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Shalaby M, Reboud J, Forde T, Zadoks RN, Busin V. Distribution and prevalence of enterotoxigenic Staphylococcus aureus and staphylococcal enterotoxins in raw ruminants' milk: A systematic review. Food Microbiol 2024; 118:104405. [PMID: 38049264 DOI: 10.1016/j.fm.2023.104405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 12/06/2023]
Abstract
Enterotoxins produced by Staphylococcus aureus are a common cause of food poisoning, leading to significant gastrointestinal symptoms and even hospitalization. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched three electronic databases for studies on detection of staphylococcal enterotoxins or enterotoxigenic S. aureus in raw ruminant milk. The 128 studies included in this systematic review showed a worldwide distribution of studies on staphylococcal enterotoxins and enterotoxigenic S. aureus, with an increase in the number from 1980 to 2021, a shift in detection methods from enterotoxins to enterotoxin genes, and a preponderance of studies from Europe and South America. Most studies focused on milk from individual animals with mastitis, especially cattle. Based on 24 studies, the within-herd prevalence of enterotoxigenic S. aureus in raw milk samples was 11.6%. Many studies failed to report the health status of sampled animals, or the numerator and denominator data needed for prevalence calculation. Cultural and legislative differences, economic status, diagnostic capabilities, and public awareness are all likely factors contributing to the observed distribution of studies. Our review highlighted a significant gap in quality and completeness of data reporting, which limits full assessment of prevalence and distribution of hazards posed by raw milk.
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Affiliation(s)
- Maha Shalaby
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom; James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom; Food Control Department, Faculty of Veterinary Medicine, Kafrelsheikh University, Kafr-El-Sheikh, 33516, Egypt.
| | - Julien Reboud
- James Watt School of Engineering, University of Glasgow, Glasgow, United Kingdom
| | - Taya Forde
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom
| | - Ruth N Zadoks
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom; Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, NSW, 2006, Australia
| | - Valentina Busin
- School of Biodiversity, One Health & Veterinary Medicine, University of Glasgow, Glasgow, United Kingdom.
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Ablan M, Canning M, Koski L, Landsman L, Stapleton GS, Nichols M, Robyn M. Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments. Zoonoses Public Health 2024. [PMID: 38396326 DOI: 10.1111/zph.13117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/22/2023] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
AIMS Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. METHODS AND RESULTS We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. CONCLUSIONS The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption.
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Affiliation(s)
- Michael Ablan
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Canning
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lia Koski
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Lisa Landsman
- Public Health Law Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - G Sean Stapleton
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megin Nichols
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Misha Robyn
- Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Williams EN, Van Doren JM, Leonard CL, Datta AR. Prevalence of Listeria monocytogenes, Salmonella spp., Shiga toxin-producing Escherichia coli, and Campylobacter spp. in raw milk in the United States between 2000 and 2019: A systematic review and meta-analysis. J Food Prot 2023; 86:100014. [PMID: 36916568 DOI: 10.1016/j.jfp.2022.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/22/2022] [Accepted: 11/13/2022] [Indexed: 01/13/2023]
Abstract
Raw (unpasteurized) milk is available for sale and direct human consumption within some states in the United States (US); it cannot be sold or distributed in interstate commerce. Raw milk may contain pathogenic microorganisms that, when consumed, may cause illness and sometimes may result in death. No comprehensive review for prevalence and levels of the major bacterial pathogens in raw milk in the US exists. The objective of the present research was to systematically review the scientific literature published from 2000 to 2019 to estimate the prevalence and levels of Listeria monocytogenes, Salmonella spp., Shiga toxin-producing Escherichia coli (STEC), and Campylobacter spp. in raw milk in the US. Peer-reviewed studies were retrieved systematically from PubMed®, Embase®, and Web of ScienceTM. The unique complete nonduplicate references were uploaded into the Health Assessment Work Collaborative (HAWC). Based on the selection criteria, twenty studies were included in the systematic review and meta-analysis. Comprehensive Meta-Analysis (CMA) was used for statistical analyses, specifically, random effects meta-analyses were used to synthesize raw bulk tank milk (BTM) and milk filters (MF) data. Data from studies using culture and non-culture-based detection methods were included. Forest plots generated in CMA (Biostat, Englewood, NJ) were used to visualize the results. The average prevalence (event rate) of L. monocytogenes, Salmonella spp., STEC, and Campylobacter spp. in raw BTM in the US was estimated at 4.3% (95% confidence intervals [CIs], 2.8-6.5%), 3.6% (95% CIs, 2.0-6.2%), 4.3% (95% CIs, 2.4-7.4%), and 6.0% (95% CIs, 3.2-10.9%), respectively. Estimated prevalence was generally larger in MF than in BTM. There was not enough data to perform a meta-analysis for the prevalence or levels of pathogens in raw milk from retail establishments or other milk categories.
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Affiliation(s)
- Elizabeth Noelia Williams
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, MD 20740, USA.
| | - Jane M Van Doren
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, MD 20740, USA
| | - Cynthia L Leonard
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, MD 20740, USA
| | - Atin R Datta
- Center for Food Safety and Applied Nutrition, US Food and Drug Administration, College Park, MD 20740, USA.
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