Tennessee E. coli outbreak linked to raw milk from multistate cow-share
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Key takeaways:
- Five cases of E. coli — two in infants — were linked to raw milk distributed in a three-state cow-share arrangement.
- The direct sale of raw milk is illegal in some states, but people may acquire it in cow-shares.
An outbreak of Shiga toxin-producing Escherichia coli in Tennessee was caused by raw milk consumption among members of a cow-share, according to a study.
Two 10-month-old infants were hospitalized in August 2022 with confirmed Shiga toxin-producing E. coli, with one of the two developing hemolytic uremic syndrome (HUS) linked to raw milk distributed as part of a cow-share program that had more than 100 participants in Georgia, Tennessee and North Carolina.
From 2013 to 2018, the CDC received reports of 75 outbreaks linked to consumption of raw milk, which is milk that has not been pasteurized to reduce the chance of pathogens causing human sickness. These outbreaks resulted in 675 illnesses and 98 hospitalizations. At least one person aged 19 years or younger was involved in nearly half.
The direct sale of raw milk is illegal in some states, including Tennessee, but the state allows people to share raw milk through cow-share arrangements.
Christine Thomas, DO, MPH, a CDC Epidemic Intelligence Service officer embedded in the Tennessee Department of Health (DOH), told Healio that people drink raw milk may be under the impression that it is more nutritious, reduces the risk for allergies, overcomes lactose intolerance and provides the consumer with good bacteria for their digestive health.
“There is not good evidence that drinking raw milk provides any of these benefits,” Thomas said. “The person who interviewed the parents of both hospitalized patients in this outbreak identified that they live in households that drink raw milk from a cow-share. Identifying this similarity prompted additional investigation into the outbreak.”
According to Thomas and colleagues, the two 10-month-old Tennessee infants experienced diarrhea on July 25, 2022, and Aug. 1, 2022, with one infant developing HUS, requiring hemodialysis and hospitalization for 27 days, and the other being hospitalized for 1 day but not developing HUS.
Both infants lived in households that participated in the same cow-share program, and at least one of the children had consumed raw milk.
Tennessee DOH officials visited the cow-share dairy farm, which had seven to 10 cows that were hand-milked daily, observing possible routes of fecal contamination during milking and milk storage at higher than recommended temperatures.
The officials also obtained the cow-share list containing 125 participants from Georgia, Tennessee and North Carolina, eventually reaching 50 people from the households, which allowed for information on 112 participants. Three additional possible E. coli cases were identified, although clinical symptoms resolved without hospitalization or lab confirmation.
The cow-share arrangement is not unique or new, because similar outbreaks have been reported in Colorado and other states, and in the last 2 decades, people have been drawn to raw milk in an effort to “get back to nature,” despite raw milk being one of the riskiest food items a person can consume, the CDC has previously said.
Researchers have failed to find the beneficial microbes, or probiotics, that raw milk believers claim the product offers, and instead have linked it to greater risk for antimicrobial resistance — on top of the “indisputable and dramatically higher” risk for foodborne illness for people who drink unpasteurized milk.
“Drinking raw milk is dangerous for health and can lead to infections, especially among those at greatest risk for illness such as young children,” Thomas said. “If ever offered a glass of raw milk, please, just say ‘no, thank you.’”
References:
- Thomas C M, et al. MMWR Morb Mortal Wkly Rep. 2023;doi:10.15585/mm7217a4.
- CDC. Raw milk questions and answers. https://www.cdc.gov/foodsafety/rawmilk/raw-milk-questions-and-answers.html. Published March 24, 2023. Accessed May 10, 2023.
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