title: Two outbreaks of campylobacteriosis associated with the consumption of raw cows' milk.
abstract: The present paper summarises the investigation of two different outbreaks of milk-associated Campylobacter enteritis in the Netherlands. In 2005, after a school trip to a dairy farm, 22 out of a group of 34 children developed diarrhoeal illness and Campylobacterjejuni was cultured from the stool samples of 11 of the cases. The illness was found to be epidemiologically associated with drinking raw milk during the farm visit; 86% of the cases could be explained by drinking raw milk. C.jejuni was also isolated from three of 10 faecal samples from dairy cattle collected at the farm. The human isolates and C.jejuni isolates from one of these three samples of cattle faeces revealed identical restriction patterns by both pulsed-field gel electrophoresis (PFGE) and flagellin (fla) typing by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Both epidemiological and bacteriological evidence implicated contaminated raw milk as the vehicle of transmission, though C.jejuni was not isolated from the bulk tank milk or the milk filter collected during the farm investigation. In 2007, an outbreak of enteritis was notified among people who had attended a lunch at a dairy farm where bulk tank milk was served. Of the 19 persons who had consumed raw milk, 16 (84%) had become ill. Of the persons who did not drink the raw milk, none became ill. A significant association was found between tasting the raw milk and being ill (risk difference=0.84, p=0.0011). C.jejuni was cultured from four of seven cases who had submitted a stool specimen. C. jejuni was also isolated from a sample of bulk tank milk and the isolate had an identical flaA PCR-RFLP genotype to isolates obtained from patients. Also in this outbreak both the epidemiological and bacteriological findings support raw milk as the vehicle for the enteritis. These two outbreaks highlight the health risks associated with the consumption of raw milk. As long as legislation allows the sale and distribution of untreated milk these risks will continue. Therefore, consumers need to be continuously informed about the dangers inherent in consuming unpasteurised milk or products made from raw milk. Farmers need to be strongly discouraged from serving raw milk to their visitors.
authors.affiliation: The Food and Consumer Product Safety Authority, 7200 AE Zutphen, The Netherlands. Annet.Heuvelink@vwa.nl
authors.forename: Annet E
authors.initials: AE
authors.lastname: Heuvelink
authors.forename: Caroliene
authors.initials: C
authors.lastname: van Heerwaarden
authors.forename: Ans
authors.initials: A
authors.lastname: Zwartkruis-Nahuis
authors.forename: Jeroen J H C
authors.initials: JJ
authors.lastname: Tilburg
authors.forename: M Hanna
authors.initials: MH
authors.lastname: Bos
authors.forename: Frank G C
authors.initials: FG
authors.lastname: Heilmann
authors.forename: Agnetha
authors.initials: A
authors.lastname: Hofhuis
authors.forename: Trynke
authors.initials: T
authors.lastname: Hoekstra
authors.forename: Enne
authors.initials: E
authors.lastname: de Boer
mesh_terms: D000818:Animals; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000635:transmission; D016123:Campylobacter jejuni / Q000302:isolation & purification*; D002417:Cattle; D002648:Child; D015169:Colony Count, Microbial; D004196:Disease Outbreaks; D004751:Enteritis / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D005506:Food Contamination / Q000032:analysis*; D005516:Food Microbiology; D006801:Humans; D008297:Male; D008892:Milk / Q000382:microbiology*; D009426:Netherlands / Q000453:epidemiology