{"id":214,"date":"2014-07-29T11:29:52","date_gmt":"2014-07-29T11:29:52","guid":{"rendered":"http:\/\/209.151.87.121\/~fomes\/iom\/?p=214"},"modified":"2016-03-16T20:01:54","modified_gmt":"2016-03-16T20:01:54","slug":"foundation-farm-raw-milk","status":"publish","type":"post","link":"https:\/\/www.outbreakmuseum.com\/mobile\/e-coli-o157\/foundation-farm-raw-milk\/","title":{"rendered":"Foundation Farm Raw Milk"},"content":{"rendered":"\n<table id=\"tablepress-9\" class=\"tablepress tablepress-id-9\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\"><b>Outbreak:<\/b> Foundation Farm Raw Milk<\/th>\n<\/tr>\n<\/thead>\n<tbody class=\"row-striping\">\n<tr class=\"row-2\">\n\t<td class=\"column-1\"><b>Product:<\/b> Foundation Farm Raw Milk<\/td>\n<\/tr>\n<tr class=\"row-3\">\n\t<td class=\"column-1\"><b>Investigation Start Date:<\/b> 04\/10\/2012<\/td>\n<\/tr>\n<tr class=\"row-4\">\n\t<td class=\"column-1\"><b>Location:<\/b> Clackamas, Mult., Wash. Counties, OR<\/td>\n<\/tr>\n<tr class=\"row-5\">\n\t<td class=\"column-1\"><b>Etiology:<\/b> <i>E. coli<\/i> (STEC) O157:H7<\/td>\n<\/tr>\n<tr class=\"row-6\">\n\t<td class=\"column-1\"><b>Earliest known case onset date:<\/b> 04\/01\/2012<\/td>\n<\/tr>\n<tr class=\"row-7\">\n\t<td class=\"column-1\"><b>Latest case onset date:<\/b> 04\/14\/2012<\/td>\n<\/tr>\n<tr class=\"row-8\">\n\t<td class=\"column-1\"><b>Confirmed \/ Presumptive Case Counts:<\/b> 11 \/ 5<\/td>\n<\/tr>\n<tr class=\"row-9\">\n\t<td class=\"column-1\"><b>Positive Samples (Food \/ Environmental):<\/b> 2 \/ 13<\/td>\n<\/tr>\n<tr class=\"row-10\">\n\t<td class=\"column-1\"><b>Hospitalizations:<\/b> 4<\/td>\n<\/tr>\n<tr class=\"row-11\">\n\t<td class=\"column-1\"><b>Deaths:<\/b> 0<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-9 from cache -->\n<div id=\"metaslider-id-245\" style=\"width: 100%; margin: 0 auto;\" class=\"ml-slider-3-99-0 metaslider metaslider-flex metaslider-245 ml-slider ms-theme-default\" role=\"region\" aria-label=\"Raw Milk 2012-2369\" data-width=\"400\">\n    <div id=\"metaslider_container_245\">\n        <div id=\"metaslider_245\">\n            <ul class='slides'>\n                <li style=\"display: none; width: 100%;\" class=\"slide-249 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:17\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/2012-2369-023-e1425546903428-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Three Jersey herdshare milkcows.\" class=\"slider-245 slide-249 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Three Jersey herdshare milkcows.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-246 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:13\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/0810_Foundation-Farm-9392-e1425546979995-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Investigators &quot;lean in&quot; to catch a thrown sample.\" class=\"slider-245 slide-246 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Investigators \"lean in\" to catch a thrown sample.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-251 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:20\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/2012-2369-029-e1425546870427-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Dr. Bill Keene leans in for a closer look.\" class=\"slider-245 slide-251 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Dr. Bill Keene leans in for a closer look.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-250 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:19\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/2012-2369-028-e1425546888970-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Dr. Keene kneels to swab the milking station.\" class=\"slider-245 slide-250 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Dr. Keene kneels to swab the milking station.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-247 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:15\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/2012-2369-009-e1425546941712-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Milking jug hung over &quot;clean&quot; milking station.\" class=\"slider-245 slide-247 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Milking jug hung over \"clean\" milking station.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1836 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:33\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Foundation-Farm-119118-1024x683-e1425607893536-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Swabbing the milking jug.\" class=\"slider-245 slide-1836 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Swabbing the milking jug.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-248 ms-image \" aria-roledescription=\"slide\" data-date=\"2014-07-29 11:45:16\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2014\/07\/2012-2369-018-e1425546918875-400x200.jpg\" height=\"200\" width=\"400\" alt=\"&quot;Sterilized&quot; containers used to hold raw milk.\" class=\"slider-245 slide-248 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\"> \"Sterilized\" containers used to hold raw milk.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1831 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:26\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Foundation-Farm-52-1024x684-e1425607947924-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Muddy fields with a deluxe chicken \u201ccoop\u201d in the background.\" class=\"slider-245 slide-1831 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Muddy fields with a deluxe chicken \u201ccoop\u201d in the background.