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E. COLI EHEC - UK (03): (ENGLAND) DAIRY PRODUCTS, PASTEURIZATION PROBLEM SUSPECTED, RECALL

E. COLI EHEC - UK (03): (ENGLAND) DAIRY PRODUCTS, PASTEURIZATION PROBLEM SUSPECTED, RECALL

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A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org>

Date: Thu 28 Nov 2019
Source: Food Safety News [edited] <https://www.foodsafetynews.com/2019/11/18-ill-in-e-coli-outbreak-linked-to-dairy-products-pasteurization-problem-cited/>


18 ill in _E. coli_ outbreak linked to dairy products: pasteurization problem cited
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A dairy in an English town has been linked to an outbreak of _Escherichia coli_, with 18 people sick. Darwin's Dairy has been advised to recall all whole, skimmed and semi-skimmed milk and cream products currently in circulation. Barnsley Council and Public Health England (PHE) informed residents across South Yorkshire of the recall. They did not mention the strain of _E. coli_ involved.

PHE Yorkshire and the Humber noted an increase in _E. coli_ cases in South Yorkshire but the dairy has not yet been confirmed as the source of the outbreak. A total of 9 of the 18 ill people consumed Darwin's Dairy products before becoming sick. In a joint statement, Julia Burrows, director of public health at Barnsley Council, and Dr Nachi Arunachalam, consultant in communicable disease control at PHE Yorkshire and the Humber, said it advised the dairy to take recall action.

This became necessary after a potential processing problem was identified with the pasteurization process that could have affected some milk and cream products that could still be stored in people's fridges. Products can be identified by a Darwin's logo on the container either "Darwin's Dairy" or "NP & DJ Darwin Ltd", wording saying: "produced at Whitefield Farm, Oxspring, Barnsley" or an oval mark with "UK YB006 EC" inside it.

Burrows and Arunachalam said the dairy was cooperating with the recall. "If you have bought these products, do not eat or drink them but dispose of them. Environmental health officers visited the dairy after PHE Yorkshire and the Humber became aware of an increase in _E. coli_ cases in South Yorkshire, though it is important to be aware that the dairy has not been confirmed as the source of the outbreak at this stage.

"A total of 18 confirmed or probable cases have been identified in people with links to Barnsley, Doncaster or Sheffield in November 2019. Of these cases, 9 are known to have consumed Darwin's Dairy products before becoming unwell. Those affected are recovering at home and in hospital."

In a post on the firm's Facebook page, Darwin's Dairy operators said the link between the illnesses and their products was "pure speculation". "I would like to clarify that there is no confirmed link or evidence with the health issues highlighted in the councils statement, it's pure speculation and I am deeply upset and frustrated that such a statement can be released without sufficient evidence. We strive to supply our loyal customers with a quality local product that is regularly tested to the highest standards required," a statement on the Facebook page says.

Darwin's Dairy has sourced milk from a neighbor to continue doing doorstep deliveries and is waiting for the local authority to give the go ahead for the firm to start bottling milk again.

Anyone who has consumed any of the implicated products and developed symptoms of _E. coli_ infection should seek medical attention and tell their doctor about their possible exposure to the bacteria. Specific tests are required to diagnose the infections, which can mimic other illnesses. The symptoms of _E. coli_ infections vary for each person but often include severe stomach cramps and diarrhea, which is often bloody. Some patients may also have a fever. Most patients recover within 5 to 7 days. Others can develop severe or life-threatening symptoms and complications, according to the Centers for Disease Control and Prevention (CDC).

About 5 to 10% of those diagnosed with [certain] _E. coli_ infections develop a potentially life-threatening kidney failure complication, known as a hemolytic uremic syndrome (HUS). Symptoms of HUS include fever, abdominal pain, feeling very tired, decreased frequency of urination, small unexplained bruises or bleeding, and pallor. Many people with HUS recover within a few weeks, but some suffer permanent injuries or death. This condition can occur among people of any age but is most common in children younger than 5 years old because of their immature immune systems, older adults because of deteriorating immune systems, and people with compromised immune systems such as cancer patients. People who experience HUS symptoms should immediately seek emergency medical care. People with HUS will likely be hospitalized because the condition can cause other serious and ongoing problems such as hypertension, chronic kidney disease, brain damage, and neurologic problems.

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communicated by: ProMED-mail <promed@promedmail.org>

[Although the strain involved is not specifically mentioned, the association with dairy products and a discussion regarding complications certainly implicate an enterohemorrhagic serotype that produces Shiga toxin.

