Consumers are strongly urged to dispose of any Organic Pastures products of these types remaining in their refrigerators, and retailers are to pull those products immediately from their shelves.

From January through April 30, 2012, the California Department of Public Health (CDPH) reports that at least 10 people with campylobacter infection were identified throughout California and reported consuming Organic Pastures raw milk prior to illness onset. Their median age is 11.5 years, with six under 18. The age range is nine months to 38 years. They are residents of Fresno, Los Angeles, San Diego, San Luis Obispo and Santa Clara counties. None of the patients have been hospitalized, and there have been no deaths.

According to CDPH, symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever. Most people with campylobacteriosis recover completely. Illness usually occurs 2 to 5 days after exposure to campylobacter and lasts about a week. The illness is usually mild and some people with campylobacteriosis have no symptoms at all. However, in some persons with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection. In addition, a rare disease called Guillain-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

William Keene, senior epidemiologist with Oregon Public Health, said the two adults had both consumed raw milk from Foundation Farm, including one person who continued to drink it after being warned about the outbreak.

Keene said one was sickened by campylobacter, the other by cryptosporidium, making 21 likely cases in the outbreak. Nineteen others were infected with E. coli. One of the worst foodborne pathogens, E. coli O157:H7 was on rectal swabs from two of the farm's four cows. Milk and manure from the farm also tested positive for the same bacteria.

Food Safety News reported on February 17 that Claravale Farm, one of two state-licensed commercial raw milk dairies in California, is under investigation for possible milk contamination with Campylobacter. The infectious disease can cause serious gastric problems and in some cases can be life-threatening.

Earlier this year, an outbreak of 78 campylobacter illnesses was tied to Your Family Cow Dairy in Chambersburg, Pennsylvania.

At that time, CDPH said state investigators were talking samples of both Claraville's products and from inside the dairy. At that time, the department had not taken any regulatory action.

Pennsylvania Department of Health officials said Thursday that the total number of cases continued to increase. The department has identified 67 cases in Pennsylvania, five in Maryland, two in New Jersey and three in West Virginia.

“This outbreak has now become the largest outbreak associated with raw milk in Pennsylvania in at least the past two decades,” health department spokeswoman Holli Senior wrote in an email.

Time to cue the comments denying that this (and other outbreaks) even exist.   There is a debate to be had in balancing public health and consumer's choices.  That debate can't start until those advocating for legality of raw milk confront the facts.

The new breakdown of illnesses by state is as follows: Pennsylvania (66 illnesses), Maryland (5), West Virginia (3), New Jersey (2).

At least 2 bottles of raw milk sold by the dairy have tested positive for the presence of Campylobacter.

Last Tuesday, the dairy resumed production after passing a state health inspection.  At that time the number of reported illnesses stood at 43. The latest breakdown of illnesses by state is as follows:

Pennsylvania (51 illnesses), Maryland (4), West Virginia (3), New Jersey (2).

In its February 3 update on the outbreak, the Pennsylvania health department said that approximately half of 36 confirmed cases were individuals under the age of 18.

And while the owners of the farm have issued an apology, it does not appear that they have been deterred from selling unpasteurized milk:

Meanwhile, the state Agriculture Department said the farm passed a final inspection late Monday afternoon and has been cleared to resume production and bottling of raw milk.

The legality of selling unpasteurized milk products varies from state to state.  For further information see www.realrawmilkfacts.com.

Earlier in the week Maryland officials reported that they had isolated the  strain of campylobacter also isolated from ill persons who consumed the milk in two unopened raw milk samples from the homes of customers.

Press says as many as 35 sick.

There was more evidence today that an outbreak of campylobacter illnesses was linked to the Family Cow dairy in Chambersburg, Pennsylvania.  The Maryland Department of Health and Mental Hygiene (DHMH) Laboratories Administration has confirmed the presence of Campylobacter jejuni in two unopened raw milk samples purchased from this farm.

