Tag Archives: unpasteurized

I child dead, 4 sick in Australia from raw milk; US says outbreaks quadrupled

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Amidst reports that the number of U.S. outbreaks caused by non-pasteurized milk increased from 30 during 2007–2009 to 51 during 2010–2012, a child in Victoria (that’s in Australia) has died and four have become ill from raw milk.

868179-068aae70-8035-11e4-9659-e3748623bf5fUnpasteurised milk is illegal to sell for human consumption in Australia, but the product consumed by the child was classed as cosmetic so was allowed on the shelves.

The child recently died on the Mornington Peninsula after drinking what was marketed as a cosmetic product and labeled “bath milk”, the Victorian Health Department said.

The U.S. Centers for Disease Control and Prevention said Wednesday that the average number of outbreaks from contaminated unpasteurized milk more than quadrupled from three a year between 1993 to 2006 to about 13 between 2007 and 2012.

Overall, there were 81 outbreaks in that last period, sickening nearly 1,000 people, including 73 who were hospitalized. The CDC said that more than 80 percent of the illnesses happened in states where retail sales of raw milk are legal.

Most outbreaks were caused by Campylobacter spp. (77%) and by nonpasteurized milk purchased from states in which nonpasteurized milk sale was legal (81%). Regulations to prevent distribution of nonpasteurized milk should be enforced.

Pasteurization is an effective way to improve milk safety; however, in the United States, illness related to consumption of nonpasteurized milk continues to be a public health problem. The first statewide requirements that dairy products be pasteurized were enacted in Michigan in 1948 (1). In 1987, the US Food and Drug Administration banned the interstate sale or distribution of nonpasteurized milk. However, the laws regulating intrastate sales are set by each state (2). Regulations for intrastate sales of nonpasteurized milk vary from complete bans to permitting sales from farms or retail outlets (2). Even in states in which sale of nonpasteurized milk is illegal, milk can often be obtained through other means. For example, some states allow cow-share or herd-share agreements, in which buyers pay farmers a fee for the care of a cow in exchange for a percentage of the milk produced (3,4).

Consumption of nonpasteurized milk has been associated with serious illnesses caused by several pathogens, including Campylobacter spp., Shiga toxin–producing Escherichia coli, and Salmonella enterica serotype Typhimurium (3,4). Despite the health risks associated with consuming nonpasteurized milk, the demand for nonpasteurized milk has increased (3,5,6). Recently, many state legislatures have considered relaxing restrictions on the sale of nonpasteurized milk (2,6). We report that the number of outbreaks associated with nonpasteurized milk increased from 2007 through 2012.

The Study

A foodborne disease outbreak is defined as the occurrence of >2 cases of a similar illness resulting from ingestion of a common food. State and local health departments voluntarily report outbreaks to the Foodborne Disease Outbreak Surveillance System of the Centers for Disease Control and Prevention through a standard web-based form (www.cdc.gov/nors). We reviewed outbreaks reported during 2007–2012 in which the food vehicle was nonpasteurized milk. Outbreaks attributed to consumption of other dairy products made with nonpasteurized milk, such as cheese, were excluded. We analyzed outbreak frequency, number of illnesses, outcomes (hospitalization, death), pathogens, and age groups of patients. Data on the legal status of nonpasteurized milk sales in each state were obtained from the National Association of State Departments of Agriculture (7–9) and an online search of state regulations. The sources from which nonpasteurized milk was obtained or purchased were categorized according to the description from the state outbreak reports, when available.

colbert.raw.milkDuring 2007–2012, a total of 81 outbreaks associated with nonpasteurized milk were reported from 26 states. These outbreaks resulted in 979 illnesses and 73 hospitalizations. No deaths were reported. The causative agent was reported for all outbreaks. Of the 78 outbreaks with a single etiologic agent, Campylobacter spp. was the most common pathogen, causing 62 (81%) outbreaks, followed by Shiga toxin–producing E. coli (13 [17%]), Salmonella enterica serotype Typhimurium (2 [3%]), and Coxiella burnetii (1[1%]) (Figure 1). Three outbreaks were caused by multiple pathogens (Figure 1). The number of outbreaks increased from 30 during 2007–2009 to 51 during 2010–2012. During 2007–2009, outbreaks associated with nonpasteurized milk accounted for ≈2% of outbreaks with an implicated food; during 2010–2012, this percentage increased to 5%. The number of outbreaks of Campylobacter spp. infection also increased, from 22 during 2007–2009 to 40 during 2010–2012.

