gel electrophoresis (PFGE) profile were involved. Between 4 December 2008 and 15 January 2009, a cumulative total of 16 E. coli O157:H7 cases with the same PFGE profile were reported to Quebec public health authorities. Among the first six cases reported, three had consumed raw milk cheese from the same producer (cheese A). Raw milk cheese is consumed by about 2 % of the Quebec population. By using the exact probability calculation, it was found that a significantly higher proportion of E. coli O157:H7 cases (with the specific PFGE profile) than expected had consumed cheese A (P < 0.001). These computations were updated during the course of the investigation to include subsequent cases and gave the same results. A case-case study corroborated this result. This article considers alternative statistical and epidemiological approaches to investigate a foodborne outbreak—in particular with an exact probability calculation and case-case comparisons. This approach could offer a fast and inexpensive alternative to regular case-control studies to target public health actions, particularly during a foodborne outbreak.

Fact fudging: what are risks associated with raw milk cheese?

The American Cheese Society has a, uh, cheese problem.

While regulators and retailers reassess the safety of raw milk cheese, ACS declared last week raw milk cheese ”when produced and sold under current FDA guidelines, can be consumed without unnecessary risk.”

The U.S. Food and Drug Administration began a comprehensive review of the 60-day aging rule in 2009. Officials said the review was done and was awaiting approval before release.

That was over a year ago.

The debate focuses on a federal rule that requires cheese made from raw milk to be aged for 60 days before it is deemed safe to eat. Aging allows the chemicals in cheese, acids and salt, time to destroy harmful bacteria. ?Scientists have found, however, that 60 days of aging is an overly simplistic guideline, in part because there are so many types of cheese and different ones may require different safeguards.

In one 2010 outbreak, 38 people in five states became sick from raw milk gouda made by Bravo Farms of Traver, Calif., and sold through Costco. In another outbreak, eight people in four states were sickened by bacteria traced to soft cheeses made by Sally Jackson, a pioneering cheesemaker in Oroville, Wash.

In Ms. Jackson’s case, investigators documented unsanitary conditions that could have played a role in making the cheese unsafe. And in the Bravo case, investigators charged the company with packaging cheese for sale before the required 60-day aging was complete.

The American Cheese Society (ACS) endorses current FDA raw milk cheese guidelines for manufacturers, including:

• producing cheese in licensed facilities that are routinely inspected on the local, regional, and federal level;
• producing cheese under the oversight of licensed dairy handlers; and,
• aging cheese for a minimum of 60 days before it is sold.

The majority (approximately two-thirds) of ACS members voluntarily exceed these standards by establishing and adhering to a Hazard Analysis & Critical Control Points (HACCP) plan, and following these additional ACS-recommended best practices:

• taking part in ongoing food safety education;
• regularly conducting product and environment testing;
• maintaining accurate and up-to-date records;
• seeking third party certification;
• building relationships with local, regional, and federal inspectors; and,
• adhering to all state and federal regulations and industry standards.

Shouldn’t any producer of potential risky food comply with food safety basics?

Nose stretcher alert: Whole Foods explains why it stopped selling raw milk in Florida

Whole Foods Market has terrible food safety advice, blames consumers for getting sick, sells raw milk in some stores, offers up fairytales about organic and natural foods, and their own CEO says they sell a bunch of junk.

Whole Foods in Florida has officially dropped raw milk from its shelves. Until Thursday, Whole Foods market sold raw milk with a pet food label. Human drinkers bought it for their personal consumption.

During an interview published yesterday by the Miami New Times, Russ Benblatt, Whole Foods regional marketing director for Florida, said,

“This was a decision that was made here at the regional level. I can’t get into too many details, but it was purely a business decision to stop selling the raw milk, and I can’t get into the specifics of it. … We made a decision to stop selling it as a pet food. We’ve never sold it for human consumption. … We’re a grocery store we try not to get involved in politics. … If we’re involved in politics then I’m not aware of it. We’re not involved in any lobbying or political action committees in the state of Florida.”

Just a grocery store. Uh-huh. There isn’t a foodie cause Whole Foods wouldn’t embrace to peddle a few more dollars worth of crap.
 

