Apr 10, 2013 - It is legal to sell unpasteurized milk in Pennsylvania, al- ... 933 Health and Welfare Building, 625 Forster St, Harrisburg, PA 17120-0701 ...
BRIEF REPORT
Campylobacter jejuni Infections Associated With Unpasteurized Milk—Multiple States, 2012 Allison H. Longenberger,1,2 Aimee J. Palumbo,2 Alvina K. Chu,3 Mària E. Moll,2 André Weltman,2 and Stephen M. Ostroff2 1 Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, Georgia; 2Pennsylvania Department of Health, Harrisburg; and 3Maryland Department of Health and Mental Hygiene, Baltimore
In 2012, a multistate outbreak of Campylobacter infections associated with unpasteurized milk resulted in 148 illnesses. A dairy with a Pennsylvania Department of Agriculture unpasteurized milk permit and minimal deficiencies identified during inspection was the outbreak source, demonstrating the ongoing hazards of unpasteurized dairy products. Keywords. Campylobacter jejuni; dairy products; disease outbreaks; foodborne diseases.
Although the majority of diarrheal illnesses from Campylobacter are sporadic, Campylobacter has been the most commonly identified pathogen in unpasteurized dairy product–associated foodborne outbreaks in the United States [1–3]. It is legal to sell unpasteurized milk in Pennsylvania, although federal authorities prohibit interstate sales [4, 5]. Farms that hold Pennsylvania Department of Agriculture (PDA) unpasteurized milk permits undergo annual inspection that includes twice-monthly testing for coliforms and standard plate counts and biannual milk culturing for bacterial pathogens [4]. During 2007–2011, 15 unpasteurized milk–related disease outbreaks were identified in Pennsylvania, resulting in 233 illnesses; 12 (80%) outbreaks were caused by Campylobacter, a reportable disease in Pennsylvania (Pennsylvania Department of Health
Received 8 January 2013; accepted 31 March 2013; electronically published 10 April 2013. Correspondence: Allison H. Longenberger, PhD, Pennsylvania Department of Health, Room 933 Health and Welfare Building, 625 Forster St, Harrisburg, PA 17120-0701 (alongenber@pa. gov). Clinical Infectious Diseases 2013;57(2):263–6 Published by Oxford University Press on behalf of the Infectious Diseases Society of America 2013. DOI: 10.1093/cid/cit231
[PADOH], unpublished data). On 24 January 2012, a member of the public contacted PADOH to report gastroenteritis among 5 family members, 4 of whom had consumed unpasteurized milk from a PDA-certified dairy. Campylobacter jejuni was detected in the stool of a family member; samples from other family members were submitted to the state public health laboratory for testing. The following day, the Maryland Department of Health and Mental Hygiene (MDHMH) notified PADOH of gastroenteritis in a Maryland family that had consumed unpasteurized milk from the same dairy. We investigated these cases to confirm and characterize the outbreak and implement control measures. EARLY INVESTIGATION AND CASE ASCERTAINMENT On 27 January PADOH and PDA notified the dairy of the illnesses; the dairy immediately and voluntarily suspended unpasteurized milk sales. State authorities issued a press release advising the public not to consume the dairy’s unpasteurized milk or homemade products derived from the milk. Clinicians were advised by health alert to test and report patients with gastrointestinal illness after consumption of the dairy’s milk. Neighboring state health departments were notified. We defined a confirmed case as laboratory-confirmed Campylobacter infection with onset during January 2012–February 2012 in a person who had consumed the dairy’s unpasteurized milk or was epidemiologically linked to a confirmed case. A probable case was diarrheal illness during the same period without laboratory confirmation in a person who had consumed the dairy’s milk and was epidemiologically linked to a confirmed case. PDA sanitarians inspected the dairy on 30 January and 6 February and collected unpasteurized milk samples from the bulk tank and onsite store. Available milk was obtained from consumers. A PDA-approved laboratory had routinely tested the dairy’s well water in November 2011; testing was not repeated during the PDA inspections. Standard bacterial culture techniques were used for clinical specimens. Unpasteurized milk was tested by polymerase chain reaction and US Food and Drug Administration standard culture methods at PDA, PADOH, and MDHMH laboratories [6, 7]. All available Campylobacter isolates were subtyped by pulsedfield gel electrophoresis (PFGE) at MDHMH using SmaI and KpnI for restriction according to the Centers for Disease Control and Prevention’s protocol [8, 9].
BRIEF REPORT
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PATIENT CHARACTERISTICS A total of 81 persons with confirmed illness were identified (70 in Pennsylvania, 6 in Maryland, 3 in West Virginia, and 2 in New Jersey). All patients (except 1 with onset 3 to 4 days after other family members) reported consuming unpasteurized milk from the dairy. An additional 67 probable cases were identified in these 4 states (total of 148 cases). Onsets ranged from 14 January 2012 through 1 February 2012 (Figure 1). Among persons with confirmed illness, median age was 31 years (range: 2–74 years); 25 (31%) were aged 150/mL, respectively, both above the
