Raw milk at the center of Wisconsin bacterial outbreak

It should have been one of those nights that high school students remember foryears. For students at Durand High School in Wisconsin, September 18 of 2014 was a memorable night for all the wrong reasons.

Durand, Wisconsin was at the center of a bacterial outbreak that sickened dozens of people in late 2014 (photo from best places.net)

Durand, Wisconsin was at the center of a bacterial outbreak that sickened dozens of people in late 2014 (photo from best places.net)

It’s tradition in many small towns across America to serve their high school football teams a group meal the night before a game. Thursday, September 18, the Durand football team got together with cheerleaders, parents, team managers, and friends to enjoy a night of togetherness, with a large selection of food on the menu.

The Durand, Wisconsin high school was at the center of a serious bacterial outbreak which began in late 2014, sickening over 2 dozen people (photo from weau.com)

The Durand, Wisconsin high school was at the center of a serious bacterial outbreak which began in late 2014, sickening over 2 dozen people (photo from weau.com)

The list of food items served at the potluck-style meal was innocent enough: a chicken entrée, a broccoli salad and other side dishes, a variety of desserts including cookies, bars and brownies, and a variety of drinks, including Kool-Aid, chocolate milk and white milk — a typical pregame meal you might see in small towns across the Midwest.

The following Monday, September 22, the Durand High School nurse called the Pepin County Health Department (PCHD) about an unusual increase in absenteeism related to a gastrointestinal illness in football players and team mangers, as well as the Panthers’ coaching staff. Symptoms included diarrhea, nausea, vomiting, headaches, fever and abdominal cramps.

The PCHD notified the staff in the Communicable Disease Epidemiology Section (CDES), Bureau of Communicable Diseases, Wisconsin Division of Public Health (WDPH), and a joint investigation was launched.

The gastrointestinal illness didn’t just hit the football team. During the joint investigation, a large increase in absenteeism showed up on the volleyball team, too.

The investigation noted that food at team meals is typically bought, prepared, and served by parents of team members. September 23, the PCHD learned that some of the milk was unpasteurized, and provided by a parent who brought it from his or her own farm. Thus, it was store-bought chocolate milk and unpasteurized white milk served at the dinner. Parents reported 3 one-half gallons of chocolate milk, and a 5-gallon cooler of white, unpasteurized milk, which was served after the chocolate milk was gone. That’s when the questions really began to intensify.

The US Food and Drug Administration website, fda.gov, defines raw milk as milk from cows, sheep or goats that has not been pasteurized to kill bacteria. This raw milk can carry dangerous bacteria, such as E. coli, salmonella and Listeria, which can cause serious food borne illnesses.

However, Wisconsin State Health Officer Karen McKeown said they didn’t necessarily assume that’s where the outbreak started.

“Even once we found out there was unpasteurized raw milk, we needed to continue to look at the whole picture,” she said. “We needed to do a thorough investigation, and not jump to conclusions. We continued to ask questions about everything that people had eaten.”

On September 23, the CDES staff began conducting phone interviews with all students, parents and staff associated with the football team. While the various health workers were doing their jobs, the community was asking a lot of questions, including why school wasn’t closed for the week following the outbreak.

“We were in constant contact with the county and state health departments as soon as we first learned about it,” said Durand Superintendent Greg Doverspike. “I posed that question to the State Health Department and they said there was no need to close school. This is confined to a cohort (group), and there’s no evidence to show it’s spreading beyond that cohort. There’s also no evidence it’s airborne, either.

“They did say to encourage students to use good hygiene by hand washing. We were also doing extra cleaning and disinfecting things like door handles, water fountains, bathrooms, desks and buses, so we were going above and beyond our normal routines.”

One of the concessions the school did make to the illness outbreak was to cancel several athletic and extracurricular activities, including the football game on September 26.

As the investigation continued, McKeown said the Wisconsin Department of Health reached out to the State Department of Agriculture for help.

“We asked the Department of Agriculture to go to the farm (where the raw milk came from) and do a test of the milk in the bulk tank,” she said. “They did not find any bacteria that would match what we had found in the investigation.”

Sixty-five people were interviewed for the investigation, and testing stool samples showed that 26 of them were infected with laboratory-tested cases of campylobacter jejuni infection. But the bacteria hadn’t shown up in the milk at the farm, which McKeown said wasn’t unheard of.

“Cows do not always shed this bacteria,” she said. “It can happen intermittently, and milk can also be contaminated after the cow has been milked, too.”

After the milk had been tested, McKeown said the Department of Health asked the Ag Department to head back to the farm for more testing. This time, they collected manure samples.

“With no bacteria in the milk, we couldn’t conclude that the milk was the source, said McKeown. “We needed additional information.”

Questions began to be answered after the manure test results came back from the lab. “We found a match between the manure samples and the samples that we received from the sick individuals,” said McKeown.

“Once we did our complete analysis, looking at what people had eaten, what thestatistical analysis showed us and looking at information from the lab, we did feel that the raw milk was the common factor in the outbreak,” said McKeown.

