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

Disease outbreaks linked to pasteurized and unpasteurized dairy products in Canada and the United States: a systematic review

OBJECTIVE

Pasteurization kills harmful microorganisms found in milk. While consumption of unpasteurized milk and its products is discouraged due to increased risk of infections, some individuals prefer unpasteurized dairy products. Our objective was to estimate the burden of illness from outbreaks arising from consumption of unpasteurized and pasteurized dairy products in Canada and the United States.

METHODS

We conducted a systematic review of dairy-associated outbreaks in Canada and the USA from 2007 onward. We searched MEDLINE, Embase, Cochrane Library, TRIP Database for guidelines, and North American government agency websites up to October 2020. We included outbreak reports where the pathogenic microbe was confirmed in both the patient and the dairy product through laboratory testing.

SYNTHESIS

Thirty-two disease outbreaks were linked to dairy consumption. Twenty outbreaks involving unpasteurized products resulted in 449 confirmed cases of illness, 124 hospitalizations, and five deaths. Twelve outbreaks involving pasteurized products resulted in 174 confirmed cases of illness, 134 hospitalizations, 17 deaths, and seven fetal losses. Listeria accounted for 10 out of 12 outbreaks from pasteurized products from 2007 through 2020.

CONCLUSION

Public warnings about the risk of unpasteurized dairy consumption need to continue and pregnant women and immunocompromised hosts need to be made aware of foods at high risk of contamination with Listeria.

Epidemiologic case investigation on the zoonotic transmission of Staphylococcus aureus infection from goat to veterinarians

Staphylococcus aureus infection led to a case of goat abortion, and four veterinarians contracted S. aureus infection from the goat during and after the abortion. Three veterinarians assisted a doe during the dystocic delivery of a dead foetus. Seventy-two hours after the dystocia, which ended with the goat's death, the veterinarians who assisted during the kidding and the veterinarian who performed the necropsy showed the presence of multiple, isolated, painful pustules 1-5 mm in diameter located along their forearms and knees. S. aureus was isolated from the pustules of the veterinarians, the placenta and uterus of the goat, the organs (brain, thymus gland, abomasum, liver and spleen) of the foetus, the scrotum and eye swabs of the buck, and mammary pustules of another goat from the same herd. Histological analysis revealed purulent metritis and inflammation of the placental cotyledons. Additional investigations eliminated the chances of other infections. S. aureus isolates recovered from the veterinarians, goats, foetus and buck were sensitive to the tested anti-microbials and did not encode staphylococcal enterotoxin genes (sea, ser, sep, see, seg and sei). The isolates were closely related, as indicated by the results of Fourier-transform infrared spectroscopy and comparative whole-genome sequencing analysis. The results of this study clearly support the hypothesis that an episode of professional zoonosis was caused by S. aureus infection during the abortion and also highlight the need for bacterial subtyping in epidemiological surveys.

Determinants of weekly raw milk use by at-home meal preparers in the USA: evidence from the 2014-2016 American Time Use Survey - Eating and Health Module

OBJECTIVE

The number of states in the USA that allows sales of raw milk for human consumption has been trending upwards and reached thirty-eight in 2016. These legislative changes could encourage raw milk consumption. The current study examined the determinants of weekly raw milk use by at-home meal preparers in the USA.

DESIGN

Using the 2014-2016 American Time Use Survey - Eating and Health Module, multivariate logit regressions and average marginal associations were estimated to examine how at-home meal preparer characteristics, time use and shopping choices, underlying health and the presence of at-risk individuals in households and raw milk legalisation status are associated with the probability an at-home meal preparer consumed or served raw milk during an average week.

SETTING

USA.

PARTICIPANTS

At-home meal preparers aged 18 years and above.

RESULTS

Estimated average marginal associations suggested younger at-home meal preparers, male at-home meal preparers, larger sized households and households located in non-metropolitan areas were more likely to use raw milk during an average week. Married households and households with a person aged 62 years or above were less likely to use raw milk. Variables indicating health characteristics of at-home meal preparers or the presence of an at-risk individual in the household were not statistically significant.

CONCLUSIONS

There are many government-sponsored information resources about the risks of raw milk currently available. Additional education may be needed to prevent illnesses from raw milk.

"We never boil our milk, it will cause sore udders and mastitis in our cows"- consumption practices, knowledge and milk safety awareness in Senegal

Background

Milk is a nutrient-rich food that makes an important contribution to diets in several Low and Middle Income Countries such as Senegal. Milk can also harbour several pathogenic microorganisms. As in other low and middle income countries, the dairy industry in Senegal is growing, with an expansion of farms to meet rapidly growing demand in the cities. However, most of the production still happens in the informal sector, and little is known about consumption of milk and milk products, or knowledge, awareness and practices of actors in informal dairy supply chains.

Methods

We conducted structured focus group discussions with dairy farmers and milk processors in three selected regions (Dakar, Thies and Fatick) in Senegal to investigate the consumption practices, awareness of milk borne hazards, and practices relevant to the risk of milk contamination to gain a deeper understanding of drivers of milk-borne diseases. Data on the consumption of milk and milk products were also collected using a closed questionnaire.

Results

Results indicate that milk is an important part of the diet in the study regionsand raw milk consumption is very common. The most common milk product consumed was fermented milk. Awareness of milk borne hazards was limited. Several farmers and processors reported risky practices, despite being aware of better practices, due to cultural beliefs. In households, children, pregnant women and older people were prioritised when milk and milk products were distributed. Dairy farmers and milk processors were more concerned with the lack of food for animals, low production and seasonality of production than the safety of the milk and milk products.

Conclusions

Lack of awareness of milk borne infections and some traditional practices put milk and milk product consumers in the study area at high risk of milk borne diseases.. Prioritising certain sub population at households (Pregnant women and children) makes then vulnerable to milk-borne hazards. It will be challenging to change the risky practices as they are motivated by cultural beliefs hence the best strategy to promote milk safety will be to encourage the boiling of milk by consumers.

