Post on 05-Jan-2016
Wise Traditions 2009 1
Impacts of Public Reporting of Outbreaks
It is acknowledged that when any apparentoutbreak is announced, there is an increase in:
– Number of people reporting similar illness
– The health professionals focus their surveillance to that specific illness and food
– Decrease in awareness of illness not associated with the announced food
Wise Traditions 2009 2
Ease of Recognizing Milkborne Illnesses by Spotting Clusters
Characteristic FUWM Operation Industrial Dairy
Herd size Small Large
Comingling milk from different farms Rare Standard Practice Inputs NO Universal
Diversity of Products Limited Common
Distribution Range (geographic) Very Limited Extremely wide
Traceability Nearly instantaneous Extraordinarily difficult
Potential exposed population Modest and well defined Huge, Undefined Number of customers from single batch
(batch size)Small , easily determined Huge
Exposure interval Usually one week Long
Public Health Impact Very small Huge
Wise Traditions 2009 3
Outbreaks and Public Health Impact
Wise Traditions 2009 4
* There are a number of slide coming up that show “outbreaks” of illness.
• An outbreak is defined as 2 or more illness that are considered to have common cause.
• There are a number of sources for the data I will be showing. But they are not my data.
• Furthermore, by showing the data I am not saying that they actually reflect proven cases of illness associated with a given food. In nearly all cases they have been identified by a government agency, investigated, and reported in official documents or published in journals.
• Some of the associations are questionable, but I am showing the data unedited. The * will indicate that I am NOT saying the data is valid.
Wise Traditions 2009 5
Foodborne Outbreaks in USA *
0
200
400
600
800
1000
1200
1400
Sal
mon
ellla
spp
E. c
oli O
157:
H7
Cam
pyoo
bact
er je
juni
List
eria
mon
ocyt
ogen
es
Yer
sini
a
USA Identified Foodborne Outbreaks1997-2006 [CDC data]
Total Identif ied FoodborneOutbreaks USA 1990-2006
Milk related Outbreaks tenyrs (1997-2006)
76 Million people sick from foodborne illness
Includes 350,000 hospitalizations
5,000 deaths
In USA each year
Bars are accumulated totals over period
1997-2006
Wise Traditions 2009 6
Foodborne Outbreaks in USA *
Est Cases in Outbreaks Attributed to Pasteurized MilkData from CDC and Oliver review
050
100150200250300
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
Listeria ( 2,500 )
Yersinia ( 100,000 )
Staph ( 185,000 )
E.coli O157:H* ( 73,000 )
Campylobacter ( 2,500,000 )
Salmonella (1,400,000 )
Est. Cases in Outbreaks Attributed to Raw MilkData from CDC and Oliver review
0
50
100
150
200
25019
80
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Wise Traditions 2009 7
0
5
10
15
20
25
30
35
Prior 2004 2005 2006 2007 2008 2009
Total Dairies Licensed
Texas Grade A Raw Milk
Wise Traditions 2009 8
Foodborne Outbreaks in USA *
Est Cases in Outbreaks Attributed to Pasteurized MilkData from CDC and Oliver review
050
100150200250300
1973
1975
1977
1979
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
Listeria ( 2,500 )
Yersinia ( 100,000 )
Staph ( 185,000 )
E.coli O157:H* ( 73,000 )
Campylobacter ( 2,500,000 )
Salmonella (1,400,000 )
Est. Cases in Outbreaks Attributed to Raw MilkData from CDC and Oliver review
0
50
100
150
200
25019
80
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
2002
2004
2006
2008
Wise Traditions 2009 9
Relative Risky Behavior
• 1 out of every 4 people have a foodborne illness every year
• 1 out of every 20,000 people who drink fresh unprocessed milk may become sick each year
• More people are killed each year from lightning strikes on golf courses than die from milkborne illness.
• More people die from defective toasters
• Unpasteurized milk is not even on the list of the top 10 most risky foods.
Wise Traditions 2009 10
What are the real food safety Risky Behaviors ?
• Industrial operations that favor investor profits rather than public health/safety
• Highly processing foods
• Co-mingled of ingredients and products
• Sourcing from variable and multiple locations
• Wide final distribution of the product
• Distribution under numerous brand names
Wise Traditions 2009 11
Any illness and certainly death is a genuine tragedy to the individuals and an empathetic community. And every outbreak must be aggressively investigated to determine if there was a breakdown of best practices, or to determine if new practices would have averted the outbreak.
However, outbreaks should not be exploited to fuel the obsession of those that want to eliminate any access to raw milk. Responsible public health policy must start with the acknowledgment that our lives can never to totally free of risk. No food can ever be considered completely safe.
Wise Traditions 2009 12
Reframing the question: Is there evidence that pasteurization would have prevented these outbreak?
• Examination of the actual historical records in the period after 1900, confirm reports of outbreaks of the epidemic illnesses associated with milk.
• Nearly all of these identified milk handlers who were either sick or carriers; or milk containers that were contaminated.
• And since it was not “the milk” pasteurization would not have prevented those outbreaks.
Currently, outbreaks should not be attributed to raw milk unless you confirm that the milk that was consumed contained the specific virulent bacteria causing the illnesses
Wise Traditions 2009 13
What is a Health Hazard?
What is the Public Health Interest ?
Wise Traditions 2009 14
9 And don’t forget…milk is inherently hazardous
Wise Traditions 2009 15
Irrational conclusion based on these dogma
Since it will be shown that ultimately there are illness and even some deaths attributed to each fresh food.
Therefore, based on the words and actions of those obsessed with banning raw milk the government will be obligated to ban all fresh food that has not been pasteurized in some form!
Wise Traditions 2009 16
Shedding of C. jejuni
Wise Traditions 2009 17
Positive tests for E. coli O157:H7 in feces