Raw milk sickens 11

A Colorado dairy has been shut down after 11 people were sickened by campylobacter, believed to be associated with the consumption of raw, unpasteurized milk, reports The Denver Post.

The Colorado Department of Public Health and Environment has shut down the Kinikin Corner Dairy LLC after 11 people were sickened by campylobacter, a common food-borne bacteria. State authorities say at least 10 people who have gotten sick since March 10 reported drinking raw milk, eight of them getting milk from Kinikin…The dairy has been ordered to stop raw-milk distribution until further notice.

A table of raw dairy outbreaks is available here, and an op-ed Doug and Brae wrote, here.
 

Raw milk: ‘media coverage far beyond its importance’

Here’s the most important point in a column written by long-time Toronto Globe and Mail medical reporter Andre Picard:

The trial of Ontario raw milk farmer Michael Schmidt has garnered media coverage far beyond its importance.

Oh, and the outcome is largely irrelevant.

It seems somewhat absurd to jail a man for selling a product that clients desperately want and which, on the surface at least, seems harmless. But, hey, it happens to pot dealers every day.

What is not harmless is Mr. Schmidt’s attack on pasteurization and on food-safety regulations more generally.

Under the guise of civil liberties and freedom, he and his supporters have uttered all kinds of nonsense and portrayed themselves as martyrs for pure food. …

Farmer Schmidt and his acolytes can suckle the milk from the teat of a cow, a goat, a cat, or any other lactating mammal to their hearts’ content.

Their rights and freedoms are in no way compromised.

What the law restricts is the commercial sale of raw milk.

Mr. Schmidt tried to circumvent this fact by selling "cow shares" and arguing that his clients were actually proprietors and free to consume raw milk from their own cows.

Whether that little manoeuvre exempts him from the law is up to the courts to decide. But it seems unlikely. After all, bar owners tried this technique to sidestep anti-smoking laws, selling "shares" in their establishment and arguing that patrons were smoking in a private club. Judges saw through the subterfuge. …

Another argument is that meat – which can also contain pathogens – is sold raw, so why not milk? The practical reason for this is obvious. It is easy and efficient to pasteurize milk; it is not practical to cook meat before selling it, but its refrigeration (designed to minimize the growth of bacteria) is mandatory and regulated.

6 cases of campylobacter linked to raw milk in Pennsylvania

The Pennsylvania Department of Health is warning consumers who purchased raw milk from Dean Farms in New Castle, Lawrence County, doing business as Pasture Maid Creamery, LLC, to immediately discard the raw milk due to potential bacterial contamination.

Recently, individuals who consumed raw milk purchased from Dean Farms were found to have gastrointestinal illness due to Campylobacter, a bacterial infection. Since January 23, a total of six confirmed cases of Campylobacter infection have been reported among raw milk drinkers in four unrelated households in western Pennsylvania. The investigation is ongoing.

The Department of Health today recommended the owner stop selling raw milk for human consumption, and the owner has agreed to stop selling at this time. In cooperation with the Department of Agriculture, the dairy is providing raw milk samples to be tested for bacterial pathogens.
 

Raw milk is really boring – except for the kids who barf

I try and take baby Sorenne and the dogs out every day for a three-mile walk. The dogs get to run off-leash on the trail, and I get to work on burning off that baby weight.

Sorenne usually conks out after 15 minutes of walking, and then I catch up on phone calls. It’s my kind of multi-tasking.

A reporter called a few days ago while out on one of these walks. She asked me about raw milk, I said I don’t care, it gets far too much attention and that public health folks have better things to do.

I also told her I had baby brain and was having trouble articulating. There’s a reason people have kids when they’re young — like I did with the other four – and not when they’re 46. Ah but it’s fun (see the video clip below – and I do compost).

The Canwest News Service story reporting that interview showed up tonight, and has the usual raw milk stuff, with me saying it is difficult to change the minds of people who hold "hocus-pocus scientific theories about the nutrient benefits of raw milk."

Amy laughed at that.

"From a public health point of view, it’s a no brainer, don’t drink it," Powell said. "From a consumer point of view, why not make raw sprouts illegal because there is the risk of Salmonella or E. coli?"

Powell said he doesn’t take issue with adults choosing to drinking raw milk, but it’s usually children who get sick because of their parents dietary choices.

