title: An outbreak of hypervitaminosis D associated with the overfortification of milk from a home-delivery dairy.
abstract: OBJECTIVE
  The purpose of the study was to identify cases of hypervitaminosis D caused by the inadvertent overfortification of milk from a home-delivery dairy and to identify risk factors for this illness.
  
  
  METHODS
  Hospital discharge, laboratory, and state health department data were used to define, identify, and describe cases of hypervitaminosis D diagnosed in the exposed communities between January 1, 1985, and June 30, 1991. To identify disease risk factors, community-based sex- and age-matched controls were used in a case-control study.
  
  
  RESULTS
  Of the 56 case patients identified, at least 41 were hospitalized; 2 died. The study included 33 case patients and 93 control subjects. Nineteen of the 33 case patients had been customers of the implicated dairy. Risk of illness rose with increasing consumption of the dairy's milk and was also associated with vitamin D supplement use, sunburn susceptibility, and cancer history. Accounting for these factors did not alter the association between drinking the dairy's milk and developing hypervitaminosis D.
  
  
  CONCLUSIONS
  Overfortification of milk with vitamin D can lead to hypervitaminosis D, manifested by severe illness and death. The episode highlights the need for monitoring the fortification process and enforcing the upper limit for vitamin D addition to milk.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Ga, USA.
authors.forename: S
authors.initials: S
authors.lastname: Blank
authors.forename: K S
authors.initials: KS
authors.lastname: Scanlon
authors.forename: T H
authors.initials: TH
authors.lastname: Sinks
authors.forename: S
authors.initials: S
authors.lastname: Lett
authors.forename: H
authors.initials: H
authors.lastname: Falk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005527:Food, Fortified / Q000009:adverse effects*; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D008892:Milk; D011041:Poisoning / Q000175:diagnosis; D012307:Risk Factors; D014807:Vitamin D / Q000506:poisoning*
chemical_list: D014807:Vitamin D