California Raw Milk Farm tied to Bird Flu, also linked to hidden Salmonella Outbreak

On October 18, 2023, an investigation of an outbreak associated with Raw Farm, LLC products was initiated. At least eight Salmonella cases who had reported consuming raw milk from Raw Farm, LLC of Fresno County, California, were discovered and reported to the California Department of Public Health (CDPH). Another nine cases from another county were discovered to be infected with Salmonella Typhimurium. Local health departments, CDPH, and the California Department of Food and Agriculture (CDFA) investigated this outbreak. This outbreak was assigned the CDC ID 2310MLJPX-2.

For this investigation, a confirmed case was defined as a laboratory confirmed infection of S. Typhimurium, within 2 alleles of code SALM1.0 – 6745.4.2.1x, that was highly related (within 4 SNPs) based on whole-genome sequencing (WGS) to the outbreak strain in a person with symptom onset since September 15, 2023. A probable case was defined as a laboratory-confirmed Salmonella infection, in a person who reported consumption of Raw Farm raw milk and had symptom onset from September 15, 2023 through May 4, 2024.

As of October 15, 2024, 171 cases (159 confirmed and 12 probable) have been reported from five states: CA (167), NM (1), TX (1), WA (1), and PA (1). In California the following counties reported cases: Los Angeles (27), San Diego (25), Orange (19), Placer (7),Riverside (7), Sacramento (7), Alameda (6), Ventura (6), Contra Costa (5), Kern (5), San Bernardino (5), Santa Clara (5), Solano (5), Santa Barbara (4), Stanislaus (4), Long Beach (4), Fresno (3), Kings (2), Madera (2), Nevada (2), San Joaquin (2), and Yolo (2).

Illness onsets ranged from September 21 to March 12, 2024. Symptoms included fever, bloody or watery diarrhea, nausea, vomiting, and headache. The age range of cases was <1 to 87 years (median 7). sixty-five percent of cases were male. twenty (14%) known require hospitalization; no deaths reported. four discovered have co-infections with S. Typhimurium and Campylobacter and/or STEC. Most illnesses were among children.

All cases who met the confirmed case definition, regardless of raw milk exposure, and all cases who met the probable case definition were also interviewed with a raw dairy supplemental questionnaire to ascertain the brand and purchase location of their exposure and whether they had any leftover product, along with any other details of raw dairy exposures prior to illness onset. Seventy-two percent (91/127) of cases reported consuming raw milk in the initial and/or supplemental questionnaire. Eighty-five percent (46/54) of California cases, in interviews with the supplemental questionnaire, reported consuming raw milk. Of those who consumed raw milk and recalled brand information, 93% (41/44) consumed Raw Farm brand raw milk. 

The proportion of confirmed patients who reported raw milk consumption during the week prior to illness was significantly higher (binomial p-value <0.001) than expected by chance alone, compared to the estimated 1.9% background rate of raw milk consumption during the prior week based on 2018 and 2019 FoodNet CA population survey estimates. All five patients who reported consuming or likely consumed other types of raw dairy products (including various cheeses, cream, and butter) also confirmed drinking Raw Farm raw milk.

Based on epidemiologic, laboratory, and traceback investigations conducted by local and state officials that indicated that raw milk consumed by cases was produced at Raw Farm, Raw Farm, LLC recalled their raw milk and raw heavy cream on October 24, 2023, including products with best by dates from October 11, 2023 to November 6, 2023. 

Products were sold at the following locations: Bristol Farm, Clark’s Nutrition, Elliott’s Natural Foods, Erewhon Market, Frazier Farms Market, Jimbo’s, Lassen’s Natural Foods, Lazy Acres, Lunardi’s, Mother’s Market, Nugget Market, and Sprouts Farmers Market locations. Specifically, the recalled products included the Raw Whole Milk in a gallon container (128 ounce) with item number 1000 and the barcode 835204006004, the Raw Whole Milk in half gallon (64 ounce) container with item number 1005 and the barcode 835204000095, the Raw Whole Milk in quart containers (32 ounce) with item number 1010 and the barcode 835204000019, and Raw Heavy Cream in 16-ounce containers with item number 3050 and the barcode 835204000132.

