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Epidemiology of Foodborne Illnesses Linked to Consumption of Unpasteurized Dairy in the United State

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Unpasteurized dairy outbreaks are defined as: Liquid unpasteurized milk ... Surveys taken by the Dairy Division of the National Association of the State ... – PowerPoint PPT presentation

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Title: Epidemiology of Foodborne Illnesses Linked to Consumption of Unpasteurized Dairy in the United State


1
Epidemiology of Food-borne Illnesses Linked to
Consumption of Unpasteurized Dairy in the United
States, 1993-2007
  • Jananne OConnell, DVM, MVPH
  • North Carolina State University
  • College of Veterinary Medicine

2
History and Background
  • The problem of food-borne illness linked to
    drinking unpasteurized milk was addressed by
    Marcia Headrick, DVM et al
  • This paper looked at both the epidemiology of raw
    dairy-associated food-borne illness and the laws
    governing the sale of unpasteurized dairy from
    state to state.

3
History and Background
  • Regulations concerning the sale, or prohibition
    thereof, of milk or dairy products that have not
    been pasteurized are made on a statewide basis

4
History and Background
  • This paper showed an association between legal
    status of raw milk sales and raw dairy-associated
    outbreaks in different states during the study
    period of 1973-1992.
  • QUESTION Does this association still hold?

5
Methods
  • Foodborne Illness Outbreak Surveillance
  • Most outbreaks are detected, investigated, and
    controlled by local and state health departments
  • CDC has a web-based reporting system that
    collects epidemiological information (electronic
    Foodborne Outbreak Reporting System, or eFORS)
  • Approximately 1300 reports annually
  • Data collected includes number ill, number
    hospitalized, number of deaths, etiology, and
    implicated food

6
Methods
  • Reviewed outbreaks reported through eFORS
  • Outbreak defined as illness of two or more people
    following the ingestion of a common food
  • Unpasteurized dairy outbreaks are defined as
  • Liquid unpasteurized milk
  • Unpasteurized cheese product

7
Methods
  • Multi-step process used to determine the legal
    status of the sale of raw milk in each state
  • Surveys taken by the Dairy Division of the
    National Association of the State Departments of
    Agriculture (NASDA) in November 2004 and the
    Division of Animal Food Industry Services,
    Office of Dairy and Foods (Virginia Department of
    Agriculture), March 2005

8
Methods
  • Forty-six of fifty states gave consistent answers
    to the relevant questions in both surveys for 92
    agreement. State Public Health Veterinarians
    were contacted for clarification in the four
    states whose answers were inconsistent.

9
Methods
  • Developed a system to classify each state for
    each year of the survey into one of 4 categories
  • Phone and email interviews with appropriate state
    governing body to verify findings from surveys
    and to confirm status of raw milk sales in the
    year 2006
  • Data from 2007 provided courtesy of Adam Langer,
    DVM, MPH, DACPVM, Preventative Medicine Fellow in
    Foodborne Diarrheal Diseases Branch, Centers
    for Disease Control and Prevention

10
Methods
  • 1 Sale of raw milk is illegal, including animal
    shares
  • 2 Sale of raw milk is illegal no restrictions
    on animal shares
  • 3 Sale of raw milk is legal on farm only
  • 4 Sale of raw milk is legal on farm and at
    retail

11
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12
2007 Additional Data
  • Total outbreaks 1993 2007 n 80
  • Liquid milk outbreaks n65
  • Unpasteurized cheese outbreaks n 27

13
Pathogens (Pasteurized/Probable Pasteurized)
  • Bacillus ceres, Calicivirus/Norovirus,
    Campylobacter jejuni/ spp., Hepatitis A, Listeria
    monocytogenes, Salmonella enteriditis, newport,
    tennessee, typhimurium. Shigella sonnei,
    Staph. aureus toxin
  • Strictly human pathogen high likelihood of
    post-pasteurization contamination

14
Pathogens (Unpasteurized/Probable Unpasteurized)
  • Brucella, Campylobacter jejuni/ spp., E. coli
    O157H7, L. monocytogenes, Salmonella
    bovismorbificans, enteriditis, java, newport,
    typhimurium, saintpaul. Shigella flexneri,
    Staph. aureus toxin

15
2007 Data Update
  • Twelve (12) additional outbreaks associated with
    unpasteurized dairy are reported (15 dairy
    outbreaks total)
  • 1/12 Salmonella spp (liquid milk)
  • 2/12 Brucella (cheese)
  • 9/12 Campylobacter spp (7 liquid milk, 2 cheese)
  • Little variation in pathogens from year to year

16
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17
2007 Update
  • California, Kansas, Pennsylvania 2 outbreaks
  • Colorado, Georgia, New York, North Carolina,
    Utah, Washington 1 outbreak each

18
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19
Results
  • 22 outbreaks associated with homemade cheese or
    queso fresco
  • Queso fresco is a soft, Mexican-style cheese
    traditionally made with unpasteurized milk
  • 9 outbreaks in California

20
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21
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22
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23
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24
Results
  • Odds Ratio
  • Unpast. Illness Past. Illness
  • Legal 751 709
  • Illegal 356 913
  • OR 2.7165 95 CI 2.3154 3.1872

25
Discussion
  • 47/62 (75)outbreaks linked to unpasteurized or
    probable unpasteurized dairy linked to
    Campylobacter (jejuni 30/47)

26
Discussion
  • Unpasteurized Dairy Outbreaks in states
    associated w/ SECEBT
  • Legal Status
  • Alabama 0 2
  • Georgia 1 2
  • Florida 0 1(2)
  • Mississippi 0 3
  • North Carolina 2 1(2)
  • South Carolina 0 4
  • Tennessee 0 2
  • Among the first states to pass laws expressly
    prohibiting animal shares in 2005. Considered a
    Category 2 state for the majority of the analysis

27
Discussion
  • NC Outbreak
  • Robeson County, November 2001
  • Unpasteurized liquid milk being served at a
    school
  • 202 ill, 33 hospitalized
  • E. coli O157H7 with 4 cases HUS
  • Outbreak resulted in written policy change that
    non-commercial foods may not be brought into or
    served in county schools

28
MANY THANKS TO…
  • State and local health department investigators
    and eFORS reporters
  • Staff of the Enteric Diseases Epidemiology Branch
  • Tracy Ayers, Michael Lynch, Fred Angulo, Ann
    Schmitz, Julian Grass, Heather Bair-Brake, Adam
    Langer
  • Greg Podolej, Stic Harris
  • Dr. Barrett Slenning, Dr. Jay Levine, Dr. Maria
    Correa, Dr. Prema Arasu, NCSU-CVM

29
  • All slides created by Tracy Ayers and used in a
    presentation to the Council of State and
    Territorial Epidemiologists are designated by the
    CDC logo
  • The findings and conclusions in this presentation
    have not been formally disseminated by the
    Centers for Disease Control and Prevention and
    should not be construed to represent any agency
    determination or policy
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