FDA warns against Udder Milk; urges treatment even if not sick

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Additional state and federal investigators have joined New Jersey, issuing public warnings about unpasteurized, raw milk being illegally distributed by Udder Milk. The milk has been linked to a case of antibiotic-resistant brucellosis.

New Jersey’s Department of Health ordered the company — self-described as a “co-op on wheels” — to cease and desist its illegal sales of raw milk on Nov. 9. The business appears to have continued operating, according to a notice from the U.S Food and Drug Administration on Friday evening.

The state and federal officials still have not discovered what dairies are supplying Udder Milk with the unpasteurized milk that it has been illegally selling. Raw milk sales of any kind are prohibited in New Jersey by state law.

Udder Milk’s website stated on its website that it sells raw milk, yogurt, sour cream, and cheese, as well as camel milk. As of Friday night, the products are still listed as available on the company’s site, with cow’s milk going for up to $11 per gallon and raw butter selling for up to $50 per pound.

The company’s website, which had provided contact information only through an email address and cell phone numbers, was inactive as of Nov. 15, according to the FDA. The FDA has been unable to contact Udder Milk to request a recall of the raw milk.

“People who drank or ate Udder Milk raw milk or raw milk products should contact their healthcare provider immediately to disclose that they may have been exposed to the RB51 strain of Brucella and to get antibiotic treatment to avoid infection,” the FDA warned.

“This is important because the RB51 is resistant to certain antibiotics. The only way to diagnose people who are infected with this strain is by growing the bacteria through bacterial culture, as opposed to a blood test.”

Threat continues for months
The danger of infection from the Brucella organism lasts long after contaminated food or drink, usually raw milk, is consumed. Health officials say anyone who ate or drank unpasteurized products from Udder Milk should closely monitor themselves for at least 30 days for symptoms.

But the hazards of raw milk contaminated with Brucella can continue for months. In some cases, symptoms do not appear for six months. In other victims, the symptoms can come and go over a period of months, making it difficult to diagnose the infection.

Federal law prohibits the sale of raw milk across state lines. New York law allows “on-farm” sales only. Rhode Island allows only the sale of raw goat milk under strict regulations. Connecticut allows on-farm and retail sales of raw milk but has specific licensing and inspection regulations. New Jersey does not allow any raw milk sales.

The Udder Milk company’s website was still offering raw milk deliveries to all four states from its New Jersey headquarters as recently as Tuesday, according to its website. As if Friday night, the company’s homepage stated: No Deliveries.

However, the list of delivery points still included a location in Greenwich, CT, and another at a Whole Foods store in Providence, RI.

Rhode Island health officials issued a cease and desist order against Udder Milk dated Wednesday. There have been no cases of brucellosis in Rhode Island in the last five years, according to the notice from the state.

“The FDA is supporting multiple state health departments, New York and New Jersey state agriculture departments, the Centers for Disease Control and Prevention and the U.S. Department of Agriculture in this investigation,” according to FDA’s announcement Friday evening.

Texas infection thought to be unrelated to New Jersey illness
A woman in New Jersey was recently confirmed with an infection from the relatively rare strain of Brucella RB51. She told authorities that she drank raw milk purchased from Udder Milk before becoming ill.

“The New Jersey patient is the second known domestically acquired illness caused by Brucella RB51 in the United States this year, the other was in Texas in July. The two incidents are not related,” according to the FDA on Friday.

As of mid-October, the CDC and the Texas State Department of Health Services had received reports from at least seven states, not counting New Jersey, about people who drank raw milk from the Texas dairy. Some people who drank K-Bar milk developed symptoms consistent with brucellosis caused by Brucella RB51 and others who were exposed are at risk of becoming infected.

States reporting illnesses with symptoms consistent with brucellosis are Alabama, Arkansas, California, Ohio, North Dakota, Tennessee and Texas.

K-Bar was stopped temporarily from selling its raw milk, but Texas officials cleared it to resume operations Oct. 11.

“Milk samples from the dairy tested positive for a Brucella strain called RB51,” according to a CDC health advisory posted Sept. 14, which reported thousands of people are at risk.

