Raw milk-related bacterial outbreaks have been an unfortunate and expanding part of business at Marler Clark. Although not an every year occurrence, and we do not get retained in all outbreaks, raw milk illnesses seem to be on the rise. And, because the proponents of the consumption of raw milk spend most of their time rejecting that the outbreaks – and illnesses related to them – even occurred, we expect continued business growth. Below is a summary of raw milk outbreaks that we have been directly involved in through representing victims. In each of the outbreaks, many of the victims, primarily children, were severely injured by the consumption of raw milk containing either E. coli O157:H7 or Campylobacter jejuni.
Dee Creek Farm E. coli Outbreak — Washington & Oregon, 2005
On December 12, 2005, the Washington State Department of Agriculture’s (WSDA) Food Safety Program (FSP) was notified that the Washington Department of Health had received a report of a positive E. coli O157:H7 test in a patient from the Vancouver, Washington, area. WSDA FSP was further notified that the Clark County Health Department had determined that several E. coli cases had been caused by the consumption of raw milk produced by Dee Creek Farm in Woodland, Washington.
Prior to the December outbreak, WSDA had learned of Dee Creek Farm’s cow-share program, and had ordered the farm to cease the dispensing, giving, trading, or selling of milk or to meet requirements for selling milk that had been laid out by WSDA. The letter was sent in August 2005, and WSDA received a response from Dee Creek Farm in September 2005, stating that the farm was not selling milk but that the farm’s owners intended to meet requirements for a milk producer and retail raw milk processor in the future.
During the December investigation into the E. coli outbreak, WSDA noted several milk processing violations that would have been addressed during the licensing process had Dee Creek applied for the license. Among the violations were the following:
- No animal health testing documentation for brucellosis and tuberculosis or health permits
- Beef cattle contact with wild elk
- No water or waste water system available at milk barn for milking operations or cleaning
- No hand washing sinks available for cleaning and sanitizing
- No bacteriological test results available for the farm’s well-water system
- Mud/manure with standing water at the entrance to the milk barn parlor
- Milking bucket in direct contact with unclean surfaces during milk production
- Multiple instances providing for the opportunity for cross-contamination
- No separate milk processing area from domestic kitchen
- No raw milk warning label provided on containers
In addition, sample testing confirmed the presence of E. coli O157:H7 in two milk samples provided by Dee Creek Farm and in five environmental samples taken from Dee Creek Farm milk-barn areas by investigators. See WSDOH Report.
When its investigation was completed, WSDA had identified eighteen people who had consumed raw milk purchased from Dee Creek Farm through the cow-share program and developed symptoms consistent with E. coli infection. Five Clark County, Washington, children were hospitalized, with two developing hemolytic uremic syndrome and requiring critical care and life support for kidney failure as a result of their E. coli infections.
Organic Pastures E. coli O157:H7 Outbreak – California, 2006
On September 18, 2006, the California Department of Health Services (CDHS) opened an investigation of a possible outbreak of E. coli O157:H7 infections after receiving reports of two patients who had been hospitalized with HUS. See CDHS and CDC Reports. One was culture confirmed infected with E. coli O157:H7. Interviews revealed that both patients had consumed unpasteurized cow milk sold by Organic Pastures in the week prior to the onset of illness.
In the following days, four additional cases of E. coli O157:H7 were identified. All of the additional cases had consumed raw milk or raw cow product sold by Organic Pastures. Isolates of the E. coli O157:H7 cultured from the five culture-positive patients had indistinguishable “genetic fingerprints” as determined by pulsed-field gel electrophoresis (PFGE) testing. These PFGE patterns were new to the national PulseNet database. In other words, the pattern associated with all of these children was unique, and had not been seen before in conjunction with any other outbreaks of E. coli O157:H7. In addition, the PFGE pattern differed markedly from the patterns associated with the outbreak of E. coli O157:H7 associated with Dole fresh-bagged baby spinach that had peaked a few weeks prior to these illnesses.
CDHS conducted an epidemiological and environmental investigation of the cluster of illnesses. A review of 50 consecutive E. coli O157:H7 cases reported to CDHS from October 2004 to June 2006 revealed that 46 of 47 cases asked about raw milk consumption reported consuming no raw milk. In contrast, five of the six patients in the cluster being investigated reported definite consumption of Organic Pastures raw dairy products. The sixth denied consuming the raw milk, but his family routinely consumed Organic Pastures raw milk during the suspected time frame.
The California Department of Food and Agriculture conducted an environmental investigation. As part of the investigation, fecal samples were collected from dairy cows at Organic Pastures. E. coli O157:H7 was isolated from five of the samples, although the PFGE patterns differed from the pattern associated with the outbreak. Testing of Organic Pastures product revealed abnormally high aerobic plate counts and fecal coliform counts. CDHS ultimately concluded: “the source of infection for these children was likely raw milk products produced by the dairy.”