Previous Raw Farm, LLC Recalls and Outbreaks

Since September 2006, Raw Farm, LLC, formerly known as Organic Pastures Dairy Company (“OPDC”), has issued multiple recalls of unpasteurized milk products, and been linked to multiple outbreaks as outlined below. 

The following table shows Raw Farm’s previous history with contaminated products: 

Date	Product	Contaminant	Recall/Illnesses
September 2006	Raw Milk	E. Coli O157:H7	Six ill, two severely ill with Hemolytic Uremic Syndrome
September 2007	Raw Cream	Listeria monocytogenes	Recall Issued
December 2007	Raw Milk	Campylobacter	Eight Illnesses
September 2008	Raw Cream	Campylobacter	Recall Issued
November 2011	Raw Milk	E. Coli O157:H7	Five ill, three severely ill with Hemolytic Uremic Syndrome
May 2012	Raw Milk/Cream	Campylobacter	10 Illnesses
October 2015	Raw Milk	Campylobacter	Recall Issued
January 2016	Raw Milk	E. Coli	Nine ill, two severely ill with Hemolytic Uremic Syndrome
May 2023	Raw Milk	Campylobacter	Recall Issued
August 2023	Unpasteurized Cheese	Salmonella	Recall Issued

The Salmonella Bacteria

Salmonella is the second most common intestinal infection in the United States. More than 7,000 cases ofSalmonella were confirmed in 2009; however, the majority of cases go unreported. The Centers for Disease Control and Prevention (CDC) estimates that over 1 million people in the U.S. contract Salmonella each year, and that an average of 20,000 hospitalizations and almost 400 deaths occur from Salmonella poisoning, according to a 2011 report.

Salmonella infections usually occur when a person eats food contaminated with the feces of animals or humans carrying the bacteria. Salmonella outbreaks are commonly associated with eggs, meat, and poultry, but these bacteria can also contaminate other foods, such as fruits and vegetables. Foods that are most likely to contain Salmonella include raw or undercooked eggs, raw milk, contaminated water, and raw or undercooked meats.

Symptoms of Salmonella infection, or salmonellosis, range widely and are sometimes absent altogether. The most common symptoms include diarrhea, abdominal cramps, and fever. 

Typical symptoms of Salmonella infection appear 6 to 72 hours after eating contaminated food, last for 3 to 7 days without treatment, and usually consist of: Diarrhea , Abdominal Cramps, Fever of 100°F to 102°F , Bloody Diarrhea, Vomiting, Headache, Body Aches.

Complications of Salmonella poisoning are more likely to occur among young children and people aged 65 or older. Possible complications like reactive arthritis are thought to occur in 2 to 15 percent of Salmonella patients. Symptoms include inflammation of the joints, eyes, or reproductive or urinary organs. On average, symptoms appear 18 days after infection. Irritable bowel syndrome (IBS) can also be a long-term complication.Salmonella infections generally last 3 to 7 days, and often do not require treatment. People with severe dehydration may need rehydration through an IV. Antibiotics are recommended for those at risk of invasive disease, including infants under three months old. Typhoid fever is treated with a 14-day course of antibiotics. Unfortunately, treatment of Salmonella has become more difficult as the pathogen has become more resistant to antibiotics. Finding the right antibiotic for a case of Salmonella is crucial to treating this bacterial infection. 

Republished with permission from Bill Marler and Marler Clark. Copyright (c) Marler Clark LLP, PS. All rights reserved.

Source: https://www.marlerblog.com/case-news/california-raw-milk-farm-tied-to-bird-flu-also-linked-to-hidden-salmonella-outbreak/