Raw milk, which is illegal in Wisconsin, was determined to be at the center of the campylobacter outbreak in Durand, Wisconsin (photo from campylobacterblog.com)

Raw milk, which is illegal in Wisconsin, was determined to be at the center of the campylobacter outbreak in Durand, Wisconsin (photo from campylobacterblog.com)

The farm owners who supplied the raw milk came from pointed out that chicken alfredo was served at the meal, and may have been a possible source of the contamination

“We looked at that as well, but since everybody ate that, there was nobody to compare it to who did not eat the food,” said McKeown. “But there were also nowhere near the percentages of people who became ill. When we ran the numbers in the statistical analysis, that helps us to pinpoint that it was the (raw) milk rather than the Chicken Alfredo.”

McKeown credited the quick thinking of the Pepin County Health Department for helping to find answers to what was affecting students and staff at Durand High School.

“As soon as Heidi (Stewart, Pepin County Health Officer) started hearing about these sick children, she moved very quickly to begin those interviews and start the identification work, and she called us in very quickly,” said McKeown. “I do think that Heidi acted well in beginning a prompt investigation of this illness.”

The dangers of raw milk cannot be over-emphasized. Despite the investigation concluding, students are still trying to recover from a very serious illness.

One student shared the timeline for their illness, and it’s scary. The student preferred to remain anonymous because of a pending court case.

September 19, the student attended the team dinner. Sunday night, September 22, the student became seriously ill, with chills, fever and vomiting. The parents initially dosed the student with NyQuil, thinking it may be the flu.

September 23, the students fever was up to 104, and immediately was taken to the hospital. The examining doctor dispensed with the initial examination, and the student was immediately admitted to the hospital and given IV fluids.

That same morning, the State Health Department interviewed the student. Parents were not allowed in the room without hospital gowns and gloves.

As the day went on, more and more students were admitted to the hospital.

When the student went to the bathroom, everything had to be kept for the State of Wisconsin Health Department to examine.

September 25, the state confirms it’s a campylobacter outbreak after testing the fecal matter of the students and manure from the farm.

September 26, the student is released from the hospital, but would be home until September 30.

The student lost 30 pounds from the illness, and suffered for months from loss of feeling in limbs, joint pain, and trouble sleeping and concentrating.

The moral of this story is simple: don’t take any chances with raw milk.

Salmonella cases linked to raw, frozen chicken entrees

MDA logoST. PAUL, Minn. – State health and minnesota-department-of-health-logoagriculture officials said today that six recent cases of salmonellosis in Minnesota have been linked to raw, frozen, breaded and pre-browned, stuffed chicken entrees. The implicated product is Antioch Farms brand A La Kiev raw stuffed chicken breast with a U.S. Department of Agriculture stamped code of P-1358. This product is sold at many different grocery store chains.

Investigators from the Minnesota Department of Health (MDH) and the Minnesota Department of Agriculture (MDA) determined that six cases of Salmonella infection from August and September 2014 were due to the same strain of Salmonella Enteritidis. One person was hospitalized for their illness.

“Our DNA fingerprinting found that the individuals were sickened by the same strain of Salmonella,” said Dr. Carlota Medus, epidemiologist for the Foodborne Diseases Unit at MDH. “The Minnesota Department of Agriculture collected samples of the same type of product from grocery stores and the outbreak strain of Salmonella was found in packages of this product.”

There have been six outbreaks of salmonellosis in Minnesota linked to these types of products from 1998 through 2008. This is the first outbreak since improvements were made in 2008 to the labeling of these products. The current labels clearly state that the product is raw.
Salmonella is sometimes present in raw chicken, which is why it is important for consumers to follow safe food-handling practices. This includes cooking all raw poultry products to an internal temperature of at least 165 degrees Fahrenheit. “The problem arises when consumers don’t realize that they are handling and preparing a raw product,” according to Dr. Carrie Rigdon, an investigator for the MDA Dairy and Food Inspection Division.

MDA and MDH officials advised that consumers with these products in their freezers, if they choose to use them, should cook them thoroughly. Other important food handling practices include hand washing before and after handling raw meat, keeping raw and cooked foods separate to avoid cross-contamination, and placing cooked meat on a clean plate or platter before serving. Consumers can find more information about safe food-handling practices on the MDH website at: www.health.state.mn.us/foodsafety

Symptoms of salmonellosis include diarrhea, abdominal pain and cramps and fever. Symptoms usually begin within 12 to 72 hours after exposure, but can begin up to a week after exposure. Salmonella infections usually resolve in 5 to 7 days, but approximately 20 percent of cases require hospitalization. In rare cases, Salmonella infection can lead to death, particularly in the elderly or those with weakened immune systems.

Approximately 700 cases of salmonellosis are reported each year in Minnesota.

More information on Salmonella and how to prevent it can be found on the MDH website at www.health.state.mn.us/divs/idepc/diseases/salmonellosis/index.html