High-Throughput 16S rRNA Gene Sequencing of Butter Microbiota Reveals a Variety of Opportunistic Pathogens

Microbial contamination of dairy products with a high fat content (e.g., butter) has been studied insufficiently. No studies using modern molecular methods to investigate microbial communities in butter have been conducted so far. In this work, we used high-throughput sequencing and Sanger sequencing of individual bacterial colonies to analyze microbial content of commercially available butter brands. A total of 21 samples of commercially available butter brands were analyzed. We identified a total of 94 amplicon sequence variants corresponding to different microbial taxa. The most abundant lactic acid bacteria in butter were Lactobacillus kefiri, Lactobacillus parakefiri, Lactococcus taiwanensis and Lactococcus raffinolactis. A large amount of Streptococcus spp. bacteria (87.9% of all identified bacteria) was found in one of the butter samples. Opportunistic pathogens such as Bacillus cereus group, Pseudomonas aeruginosa, Cronobacter spp., Escherichia coli, Listeria innocua, Citrobacter spp., Enterococcus spp., Klebsiella pneumonia were detected. The analyzed butter samples were most strongly contaminated with bacteria from the Bacillus cereus group, and to a lesser extent - with Cronobacter spp. and Enterococcus spp. The plating and Sanger sequencing of individual colonies revealed the presence of Enterobacter cloacae and Staphylococcus epidermidis. The Sanger sequencing also showed the presence of Cronobacter sakazakii in butter which can be dangerous for children under the age of 1 year. We demonstrated that butter is a good growth medium for opportunistic pathogenic bacteria. Our data indicate that despite the fact that butter is a dairy product with a long shelf life, it should be subjected to quality control for the presence of opportunistic bacteria.

Building the Evidence Base for the Prevention of Raw Milk-Acquired Brucellosis: A Systematic Review

Background: The scientific evidence of the health risks associated with the consumption of raw milk has been known for a long time. However, less clear is the impact of acquiring infectious diseases from raw milk consumption in the United States (US) due to incomplete reporting of cases and the complex factors associated with the sale and consumption of raw milk. Investigations of this current study focused on human brucellosis, one of the infectious diseases commonly acquired through the consumption of raw milk and milk products, and which continues to be a public health threat worldwide.

Methodology: A qualitative systematic review of the sources of opinions that contribute to the increased trend of raw milk sales and consumption in the US was conducted.

Results: Interestingly, opinions about the sale of raw milk and/or the benefits arising from its consumption varied by US region, with the proportion of messages supporting raw milk consumption being highest in the Northeast compared to other US regions. Several evidence gaps and factors that possibly contribute to the increased prevalence of raw milk-acquired brucellosis were identified including inadequate monitoring of the raw milk sales process and lack of approved diagnostic methods for validating the safety of raw milk for human consumption.

Conclusions: The unavailability of data specifying brucellosis cases acquired from raw milk consumption have precluded the direct association between raw milk and increased brucellosis prevalence in the United States. Nevertheless, the evidence gaps identified in this study demonstrate the need for intensified surveillance of raw-milk acquired infectious diseases including human brucellosis; establishment of safety and quality control measures for the process of selling raw milk; and design of an effective strategy for the prevention of raw milk-acquired infectious diseases including brucellosis. Overall, for the first time, this study has not only shown the gaps in evidence that require future investigations, but also, variations in the perception of raw milk consumption that may impact disease acquisition in different US regions.

A one health perspective on dairy production and dairy food safety

As the global population approaches 9.7 billion inhabitants by the year 2050, humanity faces enormous challenges to feed, house, and provide basic living requirements for the growing population while preserving the health of wildlife and the ecosystem. Dairy source foods play an important part in providing nutrient and energy dense sources of calories and establishing Bifidobacterium as a keystone species in the gut for positive health outcomes in infants and children. In developed countries, dairy products have a high food safety record when pasteurized and properly processed. However, when milk is consumed unpasteurized, as often occurs in developing countries where regulation and oversight of the dairy industry is lacking, dairy can serve as a vector for zoonotic transmission of disease and can contain adulterants such as antibiotic residues. Here we provide an overview for the importance of dairy source foods for nutrition and with a One Health perspective and discuss the historical events that have resulted in a high standard of dairy food safety in the United States. This review article covers the Origins of One Health, the role of milk in transmission of disease, management practices and regulations to ensure safe dairy products reach consumers, current challenges facing the dairy industry and impacts on public health, and how these standards can be employed in low and middle income countries to improve public health, nutrition and economic benefits to farmers.

Listeria monocytogenes in Milk: Occurrence and Recent Advances in Methods for Inactivation

Milk is one of the most important food items consumed by humans worldwide. In addition to its nutritional importance, milk is an excellent culture medium for microorganisms, which may include pathogens such as Listeria monocytogenes (L. monocytogenes). Traditional processing of milk for direct consumption is based on thermal treatments that efficiently eliminate pathogens, including pasteurization or sterilization. However, the occurrence of L. monocytogenes in milk as a consequence of failures in the pasteurization process or postpasteurization contamination is still a matter of concern. In recent years, consumer demand for minimally processed milk has increased due to the perception of better sensory and nutritional qualities of the products. This review deals with the occurrence of L. monocytogenes in milk in the last 10 years, including regulatory aspects, and recent advances in technologies for the inactivation of this pathogen in milk. The results from studies on nonthermal technologies, such as high hydrostatic pressure, pulsed electric fields, ultrasounds, and ultraviolet irradiation, are discussed, considering their potential application in milk processing plants.