Grace Harbor Farms E. coli O157:H7 Outbreak – Washington, 2006
On September 25, 2006 an employee at Children’s Hospital notified Public Health Seattle and King County (PHSKC) epidemiology staff of a presumptive positive laboratory result for E. coli O157:H7 (belonging to a child, Patient A) and sent his isolate to the PHSKC public health laboratory for confirmatory testing and subtyping. PHSKC epidemiologists Patient A’s parents that same day and questioned them about his potential risk factors for infection with E. coli O157:H7. During their conversations, Patient A’s consumption of Grace Harbor Farm raw milk was noted. Patient A’s parents said that he and his younger brother drank mostly raw milk from cows although the family also purchased raw goat milk produced at Grace Harbor Farm. The boys consumed raw milk approximately two times a day. PHSKC notified Washington State Department of Health (WDOH), of the findings.
The report to WDOH coincided with a report of an E. coli O157:H7 infection in a 5-year-old child residing in Snohomish County, Patient B. Prior to symptom onset on September 19 Patient B had also consumed raw milk produced by Grace Harbor Farm. Suspecting that the link between illness in Patient A and the Snohomish County resident was more than just coincidental, WDOH notified the Washington State Department of Agriculture (WSDA) that an outbreak of E. coli O157:H7 associated with consuming raw milk produced by Grace Harbor Farm might be underway. WDOH also notified the health officer in Whatcom County, where Grace Harbor Farm is located, of the potential outbreak. Public health investigators waited for results of molecular analysis of isolates obtained from the two children to determine if they were infected with the same strain of E. coli O157:H7 and if they were part of a larger outbreak.
On Tuesday, September 26, 2006 Patient A was laboratory confirmed to be infected with E. coli O157:H7. Investigators collected an assortment of food and milk products for testing from his home for laboratory testing. WSDA environmental staff visited Grace Harbor Farm and collected numerous environmental samples for testing. Food and environmental specimens were sent to the WSDA laboratory in Olympia for analysis. The first report that E. coli O157:H7 had been found in goat milk collected at the farm was issued on the afternoon of September 27. That same day public health investigators learned that the strain of E. coli O157:H7 that caused Patient A’s infection was indistinguishable to the strain that had infected Patient B as determined by pulsed field gel electrophoresis (“PFGE”) analysis. The strain was different from other strains that had been seen recently in Washington or elsewhere across the nation.
On September 28, 2006 WDOH issued a news release informing the public of an E. coli O157:H7 outbreak connected to Grace Harbor Farm milk. PHSKC closed its investigation into Patient A’s infection on September 28 and submitted a completed Enterohemorraghic E. coli report form to WDOH. Multiple environmental specimens collected at Grace Harbor Farm would test positive for E. coli O157:H7. DNA testing would show the strain of E. coli O157:H7 found on the farm was indistinguishable by two enzymes to the strain that infected Patients A and B. The outbreak was reported to the Centers for Disease Control and Prevention (“CDC”) on October 24, 2006. See WSDOH Report.
Whole Foods, Town Farm Dairy, E. coli O157:NM – Connecticut, 2008
On July 16, 2008, the Connecticut Department of Public Health (CDPH) was investigating two cases of HUS as part of its routine surveillance. Interviews conducted in these investigations revealed that both children had consumed raw milk produced by the Simsbury Town Farm Dairy in the week before the onset of their illnesses. CDPH notified the Connecticut Department of Agriculture (CDA), and opened an investigation. In the following two weeks five additional confirmed and seven additional probable cases of E. coli O157:NM infection were identified, each associated with consumption of raw milk from the Simsbury Town Farm Dairy.
As part of the investigation of the outbreak, CDA conducted an environmental inspection of the Simsbury Town Farm Dairy. CDA found a number of troubling practices at the dairy. These included: manual bottling of raw milk directly from the bulk tank; failure to cap valves; an improper seal around the shaft of the transport tank; and a biofilm protein residue found inside the transport tank. In addition, investigators found a number of “poor hygienic practices” at the dairy. Among these was the storage of a stainless steel milk tank in an exposed unsanitary bucket. In addition, investigators found a lack of hand soap, lack of hot water and the hand-washing sink, and soiled floors. Flies were observed in the bulk milk storage tank room. The dairy workers were unable to identify the dairy’s sanitization process for glass milk bottles that were re-used. It was also noted that the glass bottles from the dairy did not feature the statutorily required consumer advisory language.
A laboratory study was also conducted. Of the six patients that cultured positive for E. coli O157:NM, 5 had a “genetic fingerprint” that was indistinguishable. The sixth varied very slightly on one test. Samples of feces from the cows at the dairy were also tested. One of the tests was positive for E. coli O157:NM of a strain matching that of the group of five patients. The CDPH concluded: “several findings from this investigation indicated that consumption of raw milk from Farm X [Simsbury] was the cause of the outbreak.” See CHD Report.
