Abstract
In December 2016, Public Health England investigated an outbreak of campylobacteriosis in North West England, with 69 cases in total. Epidemiological, microbiological and environmental investigations associated the illness with the consumption of unpasteurised cows' milk from Farm X, where milk was predominantly sold from a vending machine. Campylobacter was detected in milk samples which, when sequenced, were identical in sequence type as pathogens isolated from cases (Clonal Complex ST-403, Sequence Type 7432). The farm was served with a Hygiene Emergency Prohibition Order to prevent further cases. To our knowledge, this is the first outbreak of campylobacter associated with unpasteurised milk in England since 1996. Our findings highlighted several important lessons, including that the current testing regime in England for unpasteurised milk is not fit for purpose and that the required warning label should include additional wording, underscoring the risk to vulnerable groups. There has been a substantial increase in both the volume of unpasteurised milk consumed in England and the use of vending machines to sell unpasteurised milk over the last 10 years, making unpasteurised milk more readily accessible to a wider population. The evidence generated from outbreaks like this is therefore critical and should be used to influence policy development.
Highlights
Campylobacter is the most frequently reported cause of food poisoning in the UK
We found that cases had significantly higher odds of having consumed raw milk than non-cases: odds ratios (ORs) 4.6 (95% confidence interval 1.87–13.67, P < 0.0001)
Analysis of the seven-loci Multi Locus Sequence Type (MLST) derived from the whole genome sequencing (WGS) data showed that all of the seven viable C. jejuni isolates from human cases and both C. jejuni isolates recovered from raw cows drinking milk (RDM) samples were all MLST clonal complex (CC) Sequence type (ST)-403 ST 7432; nine isolates in total
Summary
Campylobacter is the most frequently reported cause of food poisoning in the UK. In 2016, there were 90.2 confirmed cases per 100 000 population reported in the UK [1], a total of 58 987 confirmed laboratory campylobacter cases. Contamination of raw cows drinking milk (RDM) mainly occurs during the milking process, most commonly via faecal contamination of udders [10, 11] while the failure of milk pasteurisation is a recognised cause of campylobacter outbreaks Due to these risks, in the UK, RDM is controlled through legislation which prohibits or restricts its production and sale. In early December 2016, a local authority in Cumbria, North West England, received surveillance questionnaires from two cases of campylobacter who reported consuming RDM bought from Farm X. Upon identifying this link, EHOs proactively followed up a limited number of campylobacter cases and identified a further three cases who had consumed RDM from Farm X.
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