Shiga toxin-producing Escherichia coli O103:H2 outbreak in Germany after school trip to Austria due to raw cow milk, 2017 - The important role of international collaboration for outbreak investigations

Following a school ski-trip to Austria from 10 to 18/02/2017, nine of 25 participants of the group from Lower Saxony (Germany) developed gastroenteritis. The students and teachers (17-41 years) shared meals in a hotel. Active case finding revealed further cases among German school groups from North Rhine-Westphalia and Schleswig-Holstein, staying at the same hotel in February 2017. We conducted two retrospective cohort studies using self-administered questionnaires on clinical symptoms and food consumption. We defined a case as a trip participant in February 2017, staying at the aforementioned hotel and developing diarrhoea, vomiting or abdominal pain during or within ten days after the trip and/or who had a stool sample tested positive for STEC within four weeks after the trip. During the outbreak investigation, Austrian authorities detected that unlabeled raw cow milk delivered by a dairy farm had been offered at the hotel for breakfast during January and February 2017. Stool samples of participants, samples of milk served in the hotel and fecal samples of various animals kept at the milk-delivering farm were examined by culture and polymerase chain reaction. STEC isolates were typed using Pulsed-field Gel Electrophoresis (PFGE) and Whole-Genome Sequencing (WGS). All 25 participants from Lower Saxony completed the questionnaire on symptoms and milk consumption; 14 were cases (56%). Thirteen of 20 participants who had consumed cold milk fell ill (risk ratio (RR): 3.25; 95%-confidence interval (CI): 0.55-19.32). Of 159 trip participants from North Rhine-Westphalia, 81 completed the questionnaire (51%), 25 were cases (31%); RR for cold milk was 2.11 (CI: 0.89-5.03). The combined RR for cold milk in both groups was 2.49 (CI: 1.16-5.35). Shiga toxin 1a-gene and eaeA-gene positive STEC O103:H2 were detected in nine of 32 patients' stool samples and in two of 18 dairy farm cattle. Nine isolates from human stool samples and two isolates from cattle fecal samples yielded the same strain with an almost identical PFGE-pattern and WGS-profile. Microbiological and epidemiological evidence identified raw cow milk as the vehicle. Results may have been compromised by misclassification of cases due to a recall bias and mild symptoms. As a result of this outbreak investigation, the Austrian authorities enforced Austrian law in the hotel, to provide milk only when pasteurized. We recommend re-emphasizing the risk of raw milk consumption to providers.

Rising fluoroquinolone resistance in Campylobacter isolated from feedlot cattle in the United States

Antibiotic resistance, particularly to fluoroquinolones and macrolides, in the major foodborne pathogen Campylobacter is considered a serious threat to public health. Although ruminant animals serve as a significant reservoir for Campylobacter, limited information is available on antibiotic-resistant Campylobacter of bovine origin. Here, we analyzed the antimicrobial susceptibilities of 320 C. jejuni and 115 C. coli isolates obtained from feedlot cattle farms in multiple states in the U.S. The results indicate that fluoroquinolone resistance reached to 35.4% in C. jejuni and 74.4% in C. coli, which are significantly higher than those previously reported in the U.S. While all fluoroquinolone resistant (FQ^R) C. coli isolates examined in this study harbored the single Thr-86-Ile mutation in GyrA, FQ^RC. jejuni isolates had other mutations in GyrA in addition to the Thr-86-Ile change. Notably, most of the analyzed FQ^RC. coli isolates had similar PFGE (pulsed field gel electrophoresis) patterns and the same MLST (multilocus sequence typing) sequence type (ST-1068) regardless of their geographic sources and time of isolation, while the analyzed C. jejuni isolates were genetically diverse, suggesting that clonal expansion is involved in dissemination of FQ^RC. coli but not C. jejuni. These findings reveal the rising prevalence of FQ^RCampylobacter in the U.S. and provide novel information on the epidemiology of antibiotic-resistant Campylobacter in the ruminant reservoir.

Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae and Shiga toxin-producing Escherichia coli in asymptomatic nursery children in Lower Saxony (Germany), 2014

Children may be at higher risk for carriage of antimicrobial-resistant bacteria because of higher usage of antimicrobials. They also have higher rates of Shiga toxin-producing Escherichia coli (STEC) infections than other population groups. Some infections, particularly in children, are asymptomatic, but still lead to the excretion of large numbers of bacteria and viruses that may cause clinical disease in other individuals. That is one reason why, in Lower Saxony as in other German federal states - asymptomatic carriers of STEC are excluded from nurseries and schools until three consecutive stool samples test negative in order to prevent secondary cases. The prevalence of children who are asymptomatic STEC carriers is unknown. But if it is high, this measure would have substantial socioeconomic effects on families. Infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) are an increasing problem for public health, especially for hospitals. However, there are no reliable estimates of the prevalence of asymptomatic ESBL-E carriers in Lower Saxony, as there is no mandatory requirement to report these carriers. In order to discuss the exclusion policies for children attending nurseries and ascertain a baseline of ESBL-E carriers, we conducted a cross-sectional study. The aim was to determine the prevalence of ESBL-E and STEC and identify risk factors for carriage in nursery children without diarrhoea (asymptomatic) aged 0-6 years in four selected districts in Northern Germany. During April-September 2014, we collected stool specimens with the support of voluntarily participating nurseries. We tested for STEC by PCR and for ESBL-E on chromogenic agar. Questionnaires answered by parents contained data on eating and drinking habits, outdoor activities, prior antibiotic treatment and animal contact for each participating child. We compared the epidemiological characteristics of ESBL-E carriers vs. non-carriers by using univariable analysis (P value, odds ratio and 95% confidence interval). We could not perform a statistical analysis for STEC carriers due to the low numbers of positive STEC specimens. Of 224 asymptomatic nursery children, we found a prevalence of 2·3% for ESBL-E carriage and 0·5% for STEC carriage. Asymptomatic ESBL-E carriers were more likely to have consumed raw milk, have had contact with pet rodents, or to have taken antibiotics during the preceding 6 months. We also found a high proportion of raw milk consumption (11%). We suggest that the low STEC prevalence in asymptomatic children supports the current practice of excluding STEC carriers from nurseries. The association between ESBL-E carriage and raw milk consumption and contact with pet rodents needs further investigation.

Assessing risk factors of sporadic Campylobacter infection: a case-control study in Arizona

Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.

