[All-extension] FW: CDC 2014 Raw Milk Letter: The Ongoing Public Health Hazard of Consuming Raw Milk

Tue May 13 16:23:47 EDT 2014

FYI!
Gustavo

[The Ohio State University]
Gustavo M. Schuenemann, DVM, MS, Ph.D.
Extension Veterinarian - Dairy
Ohio State University Extension | Department of Veterinary Preventive Medicine
College of Veterinary Medicine, The Ohio State University
A100L Sisson Hall | 1920 Coffey Road Columbus, OH 43210
Ph: 614-292-6924 | Fax: 614-292-4142
schuenemann.5 at osu.edu<mailto:schuenemann.5 at osu.edu> | http://cvm.osu.edu/GustavoScheunemann.htm<http://vet.osu.edu/GustavoScheunemann.htm>

From: EXTVET Discussion List (Extension Veterinarians) [mailto:EXTVET-L at listserv.unl.edu] On Behalf Of Moore, Dale
Sent: Tuesday, May 13, 2014 3:47 PM
To: EXTVET-L at listserv.unl.edu
Subject: FW: CDC 2014 Raw Milk Letter: The Ongoing Public Health Hazard of Consuming Raw Milk

Colleagues:

Attached is a letter from CDC on raw milk.

Dale

From: Jacobs Slifka, Kara (CDC/OID/NCEZID) [mailto:ipf8 at cdc.gov]
Sent: Tuesday, May 13, 2014 12:45 PM
To: Moore, Dale
Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Gould, L. Hannah (CDC/OID/NCEZID)
Subject: CDC 2014 Raw Milk Letter: The Ongoing Public Health Hazard of Consuming Raw Milk

Hello AAEV,

We would like to share our CDC 2014 Raw Milk Letter: The Ongoing Public Health Hazard of Consuming Raw Milk.  The letter is directed to  State and Territorial Epidemiologists as well as State Public Health Veterinarians, and will be shared with numerous veterinary and medical associations as well as the food industry.  The letter provides updated information on outbreaks due to raw milk, the importance of pasteurization, and links to resources for public health officials, consumers, and health care providers.  A pdf version of the letter is attached and a version with hyperlinks is available at the bottom of the email.  Please share with your members.

Thank you,

Kara M. Jacobs Slifka MD, MPH
LT, US Public Health Service
Epidemic Intelligence Service Officer
Division of Foodborne, Waterborne, and Environmental Diseases
Outbreak Response and Prevention Branch
Centers for Disease Control & Prevention
1600 Clifton Road NE, Mailstop A-38
Atlanta, GA 30333
404-639-1461 (p)
404-471-8199 (f)

[cid:image001.jpg at 01CF6B7C.CA705570]

 Public Health Service
DEPARTMENT OF HEALTH & HUMAN SERVICES
Centers for Disease Control and Prevention (CDC) ____________________________________________________________________

May 9, 2014

To:       State and Territorial Epidemiologists

            State Public Health Veterinarians

The Ongoing Public Health Hazard of Consuming Raw Milk

The purpose of this letter is to provide state and territorial public health officials with information and resources on the risks of consuming raw milk and other unpasteurized dairy products.  Please distribute this letter to those involved with raw milk issues in your state or territory, and to others who have an interest in this important public health issue.

The role of raw milk and other unpasteurized dairy products in the transmission of infectious diseases is well documented.  Pasteurization is the process of heating milk to a high enough temperature for a long enough time to kill disease-causing bacteria.  Raw milk was recognized as a source of severe infections over 100 years ago, and pasteurization of milk to prevent these infections is one of the public health triumphs of the 20th century.  Pathogens such as Escherichia coli O157, Campylobacter jejuni, and Salmonella can contaminate milk during the milking process because they are shed in the feces of healthy-looking dairy animals, including cows and goats.  Infection with these pathogens can cause severe, long-term consequences, such as hemolytic uremic syndrome, which can result in kidney failure, and Guillan-Barré syndrome, which can result in paralysis.  These infections are particularly serious in those who are very young, very old, or who have impaired immune systems.  They can be fatal.

