Raw Milk Potentially Sold in 4 States Linked with Resistant Bacterial Infection

Outbreaks linked with raw milk continue to pop up around the United States and for the second time in 3 months, the Centers for Disease Control and Prevention (CDC) has issued a warning regarding the consumption of raw milk and raw milk products.

In September (2017), the CDC issued a health advisory regarding a rifampin/penicillin-resistant strain of Brucella abortus (B. abortus) RB51that was linked with the consumption of raw milk. That official advisory came on the heels of a health alert issued by the Texas Department of State Health Services in August (2017). The outbreak in Texas was linked with a licensed raw milk dairy based in Paradise, Texas, called K-Bar Dairy. The recent outbreak is linked with a company called Udder Milk.

The CDC confirmed the presence of B. abortus RB51 in a New Jersey woman who had fallen ill in late September after drinking raw milk from Udder Milk. The company has not provided the CDC with information about the farms that supply their milk and therefore it has not been possible to trace the source of the infection. Scientists from the CDC, state health and agriculture officials, the US Department of Agriculture and the US Food and Drug Administration are all working together to find the source of the outbreak. Because source information remains unavailable, the CDC is advising that “anyone who drank raw milk or consumed raw milk products from Udder Milk in the past 6 months visit their doctor for antibiotics to prevent illness. Information suggests that the company delivers milk in Connecticut, New Jersey, New York, and Rhode Island.”

William Bower, MD, team lead for the CDC group that investigates brucellosis, the illness caused by Brucella stated in the official CDC press release, “Because health officials have no direct way to let people know they may have drunk contaminated milk, everyone who consumed milk from Udder Milk in the past 6 months should receive antibiotics now to avoid having long-term health effects from the bacteria.”

Brucella infections can cause serious complications in all individuals; however, pregnant women can experience particularly severe outcomes, including miscarriage and other pregnancy complications. Symptoms of infection include: fever, muscle pain, lasting fatigue, arthritis, depression, and swelling of the testicles (in men). If left untreated, the CDC states that the infection, “can result in long-term health problems like arthritis; heart problems; enlargement of the spleen or liver; and, in rare cases, nervous system problems like meningitis.”

Post-exposure prophylaxis (PEP) for B. abortus RB51 infection should include doxycycline, in addition to trimethoprim-sulfamethoxazole or another suitable antimicrobial, for 21 days, according to the CDC. This is different than the PEP regimen of doxycycline and rifampin that is normally prescribed for infections with other species of Brucella because RB51 has been found to be resistant to rifampin and penicillin in vitro. Routine serologic tests are not effective for diagnosing or monitoring B. abortus RB51 infections, and so clinicians should monitor those patients who are at high risk of infection.

The CDC states that monitoring should include:

• For 4 weeks from last exposure, check temperature for fever.
• For 6 months from last exposure, watch for broader symptoms of brucellosis.

The results of antimicrobial susceptibility testing should be used if brucellosis occurs despite prophylaxis, to determine the best treatment.