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E. coli outbreak in Connecticut attributed to raw milk
Guh A. Clin Infect Dis. 2010;51:1411-1417.
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Seven confirmed cases of Escherichia coli O157-associated hemolytic uremic syndrome have been linked to unpasteurized raw milk from a retail market and a farm in Connecticut during 2008, according to new findings published in Clinical Infectious Diseases.
In July 2008, the Connecticut Department of Public Health reported cases of E. coli O157-associated hemolytic uremic syndrome in two unrelated children after raw milk consumption from the same farm. After further investigation, CDC officials reported 14 cases in the state.
For this reason, Alice Guh, MD, of the CDC, and colleagues conducted case-control studies to determine the source of the outbreak and control measures used. Dairy practices at the farm were assessed, and stool specimens of humans and animals were cultured.
In total, researchers identified 14 cases of E. coli; seven were confirmed. E. coli O157 was identified in six patients and one milking cow. Although no deaths were reported, five patients were hospitalized and three had E. coli O157-associated hemolytic uremic syndrome.
In June and July 2008, matching outbreak strains were identified in confirmed cases of E. coli O157-associated hemolytic uremic syndrome. Diarrheal illness was also confirmed among other farm customers during the same time period.
Raw milk consumption-associated illness (P=.008) and dose-related response were observed (P=.01).
“Although the exact mechanism of raw milk contamination cannot be determined, we suspect that fecal contamination with E. coli 0157 from at least one asymptomatic cow occurred during milking or the handling of milk,” the researchers wrote.
In response to the outbreak, the Connecticut Department of Agriculture proposed legislation supported by the Department of Public Health. Three control measures used for raw milk in states similar to Connecticut, where pasteurization is not required, were proposed:
- Increase of prominently displayed labels containing a detailed warning highlighting those at risk (children and the elderly);
- Increase in the frequency of raw milk testing from quarterly to monthly, and lowering the coliform threshold;
- And the limitation of raw milk sales to farm premises.
“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,” Guh said in a press release. “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.”
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