Adherence to good hygienic practices during milking can reduce, but not eliminate, the risk of milk contamination.  Pasteurization is the only way to ensure that fluid milk products do not contain harmful bacteria.  Routine pasteurization of milk from healthy cows in a hygienic setting began in the 1920s and became widespread in the United States by 1950 as a means to reduce contamination and resulting illness.  This led to dramatic reductions in many diseases previously associated with milk.  Pasteurization is recommended for all animal milk consumed by humans by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the American Academy of Pediatrics, the American Academy of Family Practitioners, the American Veterinary Medical Association, the National Association of Public Health Veterinarians, and many other medical and scientific organizations.

In 1987, the FDA prohibited the distribution of raw milk across state lines for direct sale to consumers.  Despite the federal ban on interstate sale of raw milk and broad use of pasteurization by the dairy industry, human illness and outbreaks associated with consumption of unpasteurized products continue to occur.  Raw milk is still available for sale in many states, and CDC data shows that the rate of raw milk-associated outbreaks is 2.2 times higher in states in which the sale of raw milk is legal compared with states where sale of raw milk is illegal.

>From 2007 to 2012, the CDC National Outbreak Reporting System received reports indicating:

*         81 outbreaks of infections due to consumption of raw milk resulting in 979 illnesses, 73 hospitalizations, and no deaths.

*         Most infections were caused by Campylobacter, Shiga toxin-producing Escherichia coli, or Salmonella bacteria, pathogens that are carried by cattle that appear healthy.

*         The number of outbreaks increased during this time, from 30 in the three year span 2007-2009 to 51 in 2010-2012.

*         Eighty-one percent of outbreaks were reported from states where the sale of raw milk was legal in some form; only 19% occurred in states where the sale of raw milk was illegal.

*         The reported outbreaks represent only the tip of the iceberg.  For every outbreak and illness that is reported, many others occur that are not reported; the actual number of illnesses associated with raw milk and raw milk products is likely much greater.

*         It is important to note that a substantial proportion of the raw milk-associated disease burden falls on children; 59 % of outbreaks involved at least one person aged <5 years.

To protect the health of the public, state regulators should continue to support pasteurization and consider further restricting or prohibiting the sale and distribution of raw milk and other unpasteurized dairy products in their states.

CDC has a recently updated raw milk website that contains useful information and materials, including a list of relevant publications and other scientific resources on illnesses associated with raw milk consumption reproduced in the attachment.  The website is: http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html   This information can be shared with persons involved in foodborne disease outbreak investigations and the regulation of unpasteurized dairy products.

Sincerely,

Robert V. Tauxe, MD, MPH

Deputy Director, Division of Foodborne, Waterborne, and Environmental Diseases

National Center for Emerging and Zoonotic Infectious Diseases

Centers for Disease Control and Prevention

1600 Clifton Road NE, MS C-09

Atlanta, Georgia  30333

Attachment: Raw milk resources

Raw Milk Resources

Resources for Consumers

o    CDC: Food Safety and Raw Milk

*  http://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html

*  http://www.cdc.gov/foodsafety/rawmilk/raw-milk-videos.html

*  http://www.cdc.gov/Features/RawMilk/

o    FDA: Consumer Information About Milk Safety

*  http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm079516.htm

*  http://www.fda.gov/Food/FoodborneIllnessContaminants/BuyStoreServeSafeFood/ucm341249.htm

o    FoodSafety.gov

*  http://www.foodsafety.gov/keep/types/milk/index.html

o    Real Raw Milk Facts

*  http://www.realrawmilkfacts.com/

o    Pregnant Women and Children

*  http://realrawmilkfacts.com/PDFs/Consumption-of-Raw-Milk-by-Pregnant-Women-Children.pdf

Resources for Public Health Officials

o    Selected MMWR Articles

*  CDC. Notes From the Field: Recurrent Outbreak of Campylobacter jejuni Infections Associated with a Raw Milk Dairy - Pennsylvania, April-May 2013.  MMWR Morb Mortal Wkly Rep 2013;34;702-702.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a4.htm?s_cid=mm6234a4_w

*  CDC. Notes from the Field: Salmonella Newport infections associated with consumption of unpasteurized milk --- Utah, April-June 2010. MMWR Morb Mortal Wkly Rep 2010;59;817-818.  http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5926a6.htm?s_cid=mm5926a6_w

*  CDC. Campylobacter jejuni infection associated with unpasteurized milk and cheese---Kansas, 2007. MMWR Morb Mortal Wkly Rep 2009;57:1377-1379. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5751a2.htm

*  For additional MMWR articles and other publications

http://www.cdc.gov/foodsafety/rawmilk/raw-milk-publications.html

o    Selected Publications (available online and through research libraries)

*  Robinson, TJ, Scheftel JM, Smith KE.  Raw Milk Consumption among Patients with Non-Outbreak-related Enteric Infections, Minnesota, USA, 2001-2010.  Emerging Infectious Diseases. Jan 2014; 20 (1) 38-44.

