A new study published in the Centers for Disease Control and Prevention’s (CDC) journal, Emerging Infectious Diseases, found that the rate of outbreaks caused by unpasteurized milk (raw milk) and unpasteurized milk products was 150 times greater than outbreaks linked to pasteurized milk. In addition, the study revealed that states where raw milk sales are legal had more than twice the rate of outbreaks as states where it was illegal.

The 13-year study, involved a review of dairy product outbreaks from 1993 to 2006 in all 50 states. The authors compared the amount of milk produced in the United States during the study period (about 2.7 trillion pounds) to the amount that CDC estimates was likely consumed raw (1 percent or 27 billion pounds) to determine the 150 times higher rate for outbreaks caused by raw milk products. Raw milk products include cheese and yogurt.

The study included 121 dairy–related disease outbreaks, which caused 4,413 illnesses, 239 hospitalizations and three deaths. In 60 percent of the outbreaks (73 outbreaks) state health officials determined raw milk products were the cause. Nearly all of the hospitalizations (200 of 239) were in those sickened in the raw milk outbreaks. These dairy-related outbreaks occurred in 30 states, and 75 percent (55 outbreaks) of the raw milk outbreaks occurred in the 21 states where it was legal to sell raw milk products at the time. The study also reported that seven states changed their laws during the study period.

For a consumer, it is impossible to tell if raw milk is safe to drink by simply looking at, smelling, or tasting it. Even under ideal conditions of cleanliness, the process of collecting milk introduces some bacteria. Unless the milk is pasteurized, these bacteria can multiply and grow in the milk and cause illness in those who consume it. Pasteurization involves heating milk to kill disease-causing bacteria.

“This study shows an association between state laws and the number of outbreaks and illnesses from raw milk products,” said Robert Tauxe, M.D., M.P.H., deputy director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases (DFWED). “Restricting the sale of raw milk products is likely to reduce the number of outbreaks and can help keep people healthier. The states that allow sale of raw milk will probably continue to see outbreaks in the future.”

The study also found that the raw milk product outbreaks led to much more severe illnesses, and disproportionately affected people under age 20. In the raw milk outbreaks with known age breakdowns, 60 percent of patients were younger than age 20, compared to 23 percent in outbreaks from pasteurized products. Because of their underdeveloped immune systems, children are more likely than adults to get seriously ill from the bacteria in raw milk.

“While some people think that raw milk has more health benefits than pasteurized milk, this study shows that raw milk has great risks, especially for children, who experience more severe illnesses if they get sick,” said study co-author Barbara Mahon, M.D., M.P.H., deputy chief of CDC’s DFWED Enteric Diseases Epidemiology Branch. “Parents who have lived through the experience of watching their child fight for their life after drinking raw milk now say that it’s just not worth the risk.”

Additional information on evidence-based scientific studies covering the benefits and risks of raw milk consumption can be found HERE (pdf).

Shigella bacteria cause human illness when they are ingested, and can lead to Shigella infection, or shigellosis, through various modes of transmission, including through food and water sources, animal-to-human contact, and person-to-person contact in daycares and other settings.

Improper sanitation and cross-contamination can be contributing factors to Shigella outbreaks associated with restaurant food.

The introduction of pasteurization greatly reduced the number of foodborne illness outbreaks associated with milk and other dairy sources, but the consumption of raw milk and unpasteurized cheeses remains a risk factor for Shigella infection. Shigella and other pathogens are shed in the feces of livestock such as cows and goats and can contaminate milk during the milking process.

Fresh fruits and vegetables can become contaminated before or after harvest. Water intended for recreation (e.g., pools, shallow lakes) and for human consumption can also become contaminated. When lakes become contaminated it may be several weeks or months before water quality conditions to improve or return to normal. Proper chlorination kills Shigella bacteria in pools and municipal water systems.

Person-to-person transmission of Shigella occurs through a fecal-oral route, and is particularly common among infants and young children due to their unrefined hygienic practices. Person-to-person transmission of Shigella has also been known to occur between infected individuals and their caregivers, and between infected food handlers and people who consume the food they prepare.

Shigellosis cases continue to rise in Louisville, with 18 laboratory-confirmed cases last week.

