Yersinia enterocolitica Outbreak Associated with Pasteurized Milk

In July 2019, we investigated a cluster of Yersinia enterocolitica cases affecting a youth summer camp and nearby community in northeastern Pennsylvania. After initial telephone interviews with camp owners and community members, we identified pasteurized milk from a small dairy conducting on-site pasteurization, Dairy A, as a shared exposure. We conducted site visits at the camp and Dairy A where we collected milk and other samples. Samples were cultured for Y. enterocolitica. Clinical and nonclinical isolates were compared using molecular subtyping. We performed case finding, conducted telephone interviews for community cases, and conducted a cohort study among adult camp staff by administering an online questionnaire. In total, we identified 109 Y. enterocolitica cases. Consumption of Dairy A milk was known for 37 (34%); of these, Dairy A milk was consumed by 31 (84%). Dairy A had shipped 214 gallons of pasteurized milk in 5 weekly shipments to the camp by mid-July. Dairy A milk was the only shared exposure identified between the camp and community. Y. enterocolitica was isolated from Dairy A unpasteurized milk samples. Five clinical isolates from camp members, two clinical isolates from community members, and nine isolates from unpasteurized milk were indistinguishable by whole-genome sequencing. The risk for yersinosis among camp staff who drank Dairy A milk was 5.3 times the risk for those who did not (95% confidence interval: 1.6-17.3). Because Dairy A only sold pasteurized milk, pasteurized milk was considered the outbreak source. We recommend governmental agencies and small dairies conducting on-site pasteurization collaborate to develop outbreak prevention strategies.

Evaluation of knowledge, attitudes, and practices of deer owners following identification of a cluster of captive deer with rabies in Pennsylvania in July 2010

OBJECTIVE

To evaluate knowledge, attitudes, and practices of deer owners following identification of a cluster of captive deer with rabies as an aid for the development of rabies prevention educational materials.

DESIGN

Cross-sectional study.

POPULATION

Captive-deer owners who were members of the pennsylvania deer farmers association.

PROCEDURES

Information was obtained via a mailed, self-administered questionnaire.

RESULTS

The questionnaire response rate was 59% (249/425). One hundred three of 206 (50%) respondents had incomplete knowledge of rabies virus vectors, transmission, severity, and prevention measures. Birds or snakes were incorrectly identified as rabies vectors by 96 of 213 (45%) respondents, and most (≥ 94%) respondents identified rabies virus reservoirs as vectors. Ninety of 231 (39%) respondents identified death as an outcome of rabies, and 184 of 235 (78%) respondents would seek emergency treatment if they suspected exposure. Only 62 of 235 (26%) respondents would wash a wound immediately. The majority of respondents (173/239 [72%]) did not know the clinical signs of rabies in deer. Nine respondents indicated that they vaccinated their deer against rabies, and the majority of respondents (158/214 [74%]) would be willing to vaccinate.

CONCLUSIONS AND CLINICAL RELEVANCE

Findings suggested that deer owners in Pennsylvania have a basic knowledge of rabies; however, knowledge, attitudes, and practices regarding prevention of rabies transmission could be improved considerably. Rabies educational materials for deer owners should focus on postexposure procedures, disease severity, recognition of rabies in deer, and changes in management practices such as vaccination to prevent rabies.

Recurrent outbreak of Campylobacter jejuni infections associated with a raw milk dairy--Pennsylvania, April-May 2013

During May 2013, the Pennsylvania Department of Health investigated an outbreak of campylobacteriosis among consumers of raw (unpasteurized) milk from a dairy certified by the Pennsylvania Department of Agriculture (PDA) to sell raw milk onsite, at retail stores, and at off-farm pick-up sites. Investigation by the Pennsylvania Department of Health and PDA identified six confirmed and two probable cases of campylobacteriosis associated with raw milk from the dairy. A confirmed case was defined as laboratory-confirmed campylobacteriosis in a person who drank the dairy's raw milk. A probable case was defined as diarrheal illness without laboratory confirmation in a person who had consumed the dairy's raw milk and was linked to a confirmed case. Four cases involved children aged ≤18 years. PDA identified Campylobacter in bulk tank and retail milk samples from the dairy. Available isolates from patient stool (n = 1), bulk tank milk (n = 1), and retail milk (n = 1) were identified by CDC as Campylobacter jejuni and were indistinguishable by pulsed-field gel electrophoresis (PFGE).

Campylobacter jejuni infections associated with unpasteurized milk--multiple States, 2012

In 2012, a multistate outbreak of Campylobacter infections associated with unpasteurized milk resulted in 148 illnesses. A dairy with a Pennsylvania Department of Agriculture unpasteurized milk permit and minimal deficiencies identified during inspection was the outbreak source, demonstrating the ongoing hazards of unpasteurized dairy products.