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Campylobacteriosis Associated with Raw Milk Consumption -- Pennsylvania

During May 1983, two outbreaks of gastrointestinal illness following consumption of raw milk occurred in Pennsylvania. A total of 57 people became ill.

The first outbreak occurred following a visit by 60 first-grade students and three teachers to a dairy farm in south-central Pennsylvania. Thirty-one (49%) of the 63 visitors became ill, but no acute gastrointestinal illnesses were reported by members of the farm family. Symptoms included fever greater than 39 C (102 F) (84%), of 57 people became ill.

The first outbreak occurred following a visit by 60 first-grade students and three teachers to a dairy farm in south-central Pennsylvania. Thirty-one (49%) of the 63 visitors became ill, but no acute gastrointestinal illnesses were reported by members of the farm family. Symptoms included fever greater than 39 C (102 F) (84%), abdominal pain (81%), vomiting (55%), diarrhea (52%), headache (13%), bloody stool (10%), and myalgia (7%). Onsets of disease ranged from 1 to 8 days (mean 3 days). Illness lasted from 5 hours to 12 days (mean 3.4 days). Sixteen persons saw a physician; none were hospitalized. Campylobacter jejuni was found in the stool of the only child who was cultured. Secondary illnesses compatible with Campylobacter infection abdominal pain (81%), vomiting (55%), diarrhea (52%), headache (13%), bloody stool (10%), and myalgia (7%). Onsets of disease ranged from 1 to 8 days (mean 3 days). Illness lasted from 5 hours to 12 days (mean 3.4 days). Sixteen persons saw a physician; none were hospitalized. Campylobacter jejuni was found in the stool of the only child who was cultured. Secondary illnesses compatible with Campylobacter infection occurred in two households.

Cookies and small cups of raw milk were served at the farm. Each of the 63 visitors drank one cup of raw milk and ate one cookie. Cultures of the raw milk from the farm did not yield Campylobacter. No dairy cattle were reported to have been ill, and none were cultured.

The second outbreak occurred on May 20, when 45 persons (43 kindergarten children and two teachers) visited a dairy farm in central Pennsylvania. Subsequently, 26 persons (58%) developed gastrointestinal illness characterized by abdominal pain (73%), diarrhea (69%), fever (58%), nausea (54%), headache (50%), fatigue (38%), vomiting (19%), bloody stools (12%), and myalgia (8%). The incubation period ranged from 2 to 10 days (mean 3.6 days). Duration of illness was 1-14 days (mean 3.5 days). Four children saw a physician, and one was hospitalized. C. jejuni was found in two of two stool specimens cultured.

Raw milk and cookies were also served at the second farm. Illness was associated with quantity of milk consumed. Twenty-five of the 26 ill persons each consumed H cup or more of raw milk, and 10 of 15 well persons each consumed the same amount of raw milk (p = 0.03). Illness was not associated with eating cookies, touching farm animals, or consuming raw milk from other sources or with the presence of animals in the home. Members of the farm family routinely drank raw milk, and none reported illness. There were no illnesses among the herd, and no cows were cultured. Gastrointestinal illnesses, probably representing secondary transmission, occurred in households of six patients. Reported by Microbiology Laboratory, JC Blair Hospital; DJ Blessing, M Thompson, B Fisher, D Schooley, MD, MJ Kramer, South Central District; TM DeMelfi, MA McCarthy, EJ Witte, MD, Div of Epidemiology; CW Hays, MD, State Epidemiologist; Bureau of Laboratories, Pennsylvania Dept of Health; J Smucker, Milk Safety Br, Food and Drug Administration, Washington, DC; Enteric Diseases Br, Zoonoses Activity, Div of Bacterial Diseases, Center for Infectious Diseases, CDC.

Editorial Note

Editorial Note: Raw milk is an important vehicle in the transmission of Campylobacter. In 1981 and 1982, five of 10 and six of 11 foodborne Campylobacter outbreaks reported to CDC were traced to raw milk consumption. Outbreaks of campylobacteriosis have followed consumption of raw milk on school-sponsored trips in Michigan, Minnesota, and Vermont; a field trip in Maryland resulted in an outbreak of salmonellosis and campylobacteriosis. These, and similar occurrences in England, point out the necessity of protecting school children from exposure to unpasteurized dairy products while on outings (1). The lack of illness in similarly exposed members of the farm families might be explained by gut immunity established by frequent exposure to C. jejuni through direct contact with bovine feces and routine ingestion of raw milk. Failure to isolate C. jejuni from the epidemiologically implicated raw milk, as noted in these two outbreaks, is an almost universal problem (2,3) and is probably due to the insensitivity of present microbiologic techniques.

References

  1. Robinson DA, Jones DM. Milk-borne Campylobacter infection. Br Med J 1981;282:1374-6.

  2. Potter ME, Blaser MJ, Sikes KR, et al. Human Campylobacter infection associated with certified raw milk. Am J Epidemiol 1983;117:475-83.

  3. Taylor DN, Porter BW, Williams CA, Miller HG, et al. Campylobacter enteritis: a large outbreak traced to commercial raw milk. West J Med 1982;137:365-9.

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