What I would have added is that with sprouts and other foods, there’s no simple control like there is with raw milk – pasteurization.

A table of raw dairy outbreaks is available at http://www.foodsafety.ksu.edu/articles/1138/Raw_Milk_Outbreak_Table.pdf

And here’s an op-ed Brae and I wrote a couple of years ago that predated barfblog.com. But the video at the end is far more interesting.

About Choice

Michael Schmidt, Ontario’s raw milk lord along with his evangelical disciples, maintain that their crusade is about choice.

Choice is a Good Thing.

But the 19th century English utilitarian philosopher, John Stuart Mill, noted that absolute choice has limits, stating, "if it [in this case the consumption of raw unpasteurized milk] only directly affects the person undertaking the action, then society has no right to intervene, even if it feels the actor is harming himself."

Excused from Mill’s libertarian principle are those people who are incapable of self-government – children.

In September, two children who drank raw milk from a Whatcom County dairy in Washington State became ill with E. coli O157:H7. At the same time, four children, including two eight-year-olds in San Diego County, Calif., were hospitalized with E. coli infection after consuming raw milk products.

In December 2005, 18 people in Washington and Oregon, including six children, were infected with E. coli O157:H7 after drinking an unlicensed dairy’s raw milk.

Two of the kids almost died.

In April 2005, four cases of E. coli linked to unpasteurized milk were reported to Ontario health officials — in this case, from an individual who routinely sold raw milk from the back of a vehicle parked in the city of Barrie. Dozens of other outbreaks are listed at: http://www.foodsafety.ksu.edu/articles/384/RawMilkOutbreakTable.pdf

Ontario finance minister Greg Sorbara can obliviously insist that "raw milk is safely distributed in parts of the United States and Europe" but politicians are expected to spin facts.

So are lobbyists. Thus it was that the Toronto contact for an organization strongly advocating raw milk successfully passed himself off in the National Post this morning as a food safety researcher.

Schmidt, celebrity chefs and the wannabe fashionable can devoutly state that grass fed cattle is safer than grain-fed by spinning select scientific data, except cattle raised on diets of grass, hay and other fibrous forage do contain E. coli O157:H7 bacteria in their feces as well as salmonella, campylobacter and others.

Poop happens, especially in a barn, and when it does people, usually kids, will get sick. That’s why drinking water is chlorinated and milk is pasteurized.

From Kansas, this looks like an awfully familiar clash of science and faith. But it’s not so simple as natural is good, and science — in this case pasteurization — is bad. Science can be used to enhance what nature provided; further, society has a responsibility to the many — philosopher Mill also articulated how the needs of the many outweighed the needs of the one — to use knowledge to minimize harm.

There are lots of other foods that make people sick. On the one-year anniversary of the Ontario salmonella-in-sprouts outbreak that sickened 650 people, raw sprouts are widely available and no one seems to notice. After being banned for three weeks, raw mung bean sprouts were back on grocery store shelves and being placed ever so gingerly on gourmet, supposedly healthy sandwiches.

This fall, it was spinach, lettuce and tomatoes sickening hundreds across North America. So why aren’t Ontario government-types, who treat an outwardly eco-friendly and holistic health product like raw milk as a major biohazard, setting their sights on fresh produce?

Part of the answer is that the risks associated with fresh produce have only been recognized in the past decade; the risks associated with raw milk have been recognized for over a century. Further, unlike fresh produce, there is a relatively simple and benign solution for producing safe milk: pasteurization.

And perhaps that is why health officials are adamant that a ban stay in place: there simply isn’t the resources to manage all the microbial food safety outbreaks that strike down 11-13 million Canadians each year, let alone someone proselytizing the virtues of raw milk while flaunting the law.

The only things lacking in pasteurized milk are the bacteria that make people – especially kids – seriously ill. Adults, do whatever you think works to ensure a natural and healthy lifestyle, but please don’t impose your dietary regimes on those incapable of protecting themselves … your kids.
 

67 sick from raw milk cheese in Kansas

For all the fawning media coverage and energy expended, I figured there would be millions of Americans drinking raw milk.

A story in the Dayton Daily News pegs the number at 500,000.

