There’s good news out of West Virginia in the wake of a state delegate’s illegal distribution of raw milk in the halls of the Mountain State’s Capitol. As I mentioned in this space in late March, I was disgusted by both Delegate Scott Cadle’s public flouting of state law and the failure of West Virginia Environmental Health Services Director Walter Ivey to fine Cadle. But the prologue to incident shows officials at the state’s Bureau of Public Health know a teaching moment when one presents itself. The bureau also appears to have done a good job with the investigation into whether Cadle’s raw milk toasts were responsible for a round of gastro illnesses reported by lawmakers and staff at the Capitol building. Although the investigation was inconclusive, it uncovered some less than optimum practices among urgent care and emergency room staff, which was a cue to state officials that they needed to step up education and outreach efforts. The unfortunate truths of the investigation A formal complaint filed with the bureau March 8 alerted public health officials to Cadle’s celebratory raw milk tippling on March 3 in honor Gov. Earl Ray Tomblin’s signing of a herd-share bill. The law allows people to buy a share in an animal or herd and then receive unpasteurized raw milk from that animal or herd. It remains illegal to otherwise sell or distribute unpasteurized milk in West Virginia. Cadle knew the governor was scheduled to sign the bill, so he stopped by a neighbor’s barn and picked up a couple of gallons of raw milk. He told investigators he put the milk on ice for the drive to the Capitol. He issued an open invitation from the floor of the legislature, inviting anyone within earshot to stop by his office for a taste of the raw milk. At least three people who drank the raw milk got sick, according to information submitted to the public health bureau. As part of its investigation the bureau sent epidemiological investigation surveys to all 79 people who were working in the Capitol’s East Wing on March 3. Unfortunately, only 15 of those 79 people bothered to fill out and return the surveys. Unfortunately, 40 percent of the people who did complete and return the epidemiological surveys reported they were sick with gastroenteritis during the time period in question. Unfortunately, three of those people were so sick they had to seek treatment at urgent care and emergency room facilities. Unfortunately, none of the people who drank the raw milk and became ill provided stool samples for testing. Unfortunately, the raw milk leftover from Cadle’s celebration was flushed and therefore unavailable for pathogen testing. Data gleaned from the 15 conscientious public servants who did the right thing and filled out the public health survey included:

• Six, or 40 percent of the 15 respondents, reported illnesses;
• All six people with illness reported diarrhea, the most common symptom of foodborne illnesses;
• Three of the six sick people reported drinking the raw milk;
• Two of the sick people were given antibiotics; and
• Two of the 15 survey respondents reported co-workers were sick.

“Because of the limitations of this investigation, no conclusions can be drawn about the extent of illness, etiologic agent, or the mode of transmission,” according to the report from the public health bureau. The silver lining The investigation didn’t reveal the cause of the illnesses among Capitol personnel, but West Virginia public health officials did uncover other valuable information. They found none of the healthcare providers who spoke with the sick people involved in the gastroenteritis outbreak reported the possibility of an outbreak to the health department. The public health investigators also found that some people were unaware of potential health risks associated with drinking raw milk. Kudos to the West Virginia Bureau of Public Health (BPH) for making the most of the situation. Along with the survey data, the bureau’s investigation report included a list of its recommendations and planned action. The recommendations, as detailed in the report are:

1. BPH will engage providers and laboratories to improve practices for diagnosis and management of acute diarrheal illness and foodborne outbreaks, including:
   1. Perform a good history to explore risk factors when providers see a patient with diarrheal illness.
   2. Conduct stool testing on patients as recommended by ISDA guidelines
   3. Conduct stool testing for patients who present as part of a potential outbreak.
   4. Encourage laboratories to send isolates to the Office of Laboratory Services for further characterization, including pulsed-field gel electrophoresis (PFGE).
   5. Timely reporting of all outbreaks, including possible foodborne outbreaks.
2. Office of Environmental Health Services (OEHS) will collaborate with the West Virginia Department of Agriculture to refine guidelines for environmental investigation of raw milk cases and outbreaks. These guidelines should be documented in the foodborne outbreak investigation manual.
3. BPH will provide public health education about the health benefits of milk pasteurization is needed throughout the state of West Virginia, especially targeted to pregnant women and children.
4. BPH will provide consultation to the Department of Agriculture to develop rules to sufficiently protect the health of pregnant women and children to prevent or reduce the number of outbreaks associated with the consumption of raw milk.

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