In the March 2012 issue of Emerging Infectious Diseases (Langer AJ, Ayers T, Grass J, et al. Nonpasteurized dairy products, disease outbreaks, and state laws -- United States, 1993-2006. Emerg Infect Dis. 2012; 18(3): 385-91; <http://wwwnc.cdc.gov/eid/article/18/3/11-1370_article>), the authors report on 121 foodborne outbreaks (with 4413 cases of reported illness) caused by contaminated dairy products, and 73 (60%) were involved with unpasteurized dairy products; 65 (54%) involved cheese (42% made from unpasteurized milk) and 56 (46%) involved fluid milk (82% involved unpasteurized milk). In these outbreaks, _Campylobacter_ spp were responsible for 54% of the outbreaks, followed by _Salmonella_ spp (22%), enterohemorrhagic _E. coli_ (13%), _Brucella_ spp (4%), _Listeria_ (4%), and _Shigella_ spp (3%).

Clearly, pasteurized milk can also transmit disease, and 48 outbreaks were reported. The source of contamination was reported in only 7 (14%), of which at least 4 resulted from post-pasteurization contamination by an infected food handler.

The reader is directed to the article for additional information and discussion.

Classical zoonotic organisms such as _Brucella abortus_, _B. melitensis_, _Mycobacterium bovis_, _Salmonella_ species, _Listeria monocytogenes_, _Campylobacter_ species, _Yersinia_ species, _Coxiella burnetii_, and _E. coli_ O157:H7 are associated with the ingestion of raw milk. Non-zoonotic organisms such as _Streptococcus pyogenes_, _Salmonella_ Typhi, _Corynebacterium diphtheriae_, _Shigella_ spp, _Salmonella_ Paratyphi A, _Salmonella_ Paratyphi B, enterotoxins from _Staphylococcus aureus_, and hepatitis A have also been associated with the ingestion of raw milk. - Mod.LL

HealthMap/ProMED map available at: Yorkshire, England, United Kingdom: <http://healthmap.org/promed/p/3179>]

[See Also:
E. coli EHEC - UK (02) http://promedmail.org/post/20191017.6731974
E. coli EHEC - UK: Egypt travel, multiple serotypes, alert http://promedmail.org/post/20190718.6575137

2018
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E. coli EHEC - UK (02): (England) O157, raw pet food, fatal, 2017 http://promedmail.org/post/20181019.6100174
E. coli EHEC - UK: (England) fatal http://promedmail.org/post/20181005.6071314

2017
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E. coli EHEC - UK (07): (England) O157, ground beef http://promedmail.org/post/20171223.5521386
E. coli EHEC - UK (06): (England) O55 http://promedmail.org/post/20171102.5421302
E. coli EHEC - UK (05): (England) O55, RFI http://promedmail.org/post/20171030.5413034
E. coli EHEC - UK (04): (IW) O157, unpasteurized milk http://promedmail.org/post/20171013.5378555
E. coli EHEC - UK (03): (England) O55, 2014-2015 http://promedmail.org/post/20170907.5301318
E. coli EHEC - UK (02): (Scotland) O157, race participants, alert http://promedmail.org/post/20170705.5152938
E. coli EHEC - UK: (England) O157 http://promedmail.org/post/20170622.5123423

2016
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E. coli EHEC - UK (09): (Scotland) O157, unpast. cheese, children, fatal http://promedmail.org/post/20160916.4493645
E. coli EHEC - UK (08): (Scotland, England) O157, unpast. cheese, recall, fatal http://promedmail.org/post/20160914.4488415
E. coli EHEC - UK (07): (Scotland, England) O157, unpast. cheese, fatality http://promedmail.org/post/20160907.4469162
E. coli EHEC - UK (06): (Scotland, England) O157, unpast. cheese, alert, recall http://promedmail.org/post/20160817.4420279
E. coli EHEC - UK (05): (Scotland, England) O157, unpast. cheese, alert, recall http://promedmail.org/post/20160729.4379645
E. coli EHEC - UK (04): O157, salad, fatalities http://promedmail.org/post/20160725.4367897
E. coli EHEC - UK (03): (England) O157, salad, fatalities http://promedmail.org/post/20160715.4347888
E. coli EHEC - UK (02): (England) ex Egypt http://promedmail.org/post/20160707.4330782
E. coli EHEC - UK: O157, possible salad link, RFI http://promedmail.org/post/20160706.4328712

Published 07-10-2017 in Focus on , last update 29-11-2019

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