Temporal variation in the prevalence and species richness of Campylobacter spp. in a prairie watershed impacted by urban and agricultural mixed inputs

Campylobacter spp. are a substantial cause of gastroenteritis worldwide. Human infection can result from ingestion of contaminated food or water from a variety of sources, including the consumption of fresh produce that is contaminated with the pathogen via the use of contaminated irrigation water. Using molecular methods, we investigated the occurrence of Campylobacter in the Qu’Appelle River watershed, an important source of irrigation water for vegetable producers in southern Saskatchewan, Canada. Water samples were collected from 7 sampling sites from April to September 2009 (145 samples), and from 5 sampling sites from May to October 2013 (116 samples). Campylobacter was detected in 57% and 16% of the samples collected in 2009 and 2013, respectively. Campylobacter detection was highest in May and June for both sampling years. In 2009, the predominant species were Campylobacter lari and Campylobacter jejuni, with prevalences of 84% and 41%, respectively. Other Campylobacter spp. were detected less frequently. Only C. lari was detected in 2013. The results in 2009 demonstrate the species richness of Campylobacter in water sources within the watershed. The occurrence of Campylobacter in the study area also underscores the importance of monitoring irrigation water used to irrigate fresh produce from a public health prospective.

Staphylococci in cattle and buffaloes with mastitis in Dakahlia Governorate, Egypt

The aim of this study was to provide the first detailed insight into the population structure of Staphylococcus aureus in one modern dairy farm (Gamasa) and several household cows and buffaloes in Dakahlia Governorate, Egypt. Eight hundred seventy-two quarter milk samples of 218 dairy cattle and buffaloes with clinical and subclinical mastitis were investigated. Bacteria were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, and staphylococci were further characterized by DNA sequencing of 16S rRNA genes and microarray analysis. Staphylococcus aureus was present in 5.6% of all collected samples, whereas methicillin-resistant S. aureus (MRSA) represented 24.5% of all identified S. aureus (12/49). Six clonal complexes (CC) of S. aureus were detected. Staphylococcus aureus CC398 (ST291/813)-MSSA (methicillin-susceptible S. aureus) was identified frequently in the Gamasa farm in addition to a few CC5-MRSA-V isolates. However, a small number of different isolates of S. aureus were found in household cattle and buffaloes harboring different CC. The presence of these genotypes of S. aureus in milk might indicate a public health hazard, because all of these CC have previously been isolated from human patients. Thus, a recommendation was given to the owner of the dairy farm to review the hygiene regimen on the farm. In perspective, further investigation regarding S. aureus screening of all lactating cows and personnel on the farm is warranted.

Dromedary Camels and the Transmission of Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Middle East respiratory syndrome coronavirus (MERS‐CoV) is an existential threat to global public health. The virus has been repeatedly detected in dromedary camels (Camelus dromedarius). Adult animals in many countries in the Middle East as well as in North and East Africa showed high (>90%) seroprevalence to the virus. Middle East respiratory syndrome coronavirus isolated from dromedaries is genetically and phenotypically similar to viruses from humans. We summarize current understanding of the ecology of MERS‐CoV in animals and transmission at the animal–human interface. We review aspects of husbandry, animal movements and trade and the use and consumption of camel dairy and meat products in the Middle East that may be relevant to the epidemiology of MERS. We also highlight the gaps in understanding the transmission of this virus in animals and from animals to humans.

Raw milk consumption among patients with non-outbreak-related enteric infections, Minnesota, USA, 2001-2010

Raw milk has frequently been identified as the source of foodborne illness outbreaks; however, the number of illnesses ascertained as part of documented outbreaks likely represents a small proportion of the actual number of illnesses associated with this food product. Analysis of routine surveillance data involving illnesses caused by enteric pathogens that were reportable in Minnesota during 2001-2010 revealed that 3.7% of patients with sporadic, domestically acquired enteric infections had reported raw milk consumption during their exposure period. Children were disproportionately affected, and 76% of those <5 years of age were served raw milk from their own or a relative's farm. Severe illness was noted, including hemolytic uremic syndrome among 21% of Escherichia coli O157-infected patients reporting raw milk consumption, and 1 death was reported. Raw milk consumers, potential consumers, and policy makers who might consider relaxing regulations regarding raw milk sales should be educated regarding illnesses associated with raw milk consumption.

Microbiological Quality and Safety Issues in Cheesemaking

As the manufacture of cheese relies in part on the select outgrowth of microorganisms, such conditions can also allow for the multiplication of unwanted contaminants. Milk ultimately becomes contaminated with microorganisms originating from infection, the farm environment, and feedstuffs, as well as milking and processing equipment. Thus, poor sanitation, improper milk handling, and animal health issues can result in not only decreased yield and poor quality but also sporadic cases and outbreaks of dairy-related disease. The entry, establishment, and persistence of food-borne pathogens in dairy processing environments also present a considerable risk to products postprocessing. Food safety management systems coupled with regulatory policies and microbiological standards for milk and milk products currently implemented in various nations work to reduce risk while improving the quality and safety of cheese and other dairy products. With that, cheese has enjoyed an excellent food safety record with relatively few outbreaks of food-borne disease considering the amount of cheese produced and consumed worldwide. However, as cheese production and consumption continue to grow, we must remain vigilant in ensuring the continued production of safe, high-quality cheese.

Nonpasteurized dairy products, disease outbreaks, and state laws-United States, 1993-2006

Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993-2006. We found 121 outbreaks for which the product's pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product-associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number (≈150× greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered.

Quality and safety of raw cow’s milk in Slovakia in 2011

The quality and safety of raw cow’s milk is very important for dairy companies and consumers of milk products. Due to the methods of production, it is impossible to completely eliminate contamination of milk with microorganisms, therefore the microbial content of milk is a major feature in determining its quality. Other important factors to consider include somatic cells count, veterinary drug residues, milk composition and freezing point. Somatic cells represent the udder health and can be used for monitoring of subclinical mastitis. A high level of somatic cells can increase proteolysis in milk which affects technological processes. Veterinary drugs administered to cows may lead to residues in the milk which are harmful to humans. The content of fat, protein and solids-non-fat are the main indicators used by dairies for technological purposes. In this article we discuss the quality and safety of raw cow’s milk in Slovakia during 2011. We found that 73.53% of samples tested for somatic cell count, and 84.54% of samples tested for total bacterial count, met the European Union legislation limits. We found the largest decrease in fat and protein content was during the summer period and the largest increase was in the winter period. We found that 92.14 %, 98.7% and 91.38% of samples met the limit presented in STN 570529:1999 for fat content, protein content and freezing point respectively. The percentage of drug positive samples was 0.087%.