MDHMH reports that there are now 23 confirmed outbreak-related campylobacteriosis cases: 4 in Maryland and 19 in Pennsylvania, all of whom consumed raw milk from The Family Cow Farm.

Raw milk has been connected in the past to other campylobacter outbreaks, as well as outbreaks of E. coli O157:H7.  For more information on the pros and cons of raw, or unpasteurized milk, see www.realrawmilkfacts.com

The Health Department said Monday that they have now confirmed 12 cases of Campylobacter infection in Pennsylvania and Maryland.

Officials are awaiting test results on the raw milk sold by The Family Cow store in Chambersburg, but said all of those sickened bought raw milk from the store.

Raw milk is milk that has not been pasteurized.

A formal recall has not been announced, but officials have recommended that people throw out any raw milk bought from the store after January 1.

The farm has voluntarily suspended raw milk production.

To date, there are six confirmed campylobacteriosis cases: three in Maryland and three in Pennsylvania, all of whom consumed raw milk from this farm. Maryland DHMH recommends consumers discard any product purchased from this farm since January 1, 2012.

The implicated milk is labeled “raw milk” (meaning, not pasteurized) and is sold under “The Family Cow” label in plastic gallon, half gallon, quart and pint containers. The Family Cow dairy sells directly to consumers at its on-farm retail store and at multiple drop-off locations and retail stores in the following Pennsylvania counties: Bucks, Cumberland, Dauphin, Delaware, Franklin, Lebanon, Montgomery, Philadelphia and York counties.

In a press release Thursday, the Department of Health said two people who became ill after consuming raw milk from the farm tested positive for Campylobacter bacteria.

According to the release, the bacterial infection can cause diarrhea, fever, abdominal pain, nausea, headache and muscle pain. The illness usually occurs two to five days after ingestion and generally lasts for seven to 10 days.

Tests confirmed that milk collected on the date that the first illness was reported, Sept. 22, contained Campylobacter.

The health department reported that raw milk sales at the Jerry Dell Farm will be suspended until tests show that the milk is free of pathogens.

Active Case finding

On June 24, SOE distributed an Advisory through the Public Health Alert Network (PHAN) to alert health care providers of the outbreak and to recommend testing for Campylobacter in patients who present with acute gastrointestinal (GI) illness and a history of raw milk consumption. Through the PHAN, the June 27 Bulletin, and associated press releases, members of the public were also asked to contact SOE and report acute GI illness following consumption of raw milk. SOE received calls from five community members reporting current and previous GI illness among persons in their households with a preceding history of consuming Farm A raw milk or cream. Public health nurses facilitated collection of stool specimens from recently ill persons for enteric bacterial pathogen testing at the Alaska State Public Health Laboratory (ASPHL).

Stool specimens were collected from six persons with recent GI illness and consumption of Farm A raw dairy products. Three of the six samples tested positive for Campylobacter jejuni; all isolates were the same rare strain of C. jejuni found in the four other laboratory-confirmed cases in this outbreak (pulsed-field gel electrophoresis [PFGE] pattern AKDBRS16.0166/AKDBRK02.0093). These three persons shared raw dairy products obtained from Farm A during the first week of July. A total of 11 persons who reported acute GI illness with routine consumption of Farm A dairy products but were not-laboratory confirmed were considered to have suspected campylobacteriosis (Figure).

Farm A bulk tank milk samples collected on June 22 and 27 tested negative for C. jejuni, but positive for Listeria monocytogenes. None of the Farm A raw milk that was actually consumed by ill persons was available for testing.

Discussion

The identical rare strain of C. jejuni has been identified in all laboratory-confirmed patients associated with this outbreak and Farm A cow manure specimens. These laboratory findings combined with the epidemiologic finding that Farm A raw dairy product consumption is the only exposure common to all seven laboratory-confirmed cases (and the 11 suspect cases) affirms the conclusion that this outbreak is due to consumption of Farm A raw dairy products. Contamination might have resulted from introduction of manure into the milk or cream at some point in time from milking to filling the containers, or a cow (or cows) with an infected udder may be intermittently shedding Campylobacter directly into the milk. Regardless of the exact mechanism of contamination, with confirmed cases reporting consumption of dairy products over an 8-week period from May to July, this outbreak poses an ongoing threat to Farm A raw dairy product consumers.

