The epidemiology of raw milk-associated foodborne disease outbreaks reported in the United States, 1973 through 1992

Enterotoxigenic Staphylococcus aureus in bulk milk in Norway

AIMS

To investigate the presence of enterotoxigenic Staphylococcus aureus in bulk milk and in a selection of raw milk products.

METHODS AND RESULTS

Samples of bovine (n = 220) and caprine (n = 213) bulk milk, and raw milk products (n = 82) were analysed for S. aureus. Isolates were tested for staphylococcal enterotoxin (SE) production (SEA-SED) by reversed passive latex agglutination and for SE genes (sea-see, seg-sej) by multiplex PCR. Staphylococcus aureus was detected in 165 (75%) bovine and 205 (96.2%) caprine bulk milk samples and in 31 (37.8%) raw milk product samples. Enterotoxin production was observed in 22.1% and 57.3% of S. aureus isolates from bovine and caprine bulk milk, respectively, while SE genes were detected in 52.5% of the bovine and 55.8% of the caprine bulk milk isolates. SEC and sec were most commonly detected. A greater diversity of SE genes were observed in bovine vs caprine isolates.

CONCLUSIONS

Staphylococcus aureus seems highly prevalent in Norwegian bulk milk and isolates frequently produce SEs and contain SE genes. Enterotoxigenic S. aureus were also found in raw milk products.

SIGNIFICANCE AND IMPACT OF THE STUDY

Staphylococcus aureus in Norwegian bovine and caprine bulk milk may constitute a risk with respect to staphylococcal food poisoning from raw milk products.

A multistate outbreak of Salmonella enterica serotype typhimurium infection linked to raw milk consumption--Ohio, 2003

In December 2002, the Ohio Department of Health was notified of two children with Salmonella infection. Both had a history of drinking raw milk from a combination dairy-restaurant-petting zoo (dairy). The dairy was the only establishment in Ohio licensed to sell raw milk and reported 1.35 million visitors annually. We investigated to determine the extent of the outbreak and identify illness risk factors. A case patient was any person with pulsed-field gel electrophoresis-matched Salmonella enterica serotype Typhimurium from 30 November 2002 to 18 February 2003. Sixty-two met the confirmed case definition. Forty dairy case patient patrons were included in a case-control study; 56 controls were their well meal companions. Consumption of raw milk was found to be associated with illness (odds ratio, 45.1; 95% confidence interval, 8.8 to 311.9). The dairy discontinued selling raw milk. Because 27 other states still allow the sale of raw milk, awareness of the hazards of its consumption should be raised and relevant regulations carefully reviewed.

Evaluation of IS900-PCR Assay for Detection ofMycobacterium aviumSubspeciesParatuberculosisInfection in Cattle Using Quarter Milk and Bulk Tank Milk Samples

A study was conducted to evaluate sensitivity, specificity, and predictive value of IS900-PCR assay for detection of Mycobacterium avium subspecies paratuberculosis in pooled quarter milk and bulk tank milk. Feces, blood and pooled quarter milk from 1493 lactating cattle on 29 herds were analyzed. Bulk tank milk (n = 29 bulk tanks) samples were also examined. Culture analysis revealed that 10.9%, 2.8%, and 20.6% of fecal, pooled quarter milk samples and bulk tanks were positive for M. avium subsp. paratuberculosis, respectively. While 13.5% and 27.5% of pooled quarter milk samples and bulk tanks were positive by IS900 PCR assay, respectively. Moderate to high antibody titers for M. avium subsp. paratuberculosis were detected in 223 of 1493 (14.4%) cows. Cows positive on fecal culture were taken as true positives relative to which the IS900 PCR assay was evaluated. The sensitivity and predictive value of KELA, pooled quarter milk culture, and IS900 PCR assay increased with lactation age. While the specificity of the tests decreased with increase in lactation age. Overall, the IS900 PCR assay using pooled quarter milk samples had a sensitivity, specificity and predictive value of 0.87, 0.95 and 0.71, respectively. The IS900 PCR assay using bulk tank milk had poor sensitivity (0.21), specificity (0.5) and predictive value (0.6). Pooled quarter milk culture analysis had a very low sensitivity (0.17). The kinetics ELISA had lower sensitivity (0.59), specificity (0.90) and predictive value (0.43) as compared to the IS900 PCR assay using pooled quarter milk samples. Results from our study suggest that IS900 PCR assay using bulk tank milk may not be useful for screening herds with M. avium subsp. paratuberculosis infected animals. In conclusion, use of IS900 PCR assay for cows in 2(nd) lactation and higher, using aseptically collected pooled quarter milk samples, can be a useful tool for screening and monitoring lactating cattle in herds with M. avium subsp. paratuberculosis infection.