That’s the highest number in any week so far during the current outbreak, which has seen 84 confirmed cases in 13 weeks.

Shigellosis is a highly-contagious diarrhea illness caused by Shigella bacteria. Symptoms include watery or loose stools for several days, and in severe cases abrupt onset of fever, nausea, abdominal cramping and vomiting.

For the past five years, Louisville has had an average of 62 confirmed cases annually.

To prevent the illness, health officials are urging people to wash their hands carefully with soap and water, including under the fingernails. This is especially important after handling items such as diapers, after each bowel movement, after helping children use the toilet and before preparing or eating food, health officials said.

Twenty-one cases of Shigella had been confirmed in eastern Cuyahoga County and western Lake County as of Jan. 20, and more cases were reported this week, according to officials of the Cuyahoga County Board of Health. Some cases have occurred in the Orthodox Jewish community.

“The Academy’s health professional saw a handful of cases,” Rabbi Simcha Dessler, dean of Hebrew Academy of Cleveland, said Jan. 23. “As with any health-related issues, we immediately contacted the Cuyahoga County Department of Health and continued to follow their lead. A letter and fact sheet with comprehensive information and prevention strategies were sent out to the parent body.”

Amy Anter, program manager in epidemiology at the Cuyahoga County Board of Health, said the board had been in touch with Mendel Singer, Ph.D., associate professor at Case Western Reserve University School of Medicine, director of Jewish Community Health Initiative, and CJN blogger, to help convey information about the illness.

“Shigella does pop up in the Orthodox community from time to time,” Singer said. “When there are lots of kids in diapers and not fully toilet-trained, there are opportunities for the illness to spread. It’s extremely contagious, and it takes very little of it to cause infection.

“Hand washing with warm water and soap is the best defense,” Singer said. Within the Orthodox community, soap (that requires lathering) and pre-moistened wipes (that often require tearing) become an issue on Shabbat. He recommends liquid soap as a substitute for bar soap and advises keeping soap available where ritual hand washing is taking place. If pre-moistened wipes aren’t used when diaper changing, cleaning with “Shabbat-friendly” wipes is needed, he said.

WDRB reports that Jefferson County Kentucky schools are currently seeing a significant increase in Shigella illnesses: 

In the last few months health officials say they’ve noticed the increase in Shigellosis.

A letter went out to all schools on Wednesday from the health department and will soon alert parents of the outbreak in Louisville.

On November 30th, a notice from Louisville Metro Public Health & Wellness said the health department had received reports of Shigellosis, a diarrhea illness caused by Shigella bacteria, which is highly contagious.

“Unfortunately, this is something that is transmitted fecally orally. So, since kids aren’t paying as much attention to hygiene sometimes, or parents who are taking care of kids who have a diarrhea illness, that can be a challenge,” says Dr. Paul Schulz, Medical Director of Infection Prevention with Norton Healthcare.

Fast-forward to this week and now a JCPS spokesperson says the health department has asked all schools to send out a notice to students about an outbreak of Shigellosis in Jefferson County.

JCPS spokesperson, Lauren Roberts, says they are sending the letters out because they’ve been asked to, and not as a result of any particular case in the school.

The health department has averaged 62 cases a year of the illnesses for the last five years.

However, in the last 3 months, they say they’ve already seen 60 cases.

“Technically we would call this an epidemic and try to do things to reduce that spread, like putting out these kinds of notices so that parents, teachers and other folks in the community are more aware,” says Dr. Paul Schulz.

The symptoms include blood in stools, fever, nausea, abdominal cramping and vomiting.

One of the ways they say you can prevent the spread of the disease is to wash your hands carefully, and often. They say it’s especially important to wash your hands after changing diapers, using the restroom, after helping a child use the restroom, or before preparing or eating food.

Dr. Paul Schulz, with Norton Healthcare, also recommends not going to school or work if you have the illness to avoid spreading it to other people.

Going to the doctor is at the top of the list.

“Even if you don’t feel like you’re that ill, getting evaluated and diagnosed and treated can be a good thing for you and the community,” says Dr. Paul Schulz.

There are antibiotics that doctors can prescribe to help you treat this illness.

The Health Department wants everyone to be aware, and take precautions.