That’s nothing when it comes to food dollars. And there are reasons why the numbers are so low. As the U.S. Centers for Disease Control reported in its Morbidity and Mortality Weekly Report today,

“On October 26, 2007, a family health clinic nurse informed the Kansas Department of Health and Environment (KDHE) that Campylobacter jejuni had been isolated from two ill persons from different families who were members of a closed community in a rural Kansas county. By October 29, 17 additional members of the community had reported gastrointestinal illness and visited the clinic within a week. All 19 persons reported consuming fresh cheese on October 20 that was made the same day at a community fair from unpasteurized milk obtained from a local dairy.

"This report summarizes the findings of an investigation by KDHE and the local health department to determine the source and extent of the outbreak. Eating fresh cheese at the fair was the only exposure associated with illness (relative risk [RR] = 13.9). Of 101 persons who ate the cheese, 67 (66%) became ill. C. jejuni isolates from two ill persons had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns, and the isolate from a third ill person was nearly identical to the other two. Although all samples of cheese tested negative for Campylobacter, results of the epidemiologic investigation found an association between illness and consumption of fresh cheese made from unpasteurized milk. To minimize the risk for illness associated with milkborne pathogens, unpasteurized milk and milk products should not be consumed."
 

Unpasteurized milk poses health risks without benefits

With disease outbreaks linked to unpasteurized milk rising in the United States, a review published in the January 1, 2009 issue of Clinical Infectious Diseases examines the dangers of drinking raw milk.

Milk and dairy products are cornerstones of a healthy diet. However, if those products are consumed unpasteurized, they can present a serious health hazard because of possible contamination with pathogenic bacteria. An average of 5.2 outbreaks per year linked to raw milk have occurred in the United States between 1993 and 2006—more than double the rate in the previous 19 years, according to co-authors Jeffrey T. LeJeune and Päivi J. Rajala-Schultz of the College of Veterinary Medicine in Columbus, Ohio. …

Raw milk advocates claim that unpasteurized milk cures or prevents disease, but no scientific evidence supports this notion. Testing raw milk, which has been suggested as an alternative to pasteurization, cannot ensure a product that is 100 percent safe and free of pathogens. Pasteurization remains the best way to reduce the unavoidable risk of contamination, according to the authors.

Raw milk crusader Michael Schmidt: A thoroughly modern Marie Antoinette

Amy and I went to Versailles last summer while touring around France, and I’ve seen that Marie Antoinette movie so I consider myself well-versed in the French aristocracy of the late 18th century.

Toronto Globe and Mail columnist John Doyle explored the same themes this morning in a review of a documentary about Ontario raw milk crusader Michael Schmidt which is being broadcast tonight on Wallyworld – sorry, Newsworld, Canada’s cable news program.

It’s a fascinating documentary with many passionate declarations on whether farmers should be allowed to sell raw milk and the public should be allowed to consume it. It’s rich in irony.

It’s also an enraging program, largely because the real issue is the existence of the urban bourgeoisie’s delusion of invincibility, ignorance about science and tendency to posture in order to justify selfishness.

Schmidt himself is a fascinating character, self-mythologizing relentlessly and shrewdly. He’s always in a hat or cap and presents himself as an artist. No doubt his little farm is clean and well-run, but when Schmidt and his cabal of celebrity-chef supporters appear together and prattle on about taste and claim to be against "big business," they’re just nitwits. …

The vulnerability of children is a key issue. Sure, adults are entitled to choice – but allowed the choice of giving unpasteurized milk to children, who have no choice? Call me peculiar, but the safety of children has nothing to do with the "nanny state" interfering in some alleged gourmand’s taste for dangerous foods. One reason the nanny state exists is to protect the young, the elderly and the vulnerable. …

Watching Schmidt and his supporters, I was reminded of the one of the phenomena of the Romantic period in Europe – all those pastoral elegies of the 1700s, in which the poet idealizes rustic life, especially the shepherd, for the enjoyment of aristocrats.

That phenomenon peaked, I suppose, in France, in the late 18th century, when it was a fad at the French court to play at being part of the pastoral world. Marie Antoinette liked nothing better than to pretend she was a shepherdess (that’s her Versailles farmhouse, right and below). It was an indulgent fantasy, very far removed from the reality of rustic life. Then came the Revolution. And little wonder. The raw-milk issue is about today’s Marie Antoinettes.