Prevalence of foodborne pathogens in bulk tank milk

Bulk tank milk from 131 dairy herds in eastern South Dakota and western Minnesota was examined for the presence of for foodborne pathogens. Campylobacter jejuni, shiga-toxin producing Escherichia coli, Listeria monocytogenes, Salmonella spp., and Yersinia enterocolitica were detected in 9.2, 3.8, 4.6, 6.1, and 6.1% of bulk tank milk samples, respectively. Thirty-five of 131 (26.7%) bulk tank milk samples contained one or more species of pathogenic bacteria. Isolates of Salmonella belonged to group D (n = 4), B (n = 2), C (n = 1), and E (n = 1) "O" serogroups. All six isolates of Listeria monocytogenes were identified as O antigen type 1. Four of five isolates of E. coli encoded for the shiga-toxin 2 gene, while one strain encoded for the shiga-toxin 1 gene. Escherichia coli O157:H7 was not isolated from bulk tank milk samples. Based on autoagglutination testing, it was inferred that all eight isolates of Yersinia enterocolitica were likely to be virulent. Non A-grade (manufacturing grade) raw milk producers were at a higher risk (odd's ratio, 4.98; confidence interval, 1.96 to 12.22) of having one or more pathogens in their bulk tank milk than were Grade A producers. It was observed that 21 of 79 (26.6%) dairy producers who consumed raw milk had one or more pathogenic bacteria in their bulk tank milk. The findings of the study warrant the need for educational programs for dairy producers about the risks associated with consumption of raw milk.

Epidemic nephritis in Nova Serrana, Brazil

BACKGROUND

Outbreaks of nephritis have been rare since the 1970s. From December, 1997, to July, 1998, 253 cases of acute nephritis were identified in Nova Serrana, Brazil. Seven patients required dialysis, and three patients died. We did a case-control study to investigate the cause of the outbreak.

METHODS

Using a matched cluster design, we examined seven recent patients, their family members (n=23), and members of neighbourhood-matched control households (n=22). We subsequently interviewed 50 patients and 50 matched controls about exposure to various dairy products. We also cultured dairy foods and took udder-swab and milk samples from cows.

FINDINGS

Throat cultures indicated that nephritis was associated with group C Streptococcus equi subspecies zooepidemicus, a cause of bovine mastitis. S. zooepidemicus was detected in four of seven case households (six of 30 people) and no control households (p=0.09). Patients were more likely than matched controls to have consumed a locally produced cheese called queijo fresco (matched odds ratio 2.1, p=0.05). The nephritis attack rate was 4.5 per 1000 in Nova Serrana but 18 per 1000 in the village Quilombo do Gaia (p=0.003). The largest supplier of unpasteurized queijo fresco was a farm in Quilombo do Gaia. S. zooepidemicus was not detected in food samples or in swabs collected from cows in August, 1998, although mastitis was evident among cows on the suspected farm. Throat cultures of the two women who prepared cheese on this farm yielded the outbreak strain of S. zooepidemicus. After the cheese was removed from the distribution system, no further cases were reported.

INTERPRETATION

A large outbreak of glomerulonephritis was attributed to S. zooepidemicus in unpasteurised cheese. This outbreak highlights the dangers of consuming unpasteurized dairy products and need for global efforts to promote food safety.