Alabama’s 13 reports that the local health department has notified the school board for Springville Elementary, Middle, and High Schools that at least 6 students have tested positive for shigella.  There have also been 2 possible additional cases.  This has resulted in the closure of the school on Monday, December 19, 2011.  On Monday, the school plans to make an assessment of the facilities with the health department and school nurses to make sure the area is clean and safe for students.  The plan is for school to reconvene on Tuesday.

There has been a noticeable spike in Shigella infections throughout Florida and Georgia (the First Coast). In Florida, for example, there were 1,213 reported Shigella infections in 2010. This year, there has been 2,218 cases. The reason for the spike is not currently known, although the Duval County Health Department is busy investigating.

Shigella belongs to a family of bacteria that can cause sudden and severe diarrhea in humans. Shigellosis, the illness caused by the ingestion of Shigella bacteria, is also known as bacillary dysentery. Shigella thrives in the human intestine and is commonly spread both through food and person-to-person contact. Shigella is the third most common pathogen transmitted through food.

Jacksonville NBC affiliate First Coast News reports:

Duval County health leaders say kids are very vulnerable to the infection. Seventy-four percent of cases here have been people between the 0-and-19 age range.

“It’s harder to get kids to wash their hands properly and certainly the little kids like two to four year olds, you have to watch them wash their hands because they’re still learning to wash their hands and so you just really have to encourage that good behavior,” said Karen Elliott, surveillance epidemiologist with the Duval County Health Department.

Originally reported as an outbreak only at Worth County public schools, the Southwest Health District has indicated that the Shigella outbreak has spread to 6 counties.  Shigella is a highly contagious and infectious disease. Ingestion of fewer than 100 Shigella bacteria can cause food poisoning (American Public Health Association [APHA], 2000), making Shigella one of the most communicable and severe forms of the bacterial-induced diarrheas (Gomez et al., 2002).

Most Shigella infections are passed through the fecal-oral route. This happens when basic hygiene and handwashing habits are inadequate and can happen during certain types of sexual activity.  Shigella outbreaks are particularly likely to occur among toddlers who are not fully toilet-trained. Family members and playmates of such children are at high risk of becoming infected.

Shigella is the third most common pathogen transmitted through food. In FoodNet surveillance areas in 2008, the rate of Shigella food poisoning was 6.6 per 100,000 population, exceeded only by Salmonella (15.2/100,000) and Campylobacter (12.7/100,000) (CDC, 2009c).

Shigella is also responsible for a substantial portion of foodborne outbreaks on cruise ships. In a review of cruise ship outbreaks worldwide over several years, 16% of outbreaks were attributed to Shigella, affecting over 2,000 passengers (Rooney et al., 2004). Sanitation violations related to food handling and communicable disease have decreased substantially over the past 15 years (Cramer et al., 2008).

Forty-five people in Brooklyn’s ultra-Orthodox communities in Williamsburg and Borough Park have been infected by shigella since August, according to city health officials.

Each year, New York City has between 300 and 400 cases of the disease, which frequently crops up in day care centers and other places where children congregate. The majority of those affected in this latest outbreak were also children.

No one has been hospitalized, city health department officials said.  The health department has asked doctors not to use antibiotics to treat shigella because drug-resistant strains of the bacteria may be starting to spread.

Worth County Schools are closed Monday and Tuesday, after an outbreak of Shigella as infected students.

At least five students have tested positive for the intestinal bacteria, but the number of students who have it is likely much higher.

And it is not confined to schools, there has already been 260 possible cases in the community.

Now parents and students in Worth County are worried about being exposed to the bacteria.

The Shigella outbreak in Worth County has parents and students concerned about sanitary practices at school.

“Just keep them in the house away from other kids,” says Eric Winstead, Concerned Parent.

“It is pretty scary for me since there is no cure for it, and it spreads really quickly, and it is really contagious so it scares me a lot,” says Tori Smith, attends Worth County Elementary School.

“Both of my kids have pretty low immune systems, so I am always worried if they are going to come home and get it and spread it to anybody else, to us, my husband, to me,” says Kyla Nelms, concerned parent.

Shigella is an intestinal bacteria, causing diarrhea, fever, and stomach cramps.