How milk was obtained was reported for 68 (84%) outbreaks. Nonpasteurized milk was obtained from dairy farms (48 [71%] outbreaks), licensed or commercial milk sellers (9 [13%]), cow- or herd-share arrangements (8 [12%]), and other sources (3 [4%]). Of the 81 outbreaks, 66 (81%) were reported from states where the sale of nonpasteurized milk was legal in some form: Pennsylvania (17 outbreaks), New York, Minnesota (6 outbreaks each), South Carolina, Washington, and Utah (5 outbreaks each). A total of 15 (19%) outbreaks were reported in 8 states in which sales were prohibited. Among these outbreaks, the sources of nonpasteurized milk were reported as a dairy farm (6 outbreaks), cow or herd share (4 outbreaks), and unknown (5 outbreaks).

Conclusions

Within this 6-year period, the number of outbreaks associated with nonpasteurized milk increased. The number of outbreaks caused by Campylobacter spp. nearly doubled. The average number of outbreaks associated with nonpasteurized milk was 4-fold higher during this 6-year period (average 13.5 outbreaks/year) than that reported in a review of outbreaks during 1993–2006 (3.3 outbreaks/year) (4). This increase was concurrent with a decline in the number of states in which the sale of nonpasteurized milk was illegal, from 28 in 2004 to 20 in 2011 (7–9) and with an increase in the number of states allowing cow-share programs (from 5 in 2004 to 10 in 2008) (8,9). The decision to legalize the sale of nonpasteurized milk or allow limited access through cow-share programs may facilitate consumer access to nonpasteurized milk (5). The higher number of outbreaks in states in which the sale of nonpasteurized milk is legal has been reported elsewhere (4).

The legal status of nonpasteurized milk sales in 1 state can also lead to outbreaks in neighboring states. In a 2011 outbreak of Campylobacter spp. infections associated with nonpasteurized milk in North Carolina, where sales of this product were prohibited, milk was purchased from a buying club in South Carolina, where sales were legal. Another outbreak of Campylobacter spp. infection in 2012 implicated nonpasteurized milk from a farm in Pennsylvania, where sales are legal; cases from this outbreak were reported from Maryland, West Virginia, and New Jersey, all of which prohibit sale of raw milk (10). All patients residing outside Pennsylvania had traveled to Pennsylvania to purchase the milk (10).

Outbreaks associated with nonpasteurized milk continue to pose a public health challenge. Legalization of the sale of nonpasteurized milk in additional states would probably lead to more outbreaks and illnesses. This possibility is especially concerning for vulnerable populations, who are most susceptible to the pathogens commonly found in nonpasteurized milk (e.g., children, senior citizens, and persons with immune-compromising conditions). Public health officials should continue to educate legislators and consumers about the dangers associated with consuming nonpasteurized milk; additional information can be obtained at http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html. In addition, federal and state regulators should enforce existing regulations to prevent distribution of nonpasteurized milk.

Ms Mungai is a surveillance epidemiologist at the Atlanta Research and Education Foundation and at the Centers for Disease Control and Prevention. Her interests include infectious disease epidemiology and food safety.

References

Steele JH. History, trends and extent of pasteurization. J Am Vet Med Assoc. 2000;217:175–8 . DOIPubMed

Weisbecker A. A legal history of raw milk in the United States. J Environ Health. 2007;69:62–3 .PubMed

Oliver SP, Boor KJ, Murphy SC, Murinda SE. Food safety hazards associated with consumption of raw milk. Foodborne Pathog Dis. 2009;6:793–806. DOIPubMed

Langer AJ, Ayers T, Grass J, Lynch M, Angulo FJ, Mahon BE. Nonpasteurized dairy products, disease outbreaks, and state laws—United States, 1993–2006. Emerg Infect Dis. 2012;18:385–91. DOIPubMed

Buzby JC, Gould LH, Kendall ME, Timothy FJ, Robinson T, Blayney DP. Characteristics of consumers of unpasteurized milk in the United States. J Consum Aff. 2013;47:153–66.