It is not surprising that C. jejuni was not detected in Farm A bulk tank samples because C. jejuni is notoriously difficult to culture from environmental specimens other than raw stool,2 and few campylobacteriosis outbreak investigations yield laboratory confirmation of an implicated food source such as raw milk or produce.3 Furthermore, none of the raw milk that was actually consumed by ill persons prior to their illness onset was available for testing. Numerous C. jejuni strains were detected on Farm A, which was anticipated given that many farm animals are known reservoirs for the bacteria. Finding only a single or predominant strain shared by the human cases is not unusual, and might relate to factors associated with seasonality or adaptation of the strain to humans.4 Finally, as was the case in May, the Farm A raw milk samples collected in June tested positive for L. monocytogenes, which can cause life-threatening meningitis in children and persons with compromised immune systems.

Environmental and Milk Testing Results

Eleven composite cow manure samples, one composite chicken manure sample, and one swab from the milking parlor drain were collected on June 22. ASPHL cultured the samples with guidance from the Centers for Disease Control and Prevention (CDC) Campylobacter Laboratory. Any culture suspicious for Campylobacter growth had up to six colonies chosen and plated for identification. From the 13 samples collected at the farm and submitted for culture, 18 separate colonies were identified as C. jejuni and underwent PFGE analysis; seven different PFGE patterns were identified. PFGE pattern AKDBRS16.0166/AKDBRK02.0093 was isolated in manure samples from the grazing field and the calf barn; this pattern was identical to the pattern of the C. jejuni isolated from the seven laboratory-confirmed patients.

According to AP, the owner of a South Carolina dairy says an investigation by two states and the federal government into whether raw milk from her cows made eight people sick is a case of jumping to conclusions.

"They didn't wait for all the tests to come in," said Carolyn Adkins, owner and operator of the Tucker Adkins Dairy in York, S.C. "In fact, they have milk that they're still testing right now."

Campylobacter is a common diarrheal infection that is caused by ingesting fecal bacteria, often from contaminated food or water but also from exposure to farm animals and certain pets. The illness "can be extremely unpleasant," a Wyoming health official noted, but it can also lead to a life-threatening complication.

In some cases infected people develop GBS, in which the immune system attacks the body's nerves. It can cause paralysis and usually requires intensive care. The Centers for Disease Control and Prevention (CDC) estimates that about 40 percent of GBS disorders are preceded by a Campylobacter infection.

The Wyoming Department of Health said it has identified 29 cases of Campylobacter infections since June 1, a four-fold increase compared with the number typically reported during the same time period. At least six people have been hospitalized.

"While the increase in these infections appears to be sporadic with no single common source, it's clear than animal-related illness is at least partially driving the increase," said Kelly Weidenbach, a health department epidemiologist, in a news release.

Most of the case patients interviewed so far had contact with animals, especially cattle and dogs, and in many cases the animals were noted to be ill with diarrhea. Several case patients were ranchers or others who had recently attended a cattle branding, Weidenbach said.

According to a report in the Yuma Sun, health authorities there and across the border in San Luis Rio Colorado, Sonora, have reported an increase in Campylobacter infections and cases of GBS over the past three months.

As of July, there have been six confirmed and one suspected cases of GBS. The Yuma Sun said a June 18 article in Tribuna de San Luis reported 15 cases of GBS there.

The Yuma County Health District said it is working with the Arizona Department of Health Services, the CDC and Sonora health officials to determine the source of the outbreak. "An investigation of this nature takes a lot of time and a lot of people. It's like putting a puzzle together. You need all the pieces before you see the picture," said health district director Becky Brooks in a news release.

According to DHSS spokesperson Greg Wilkinson, state law doesn’t allow the sale of raw milk, but does permit owning shares of an animal to receive its milk -- which doesn’t have to be tested or pasteurized before it’s distributed.

