A ProMED-mail post
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International Society for Infectious Diseases
Date: Thu 27 May 2010
Source: Star Tribune, Minneapolis-St. Paul (MN) [edited]
A Minnesota toddler has been hospitalized with a life-threatening
illness and 3 other people have been sickened by _E. coli_-tainted
raw milk, an outbreak that is likely to sharpen a national debate on
the growing popularity of the controversial beverage.
3 of the 4 _E. coli_ cases are linked to unpasteurized milk produced
at the Hartmann Dairy Farm in Gibbon, Minnesota, which is also known
as MOM, or Minnesota Organic Milk, state health and agricultural
department officials said Wednesday, 26 May 2010. They said consumers
should discard any dairy products, including cheese and ice cream,
made by Hartmann.
Of the 4 cases of _E. coli_ O157:H7, 2 were reported in the metro
area, the other 2 in outstate counties, state officials said. None of
the milk involved so far appears to have been sold in stores, said
Heidi Kassenborg, the Minnesota Department of Agriculture's director
of dairy and food inspection.
Raw milk hasn't been pasteurized, that is, treated with heat to kill
organisms that can make people sick. Interstate sales of raw milk are
banned, but more than 20 states allow sales, usually limited, of the
product. In Minnesota, raw milk is restricted to "occasional
purchases directly at the farm where the milk is produced,"
Kassenborg said.
Raw milk is roundly condemned by public health authorities because it
can carry dangerous bacteria such as _E. coli_, _Salmonella_, and
_Campylobacter_. But there is a growing movement of raw milk
advocates who believe the drink has health benefits, and that they
should have the right to drink it.
Last week [week of 17 May 2010] Wisconsin Gov. Jim Doyle vetoed a
bill that would have allowed limited sales of raw milk, irking raw
milk supporters but winning praise from food safety advocates.
Each year, several dozen people are usually sickened by raw milk in
Minnesota. But this is the 1st outbreak, 2 or more cases that are
linked, in at least 15 years, Health Department officials say.
"The fact is, raw milk is unsafe to drink, and that's unfortunately
been evidenced by the outbreak we've seen" in Minnesota, Kassenborg
said.
Assistant state epidemiologist Richard Danila said the Health
Department found 4 cases of _E. coli_ 0157:H7 between 1 and 21 May
2010, all of which had the same DNA fingerprint. 2 of those sickened
were school-age children, 1 was a man who was at least 70 years old,
and the 4th was a toddler. All 4 were hospitalized: 1 overnight, 2
for 4 days, and the other, the toddler, is still in the hospital
after being admitted late last week [week of 17 May 2010].
According to the Health and Agriculture Departments [the man who]
operates the farm, couldn't be reached for comment.
A parent of 1 of the sickened children told state investigators that
he or she didn't realize the Hartmann milk was raw milk. The parents
of the toddler with HUS [hemolytic uremic syndrome] knew they were
buying raw milk, it was said, adding that doesn't necessarily mean
they understood it was unpasteurized and potentially unhealthy. The
toddler's parents were characterized as "distraught."
State officials aren't sure where the Hartmann raw milk was
purchased. But some of it may have been purchased at a metro-area
"pickup point," Danila said without elaborating. One Hartmann Dairy
customer, a south Minneapolis resident, said she picks up raw milk
weekly at a neighbor's house through a "milk club." Several families
belong, and pay Hartmann directly. The arrangement appears to be
common.
The state revoked Hartmann Dairy Farm's license to produce Grade A
milk in 2001 for "general unsanitary conditions," Kassenborg said.
[Byline: Mike Hughlett]
--
Communicated by:
ProMED-mail
[The state of Minnesota in the Midwestern US can be located on the
HealthMap/ProMED-mail interactive map at
[A previous ProMED-mail posting (E. coli O157, unpasteurized milk,
2005 - USA (WA) 20070302.0741) contains an excellent discussion on
the subject of enteric illnesses such as _E. coli_ O157:H7,
salmonellosis and campylobacteriosis transmitted by unpasteurized
dairy products.
Certain other diseases that can be related to unpasteurized milk are
highlighted in these paragraphs extracted from Leedom JM: Milk of
nonhuman origin and infectious diseases in humans. Clin Infect Dis
2006; 43(5): 610-5
(
citations renumbered to be consecutive starting from 1:
"In 1996 and 1998, there were 2 episodes involving rabid cows that
occurred in Massachusetts (1). Milk from rabid cows can contain
rabies virus, and transmission via unpasteurized milk is
theoretically possible. Temperatures reached during pasteurization
kill the virus. A total of 80 persons consumed unpasteurized milk
that was collected from the 2 cows, and 9 more had contact with
saliva from the cows. All 89 persons received post-exposure rabies
prophylaxis, and there were no human cases of rabies. A similar
report in Oklahoma of possible rabies exposure associated with the
consumption of raw milk or cream from a rabid cow was circulated in
2006 (2).