David SD. Raw milk in court: implications for public health policy and practice. Public Health Rep. 2012;127:598–601 .PubMed

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2011 [cited 2012 Nov 2]. http://www.nasda.org/file.aspx?id=3916

National Association of State Departments of Agriculture. Dairy division of national association of state departments of agriculture raw milk survey, November, 2004 [cited 2012 Nov 2]. http://www.nasda.org/File.aspx?id=1582

National Association of State Departments of Agriculture. NASDA releases raw milk survey 2008. [cited 2012 Nov 2]. www.nasda.org/File.aspx?id=2149

Longenberger AH, Palumbo AJ, Chu AK, Moll ME, Weltman A, Ostroff SM. Campylobacter jejuni infections associated with unpasteurized milk—multiple states, 2012. Clin Infect Dis. 2013;57:263–6. DOIPubMed

Suggested citation for this article: Mungai EA, Behravesh CB, Gould LH. Increased outbreaks associated with nonpasteurized milk, United States, 2007–2012. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140447

Australian reporter drank camel milk for a month, here’s what happened

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PJ Madam writes: This is a story about camels, their milk, and my bowel moments.

What could possibly be more interesting and attractive?

camel.milkAs a reporter on Sunday Night, I’m encouraged to get involved in the story as much as possible.

In the case of camel milk – all I had to do was drink some, right? Well, drink and document the effects, which has been a little tricky.

See, I’m one of those people who repeatedly test negative to allergies and intolerances.

According to multiple tests, I should be able to digest the main culprits: wheat, gluten, dairy, eggs and nuts.

Yet I’m embarrassed to say, my stomach tells me otherwise.

For the past 10 years, I’ve had a sensitive and weak constitution. I get cramps, sharp pain, bloating followed by the bathroom dramas.

It’s humiliating and frustrating.

Sometimes there’s a pattern. Most times, there’s not.

My doctor strongly believes I have Irritable Bowel Syndrome. I’ve been asked to have a colonoscopy and urged to try a food elimination diet but make every excuse under the sun to dodge both.

I like so many Australians, just watch what I eat, and put up with the symptoms.

So never in my wildest dreams did I imagine turning to camel milk to help the symptoms.

To me, the whole concept was plain weird.

Who wants to drink milk that comes from a camel?

They spit, they kick, they smell, they grunt and a whiff of their bad breath is enough to make you pass out.

I figured there was no point to investigating the health benefits of camel milk if I wasn’t drinking it myself.

For the past two months I traveled through the Middle East and outback Australia, investigating if the benefits of camel’s milk were fad or fact.

I spoke to many families who drink it to treat their child’s autism or asthma.

One man I spoke to suffers from Common Variable Immune Deficiency and swears by it being a staple in his diet.

The list doesn’t end there. The science behind the milk – known as ‘white gold’ – shows it can also help treat diabetes, cholesterol, Irritable Bowel Syndrome, Crohn’s disease, hepatitis and leaky gut.

camel.milk 2Nearly everyone I met told me it has helped.

It sounded too good to be true. Annoyingly, some were even calling it a ‘super food’.

I was comfortably skeptical.

And that’s when I was given a challenge.

Tucked away among the hills in Perth is Australia’s only camel dairy farmer.

At 70, Chris O’Hora is hilariously inappropriate, very generous but incredibly passionate and knowledgeable about camel milk.

Chris O’Hora sells his camel milk raw, unpasteurized, which scientists say is better for you.

Under Australian law, selling raw milk also happens to be illegal. Chris covers his milk bottles with stickers saying “not fit for human consumption” so it’s my choice whether to drink it or not.

I chose yes. I’d been to Chris’ farm; saw the camels, where they lived, the milking process and hygiene standards so I felt very confident about drinking his milk.

That farm was cleaner than my kitchen.

Also, camels unlike cows naturally carry lower levels of dangerous bacteria that force us to pasteurize bovine milk. Despite this, Chris insists testing his milk every single day. I saw this and was more than confident about what I was about to do.

Australia has the largest population of wild camels in the world but that doesn’t mean they line up and stand still to be milked.

Catching them in the wild is difficult and expensive. Once you have one, they yield around four times less than a cow.

It also costs $25 a litre.

