Unpasteurized Milk: A Continued Public Health Threat

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Abstract

Although milk and dairy products are important components of a healthy diet, if consumed unpasteurized, they also can present a health hazard due to possible contamination with pathogenic bacteria. These bacteria can originate even from clinically healthy animals from which milk is derived or from environmental contamination occurring during collection and storage of milk. The decreased frequency of bovine carriage of certain zoonotic pathogens and improved milking hygiene have contributed considerably to decreased contamination of milk but have not, and cannot, fully eliminate the risk of milkborne disease. Pasteurization is the most effective method of enhancing the microbiological safety of milk. The consumption of milk that is not pasteurized increases the risk of contracting disease from a foodstuff that is otherwise very nutritious and healthy. Despite concerns to the contrary, pasteurization does not change the nutritional value of milk. Understanding the science behind this controversial and highly debated topic will provide public health care workers the information needed to discern fact from fiction and will provide a tool to enhance communication with clients in an effort to reduce the incidence of infections associated with the consumption of unpasteurized milk and dairy products.

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Most cited references 43

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Foodborne pathogens in milk and the dairy farm environment: food safety and public health implications.

J Almeida, John S. Oliver, Bhushan M. Jayarao (2004)

Milk and products derived from milk of dairy cows can harbor a variety of microorganisms and can be important sources of foodborne pathogens. The presence of foodborne pathogens in milk is due to direct contact with contaminated sources in the dairy farm environment and to excretion from the udder of an infected animal. Most milk is pasteurized, so why should the dairy industry be concerned about the microbial quality of bulk tank milk? There are several valid reasons, including (1) outbreaks of disease in humans have been traced to the consumption of unpasteurized milk and have also been traced back to pasteurized milk, (2) unpasteurized milk is consumed directly by dairy producers, farm employees, and their families, neighbors, and raw milk advocates, (3) unpasteurized milk is consumed directly by a large segment of the population via consumption of several types of cheeses manufactured from unpasteurized milk, (4) entry of foodborne pathogens via contaminated raw milk into dairy food processing plants can lead to persistence of these pathogens in biofilms, and subsequent contamination of processed milk products and exposure of consumers to pathogenic bacteria, (5) pasteurization may not destroy all foodborne pathogens in milk, and (6) inadequate or faulty pasteurization will not destroy all foodborne pathogens. Furthermore, pathogens such as Listeria monocytogenes can survive and thrive in post-pasteurization processing environments, thus leading to recontamination of dairy products. These pathways pose a risk to the consumer from direct exposure to foodborne pathogens present in unpasteurized dairy products as well as dairy products that become re-contaminated after pasteurization. The purpose of this communication is to review literature published on the prevalence of bacterial foodborne pathogens in milk and in the dairy environment, and to discuss public health and food safety issues associated with foodborne pathogens found in the dairy environment. Information presented supports the model in which the presence of pathogens depends on ingestion of contaminated feed followed by amplification in bovine hosts and fecal dissemination in the farm environment. The final outcome of this cycle is a constantly maintained reservoir of foodborne pathogens that can reach humans by direct contact, ingestion of raw contaminated milk or cheese, or contamination during the processing of milk products. Isolation of bacterial pathogens with similar biotypes from dairy farms and from outbreaks of human disease substantiates this hypothesis.

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Mycobacterium avium subspecies paratuberculosis and Crohn's disease: a systematic review and meta-analysis.

Ekkehardt Altpeter, Roger Stephan, Matthias Egger … (2007)

This systematic review assesses the evidence for an association between Mycobacterium avium subspecies paratuberculosis (MAP) and Crohn's disease. We analysed 28 case-control studies comparing MAP in patients with Crohn's disease with individuals free of inflammatory bowel disease (IBD) or patients with ulcerative colitis. Compared with individuals free of IBD, the pooled odds ratio (OR) from studies using PCR in tissue samples was 7.01 (95% CI 3.95-12.4) and was 1.72 (1.02-2.90) in studies using ELISA in serum. ORs were similar for comparisons with ulcerative colitis patients (PCR, 4.13 [1.57-10.9]; ELISA, 1.88 [1.26-2.81]). The association of MAP with Crohn's disease seems to be specific, but its role in the aetiology of Crohn's disease remains to be defined.