The four people infected with Campylobacter jejuni bacteria from May 7 through June 4 were Southcentral Alaska residents ranging in age from 1 to 81 years old. All four experienced severe stomach flu after drinking raw milk from one of the unnamed farm’s cows, and two said family members also experienced symptoms but did not seek medical attention.

Staff with the state Department of Conservation's Division of Environmental Health visited the farm in May to evaluate sanitary conditions and pick up a bulk milk tank for testing. The sample tested negative for Campylobacter but positive for Listeria monocytogenes, a foodborne pathogen that can cause life-threatening infections in newborns and adults.

Officials believe the month-long pattern of cases points to a series of contamination events rather than a single bad batch, which is possible given the rich nutrients contained in milk.

“Raw milk is an ideal substance for the proliferation of bacteria introduced through fecal contamination,” said Dr. Joe McLaughlin, chief of the DHSS Section of Epidemiology. “Unpasteurized milk can be infected with a number of pathogens including Listeria, Salmonella, and as we’ve seen in this case, Campylobacter.”

A fact sheet on Listeria was distributed to the 1,100 shareholders in the farm’s cow-share program following DEC's May visit. Test results from a June 22 follow-up visit by DEC and DHSS personnel are still pending.

Stool samples submitted to the WRCHD by ill students and adults were sent to the State Laboratory of Hygiene where they tested positive for the bacteria. Department of Agriculture, Trade and Consumer Protection (DATCP) food inspectors collected milk samples from the bulk tank at the farm, which tested positive for Campylobacter jejuni. Further testing by the State Hygiene lab showed the bacteria strain from the stool samples and the milk samples matched. Additionally, interviews with event attendees revealed that consuming the unpasteurized milk was statistically associated with illness. Health officials said that this combination of laboratory and epidemiologic evidence indicates that the illnesses were caused by the unpasteurized milk consumed at the school event.

Campylobacter jejuni bacteria can cause diarrhea, which can be bloody, abdominal cramping, fever, nausea and vomiting. Rarely, an infection may lead to paralysis after initial symptoms have disappeared. Campylobacter can be transmitted by consuming food contaminated directly or indirectly by animal feces or handled by someone with the infection who has not adequately washed hands after using the bathroom

The farm did not sell the unpasteurized milk and there was no legal violation associated with the milk being brought to the school event. The farm is licensed and in good standing with the Department of Agriculture, Trade and Consumer Protection.

Abstract

Background. Campylobacter jejuni is a leading cause of acute gastroenteritis worldwide, and most cases are identified as sporadic events rather than as parts of recognized outbreaks. We report findings from a substantial 2008 campylobacteriosis outbreak with general implications for fresh produce safety.

Methods. We conducted a matched case-control study to determine the source of the outbreak and enhanced surveillance to identify additional cases. Clinical and environmental specimens were tested for Campylobacter, and isolates were subtyped by pulsed-field gel electrophoresis (PFGE).

Results. By routine surveillance, we identified 63 cases of laboratory-confirmed infection. Only raw peas, consumed by 30 (67%) of 45 case-patients and by 15 (17%) of 90 control participants, were associated with illness (adjusted odds ratio: 8.2; P < .001). An additional 69 patients (26 laboratory-confirmed) who reported eating raw peas within 10 days of illness onset were identified through enhanced surveillance. In all, 5 cases were hospitalized, and Guillain-Barré syndrome developed in 1 case; none died. The implicated pea farm was located near a Sandhill crane (Grus canadensis) stopover and breeding site. Of 36 environmental samples collected, 16 were positive for C. jejuni-14 crane-feces samples and 2 pea samples. We identified 25 unique combined SmaI-KpnI PFGE patterns among clinical isolates; 4 of these combined PFGE patterns identified in 15 of 55 human isolates were indistinguishable from PFGE patterns identified in environmental samples.

Conclusions. This investigation established a rare laboratory-confirmed link between a campylobacterosis outbreak and an environmental source and identified wild birds as an underrecognized source of produce contamination.