It’s only been 18 years since Odwalla: Cider recall has producer on the defensive

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When Amy provides some medical advice, I remind her she’s not a medical doctor or scientist, she’s a doctor of French professoring.

apple.cider.pressSo when a farmer says, one bad batch of unpasteurized apple cider shouldn’t scare the public away from the health benefits of the natural juice, maybe he needs to be reminded he’s a farmer.

E. coli O157 is natural; so is smallpox; I don’t want them.

I’m all for looking for expertise in weird places because we all have our own weird experiences: but that’s not a basis for public policy; scientific experimentation and peer review is about the best we’ve got at this point, although I’m open to any idea.

As the Canadian Food Inspection Agency expands the recall of unpasteurized apple cider products sold at the St. Jacobs Farmers’ Market located in Waterloo, Ontario (that’s in Canada), Dale Wilson, the owner of Osoleo Wildcrafters, one of the companies whose locally-made apple cider has been recalled after suspected cases of E. coli poisoning struck three people in Ontario told the K-W Record that it’s an overreaction to suggest people ought to steer clear of raw, or unpasteurized, apple cider. He sells much of his cider directly to consumers at markets who believe the raw, preservative-free version of the juice is better for their health.

“Here’s an accidental situation that happens maybe once a year, and suddenly becomes the hue and cry for shutting down the entire system,” he said. “There’s two sides to this story.”

To its advocates, unpasteurized apple cider is a healthy, natural food product that can help ward off colds and the flu and cleanse the digestive system. Pasteurization kills off the taste and the good bacteria that can help your body, Wilson said.

“The risks are not outweighed by any perceived health benefits,” said Chris Komorowski, food safety manager at Waterloo Region public health.

odwalla.cider.e.coliUnlike unpasteurized milk, it’s legal to sell raw cider in Ontario as long as it’s labelled properly.

Here’s the abstract from a paper Amber Luedtke and I published back in 2002:

A review of North American apple cider outbreaks caused by E. coli O157:H7 demonstrated that in the U.S., government officials, cider producers, interest groups and the public were actively involved in reforming and reducing the risk associated with unpasteurized apple cider. In Canada, media coverage was limited and government agencies inadequately managed and communicated relevant updates or new documents to the industry and the public.

Therefore, a survey was conducted with fifteen apple cider producers in Ontario, Canada, to gain a better understanding of production practices and information sources. Small, seasonal operations in Ontario produce approximately 20,000 litres of cider per year. Improper processing procedures were employed by some operators, including the use of unwashed apples and not using sanitizers or labeling products accurately.

Most did not pasteurize or have additional safety measures. Larger cider producers ran year-long, with some producing in excess of 500,000 litres of cider. Most sold to large retail stores and have implemented safety measures such as HACCP plans, cider testing and pasteurization. All producers surveyed received government information on an irregular basis, and the motivation to ensure safe, high-quality apple cider was influenced by financial stability along with consumer and market demand, rather than by government enforcement.

At least three sick with E. coli O157 in Canada from unpasteurized apple cider

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I confess. I experimented with something else while a university undergraduate: unpasteurized apple cider.

powell.kids.ge.sweet.corn.cider.00The ex and I would go to the Guelph Farmer’s Market and stock up, including unpasteurized cider.

After moving to Kitchener (that’s in Ontario, Canada), we would bike with the kids out to the St. Jacobs Farmers’ Market in Waterloo, Ontario (that’s also in Canada) on Saturday mornings, buy some local wares, including cider, although we preferred the Waterloo County Farmer’s Market across the street.

By the time we moved back to Guelph in 1997, I’d finished my PhD in food science, and had become exceedingly wary of unpasteurized cider.

So had the U.S. government.

In October, 1996, 16-month-old Anna Gimmestad of Denver drank Smoothie juice manufactured by Odwalla Inc. of Half Moon Bay, Calif. She died several weeks later; 64 others became ill in several western U.S. states and British Columbia after drinking the same juices, which contained unpasteurized apple cider –and E. coli O157:H7. Investigators believe that some of the apples used to make the cider may have been insufficiently washed after falling to the ground and coming into contact with deer feces.

By 1997, one of my first students was working with a cider producer at the Guelph market, who had gone so far as to set up his own microbiology lab at his farm.

20141030ba_1414719717551_engGood for him.

