Food Protection Trends - April 2009 - 218

FIGURE 4. U.S. states that have legalized the sale of raw milk for human consumption, but require warning labels (shaded) THE EUROpEAN SOLUTION Europe has a rich tradition of producing unpasteurized milk products (mainly cheese), the safety of which is regulated by the European Commission (EC). The EC requires that these products meet process hygiene, food safety, and microbiological standards. It also regulates the production and labeling of raw milk products (72). Countries of the European Union must then create their own laws and regulations in compliance with EC regulations. Products made with unpasteurized milk must bear the label ‘made with raw milk’ (72). For instance, in England, the sale of raw milk is legal provided that the containers have a green top (40). RECOMMENDATIONS Given the evidence, it is clear that unpasteurized milk and cheese have the potential to pose a risk to health. While some purport that an outright ban may help abate the incidence of unpasteurized milk and cheese outbreaks, many believe that imposing a ban on such products is an infringement on freedom of choice. If a ban were imposed, it would pose a variety of problems for key stakeholders, such as state agricultural departments, dairy farmers, and raw milk and cheese consumers. The time, energy, and resources needed to enact a ban would overstrain state agricultural departments. Furthermore, surveillance and regulation of sales is impractical because of labor and costs and may not be completely effective in preventing the illegal production and sale of these products, which would most likely continue. A ban on unpasteurized milk cheeses would also cause a great deal of economic concern for states, as many cheeses in cheese-producing states are made using unpasteurized milk, and a large portion of state agricultural revenue may come from milk and milk products, particularly in states like Vermont. A successful intervention called The Abuela Project has shown how effective safe cheese workshops encouraging the use of pasteurized milk can reduce the incidence of S. Typhimurium outbreaks (17). The intervention focused on the use of pasteurized milk in the preparation of queso fresco among a Hispanic community in Washington state (17). Twohundred twenty-five attendees reported an acceptance of a new recipe and, as a and those who only had consumed unpasteurized milk products (75%, 9 of 12, P = 0.009), compared with those who had neither worked with the goats nor consumed unpasteurized goat milk products (0 of 5) (46). Other European countries have also had raw soft milk cheese-associated outbreaks. In Malta, a soft cheese made from unpasteurized goats’ and sheeps’ milk affected 135 people as a result of Brucella melitensis infection (22). Cheeses made from unpasteurized cows’ milk led to food poisoning in England and Wales; 42 people who consumed Irish soft cheese were infected with S. Dublin (69). In Spain, 81 cases of brucellosis were associated with consumption of fresh unpasteurized cottage cheese (OR = 311.9, 95% CI 41.28 – 12,735) (25). Consumption of fresh, unpasteurized goat cheese in a local dairy farm in Finland led six people to develop septicemia and one person to develop purulent arthritis secondary to Streptococcus equi subspecies zooepidemicus infection (67). Fresh, unpasteurized cheese curds are also a potential source of infection. In Wisconsin, 55 patients contracted E. coli infection after eating fresh cheese curds (8). Furthermore, more than 40 people had symptoms of abdominal cramping, bloody diarrhea, fever, vomiting, and nausea after the ingestion of white cheese curds produced in Wisconsin (8). The cheese curds tested positive for C. jejuni and, as a result, all dairy manufacturing activity was terminated (64). Unpasteurized hard cheese From 1948 to 1988, six outbreaks implicated hard cheeses produced in the United States (60). Several reports have called the existing 60-day aging period in the manufacture of hard cheeses made with unpasteurized milk into question because of safety concerns, suggesting that all cheeses should be made from pasteurized milk (83). The FDA’s Center for Food Safety and Applied Nutrition has also begun examining the safety of all raw milk cheeses and plans to conduct a full risk profile of each type of cheese (83). Thirteen cases of E. coli hemorrhagic colitis associated with unpasteurized Gouda cheese in Canada led Honish and colleagues to suggest that Canadian authorities question current federal legislation that permits sale and consumption of unpasteurized milk cheeses aged over 60 days (56). After consuming Stilton cheese, 155 people were thought to have been infected with S. aureus enterotoxin (69). In 2008, several hard raw milk cheeses were recalled in Indiana because of high levels of S. aureus in Colby cheese, jalapeño natural cheese, garlic pepper cheese, and Monterey Jack cheese (21). There was also a recall of Berkshire Blue Cheese, a cheese made in Massachusetts, after routine FDA sampling discovered elevated levels of L. monocytogenes (14). There is limited information in the scientific literature concerning pasteurized milk cheese disease outbreaks. 218 FOOD PROTECTION TRENDS | APRIL 2009

Food Protection Trends - April 2009

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