In July of 2019, an outbreak of Y. enterocolitica occurred in northeastern PA with 109 cases (48 confirmed and 61 probable). Ninety-two cases (84%) occurred among ∼535 campers and camp staff who were at a youth summer camp, and 17 (16%) occurred among community members. Onset dates were June 7 to July 26 (Fig. 2).
The cases were linked to a local dairy that pasteurized its own milk. "Y. enterocolitica was isolated from all three unpasteurized milk samples collected from the bulk milk tank. Nine isolates from the three samples were confirmed Y. enterocolitica bioserotype 1B/O:8. Y. enterocolitica was not isolated from any of the unopened pasteurized milk, environmental, or well water samples."
The dairy is "a small independent producer certified by PDA to produce grade A pasteurized milk. The dairy milked 75 cows and produced 17,500–24,500 pounds of milk per week. About 3,500 pounds (∼15%–20%) of milk per week were pasteurized on site with a high-temperature short-time pasteurizer that was purchased used 10 years previously. The dairy produced whole, 2%, skim, flavored milk, and heavy cream. Products pasteurized on site were bottled in single-use gallon, half-gallon, and pint-sized plastic bottles."
"The primary reservoir of Y. enterocolitica bioserotype 1B/O:8 is unknown, but isolates have been recovered from pigs (Doyle et al., 1981), a wild boar (Syczyło et al., 2018), and wild rodents (Hayashidani et al., 1995). This bioserotype was found in two similar outbreaks in the United States related to pasteurized milk from small dairies in New England (Ackers et al., 2000) and Pennsylvania (Longenberger et al., 2014). In the New England outbreak, nonpathogenic strains of Y. enterocolitica, including bioserotype 1A/O:8, were isolated from pigs at the dairy, and pigs were hypothesized to be the outbreak source. In the 2011 Pennsylvania outbreak, pigs were not present in the dairy, but milk crates might have been contaminated during home deliveries at the farms of several people reporting direct contact with pigs.
The cases were linked to a local dairy that pasteurized its own milk. "Y. enterocolitica was isolated from all three unpasteurized milk samples collected from the bulk milk tank. Nine isolates from the three samples were confirmed Y. enterocolitica bioserotype 1B/O:8. Y. enterocolitica was not isolated from any of the unopened pasteurized milk, environmental, or well water samples."
The dairy is "a small independent producer certified by PDA to produce grade A pasteurized milk. The dairy milked 75 cows and produced 17,500–24,500 pounds of milk per week. About 3,500 pounds (∼15%–20%) of milk per week were pasteurized on site with a high-temperature short-time pasteurizer that was purchased used 10 years previously. The dairy produced whole, 2%, skim, flavored milk, and heavy cream. Products pasteurized on site were bottled in single-use gallon, half-gallon, and pint-sized plastic bottles."
"The primary reservoir of Y. enterocolitica bioserotype 1B/O:8 is unknown, but isolates have been recovered from pigs (Doyle et al., 1981), a wild boar (Syczyło et al., 2018), and wild rodents (Hayashidani et al., 1995). This bioserotype was found in two similar outbreaks in the United States related to pasteurized milk from small dairies in New England (Ackers et al., 2000) and Pennsylvania (Longenberger et al., 2014). In the New England outbreak, nonpathogenic strains of Y. enterocolitica, including bioserotype 1A/O:8, were isolated from pigs at the dairy, and pigs were hypothesized to be the outbreak source. In the 2011 Pennsylvania outbreak, pigs were not present in the dairy, but milk crates might have been contaminated during home deliveries at the farms of several people reporting direct contact with pigs.
"Although [investigators] could not determine the pathogen's origin at Dairy A, the possibility exists that the pigs or wildlife near the dairy provided a potential source of Y. enterocolitica. Unfortunately, [investigators] were unable to test the pigs before their removal from Dairy A."
From the FDA Bad Bug Book
From the FDA Bad Bug Book
- Y. enterocolitica is psychotropic (i.e., a microorganism that grows well at low temperature) and has the ability to grow at temperatures below 4°C.
- Has been isolated from animals, such as pigs, birds, beavers, cats, dogs, frogs, flies, and fleas. Y. enterocolitica has been detected in environmental sources, such as soil and water (e.g., ponds and lakes).
- Yersinia enterocolitica has been linked to illness from consumption of pork (including 'chitlins') unpasteurized milk and oysters.
- Symptoms start from one day to two weeks after infection and include high fever and stomach pain with diarrhea (in some cases bloody) and sometimes vomiting. Some people will get arthritis-like symptoms. Symptoms may last from a few days to several weeks.
- People in high risk categories are at .......a higher risk.
Yersinia enterocolitica Outbreak Associated with Pasteurized Milk | Foodborne Pathogens and Disease (liebertpub.com)
Yersinia enterocolitica Outbreak Associated with Pasteurized Milk
Joann F. Gruber, Sheri Morris, Kimberly A. Warren, Kelly E. Kline, Betsy Schroeder, Lisa Dettinger, Brigitte Husband, Kerry Pollard, Carina Davis, Judith Miller, Andre Weltman, Mia Mattioli, Logan Ray, Cheryl Tarr, and Allison H. Longenberger
Published Online:9 Jul 2021https://doi.org/10.1089/fpd.2020.2924
Yersinia enterocolitica Outbreak Associated with Pasteurized Milk
Joann F. Gruber, Sheri Morris, Kimberly A. Warren, Kelly E. Kline, Betsy Schroeder, Lisa Dettinger, Brigitte Husband, Kerry Pollard, Carina Davis, Judith Miller, Andre Weltman, Mia Mattioli, Logan Ray, Cheryl Tarr, and Allison H. Longenberger
Published Online:9 Jul 2021https://doi.org/10.1089/fpd.2020.2924
Abstract
In July 2019, we investigated a cluster of Yersinia enterocolitica cases affecting a youth summer camp and nearby community in northeastern Pennsylvania. After initial telephone interviews with camp owners and community members, we identified pasteurized milk from a small dairy conducting on-site pasteurization, Dairy A, as a shared exposure. We conducted site visits at the camp and Dairy A where we collected milk and other samples. Samples were cultured for Y. enterocolitica. Clinical and nonclinical isolates were compared using molecular subtyping. We performed case finding, conducted telephone interviews for community cases, and conducted a cohort study among adult camp staff by administering an online questionnaire. In total, we identified 109 Y. enterocolitica cases. Consumption of Dairy A milk was known for 37 (34%); of these, Dairy A milk was consumed by 31 (84%). Dairy A had shipped 214 gallons of pasteurized milk in 5 weekly shipments to the camp by mid-July. Dairy A milk was the only shared exposure identified between the camp and community. Y. enterocolitica was isolated from Dairy A unpasteurized milk samples. Five clinical isolates from camp members, two clinical isolates from community members, and nine isolates from unpasteurized milk were indistinguishable by whole-genome sequencing. The risk for yersinosis among camp staff who drank Dairy A milk was 5.3 times the risk for those who did not (95% confidence interval: 1.6–17.3). Because Dairy A only sold pasteurized milk, pasteurized milk was considered the outbreak source. We recommend governmental agencies and small dairies conducting on-site pasteurization collaborate to develop outbreak prevention strategies.
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