In the fall of 1998, I accompanied one of my then four daughters on a kindergarten trip to the farm. After petting the animals and touring the crops –I questioned the fresh manure on the strawberries –we were assured that all the food produced was natural. We then returned for unpasteurized apple cider. The host served the cider in a coffee urn, heated, so my concern about it being unpasteurized was abated. I asked: “Did you serve the cider heated because you heard about other outbreaks and were concerned about liability?” She responded, “No. The stuff starts to smell when it’s a few weeks old and heating removes the smell.”

Today, Chapman reported that the Canadian Food Inspection Agency noted an outbreak of E. coli O157 linked to unpasteurized cider sold at the St. Jacobs Farmers’ Market.

Why CFIA reports an outbreak but relies on Health Canada or the Public Health Agency of Canada to report actual illnesses is baffling. Guess it keeps the different bureaucrats busy.

Fortunately there are a handful of reporters still employed in Ontario, and one at the K-W Record says at least three people have been sickened with E. coli O157 from the unpasteurized cider.

Food safety inspectors are searching across southern Ontario for 2,000 litres of E. coli-contaminated apple cider that’s already made three people ill.

Some of the unpasteurized juice from Rolling Acres Cider Mill, 1235 Martin Creek Rd., near St. Jacobs, is in unmarked, 1.3-litre plastic bags.

local.children.halloween.oct.14A Waterloo health official suspects some of the perishable juice it is already stashed away in household freezers for use weeks or months later.

Health officials are also tracking cider made for other retailers on Oct. 10, which is also likely contaminated with the bacteria that causes brutal stomach upset.

“The tracing is still ongoing,” said Chris Komorowski, food safety manager, at Waterloo Region public health.

Suspect cider pressed Oct. 10 at Rolling Acres has likely been sold as far east as Toronto and west of Waterloo, he said. “It’s all of southern Ontario.”

Rolling Acres is co-operating with the investigation, providing paperwork to track Oct. 10 batches of cider, Komorowski said. Waterloo and federal food inspectors have taken a close look at the apple press operation and found no problems.

“Currently they are meeting all regulatory food safety requirements from both agencies,” Komorowski said. “They’re in full compliance with that.”

The owner of Rolling Acres wasn’t available for comment.

Here’s the abstract from a paper Amber Luedtke and I published back in 2002:

A review of North American apple cider outbreaks caused by E. coli O157:H7 demonstrated that in the U.S., government officials, cider producers, interest groups and the public were actively involved in reforming and reducing the risk associated with unpasteurized apple cider. In Canada, media coverage was limited and government agencies inadequately managed and communicated relevant updates or new documents to the industry and the public.

Therefore, a survey was conducted with fifteen apple cider producers in Ontario, Canada, to gain a better understanding of production practices and information sources. Small, seasonal operations in Ontario produce approximately 20,000 litres of cider per year. Improper processing procedures were employed by some operators, including the use of unwashed apples and not using sanitizers or labeling products accurately.

Most did not pasteurize or have additional safety measures. Larger cider producers ran year-long, with some producing in excess of 500,000 litres of cider. Most sold to large retail stores and have implemented safety measures such as HACCP plans, cider testing and pasteurization. All producers surveyed received government information on an irregular basis, and the motivation to ensure safe, high-quality apple cider was influenced by financial stability along with consumer and market demand, rather than by government enforcement.

4 sickened: apple cider producer faces charges in Michigan year later

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A northern Michigan farm owner faces criminal charges after at least four people who drank apple cider got sick.

James Ruster of Mitchell Hill Farm in Antrim County is charged with knowingly making adulterated, or unsanitary, food. Inspectors said his cider equipment was unsanitary and had powell_kids_ge_sweet_corn_cider_00-300x227dried food on it.

His customers got sick a year ago, including three who tested positive for E. coli. Ruster couldn’t be reached for comment Sunday. Someone who answered the phone at the farm hung up during a call from The Associated Press.

A table of fresh juice-related outbreaks is available at http://bites.ksu.edu/fresh-juice-outbreaks.

Unpasteurized apple cider sickens 11 in Johnson County

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In 1923, 24 people were sickened with Salmonella in unpasteurized apple cider.

In 1993, 213 people were sickened with Cryptosporidium from unpasteurized cider in Maine.

The complete list is here.

But in the face of fawning N.Y.Times articles that promote food porn powell.kids_.ge_.sweet_.corn_.cider_.00-300x227over safety with cider, it’s expected that outbreaks will continue.