Alexandre Ecodairy Campylobacter Outbreak – California, 2008
On October 2, 2008, the California Department of Public Health (CDPH) issued a report linking an outbreak of Campylobacter illnesses to unpasteurized milk from Alexandre Eco Farms Dairy. The report was the result of an investigation commenced on July 14, 2008, when Dr. Thomas Martinelli, the County Health Officer for Del Norte County, California reported four cases of laboratory-confirmed Campylobacter infections and five additional cases of diarrhea in Del Norte County residents. Eight of the original nine sick individuals were members of the Alexandre Eco Farms “cow-leasing” program. Eight of these individuals had consumed milk produced on the farm. The ninth sick individual worked with cattle on the Alexandre EcoDairy Farms. One of the eight individuals who was sick, Patient X, had already been hospitalized with GBS following the onset of acute gastroenteritis after consumption of the milk.
As part of the investigation, health department officials retrieved a refrigerated carton of partially consumed Alexandre EcoDairy Farms milk from Patient X’s home. Patient X had consumed a portion of the milk before her illness. The specimen tested positive for Campylobacter jejuni DNA using a test called polymerase chain reaction (PCR). Testing indicated that multiple strains of Campylobacter jejuni were present in the milk. Del Norte County officials eventually identified 16 cases of Campylobacter jejuni associated with the outbreak. Fifteen of those were persons who consumed milk from Alexandre EcoDairy Farms. The 16th case was a farm employee. CDPH and Del Norte county officials concluded that “the available epidemiologic and laboratory data support the conclusion that this cluster of acute diarrheal illness in Del Norte County was an outbreak of C. jejuni infections caused by consumption of unpasteurized milk from [Alexandre EcoDairy Farms.]”
Patient X’s injuries were so remarkable that the physicians who treated her are publishing a report on her case entitled, “Investigation of the First Case of Guillain-Barre Syndrome Associated with Consumption of Unpasteurized Milk – California, 2008.” Amy K. Earon, T. Martinelli, W. Miller, C. Parker, R. Mandrell, D. Vugia. The authors explained the laboratory methods used in investigating Patient X’s illness:
We reviewed the patient’s medical record and interviewed her husband to assess her symptoms and exposures. We used polymerase chain reaction (PCR) and multilocus sequence typing (MLST) to test a six-week old unpasteurized milk sample, obtained from the cow leasing-program and partially consumed by the patient, for genes encoding the bacterial membrane component lipooligosaccharide (LOS) in GBS-associated Campylobacter jenuni.
In addition to the DNA testing, the authors also tested Patien A’s blood for antibodies to GBS. The authors then explained that the PCR and MLST testing of the milk detected Campylobacter jejuni gene. In addition, the blood test was positive for antibodies that indicated the presence of GBS. The authors concluded: “Combined laboratory and epidemiologic evidence established the first reported association between GBS and unpasteurized milk consumption.” See article.
This conclusion echoes the conclusions reached by investigating officials with Del Norte County and the State of California, as noted above: “the available epidemiologic and laboratory data support the conclusion that this cluster of acute diarrheal illness in Del Norte County was an outbreak of C. jejuni infections caused by consumption of unpasteurized milk from [Alexandre EcoDairy Farms.]” See CDPH Report.
Herb Depot And Autumn Olive Farms E. coli O157:H7 Outbreak – Missouri, 2008
On May 12, 2008 the Lawrence County Health Department (LCHD) was notified of a case of HUS in a child with a history of bloody diarrhea. The health care provider reported that the child had consumed unpasteurized goat’s milk obtained from a local store, the Herb Depot, in Barry County, Missouri. The milk had been purchased on April 29, 2008. It was quickly learned that an additional Barry County child that had cultured positive for E. coli O157:H7 had also consumed unpasteurized goat’s milk from the same store. As a result, the LCHD contacted the Missouri Department of Health and Senior Services (DHSS) who began a full epidemiological and environmental investigation of the illnesses. The investigation revealed that the milk consumed by both ill children had been produced at Autumn Olive Farms.
At the conclusion of its investigation, the DHSS announced that there were four cases of E. coli O157:H7 associated with the outbreak. Of these, three were laboratory confirmed, and one was identified as a probable case. Each of these individuals resided in different counties in Southwest Missouri, and were not known to have any relation to each other. Nonetheless, each shared a common exposure to milk from Autumn Olive Farms. In addition, the three culture-confirmed cases shared a common, indistinguishable genetic strain of E. coli O157:H7. The strain was identified as a unique subtype of E. coli O157:H7, never before reported in Missouri. Each of the four cases had consumed milk from Autumn Olive Farms within 3-4 days of onset of illness. The DHSS reported: “no other plausible sources of exposure common to all four cases were identified [other than the milk.]” The final outbreak report ultimately concluded: “the epidemiological findings strongly suggest the unpasteurized goat’s milk from Farm A [Autumn Olive] was the likely source of infection for each of the cases associated with this outbreak.” See MDOH Report.