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1832 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:27\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Foundation-Farm-58-1024x684-e1425607996832-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Pig sty just underneath the milking area.\" class=\"slider-245 slide-1832 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Pig sty just underneath the milking area.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1833 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:29\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Foundation-Farm-59-1024x684-e1425607930316-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Resident turkey overseeing the epi investigation.\" class=\"slider-245 slide-1833 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Resident turkey overseeing the epi investigation.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-1838 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-06 02:07:36\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Foundation-Farm-samples-125-1024x684-e1425607880854-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Milk jars from customer households \u2013 one of which tested positive for E. coli O157:H7.\" class=\"slider-245 slide-1838 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Milk jars from customer households \u2013 one of which tested positive for <i>E. coli<\/i> O157:H7.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2070 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-27 23:07:57\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/Muddy-Boots-400x200.jpg\" height=\"200\" width=\"400\" alt=\"A picture of muddy boots with the caption Another day in the life of a field epidemiologist.\" class=\"slider-245 slide-2070 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Another day in the life of a field epidemiologist.<\/div><\/div><\/li>\n                <li style=\"display: none; width: 100%;\" class=\"slide-2072 ms-image \" aria-roledescription=\"slide\" data-date=\"2015-03-27 23:15:31\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/2012-2369-epi-curve-400x200.jpg\" height=\"200\" width=\"400\" alt=\"Epidemic curve of the outbreak.\" class=\"slider-245 slide-2072 msDefaultImage\" \/><div class=\"caption-wrap\"><div class=\"caption\">Epidemic curve of the outbreak.<\/div><\/div><\/li>\n            <\/ul>\n        <\/div>\n        \n    <\/div>\n<\/div>\n<p style=\"text-align: justify;\">\n<table id=\"tablepress-55\" class=\"tablepress tablepress-id-55\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Outbreak Summary:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">This outbreak highlighted the persistent hazard of raw milk consumption, already well documented in the medical literature. Four persons were hospitalized \u2014 some critically ill and all with hemolytic-uremic syndrome, subsequently shown to have been caused by <i>E. coli<\/i> O157:H7. Although most sales of raw milk are illegal in Oregon, the farm implicated here is an example of one method by which those determined to get the product can skirt the law: instead of \u201cpurchasing milk,\u201d families bought \u201cshares\u201d in Foundation Farm cows, their dividends being the milk produced by them and then consumed without pasteurization.<br \/>\n<br \/>\nThe cause of the outbreak wasn\u2019t long a mystery: Oregon public health nurses routinely interview each O157 case and ask about \u201cusual suspect\u201d exposures \u2014 one of which is whether the case consumed unpasteurized milk. A single case having a high-risk exposure like this one is sufficient to raise suspicion and to warrant further investigation. As the investigation progressed, it transpired that the families that participated in this \u201ccow-share\u201d arrangement had been aware of many illnesses and communicating about them; and the dairy farmer had already advised the shareholders not to drink the milk. The farm ceased production, and several parents publicly advised the unwary not to serve unpurified milk to their children.<br \/>\n<br \/>\n<ul><li>\u2022 <a href=\"http:\/\/www.outbreakmuseum.com\/mobile\/wp-content\/uploads\/2015\/03\/2012-2369-Q_FINAL.pdf\">Outbreak Questionnaire (PDF)<\/a><\/li><\/ul><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-55 from cache --><\/p>\n<p style=\"text-align: justify;\">\n<table id=\"tablepress-69\" class=\"tablepress tablepress-id-69\">\n<thead>\n<tr class=\"row-1\">\n\t<th class=\"column-1\">Details:<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr class=\"row-2\">\n\t<td class=\"column-1\">On April 10, 2012, Multnomah CHD was notified by a clinician about a 1 year-old child with HUS (culture pending; later shown to be O157:H7). The child attended a day-care center in Washington County and had a history of regular raw milk consumption, both of which indicated a need for public health follow-up.<br \/>\n<br \/>\nWashington CHD investigated the child care setting and found nothing to suggest any other illness of significance there. Meanwhile, it was agreed that ACDP would contact ODA and discuss what we could do about the herd share operation that was reportedly the source of the raw milk. It was determined that this was operation (dba Foundation Farm) was ostensibly legal with 4 cows (3 in production) that was unlicensed, unregulated by, and unknown to ODA. (Dairies of this type are not required to be licensed or regulated.)<br \/>\n<br \/>\nThe Oregon Department of Agriculture contacted the farm owner to request a list of all customers of the farm; all needed to be contacted to look for potential illness.