Tickborne encephalitis, a zoonotic arbovirus infection usually
transmitted to humans by the bite of an _Ixodes persulcutus_ or
_Ixodes ricinis_ tick, is endemic to Central Europe, Eastern Europe,
and Russia (3). However, the virus can be found in the milk of cows
and goats with tickborne encephalitis and was reported to be
transmissible to humans by the consumption of unpasteurized milk (4).
A case-control study failed to confirm oral transmission (5).
A diarrhea syndrome (later named Brainerd diarrhea) occurred among
122 residents of Brainerd, Minnesota, during the period December
1983-July 1984 (6). It was characterized by acute onset, marked
urgency, lack of systemic symptoms, failure to respond to
conventional antimicrobial agents, and a long median duration of
illness (median duration, 16.5 months). The syndrome was linked to
consumption of raw milk from a single dairy (6). No etiologic agent
was ever isolated. The outbreak of Brainerd diarrhea stopped when all
of the dairy's output was diverted and pasteurized (6, MT Osterholm,
personal communication).
Subsequent outbreaks in Illinois and Texas were not directly
associated with milk, although cattle had been in the vicinity of an
Illinois well that had its water implicated as a vehicle of
transmission (7). Another outbreak of Brainerd-like diarrhea,
although not associated with raw milk, affected 58 (15 per cent) of
394 passengers aboard a cruise ship visiting the Galapagos Islands in
Ecuador (8).
References
----------
1. CDC: Mass treatment of humans who drank unpasteurized milk from
rabid cows -- Massachusetts, 1996-1998. JAMA 1999; 281: 1371-2
[available at
2. Rabies, bovine, human exposure -- USA (OK). 2006 [ProMED-mail
archive no. 20060101.0005>. Accessed 26 Jul 2006].
3. Dumpis U, Crook D, Oksi J: Tick-borne encephalitis. Clin Infect
Dis 1999; 28 (4): 882-90 [available at
4. Matuszczyk I, Tarnowska H, Zabica J, Gut W: The outbreak of an
epidemic of tick-borne encephalitis in Kielec province induced by
milk ingestion [in Polish]. Przegl Epidemiol 1997; 51(4): 381-8
[abstract available at
5. Rieger MA, Nubling M, Kaiser R, et al: Tick-borne encephalitis
transmitted by raw milk -- what is the significance of this route of
infection? Studies in the epidemic region of Southwest Germany.
Gesundheitswesen 1998; 60(6): 348-56 [abstract available at
6. Osterholm MT, MacDonald KL, White KE, et al: An outbreak of a
newly recognized chronic diarrhea syndrome associated with raw milk
production. JAMA 1986; 256(4): 484-90 [available at
7. Mintz ED, Parsonnet J, Osterholm MT: Chronic idiopathic diarrhea
[letter]. N Engl J Med 1993; 328(23): 1713-4.
8. Mintz ED, Weber JT, Guris D, et al: An outbreak of Brainerd
diarrhea among travelers to the Galapagos Islands. J Infect Dis 1998;
177: 1041-5 [available at
[see also:
Campylobacteriosis, unpasteurized milk - USA (02): (UT) 20100519.1654
Salmonellosis, unpasteurized milk - USA: (UT) 20100517.1616
Campylobacteriosis, unpasteurized milk - USA: (MI ex IN) 20100329.0981
2009
----
Campylobacteriosis, unpasteurized milk - USA (02): (WI) 20090917.3264
Campylobacteriosis, unpasteurized milk - USA: (CO) 20090415.1430
2008
----
Campylobacteriosis, unpasteurized milk - USA (CA) 20080817.2557
2007
----
Campylobacteriosis, unpasteurized milk - USA (KS) 20071205.3922
Salmonellosis, serotype Typhimurium, raw milk - USA (02): (PA), CDC
report 20071108.3629
Salmonellosis, free unpasteurized milk - USA (PA) (03) 20070815.2667
Campylobacteriosis, unpasteurized milk - USA (GA) 20070803.2520
Salmonellosis, free unpasteurized milk - USA (PA) 20070722.2354
Listeriosis, unpasteurized cheese - USA (IN) 20070425.1351
Campylobacteriosis, unpasteurized milk - USA (UT) (02) 20070324.1033
Campylobacteriosis, unpasteurized milk - USA (UT) 20070322.1004
Salmonellosis, serotype Typhimurium, raw milk - USA (PA) 20070303.0748
E. coli O157, unpasteurized milk, 2005 - USA (WA) 20070302.0741
2006
----
Foodborne illness, unpasteurized milk - USA (OH) 20060929.2794
E. coli O157, unpasteurized milk - USA (CA) (03) 20060929.2791
E. coli O157, unpasteurized milk - USA (WA): recall 20060929.2790
E. coli O157, unpasteurized milk - USA (CA) (02): background 20060927.2761
E. coli O157, unpasteurized milk - USA (CA) 20060922.2706
E. coli O157, unpasteurized milk - USA (OR, WA) (04) 20060121.0199
2005
----
E. coli O157, unpasteurized milk - USA (OR, WA) 20051216.3622
2003
----
Salmonellosis, raw milk - USA (Ohio) (03) 20030204.0308
Salmonellosis, raw milk - USA (Ohio) 20030105.0033]
...................................ll/mj/lm
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