Apple cider – not the hard stuff but the northern version of pressed apples into juice — is suspected as the cause of a food-poisoning outbreak in eastern Iowa.

The Johnson County Public Health Department said Friday that it is investigating a cluster of cryptosporidium infections.

Doug Beardsley, the county’s public health director, said 11 people became ill, including one who had to be hospitalized. All reported drinking unpasteurized apple cider, he said, though it’s not clear if the cider came from a single source.

Beardsley said no new illnesses are cropping up. He said that even if authorities determine who made or sold the cider, his department wouldn’t necessarily identify the business publicly. That decision would be up to the state health department, he said. The state agency often has declined to identify businesses in such cases if outbreaks are no longer spreading.

Cryptosporidium infections have been widespread in Iowa this year, with more than 1,200 confirmed cases. Many of the infections stemmed from contaminated swimming pools over the summer, though authorities have noted that the parasite can also come from contaminated food and from contact, especially in child-care settings. The state health department said only Johnson County has recently reported cases related to apple cider.

 

Raw is risky: unpasteurized apple cider glorified

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From the we’ve-always-done-it-this-way-and-no-one-has-gotten-sick files, 78-year-old Doris Van Duyne Heddy Cooke of Montville, NJ, the co-owner of an apple farm and cider press that has powell.kids.ge.sweet.corn.cider.00operated since 1896, told the Times, “Some people come here specifically because it’s not pasteurized. … We have our regulars who come every year, very nice people who keep coming back. They love that our cider is made like it always was.”

A table of fresh juice related outbreaks is available at http://bites.ksu.edu/fresh-juice-outbreaks.

Israelis warned to avoid unpasteurized milk on mouth lesions

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Unpasteurized goat milk should not be applied to ulcers of the mouth because of the risk of pathogens such as E. coli, listeria, and brucella.

So says the Israeli Ministry of Health in warning residents to avoid the practice “even if they only gargle the milk without swallowing or only spread it on wounds.”Mouth-Ulcers-Due-To-Diabetes

E. coli cases in Michigan may be linked to apple cider

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The Health Department of Northwest Michigan is working with the Michigan Departments of Agriculture and Rural Development and Community Health to determine whether multiple local illnesses may be linked to the consumption of unlabeled, unpasteurized apple cider.

An investigation is underway into a possible link between several E. coli cases and apple cider in Antrim County.

Shiga toxin-producing E. coli (STEC) bacteria have been detected in stool samples from several Antrim County residents who developed severe intestinal illness and diarrhea during the past two weeks. Samples have also been collected to determine whether these cases may be linked to unpasteurized apple cider that was produced locally by an unlicensed facility and without the warning labels required by law for unpasteurized products.

According to Joshua Meyerson, M.D., Medical Director for the Health Department of Northwest Michigan, apple cider – whether pasteurized or unpasteurized – should be obtained only from licensed facilities or vendors.

A table of fresh juice-related outbreaks is available at http://bites.ksu.edu/fresh-juice-outbreaks.

Unpasteurized juices still risky

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My hockey equipment is covered in pigeon poop.

Or so I’m told by my friend Steve, who has organized pick-up hockey in Guelph for decades, and in whose barn my equipment has sat since 2006.

I never had fancy equipment; I bought my goalie pads off a 12-year-old whose parents were apparently more affluent than I.

But I could sell them for four times their value in Australia, where hockey exists, and Canadians always return with a bag full of gear, because it costs so much less in North America.

With Sorenne about to turn four-years-old, it’s time to introduce her to the ice – and there’s a rink in Brisbane. And with us returning to the U.S. for Dec. and Jan., the time was right to salvage what was left of my equipment and get some stuff for Sorenne.

Steve says he only found one of my skates.

Steve also works in government.

While driving to Florida this week, Steve took some of my equipment to Chapman in North Carolina (or mailed it) because I’ll see Chapman for a meeting about our shiga-toxic producing E. coli research.

While driving down the North Carolina coast, Steve stopped at this roadside market for some ol’ timey apple cider; unpasteurized cider has been the source of many an outbreak of foodborne illness.

Steve thought the name of the market was particularly apt.

A table of fresh juice-related outbreaks is available at http://bites.ksu.edu/fresh-juice-outbreaks.