Consumption of raw or unpasteurized milk and milk products by pregnant women and children.

Sales of raw or unpasteurized milk and milk products are still legal in at least 30 states in the United States. Raw milk and milk products from cows, goats, and sheep continue to be a source of bacterial infections attributable to a number of virulent pathogens, including Listeria monocytogenes, Campylobacter jejuni, Salmonella species, Brucella species, and Escherichia coli O157. These infections can occur in both healthy and immunocompromised individuals, including older adults, infants, young children, and pregnant women and their unborn fetuses, in whom life-threatening infections and fetal miscarriage can occur. Efforts to limit the sale of raw milk products have met with opposition from those who are proponents of the purported health benefits of consuming raw milk products, which contain natural or unprocessed factors not inactivated by pasteurization. However, the benefits of these natural factors have not been clearly demonstrated in evidence-based studies and, therefore, do not outweigh the risks of raw milk consumption. Substantial data suggest that pasteurized milk confers equivalent health benefits compared with raw milk, without the additional risk of bacterial infections. The purpose of this policy statement was to review the risks of raw milk consumption in the United States and to provide evidence of the risks of infectious complications associated with consumption of unpasteurized milk and milk products, especially among pregnant women, infants, and children.

Nonpasteurized dairy products, disease outbreaks, and state laws-United States, 1993-2006.

Although pasteurization eliminates pathogens and consumption of nonpasteurized dairy products is uncommon, dairy-associated disease outbreaks continue to occur. To determine the association of outbreaks caused by nonpasteurized dairy products with state laws regarding sale of these products, we reviewed dairy-associated outbreaks during 1993-2006. We found 121 outbreaks for which the product's pasteurization status was known; among these, 73 (60%) involved nonpasteurized products and resulted in 1,571 cases, 202 hospitalizations, and 2 deaths. A total of 55 (75%) outbreaks occurred in 21 states that permitted sale of nonpasteurized products; incidence of nonpasteurized product-associated outbreaks was higher in these states. Nonpasteurized products caused a disproportionate number (≈150× greater/unit of product consumed) of outbreaks and outbreak-associated illnesses and also disproportionately affected persons <20 years of age. States that restricted sale of nonpasteurized products had fewer outbreaks and illnesses; stronger restrictions and enforcement should be considered.

The effect of emissions on heavy metals concentrations in cattle from the area of an industrial plant in Slovakia.

Attention was devoted to the effects of risk element-containing industrial emissions on the biological material of cattle bred on farms in the vicinity of a metallurgical plant in East Slovakia. The observations lasted two years and included four agricultural farms in the polluted area and one control farm outside this area. In 1991, 20, 30, 30, 30, and 30 samples of milk, muscle, liver, heart, and kidney tissue were analyzed, whereas in 1992, 30, 48, 48, 48, and 48 respective samples were taken. For Cu, Zn, Mn, Cd, Pb, and Ni analyses, the AAS method was employed, using the UNICAM 939 device, while Hg residues were determined on the TMA 254 analyzer. In 1991, of a total of 120 samples of tissue and organs, 12.5%, 9.16% and 0.8% were found to contain above-limit levels of Cd, Ni, and Cu, respectively. The concentrations of the remaining elements, viz., Zn, Mn, Pb, and Hg, did not surpass the permitted maxima. In 1992, 1.03%, 2.60%, 0.51%, and 5.20% of 192 samples of tissue and organs contained above-limit Cd, Cu, Ni, and Zn levels.

Surto epidêmico de toxinfecçäo alimentar envolvendo queijo tipo Minas Frescal em Pará de Minas / Epidemic foodborne disease involving white cheese type Minas Frescal in Pará de Minas, Brazil

Relata-se a ocorrência de um surto epidêmico de toxinfecçäo alimentar envolvendo queijo Minas Frescal, fabricado artesanalmente no Município de Pará de Minas (MG). Neste surto, 15 indivíduos estiveram expostos à possível fonte de infecçäo (quatro queijos manufaturados com leite cru). A idade dos expostos variou de 10 a 60 anos e a taxa de ataque observada foi de 93,33 por cento. Ressalta-se que um indivíduo que consumiu o mesmo alimento tratado termicamente näo adoeceu. O grupo controle, composto de três pessoas que näo consumiram o alimento, näo apresentou sintomas. O período de incubaçäo médio foi de 17 h com variaçäo de 7 a 26 h. O curso variou de 24 a 192 h com período médio de 107 h. Os principais sintomas relatados foram náusea ou vômito (60 por cento), diarréia (93,83 por cento), febre (73,33 por cento), tremores e dores abdominais (80 por cento) e fraqueza muscular (13,33 por cento). Diarréia aquosa, amarelada e fétida foi relatada em 46,67 por cento dos casos e diarréia escura em 13,33 por cento dos casos. Ausência de febre foi notificada em 26,67 por cento dos casos. Cinco indivíduos (33,3 por cento) procuraram serviço médico e 13,33 por cento dos indivíduos foram internados por períodos de 2 h a 3 dias. O diagnóstico médico foi de gastroenterite. Uma amostra dos queijos suspeitos analisada demonstrou presença de Salmonella sp, de Staphylococcus aureus (4,1 x 10 à sexta potência UFC/g) coagulase +, DNASE +, termonuclease + e coliformes totais e fecais (110.000 NMP/g). Considerando-se os indicadores, período de incubaçäo, sintomas, taxas de ataque, tipo e grau de contaminaçäo do alimento, infere-se que o surto em questäo tenha sido causado principalmente pela associaçäo de infecçäo por Salmonella, coliformes fecais e/ou intoxicaçäo por toxina estafilocócica

Analysis of enterotoxin production by Bacillus cereus from dairy products, food poisoning incidents and non-gastrointestinal infections.