<br \/>\n<br \/>\nOn the morning of the 11th Mr Salyers sent ODA a spreadsheet listing the 48 household contacts for his customers, and gave ODA oral authorization to visit the premises and collect any specimens we wanted from the working part of the farm (but not the residence building). He also reported to ODA that, following his attempts to contact his customers through Facebook, he had learned of \u201cseveral\u201d additional illnesses. (He already knew about the index case). He also reported that he had voluntarily stopped distribution of milk (which turned into a permanent closure) and had recommended to his customers that they discard any available product.<br \/>\n<br \/>\nOn the afternoon of the 11th, while local and state health department staff attempted case finding among herd share households, a group from ACDP (Keene, Tourdjman, Buser, Poissant) met Jim Postlewait from ODA at the farm in Wilsonville. There were no family members apparent on the premises while we were there; Mr Salyers had told us that he would be away and he had asked us not to bother people in the house. We collected a convenience sample of 63 samples including rectal swabs on all 4 animals, surfaces in and around the milking parlor, and fecal pat samples from adjacent pastures. No milk was available at the farm for testing.<br \/>\n<br \/>\nOver the subsequent days, we attempted to interview all households on the list using a standardized questionnaire that covered history of Foundation Farm milk consumption, several other possible food exposures, and diarrheal illness in household members. A press release was issued to warn the public about the risk and to stimulate reporting; one of the earliest identified cases was from a household that was not on the customer list. That child had consumed the milk while visiting a family friend.<br \/>\n<br \/>\nLeftover raw milk samples were collected on April 12 and 13 from two shareholder households for testing.<br \/>\n<br \/>\n<b>Results:<\/b><br \/>\nEventually we identified 11 lab-confirmed cases\u2014including 1 Washington state resident who consumed milk when visiting family in Oregon\u2014and 5 presumptive cases. Four other household members reported very mild concurrent diarrheal symptoms and were not counted<br \/>\nas cases. Four cases were hospitalized\u2014all with HUS. Three cases were hospitalized for >25 days\u2014one of them for ~60 days.<br \/>\n<br \/>\nWe were able to successfully interview 30 (62%) of 48 herd-share households, comprising 91 individuals. Numerous attempts were made to interview members of the other 18 households to no avail; some were contacted but refused to cooperate with the investigation. All 15 cases reported consumption of FF milk on one or usually multiple occasions. No other suggestive common exposures were identified.<br \/>\n<br \/>\nThe farm setup was described by ODA as fairly typical for a family farm. The layout was very poorly designed from a food safety perspective. The premises appeared to be dirty and difficult to maintain in a hygienic manner for food production. There were no facilities to rapidly chill milk. Although we did not see it (because it was in the garage of the home), milk bottles were allegedly stored in an ordinary (non-commercial) refrigerator.<br \/>\n<br \/>\nThirteen (21%) of 63 samples collected at Foundation Farm were positive for <i>E. coli<\/i> O157:H7, including 10 samples of animal manure; 2 cattle rectal swabs; and 1 swab of fencing at the milking station. One of two milk samples collected from customer households was also positive. All but one O157 cultures from cases, milk, and the farm were indistinguishable by 2-enzyme pulsed-field gel electrophoresis (PFGE); one case appeared to have an extra band on XbaI.<br \/>\n<br \/>\n<b>Conclusions:<\/b><br \/>\nThe outbreak was caused by consumption of contaminated raw milk. Efforts should be continued to warn consumers about the risks of raw milk consumption, which can result in horrific illness and death.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<!-- #tablepress-69 from cache --><\/p>\n<p style=\"text-align: justify;\"><a href=\"https:\/\/www.outbreakmuseum.com\/mobile\/exhibits\/\"><strong>Back to Outbreak Exhibits<\/strong><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Back to Outbreak Exhibits<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":true,"template":"","format":"standard","meta":{"footnotes":""},"categories":[66],"tags":[81,77,117,82,100,80,87,88,79,78],"class_list":["post-214","post","type-post","status-publish","format-standard","hentry","category-e-coli-o157","tag-acute-and-communicable-disease-prevention","tag-dr-bill-keene","tag-e-coli-o157h7","tag-fomes","tag-foundation-farm-raw-milk","tag-integrated-food-safety-center-of-excellence","tag-international-outbreak-museum","tag-iom","tag-oregon-health-authority","tag-tribute"],"_links":{"self":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/214","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/comments?post=214"}],"version-history":[{"count":12,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/214\/revisions"}],"predecessor-version":[{"id":1775,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/posts\/214\/revisions\/1775"}],"wp:attachment":[{"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/media?parent=214"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/categories?post=214"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.outbreakmuseum.com\/mobile\/wp-json\/wp\/v2\/tags?post=214"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}