Raw milk loophole results in drug-resistant bacteria outbreak in Colorado

A regulatory loophole in Colorado that lets residents drink raw milk led to an outbreak of at least a dozen cases of drug-resistant Campylobacter jejuni infections, investigators said.

According to the CDC, people may drink raw, unpasteurized milk in an attempt to get “back to nature” by consuming fewer processed products. But the agency considers raw milk to be one of the riskiest food items that a person can consume.

The product is commonly associated with disease-causing bacteria like Campylobacter, Escherichia coli, Listeria and Salmonella that are usually killed by pasteurization, a process that the CDC says protects patients with little loss of nutrition. In November, the agency warned people in several Northeast states about raw milk products containing Brucella abortus RB51, a dangerous pathogen that can cause miscarriage and other complications in pregnant women and severe illness in people with weakened immune systems.

Image of raw milk
Raw milk from a Colorado herd-share program sickened at least 12 people.
Source: CDC

Colorado is one of many states that have banned the sale of raw milk for human consumption or enacted laws limiting its availability. However, since 2005, it has been legal for Colorado residents who belong to unregulated herd-share programs in which they have purchased shares in cows or goats to obtain and drink raw milk from the animals, according to investigators in an MMWR report.

Up to 17 people may have been infected with C. jejuni in 2016 after consuming raw milk from a herd-share dairy in Pueblo County, Colorado, investigators said. They confirmed 12 infections that began on or after Aug. 1 and said there were five other probable cases. Every isolate tested in the outbreak was resistant to ciprofloxacin, tetracycline and nalidixic acid.

The public health response to the outbreak was hampered by state laws regarding herd-shares. According to investigators, local public health officials notified shareholders about the outbreak three times and required the dairy to provide written notification about the outbreak where milk was distributed. They said two local public health agencies (LPHAs) issued a press release about the outbreak following reports of nonshareholders drinking the milk, including at least one who became infected.

But the Colorado Department of Public Health (CDPHE) “did not close the dairy or stop distribution of its milk because without pasteurization, CDPHE could not create standards for safely reopening the dairy,” investigators wrote.

They said shareholders were urged to throw away raw milk that was distributed since Aug. 1 “and were reminded that Colorado statute prohibits redistribution of raw milk.”

“All tested isolates’ resistance to three antibiotics was concerning, particularly as fluoroquinolones are frequently used to treat Campylobacter infections in those cases where treatment is indicated,” they concluded. “In collaboration with LPHAs, CDPHE is creating guidelines to address future outbreaks related to raw milk from herd-shares. As more states legalize the sale or other distribution of unpasteurized milk, the number of associated outbreaks will likely increase. The role of public health in responding to raw milk-related outbreaks should be further defined. State-level guidelines might assist with this process.” – by Gerard Gallagher

Reference:

Burakoff A, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6705a2.

Disclosures: The authors report no relevant financial disclosures.

A regulatory loophole in Colorado that lets residents drink raw milk led to an outbreak of at least a dozen cases of drug-resistant Campylobacter jejuni infections, investigators said.

According to the CDC, people may drink raw, unpasteurized milk in an attempt to get “back to nature” by consuming fewer processed products. But the agency considers raw milk to be one of the riskiest food items that a person can consume.

The product is commonly associated with disease-causing bacteria like Campylobacter, Escherichia coli, Listeria and Salmonella that are usually killed by pasteurization, a process that the CDC says protects patients with little loss of nutrition. In November, the agency warned people in several Northeast states about raw milk products containing Brucella abortus RB51, a dangerous pathogen that can cause miscarriage and other complications in pregnant women and severe illness in people with weakened immune systems.

Image of raw milk
Raw milk from a Colorado herd-share program sickened at least 12 people.
Source: CDC

Colorado is one of many states that have banned the sale of raw milk for human consumption or enacted laws limiting its availability. However, since 2005, it has been legal for Colorado residents who belong to unregulated herd-share programs in which they have purchased shares in cows or goats to obtain and drink raw milk from the animals, according to investigators in an MMWR report.

Up to 17 people may have been infected with C. jejuni in 2016 after consuming raw milk from a herd-share dairy in Pueblo County, Colorado, investigators said. They confirmed 12 infections that began on or after Aug. 1 and said there were five other probable cases. Every isolate tested in the outbreak was resistant to ciprofloxacin, tetracycline and nalidixic acid.

The public health response to the outbreak was hampered by state laws regarding herd-shares. According to investigators, local public health officials notified shareholders about the outbreak three times and required the dairy to provide written notification about the outbreak where milk was distributed. They said two local public health agencies (LPHAs) issued a press release about the outbreak following reports of nonshareholders drinking the milk, including at least one who became infected.

But the Colorado Department of Public Health (CDPHE) “did not close the dairy or stop distribution of its milk because without pasteurization, CDPHE could not create standards for safely reopening the dairy,” investigators wrote.

They said shareholders were urged to throw away raw milk that was distributed since Aug. 1 “and were reminded that Colorado statute prohibits redistribution of raw milk.”

“All tested isolates’ resistance to three antibiotics was concerning, particularly as fluoroquinolones are frequently used to treat Campylobacter infections in those cases where treatment is indicated,” they concluded. “In collaboration with LPHAs, CDPHE is creating guidelines to address future outbreaks related to raw milk from herd-shares. As more states legalize the sale or other distribution of unpasteurized milk, the number of associated outbreaks will likely increase. The role of public health in responding to raw milk-related outbreaks should be further defined. State-level guidelines might assist with this process.” – by Gerard Gallagher

Reference:

Burakoff A, et al. MMWR Morb Mortal Wkly Rep. 2018;doi:10.15585/mmwr.mm6705a2.

Disclosures: The authors report no relevant financial disclosures.