Raw milk is consumed by an estimated 1-3 percent of the United States population. Raw milk and raw cheeses are responsible for almost 70 percent of reported dairy outbreaks. On July 16, 2008, the Connecticut Department of Public Health identified two unrelated children who had experienced hemolytic uremic syndrome after consuming raw milk from the same farm. The authors investigated the situation further and found more cases of people affected by raw milk from the same farm. The details of their study are chronicled in the Dec. 15 issue of Clinical Infectious Diseases, available online (http://www.journals.uchicago.edu/doi/abs/10.1086/657304).
Fourteen cases were identified and seven were confirmed. The E. coli found in a fecal sample from one of the dairy cows at the farm matched the outbreak strain. Despite acceptable regulation milking standards and sanitation procedures, it is believed that fecal contamination from an asymptomatic cow occurred during milking or the handling of milk.
In response to this outbreak, the Connecticut Department of Agriculture proposed legislation supported by the Connecticut Department of Public Health that included three control measures for raw milk: the strengthening of prominently displayed labels containing a detailed warning, increasing the frequency of raw milk testing from quarterly to monthly, and limiting raw milk sale to farm premises.
"This finding reinforces the fact that pasteurization remains the most effective method for ensuring the safety of milk," said study author Alice Guh, MD, of the Centers for Disease Control and Prevention. "However," she added, "in states where attempts to implement pasteurization and ban raw milk sales have been unsuccessful, alternative control measures to minimize occurrences of raw milk-associated infections are critically needed. Although the proposed legislation in Connecticut was not passed due to the strong opposition of raw milk advocates, this outbreak led to the discontinuation of raw milk sales in at least one major retail store. It also led to the insurance industry re-evaluating the provision of product liability insurance to retail stores and milk producers that sell raw milk."
Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org.
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