Responding to outbreaks of illness linked to unpasteurized milk: A needs assessment of state health and agriculture departments.

AIMS: Consumption of unpasteurized milk can result in severe illness or death. In the United States, the number of people who regularly consume unpasteurized milk is relatively low, but outbreaks resulting from unpasteurized milk outnumber outbreaks linked to pasteurized milk. The sale of unpasteurized milk for human consumption through interstate commerce is prohibited at the federal level, but laws among states vary considerably with respect to the sale of unpasteurized milk. Each state has a different perspective on responding to and preventing outbreaks of illness linked to consuming unpasteurized milk. METHODS AND RESULTS: We conducted a needs assessment of state health and agriculture departments to gather information on state-level strategies to prevent illnesses linked to consuming unpasteurized milk, characterize challenges states face, and identify areas where partners can support state efforts to prevent illnesses. We deployed a survey from 6 January 2021 to 1 March 2021, using a snowball sampling strategy and had 158 respondents. Of 115 respondents, 46 (40%) believed that state laws were ineffective in preventing illnesses, and 92 (80%) agreed that consumers continue to find ways to get unpasteurized milk despite laws restricting sale. Respondents from 19 states were aware of future legislative or regulatory efforts surrounding unpasteurized milk in their state, with 14 (74%) indicating these efforts would expand consumer access. The most common outbreak prevention strategies respondents mentioned included sharing knowledge and experiences with other public health and agriculture officials, providing information to inform legislative efforts, and communicating to the public about outbreaks. Most respondents (41/50, 91%) were interested in pursuing further efforts to prevent unpasteurized milk-associated illnesses in their state. CONCLUSIONS: The results from this needs assessment can be used to inform future strategies for preventing illness outbreaks associated with unpasteurized milk consumption.

Foodborne illness outbreaks linked to unpasteurised milk and relationship to changes in state laws - United States, 1998-2018.

Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013-2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0-19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4-7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3-9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.

Differences in rapid increases in county-level COVID-19 incidence by implementation of statewide closures and mask mandates - United States, June 1-September 30, 2020.

BACKGROUND AND OBJECTIVE: Community mitigation strategies could help reduce COVID-19 incidence, but there are few studies that explore associations nationally and by urbanicity. In a national county-level analysis, we examined the probability of being identified as a county with rapidly increasing COVID-19 incidence (rapid riser identification) during the summer of 2020 by implementation of mitigation policies prior to the summer, overall and by urbanicity. METHODS: We analyzed county-level data on rapid riser identification during June 1-September 30, 2020 and statewide closures and statewide mask mandates starting March 19 (obtained from state government websites). Poisson regression models with robust standard error estimation were used to examine differences in the probability of rapid riser identification by implementation of mitigation policies (P-value< .05); associations were adjusted for county population size. RESULTS: Counties in states that closed for 0-59 days were more likely to become a rapid riser county than those that closed for >59 days, particularly in nonmetropolitan areas. The probability of becoming a rapid riser county was 43% lower among counties that had statewide mask mandates at reopening (adjusted prevalence ratio = 0.57; 95% confidence intervals = 0.51-0.63); when stratified by urbanicity, associations were more pronounced in nonmetropolitan areas. CONCLUSIONS: These results underscore the potential value of community mitigation strategies in limiting the COVID-19 spread, especially in nonmetropolitan areas.