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
Robinson DA, Jones DM. Milk-borne Campylobacter infection. Br
Med J 1981;282:1374-6.
Potter ME, Blaser MJ, Sikes KR, et al. Human Campylobacter
infection associated with certified raw milk. Am J Epidemiol
1983;117:475-83.
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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