*  Buzby, JC, Gould LH, Kendall ME, Jones TF, Robinson T, Blayney DP. Characteristics of Consumers of Unpasteurized Milk in the United States. Journal of Consumer Affairs, Spring 2013; 47(1):153-166.

*  Langer AJ, Ayers T, Grass J, Lynch M, Angulo FJ, Mahon BE.  Nonpasteurized dairy products, disease outbreaks, and state laws-United States, 1993-2006.  Emerging Infectious Diseases. Mar 2012;18(3):385-391.

*  Lejeune JT, Rajala-Schultz PJ.  Unpasteurized Milk: A Continued Public Health Threat.  Clin Infect Dis. 2009; 48(1) 93-100.

*  Gould LH, Mungai E, Barton Behravesh C. Outbreaks Attributed to Cheese: Differences Between Outbreaks Caused by Unpasteurized and Pasteurized Dairy Products, United States, 1998-2011. Foodborne Pathog Dis. 2014 Epub, ahead of print.

o    Position Statements by National Organizations

*  American Academy of Pediatrics

http://pediatrics.aappublications.org/content/early/2013/12/10/peds.2013-3502

*  National Environmental Health Association Position Statement

http://www.neha.org/position_papers/position_raw_milk.htm

*  American Association of Public Health Veterinarians

http://www.marlerclark.com/images/uploads/about_ecoli/PUBLIC_HEALTH_VETERINARIAN_COALITION_COMMITTEE.pdf

*  American Veterinary Medical Association Position Statement

https://www.avma.org/KB/Policies/Pages/Raw-Milk.aspx

*  American Medical Association (AMA) - page 144

http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf

*  International Association for Food Protection Position Statement

http://www.foodprotection.org/files/general-interests/Milk_Pasteurization_Paper.pdf

*  National Conference on Interstate Milk Shipments

http://www.ohiodairyvets.org/wp-content/uploads/2007/08/ncims-raw-milk-resolution.pdf

*  Association of Food and Drug Officials

http://www.ohiodairyvets.org/wp-content/uploads/2007/08/ncims-raw-milk-resolution.pdf

*  Dairy Processors of Canada

http://www.newswire.ca/en/story/616469/dairy-processors-support-government-actions-to-ban-the-sale-of-raw-milk

*  Health Canada

http://www.hc-sc.gc.ca/fn-an/securit/facts-faits/rawmilk-laitcru-eng.php

*  International Dairy Foods Association & National Milk Producers Federation

http://www.realrawmilkfacts.com/PDFs/NMPF-IDFA-Letter-Sen-Rand-Amendment-060812.pdf

*  Kentucky Association of Milk, Food, and Environmental Sanitarians

http://www.kamfes.com/rawmilkpp.pdf

*  National Mastitis Council

http://nmconline.org/docs/RawMilkStatement.pdf

*  North Carolina Association of Local Health Directors

http://www.ncalhd.org/documents/RawMilkPosition.pdf

o    FDA Health Education Materials

*  Educator's Toolkit on Preventing Listeriosis in Hispanic Populations (in English and Spanish)

http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm062993.htm

*  Food Safety for Moms-to-Be Educator's Toolkit with section on Listeriosis (in English and Spanish)

http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm

*  Moms-to-Be video (with Listeria information section in English and Spanish)

http://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm089619.htm

*  Food Fact Sheet on the Dangers of Raw Milk (in English and Spanish)

http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm079516.htm

o    FDA "Grade 'A' Pasteurized Milk Ordinance." 2011 Revision.

http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/Milk/ucm297717.htm

o    Abuela Project

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1508756

*         Resources for Health Care providers

o    American Academy of Pediatrics Committee on Infectious Diseases. Appendix VIII. Prevention of Disease From Potentially Contaminated Food Products. Red Book; 2009:857-859. [Subscription Required]

http://aapredbook.aappublications.org/cgi/content/full/2009/1/6.8

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