“Brucella strain RB51 is resistant to rifampin and penicillin. A combination of doxycycline and trimethoprim/sulfamethoxazole for 21 days is the recommended first-line PEP regimen for RB51 exposure.”

A month before the CDC advisory, Texas officials warned the public against drinking raw milk from K-Bar Dairy. They also urged anyone who consumed raw milk from K-Bar and developed symptoms consistent with brucellosis to immediately seek medical attention and tell their doctors about their possible exposure to the bacteria.

Also, people who consumed raw dairy products from K-Bar Dairy or Udder Milk and did not quickly become ill should monitor themselves — and their children if they served them the unpasteurized milk — for six months because it can take that long for symptoms to develop, the CDC warns.

Brucella could have come from vaccinated cows
The New Jersey woman was infected with Brucella abortus RB51, a from more serious strains of Brucella.

In some cases, vaccinated cows can shed RB51 in their milk. Pasteurization of milk kills this bacteria and other pathogens.

Raw milk is not pasteurized and therefore can be contaminated with a variety of bacteria, viruses, and parasites that are not detectable without laboratory analysis.

From 1993 through 2012, there were 127 outbreaks linked to raw milk that were reported to the CDC. Those outbreaks resulted in 1,909 laboratory-confirmed illnesses.

People infected with Brucella may experience flu-like symptoms that can include fever, sweats, malaise, lack of appetite, headache, muscle, joint and/or back pain, and fatigue.

The symptoms wax and wane over time and that can progress to severe complications, including recurring fevers, arthritis, swelling of the heart, swelling of the testicles, and neurologic symptoms, among others.

Who is at risk?
People can get brucellosis when they are exposed to infected animals or raw or undercooked food from infected animals. Eating or drinking raw dairy products is the most common way that people get the infection.

Veterinarians, slaughterhouse workers, and meat-packing plant employees, as well as hunters, can also be infected through close contact with infected animals, or their bodily fluids or carcasses. People can breathe in the bacteria or it can enter through a skin wound.

Advice for restaurants and retailers
Retailers and restaurants should not serve or sell any of the Udder Milk raw milk or raw milk products. Wash and sanitize display cases and refrigerators where potentially contaminated products were stored.

Wash and sanitize cutting boards, surfaces, and utensils used to cut, serve, or store potentially contaminated products. Wash hands with warm water and soap following the cleaning and sanitation process.

Retailers, restaurants, and other foodservice operators who have processed and packaged any potentially contaminated products need to be concerned about cross-contamination of cutting surfaces and utensils through contact with the potentially contaminated products.

Retailers, restaurants, and other foodservice operators may wish to consider whether other foods available for sale could have been cross-contaminated from the potentially contaminated products, and should be discarded.

Advice for consumers
If you bought raw milk or raw milk products from Udder Milk, do not eat or drink it. Contact your health care provider immediately and be sure to tell them that you may have been exposed to the RB51 strain of Brucella.

Raw milk can contain dangerous bacteria that are harmful to your health. Please consult FDA’s website about The Dangers of Raw Milk: Unpasteurized Milk Can Pose a Serious Health Risk.

Consumers who had Udder Milk products in their homes should follow these simple steps:

  • Wash hands with warm water and soap for at least 20 seconds before and after handling food.
  • Wash the inside walls and shelves of the refrigerator, cutting boards and countertops; then sanitize them with a solution of one tablespoon of chlorine bleach to one gallon of hot water; then dry with a clean cloth or paper towel that has not been previously used.
  • Wipe up spills in the refrigerator immediately and clean the refrigerator regularly.
  • Always wash hands with warm water and soap following the cleaning and sanitization process.

Advice for healthcare providers
Health care providers should administer post-exposure prophylaxis (PEP) to patients who drank the contaminated raw milk to avoid infection.

“Brucella strain RB51 is resistant to rifampin and penicillin. A combination of doxycycline and trimethoprim/sulfamethoxazole for 21 days is the recommended first-line PEP regimen for RB51 exposure, according to the CDC”

Health care providers can consult the CDC page, Exposure to RB51 through Raw Milk or Milk Products: How to Reduce Risk of Infection, for additional treatment information.

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