Pasteurized Milk as a Vehicle of Infection in an Outbreak of Listeriosis

TLDR

Listeria monocytogenes had been detected in dairy cows on the farms supplying the implicated milk during the outbreak. The outbreak involved 49 Massachusetts patients who acquired listeriosis between June 30 and August 30, 1983. The outbreak caused 49 cases, including 7 fetal/infant and 42 immunosuppressed adult cases, with a 29 % mortality rate; 32 of 40 isolates were serotype 4b, and case‑control studies showed a strong association with a specific brand of pasteurized milk (OR 9–11.5), a dose‑response effect, a protective effect of skim milk, and a phage type linked to the disease.

Abstract

Between June 30th and August 30th, 1983, 49 patients in Massachusetts acquired listeriosis. Seven cases occurred in fetuses or infants and 42 in immunosuppressed adults; 14 patients (29 per cent) died. Of 40 Listeria monocytogenes isolates available for testing, 32 were serotype 4b. Two case-control studies, one matching for neighborhood of residence and the other for underlying disease, revealed that the illness was strongly associated with drinking a specific brand of pasteurized whole or 2 per cent milk (odds ratio = 9, P less than 0.01 for the neighborhood-matched study; odds ratio = 11.5, P less than 0.001 for the illness-matched study). The association with milk was further substantiated by four additional analyses that suggested the presence of a dose-response effect, demonstrated a protective effect of skim milk, associated cases with the same product in an independent study in another state, and linked a specific phage type with the disease associated with milk. The milk associated with disease came from a group of farms on which listeriosis in dairy cows was known to have occurred at the time of the outbreak. Multiple serotypes of L. monocytogenes were isolated from raw milk obtained from these farms after the outbreak. At the plant where the milk was processed, inspections revealed no evidence of improper pasteurization. These results support the hypothesis that human listeriosis can be a foodborne disease and raise questions about the ability of pasteurization to eradicate a large inoculum of L. monocytogenes from contaminated raw milk.