Of 85 strains of Bacillus cereus isolated in Norway from dairy products, 59% were found to be enterotoxigenic, and 15% were psychrotrophic. Six of the isolates (7%) were identified as potential psychrotrophic food-poisoning strains as they were both enterotoxigenic and exhibited good growth at 6 degrees C. Enterotoxin production was detected using the Western immunoblot technique, and a commercially available reversed passive latex agglutination (RPLA) assay (Unipath BCET-RPLA TD950). Both methods gave essentially the same results. In a separate study, the Western immunoblot and RPLA assays were used in a conjunction with the in vivo vascular permeability reaction (VPR) assay to determine enterotoxin production among 25 isolates of Bacillus cereus referred to the PHLS Food Hygiene Laboratory from incidents of diarrhoeal- and emetic-syndrome food poisoning and non-gastrointestinal infections. Eighty-four percent of these isolates were found to be enterotoxigenic by the Western immunoblot and the RPLA assays, and these results were in good agreement with those obtained by the VPR assay. In both studies, the BCET-RPLA kit proved to be a simple and reliable means for determining enterotoxin production by strains of Bacillus cereus.

Food poisoning outbreaks associated with manufactured foods in England and Wales: 1980-1989.

In the ten-year period, 1980-89, 294 reported outbreaks of food poisoning were associated with eating pre-cooked sliced meats, meat products and other manufactured foods in England and Wales, including 65 outbreaks in which the product was imported. Salmonellas were the most commonly reported agent, causing 132 (45%) of the outbreaks; other bacteria caused a further 51 (17%) outbreaks. The remainder were due to viruses (five outbreaks), scombrotoxin (60 outbreaks), or were of unknown cause (46 outbreaks). The number of outbreaks associated with manufactured foods accounted for only a small proportion (less than 5%) of food poisoning outbreaks reported to CDSC during this period and needs to be set against the huge amounts of manufactured foods consumed. However, because of the quantities made and the widespread distribution of particular products, such outbreaks may affect many individuals who are geographically widespread.

Communicable disease associated with milk and dairy products in England and Wales: 1983-1984.

During the period 1983-1984 32 outbreaks of disease (II in 1983 and 21 in 1984) associated with consumption of milk and dairy products and affecting at least 714 people were reported from England and Wales. Twenty-seven of the outbreaks were attributed to raw milk, two to contaminated pasteurised milk and one each to cheese, cream and ice-cream. Twenty-two were due to salmonellas, seven to campylobacters and one each to Staphylococcus aureus, Yersinia enterocolitica and Streptococcus zooepidemicus. Two sporadic cases of Corynebacterium ulcerans infection associated with raw milk were also reported. There were eight deaths, all associated with the S. zooepidemicus outbreak. The continuing occurrence of milk-borne outbreaks, and an increasing number of incidents affecting rural communities, emphasises the urgent need for enforcing pasteurisation of milk and dairy products in England and Wales.

Comparison of findings among residents on Michigan dairy farms and consumers of produce purchased from these farms.

Consumers who had purchased farm products from both quarantined and nonquarantined farms were examined during the cross-sectional clinical survey of 1,029 Michigan residents. Since PBB had inadvertently contaminated cattle and other farm animals, ingestion of meat, milk, eggs and other farm products was thought to have possibly resulted in significant PBB body burdens in some consumers. Findings were considered in comparison with those made among farm residents. Prevalence of symptoms in consumers of farm products from quarantined farms (CQ) was similar to that found in farmers on quarantined farms (FQ); the prevalence was lower in consumers of products from nonquarantined farms (CNQ). Liver function abnormalities were found with similar prevalence in dairy farmers and consumers. Distribution, mean and median values of PBB serum levels in consumers were found to be similar to those of dairy farmers. These results indicate that significant body burdens of PBB had been accumulated by some consumers of farm products in Michigan and that prevalence of symptoms and liver function abnormalities resembled those found among dairy farm residents.

Unanticipated prevalence of symptoms among dairy farmers in Michigan and Wisconsin.

Adverse human health effects resulting from exposure to polychlorinated biphenyls (PBBs) were unknown until the accidental contamination of Michigan dairy farm animal feed in 1973-1974. Human exposure resulted from the consumption of contaminated meat, milk, dairy products, and eggs. In November 1976, the Environmental Sciences Laboratory conducted comprehensive examinations of 933 farmers and residents in Mighigan who were likely to have consumed farm products contaminated with PBB. A comparison group of 229 Wisconsin dairy farmers were examined in March 1977 and the same scientific and medical staffs that conducted the Michigan survey were responsible and the same procedures used. A complete history of symptomatology by organ system, including year of first onset, duration, frequency, and severity of each symptom was obtained by a physician on all adults examined. Statistical analysis of the prevalence of symptoms at the time of examination or during the preceding year in the Michigan and Wisconsin populations studied found the Michigan group to have a significantly higher prevalence of skin, neurological and musculoskeletal symptoms. The increase was seen among the younger age groups 16-35 and 36-55. Michigan females had a higher prevalence of neurological symptoms than the Michigan males. The existing differences could not be explained without considering an etiologic role for exposure to PBB.