An outbreak of Salmonella serotype Typhimurium infections with an unusually long incubation period

A 1998 investigation of an outbreak of Salmonella serotype Typhimurium infections among children tasting unpasteurized milk during tours of a dairy farm demonstrated a distribution of unusually long incubation periods (median, 8 days; interquartile range [IQR], 6-14 days). Bacterial isolates were highly acid tolerant and contained genes associated with protection against destructive phagocytic reactive oxygen intermediates. We hypothesize that exposure to low-dose oral inoculum of a pathogen with these properties could have contributed to cases of non-typhoidal salmonellosis with the longest incubation period reported to the Centers for Disease Control and Prevention (CDC).

A systematic review and meta-analysis of the effects of pasteurization on milk vitamins, and evidence for raw milk consumption and other health-related outcomes

Pasteurization of milk ensures safety for human consumption by reducing the number of viable pathogenic bacteria. Although the public health benefits of pasteurization are well established, pro-raw milk advocate organizations continue to promote raw milk as "nature's perfect food." Advocacy groups' claims include statements that pasteurization destroys important vitamins and that raw milk consumption can prevent and treat allergies, cancer, and lactose intolerance. A systematic review and meta-analysis was completed to summarize available evidence for these selected claims. Forty studies assessing the effects of pasteurization on vitamin levels were found. Qualitatively, vitamins B12 and E decreased following pasteurization, and vitamin A increased. Random effects meta-analysis revealed no significant effect of pasteurization on vitamin B6 concentrations (standardized mean difference [SMD], -2.66; 95% confidence interval [CI], -5.40, 0.8; P = 0.06) but a decrease in concentrations of vitamins B1 (SMD, -1.77; 95% CI, -2.57, -0.96; P < 0.001), B2 (SMD, -0.41; 95% CI, -0.81, -0.01; P < 0.05), C (SMD, -2.13; 95% CI, -3.52, -0.74; P < 0.01), and folate (SMD, -11.99; 95% CI, -20.95, -3.03; P < 0.01). The effect of pasteurization on milk's nutritive value was minimal because many of these vitamins are naturally found in relatively low levels. However, milk is an important dietary source of vitamin B2, and the impact of heat treatment should be further considered. Raw milk consumption may have a protective association with allergy development (six studies), although this relationship may be potentially confounded by other farming-related factors. Raw milk consumption was not associated with cancer (two studies) or lactose intolerance (one study). Overall, these findings should be interpreted with caution given the poor quality of reported methodology in many of the included studies.

Inhibition of growth of pathogenic bacteria in raw milk by legume protein esters

Protein isolates from soybean and chickpea, as well as their methylated esters, were tested for their inhibitory action against the propagation of pathogenic bacteria in raw milk during its storage either at room temperature or under refrigeration. Raw milk was inoculated with a mixed culture of Listeria monocytogenes Scott A and Salmonella enterica serovar Enteritidis strain PT4 at ca. 2 log CFU ml⁻¹. Aerobic plate count, coliform count, and presumptive E. coli in raw milk treated with esterified legume proteins were inhibited by 2 to 3 log relative to a control after 6 to 8 days of storage at 4°C. At room temperature, bacterial populations (aerobic plate count, coliform count, and presumptive E. coli) in raw milk treated with esterified legume proteins were inhibited by ca. 1.5 to 1.6 log relative to the control after 12 h. Supplementation of raw milk with esterified soybean protein could significantly inhibit the counts of the two inoculated pathogens (L. monocytogenes Scott A and Salmonella Enteritidis PT4), which were initially inoculated at ca. 2 log CFU ml⁻¹, by ca. 2.4 log and 1.6 log CFU ml⁻¹, respectively, on day 8 of storage under cold conditions. Corresponding reductions amounting to 2.7 and 1.8 log CFU ml⁻¹ were observed after 12 h of storage at room temperature. Supplementation of raw milk with esterified soybean protein (0.5%) reduced the maximum level of titratable acidity to 0.21 and maintained the pH level at 6.4 after 8 days of storage under cold conditions as compared with 4 days for untreated raw milk. Similar results were observed when raw milk was stored at room temperature for 10 h.

Quantitative risk assessment of listeriosis due to consumption of raw milk

The objectives of this study were to estimate the risk of illness for raw milk consumers due to Listeria monocytogenes in raw milk sold by permitted dealers, and the risk for people on farms who consume raw milk. Three scenarios were evaluated for raw milk sold by dealers: raw milk purchased directly from bulk tanks, from on-farm stores, and from retail. To assess the effect of mandatory testing of raw milk by regulatory agencies, the number of listeriosis cases per year was compared where no raw milk testing was done, only a screening test to issue a permit was conducted, and routine testing was conducted and milk was recalled if it was L. monocytogenes positive. The median number of listeriosis cases associated with consumption of raw milk from bulk tanks, farm stores, and retail for an intermediate-age population was 6.6 × 10(-7), 3.8 × 10(-5), and 5.1 × 10(-5) cases per year, respective ly. In populations with high susceptibility, the estimated median number of cases per year was 2.7 × 10(-7) (perinatal, i.e., pregnant women and their fetuses or newborns) and 1.4 × 10(-6) (elderly) for milk purchased from bulk tanks, 1.5 × 10(-5 ) (perinatal) and 7.8 × 10(-5) (elderly) for milk from farm stores, and 2.1 × 10(-5) (perinatal) and 1.0 × 10(-4) (elderly) for milk from retail. For raw milk consumed on farms, the median number of listeriosis cases was 1.4 × 10(-7) cases per year. A greater risk of listeriosis was associated with consumption of raw milk obtained from retail and farm stores as compared with milk obtained from bulk tanks. This was likely due to additional time-temperature combination steps in the retail and farm store models, which increased the chances for growth of L. monocytogenes in raw milk. A close relationship between prevalence of L. monocytogenes in raw milk and the values of disease incidence was observed. Hence, a reduction in the number of cases per year in all populations was observed when a raw milk-testing program was in place, especially when routine testing and recalling of milk was conducted.