Fecal shedding of Campylobacter and Arcobacter spp. in dairy cattle

Campylobacter jejuni, Campylobacter coli, and Arcobacter spp. were detected in feces of healthy dairy cows by highly specific multiplex-PCR assays. For C. jejuni, at this one-time sampling, cows from 80.6% of farm operations (n = 31) and 37.7% of individual dairy cattle fecal samples (n = 2,085) were positive. Farm management factors were correlated with prevalence in herds in which >25% of cows were positive for C. jejuni. Statistical significance was set at a P of 0.20. Using these criteria, application of manure with broadcast spreaders (P = 0.17), feeding of whole cottonseed or hulls (P = 0.17) or alfalfa (P = 0.15), and accessibility of feed to birds (P = 0.17) were identified as possible risk factors for C. jejuni infection. C. coli was detected in at least one animal in 19.4% of operations and 1.8% of individual cows (n = 2,085). At the herd level, use of broadcaster spreaders was not a risk factor for C. coli infection. For Arcobacter, cows from 71% of dairy operations (n = 31) and 14.3% of individual dairy cattle fecal samples (n = 1,682) were positive. At the herd level, for Arcobacter spp., feeding of alfalfa (P = 0.11) and use of individual waterers (P = 0.19) were protective. This is the first description of Arcobacter spp. in clinically healthy dairy cattle and the first attempt to correlate their presence with C. jejuni.

Food handlers and foodborne diseases: knowledge, attitudes, and reported behavior in Italy

The purpose of this study was to evaluate knowledge, attitudes, and behavior concerning foodborne diseases and food safety issues among food handlers in Italy. Face-to-face interviews were conducted within a random sample using a structured questionnaire. Of the 411 food handlers responding, 48.7% knew the main foodborne pathogens (Salmonella spp., Staphylococcus aureus, Vibrio cholerae or other Vibrio spp., Clostridium botulinum, hepatitis A virus), and this knowledge was significantly greater among those with a higher education level, in practice from a longer period of time, and who had attended education courses (P < 0.05). A vast majority (90.4%) correctly indicated those foods classified as common vehicles for foodborne diseases, and only 7.1% of food handlers were able to name five different food vehicles, each of which transmit one of the five pathogens. The proportion of those who were able to specify a food vehicle that transmitted hepatitis A virus was significantly higher for those with a higher educational level and with a longer food-handling activity. A positive attitude toward foodborne diseases control and preventive measures was reported by the great majority of food handlers, and it was more likely achieved by those who had attended education courses. This attitude was not supported by some of the self-reported safe practices observed for hygienic principles, because only 20.8% used gloves when touching unwrapped raw food, and predictors of their use were educational level and attending education courses. Results strongly emphasize the need for educational programs for improving knowledge and control foodborne diseases.

A multi-state survey of consumer food-handling and food-consumption practices

INTRODUCTION

In the United States, foodborne infections cause an estimated 6.5-33 million illnesses a year. Also included in the burden of foodborne illnesses are sequelae such as hemolytic uremic syndrome, Guillain-Barré syndrome, and reactive arthritis. Surveillance for risky food-handling and food-consumption practices can be used to identify high-risk populations, develop educational efforts, and evaluate progress toward risk reduction.

DESIGN

In 1995 and 1996, Behavioral Risk Factor Surveillance System interviews of 19,356 adults in eight states (1995: Colorado, Florida, Missouri, New York, and Tennessee; 1996: Indiana, New Jersey, and South Dakota) included questions related to food-handling and/or food-consumption practices. Risky food-handling and food-consumption practices were not uncommon. Overall, 19% of respondents did not adequately wash hands or cutting boards after contact with raw meat or chicken. During the previous year, 20% ate pink hamburgers, 50% ate undercooked eggs, 8% ate raw oysters, and 1% drank raw milk. Men were more likely to report risky practices than women. The prevalence of most risky behaviors increased with increasing socioeconomic status.

CONCLUSION

Targeted education efforts may reduce the frequency of these behaviors. Periodic surveillance can be used to assess effectiveness. In addition to consumer education, prevention efforts are needed throughout the food chain including on the farm, in processing, distribution, and at retail.