The Role of the spv Genes in Salmonella Pathogenesis

Salmonella strains cause three main types of diseases in people: gastroenteritis, enteric (typhoid) fever, and non-typhoid extra-intestinal disease with bacteremia. Genetic analysis indicates that each clinical syndrome requires distinct sets of virulence genes, and Salmonella isolates differ in their constellation of virulence traits. The spv locus is strongly associated with strains that cause non-typhoid bacteremia, but are not present in typhoid strains. The spv region contains three genes required for the virulence phenotype in mice: the positive transcriptional regulator spvR and two structural genes spvB and spvC. SpvB and SpvC are translocated into the host cell by the Salmonella pathogenicity island-2 type-three secretion system. SpvB prevents actin polymerization by ADP-ribosylation of actin monomers, while SpvC has phosphothreonine lyase activity and has been shown to inhibit MAP kinase signaling. The exact mechanisms by which SpvB and SpvC act in concert to enhance virulence are still unclear. SpvB exhibits a cytotoxic effect on host cells and is required for delayed cell death by apoptosis following intracellular infection. Strains isolated from systemic infections of immune compromised patients, particularly HIV patients, usually carry the spv locus, strongly suggesting that CD4 T cells are required to control disease due to Salmonella that are spv positive. This association is not seen with typhoid fever, indicating that the pathogenesis and immunology of typhoid have fundamental differences from the syndrome of non-typhoid bacteremia.

Contribution to the debate on the microbiological quality of raw milk from vending machines

Microbiological quality or raw milk from vending maschine was analyzed in this work. Despite the pathogenic bacteria may be present in raw milk, the analyses and evaluations were focused to bacterial indicators only. Refer to total bacterial counts, the criterion ≤ 100,000 cfu/ml met 12 from 15 samples (80%) and all samples complied with the supplementary criterion of 5×104cfu/ml for psychrotrophs. Numbers of coagulase-positive staphylococci ranged closely around the average value 2.9×102cfu/ml. Average numbers of coliforms and E. coli in raw milk were found 4.34 ± 0.42 and 3.25 ± 0.83 log CFU/ml, respectively. These values significantly exceeded even the limits applicable in the past. On the basis of unchanged numbers of these bacteria in milk after 24 h at 6 °C, we assume that the high numbers of coliforms and E. coli present in milk are the result of fecal contamination and not growth. As E. coli is an indicator of faecal contamination of raw milk comprising the possible presence of Salmonella sp. Campylobacter sp. and other pathogens, microbiological survey suggested appropriate preventive measures that should be applied in terms of risk management.

Isolation of microbial pathogens of subclinical mastitis from raw sheep's milk of Epirus (Greece) and their role in its hygiene

The natural raw milk microflora is a factor that expresses its sensorial characteristics. The microbial charge into the mammary gland of healthy animal is low and the application of right and healthy conditions during milking and cheese making procedure, prevents from contaminating as well as maintains the natural microflora in order to lend the particular characteristics of milk. The purpose of the present project was the study of the Total Viable Count (T.V.C.) and the count of total psychrotropic bacteria of raw sheep milk from Boutsiko and Karamaniko breeds, collected from healthy animals, as well as the isolation, identification and enumeration of pathogenic bacteria related with the hygiene and the quality of raw sheep milk (with a particular interest in bacteria that may cause human infection). During the experiment we examined two hundred forty (240) samples of raw sheep milk. In these samples a) Staphylococcus aureus, Salmonella sp., Escherichia coli, Clostridium perfringens (vegetative cells and spores) and Bacillus sp. were isolated and identified b) the Total Viable Count and the total number of psychrotropic bacteria were also specified. The sampling, the preparation of samples and decimal dilutions were based on international methods. The Total viable count was determined using the standard methods of the American Public Health Association, 2002. The total number of psychrotropic bacteria was determined using APHA 1976, 1978 rules. The identification of the bacteria was carried out according to the Bergey's manual. Microscopic examination of Gram stained cells, catalase, oxidase and biochemical tests were performed when necessary to further identify. From the 240 milk samples tested, only 5% were E. coli positive, with mean counts ranged from 2 × 10(3) to 2.4 × 10(4) cfu/ml. S. aureus was isolated from 24% of the samples and the mean count per ml was ranged from <10 to 3.4 × 10(2). Meanwhile, Bacillus spp. was also detected in 29% samples. Vegetative forms and spores of C. perfringens were detected in 13% and 63% of the samples respectively. However, microbiological analyses revealed the presence of a small number of selected pathogens in milk samples such as Salmonella, which was only detected in 5% of the samples. Listeria sp., Pseudomonas sp. and Vibrio cholerae were never found. From the experimental results, the Total Viable Count from raw sheep milk samples, fulfils the microbiological criteria of EU Legislation in a percentage of approximately 97%.

Establishing a milkborne disease outbreak profile: potential food defense implications

OBJECTIVES

The main objectives of this study were to establish baseline characteristics for milkborne outbreaks, establish an expected milkborne outbreak profile, and identify potential indicators of food terrorism.

MATERIALS

This study used 1990-2006 data from the Centers for Disease Control and Prevention Annual Listings of Disease Outbreaks and the Foodborne Outbreak Database (FOOD) to establish epidemiologic baseline characteristics for disease outbreaks associated with fluid milk. FOOD data from 2007 were used to qualitatively validate the potential of the baseline characteristics and the expected outbreak profile.

RESULTS

Eighty-three fluid milkborne outbreaks were reported between 1990 and 2006, resulting in 3621 illnesses. The mean number of illnesses per outbreak was 43.6 (illness range: 2-1644). Consumption of unpasteurized milk was associated with 55.4% of reported outbreaks. Campylobacter spp., Escherichia coli, and Salmonella spp. caused 51.2%, 10.8%, and 9.6% of reported outbreaks, respectively. Private homes accounted for 41.0% of outbreak locations. Number ill, outbreak location, and etiology were the primary characteristics which could signal a potential intentional contamination event. In 2007, one pasteurized milk outbreak caused by Listeria was flagged as aberrative compared with the expected outbreak profile.

CONCLUSIONS

The creation and dissemination of expected outbreak profiles and epidemiologic baseline characteristics allow public health and Homeland Security officials to quickly assess the potential of intentional food contamination. A faster public health and medical system response can result in decreased morbidity and mortality.

Bacteriological and molecular investigations of Staphylococcus aureus in dairy goats

In order to investigate reservoirs of Staphylococcus aureus in dairy goats, samples for bacteriological analyses were collected from seven herds. S. aureus was detected in 353 (6.2%) of 5671 milk samples, 53 (9.9%) of 535 teat skin swabs, 392 (68.9%) of 569 nasal swabs and in 180 (31.6%) of 569 vaginal swabs. Vaginal swabs were more often S. aureus-positive after kidding (44.9%) than before drying off (19.1%), while nasal swabs were more often positive before drying off (75.6%) than after kidding (62.0%). Retrieved S. aureus isolates were compared by pulsed-field gel electrophoresis (PFGE), and selected isolates were tested for enterotoxin genes (se) by PCR. By PFGE, 505 S. aureus isolates were divided into 33 pulsotypes (PTs). The five most prevalent PTs included 73.3% of the isolates and were found in 3-5 herds. Pairs of S. aureus isolates from persistent intramammary infections (IMI), repeated vaginal swabs, and from milk and teat skin from the same animal were usually identical. Paired isolates from other body sites of the same animal, including from bilateral IMI, were identical in less than 50% of the situations. The majority (71.9%) of analysed S. aureus isolates were se-positive. The genes sec, sell and tst were detected almost exclusively, but no correlation was observed between persistence of IMI and the enterotoxin gene profile of the causal S. aureus strains. The frequent presence of S. aureus on the mucous membranes may contribute to dispersal of the bacteria among dairy goats, hampering effective transmission control in dairy goat herds.

Food safety: unpasteurized milk: a continued public health threat

Although milk and dairy products are important components of a healthy diet, if consumed unpasteurized, they also can present a health hazard due to possible contamination with pathogenic bacteria. These bacteria can originate even from clinically healthy animals from which milk is derived or from environmental contamination occurring during collection and storage of milk. The decreased frequency of bovine carriage of certain zoonotic pathogens and improved milking hygiene have contributed considerably to decreased contamination of milk but have not, and cannot, fully eliminate the risk of milkborne disease. Pasteurization is the most effective method of enhancing the microbiological safety of milk. The consumption of milk that is not pasteurized increases the risk of contracting disease from a foodstuff that is otherwise very nutritious and healthy. Despite concerns to the contrary, pasteurization does not change the nutritional value of milk. Understanding the science behind this controversial and highly debated topic will provide public health care workers the information needed to discern fact from fiction and will provide a tool to enhance communication with clients in an effort to reduce the incidence of infections associated with the consumption of unpasteurized milk and dairy products.

Outbreak of Escherichia coli O157:H7 associated with raw milk consumption in the Pacific Northwest

In late 2005, health officials in Clark County, Washington noted a higher than expected number of Escherichia coli cases among residents and sought to identify a possible common source for infection. In order to identify risk factors, health officials conducted a retrospective cohort study and an environmental site investigation using pulsed-field gel electrophoresis (PFGE) to identify and prevent future cases from occurring. Several lines of evidence supported raw milk as the cause of infections: 1) all ill persons drank raw milk from the same cow share; 2) illness was associated with an increasing amount of milk consumed; 3) E. coli O157:H7 was isolated from raw milk samples and environmental samples collected from the floor of the milking parlour; and 4) PFGE patterns were indistinguishable between case-patients, raw milk samples, and environmental samples. Together, these findings made clear the health risks associated with the consumption of raw milk. The high amount of media interest in this investigation empowered public health officials to work with state legislators to pass State Senate Bill 6377 in Washington State which clarified that state licensing requirements apply to all milk production facilities including cow-share programs.

Low incidence of foodborne pathogens of concern in raw milk utilized for farmstead cheese production

Overall milk quality and prevalence of four target pathogens in raw milk destined for farmstead cheesemaking was examined. Raw milk samples were collected weekly from June to September 2006 from 11 farmstead cheese operations manufacturing raw milk cheese from cow's, goat's, and sheep's milk. Samples were screened for Listeria monocytogenes, Staphylococcus aureus, Salmonella, and Escherichia coli O157:H7 both quantitatively (direct plating) and qualitatively (PCR). Overall, 96.8% of samples had standard plate counts of < 100,000 CFU/ml, 42.7% of which were < 1,000 CFU/ml. Although no federal standards exist for coliforms in raw milk, 61% of samples tested conformed to pasteurized milk standards under the U.S. Pasteurized Milk Ordinance (PMO) at < 10 CFU/ml. All cow and sheep milk samples and 93.8% of goat milk samples were within the limits dictated by the PMO for somatic cell counts. Of the 11 farms, 8 (73%) produced samples that were positive for S. aureus, which was detected in 34.6% (46 of 133) of milk samples. L. monocytogenes was isolated from three milk samples (2.3%), two of which were from the same farm. E. coli O157:H7 was recovered from one sample of goat's milk for an overall incidence of 0.75%. Salmonella was not recovered from any of the 133 samples. The findings of this study suggest that most raw milk intended for farmstead cheesemaking is of high microbiological quality with a low incidence of pathogens. These data will help inform risk assessments associated with the microbiological safety of farmstead cheeses, particularly those manufactured from raw milk.

Public Health Significance of Antimicrobial-Resistant Gram-Negative Bacteria in Raw Bulk Tank Milk

The dairy farm environment and animals on the farm serve as important reservoirs of pathogenic and commensal bacteria that could potentially gain access to milk in the bulk tank via several pathways. Pathogenic gram-negative bacteria can gain access to bulk tank milk from infected mammary glands, contaminated udders and milking machines, and/or from the dairy farm environment. Contaminated raw milk when consumed by humans or fed to animals on the farm can result in gastroenteric infections in humans and animals and also provide an opportunity for organisms to colonize the farm environment. This scenario becomes much more complicated when pathogenic bacteria such as Salmonella, Shiga toxin-producing Escherichia coli, and commensal gram-negative enteric bacteria encode for antimicrobial resistance determinants. In recent years, the role of commensal bacteria as reservoirs of genetic determinants for antimicrobial resistance has come under closer scrutiny. Commensal bacteria in bulk tank milk can be a significant reservoir of antimicrobial determinants. Raw milk consumption can result in exposure to antimicrobial-resistant commensal gram-negative bacteria. This paper examines the prevalence and role of commensal gram-negative enteric bacteria in bulk tank milk and their public health significance.

Clinical Practice: Milk of Nonhuman Origin and Infectious Diseases in Humans

Milk and milk products from domestic animals, which are potential infectious hazards, are made more so by modern milk production, because milk from thousands of animals is often pooled prior to bottling or before manufacturing derivative products. Thus, contaminated milk from 1 animal can result in a widespread problem. Pasteurization largely eliminates this hazard. Most disease transmission caused by contamination of the milk supply has been eliminated by hygienic production measures and pasteurization. However, contamination may occur after pasteurization, and no process works perfectly all of the time. Despite scientific opinion that pasteurized products are safer than raw ones--and are equally nutritious--segments of the population regard raw milk products as more nutritious and better tasting than pasteurized milk products. Thus, low levels of raw milk consumption persist in the United States and other developed nations. Occasional milk-associated disease outbreaks caused by raw milk consumption or by breakdowns in the proper production of pasteurized products still occur.

A Survey of Foodborne Pathogens in Bulk Tank Milk and Raw Milk Consumption Among Farm Families in Pennsylvania

A 2-part study was conducted to determine the risk of exposure to human pathogens from raw milk. The first part of the study focused on determining raw milk consumption habits of dairy producers. A total of 248 dairy producers from 16 counties in Pennsylvania were surveyed. Overall, 105 (42.3%) of the 248 dairy producers consumed raw milk and 170 (68.5%) of the 248 dairy producers were aware of foodborne pathogens in raw milk. Dairy producers who were not aware of foodborne pathogens in raw milk were 2-fold more likely to consume raw milk compared with dairy producers who were aware of foodborne pathogens. The majority of dairy producers who consumed raw milk indicated that taste (72%) and convenience (60%) were the primary factors for consuming raw milk. Dairy producers who resided on the dairy farm were nearly 3-fold more likely to consume raw milk compared with those who lived elsewhere. In the second part of the study, bulk tank milk from the 248 participating dairy herds was examined for foodborne pathogens. Campylobacter jejuni (2%), Shiga toxin-producing Escherichia coli (2.4%), Listeria monocytogenes (2.8%), Salmonella (6%), and Yersinia enterocolitica (1.2%) were detected in the milk samples. Salmonella isolates were identified as S. enterica serotype Typhimurium (n = 10) and S. enterica serotype Newport (n = 5). Of the 248 bulk tank milk samples, 32 (13%) contained > or = 1 species of bacterial pathogens. The findings of the study could assist in developing farm community-based educational programs on the risks of consuming raw milk.

Spatial analysis of campylobacter infection in the Canadian province of Manitoba

BACKGROUND

The study describes population level variations in campylobacter incidence within the Canadian province of Manitoba, and the relationship to sociodemographic and landscape related characteristics. Using data derived from the Manitoba Health Public Health Branch communicable disease surveillance database, the study applied a number of spatial and ecological techniques to visualize, explore and model campylobacter incidence for the years 1996 to 2004. Analytical techniques used in the study included spatial smoothing, the spatial scan statistic, the Gini coefficient, and Poisson regression analysis.

RESULTS

The study demonstrated marked and statistically significant geographic variability in the rates of campylobacter incidence in Manitoba.. The incidence of campylobacter was observed to be significantly higher in populations living in rural and agricultural areas of the province, with the highest rates occurring in populations living in proximity to high densities of farm animals (cows, pigs, chickens). The study also observed that the age specific pattern of campylobacter incidence in rural Manitoba was very different than the urban pattern, with the incidence rate in the 0-4 year age group seven times higher in rural Manitoba than in the City of Winnipeg.

CONCLUSION

The study demonstrates the value of a deploying a diverse set of spatial techniques to better understand the dynamics of an enteric disease such as campylobacter infection. The study concludes that there may be three distinct mechanisms for the transmission of campylobacter in Manitoba which are operating simultaneously. These include broad population exposure to a centralized food system endemically infected with the campylobacter organism, exposure to local level factors such as farm animals or contaminated water, and exposure to campylobacter infection through foreign travel.

The Occurrence of Staphylococcus aureus on a Farm with Small-Scale Production of Raw Milk Cheese

In recent years, the small-scale production of raw milk products has increased in Norway, and there is some concern that such foods may pose a risk of staphylococcal food poisoning to consumers. The aim of the study was to evaluate potential sources of contamination of raw milk cheese with Staphylococcus aureus on a bovine dairy farm with small-scale production. Samples for bacteriological analyses (n = 144) were collected from the animals, the environment, processing equipments, from humans, and from cheeses at various stages of production. Staphylococcus aureus was isolated from 10 of 11 cows, the farmer, equipment, the environment, and the cheese. Seventy-five Staph. aureus isolates were genotyped by pulsed-field gel electrophoresis, tested for enterotoxin (SE) production by reversed passive latex agglutination, for SE genes by multiplex polymerase chain reaction, and for penicillin resistance by the cloverleaf method. Five different pulsotypes were identified and SE gene fragments were identified in 11 isolates, but no isolates produced SE or were penicillin resistant. Staphylococcus aureus was found throughout the farm, and appeared to be spread with the milk to the environment, equipment, and to products. One pulsotype dominated and was identified from most sample sites on the farm. Raw milk products are vulnerable to contamination with Staph. aureus. Strategies to reduce the occurrence of Staph. aureus in bulk milk are of particular importance on farms where milk is used for raw milk products.