Abstract
Objective
Pasteurization kills harmful microorganisms found in milk. While consumption of unpasteurized milk and its products is discouraged due to increased risk of infections, some individuals prefer unpasteurized dairy products. Our objective was to estimate the burden of illness from outbreaks arising from consumption of unpasteurized and pasteurized dairy products in Canada and the United States.
Methods
We conducted a systematic review of dairy-associated outbreaks in Canada and the USA from 2007 onward. We searched MEDLINE, Embase, Cochrane Library, TRIP Database for guidelines, and North American government agency websites up to October 2020. We included outbreak reports where the pathogenic microbe was confirmed in both the patient and the dairy product through laboratory testing.
Synthesis
Thirty-two disease outbreaks were linked to dairy consumption. Twenty outbreaks involving unpasteurized products resulted in 449 confirmed cases of illness, 124 hospitalizations, and five deaths. Twelve outbreaks involving pasteurized products resulted in 174 confirmed cases of illness, 134 hospitalizations, 17 deaths, and seven fetal losses. Listeria accounted for 10 out of 12 outbreaks from pasteurized products from 2007 through 2020.
Conclusion
Public warnings about the risk of unpasteurized dairy consumption need to continue and pregnant women and immunocompromised hosts need to be made aware of foods at high risk of contamination with Listeria.
Résumé
Objectif
La pasteurisation tue les micro-organismes dangereux contenus dans le lait. Même si la consommation du lait non pasteurisé et ses produits fût déconseillée en raison d’un risque accru d’infection, certaines personnes préfèrent des produits laitiers non pasteurisés. Notre objectif était d’évaluer le fardeau de maladie des éclosions résultant de la consommation des produits laitiers non pasteurisés et pasteurisés au Canada et aux États-Unis.
Méthode
Nous avons mené une revue systématique des éclosions liées aux produits laitiers au Canada et aux États-Unis depuis 2007. Nous avons cherché dans MEDLINE, Embase, Cochrane Library, TRIP Database et les sites web des agences gouvernementales Nord-Américaines pour la période 2007 jusqu’au mois d’octobre 2020. Nous avons inclus des rapports d’éclosion lorsque les essais en laboratoire ont confirmé la présence du microbe pathogène dans le patient ainsi que dans le produit laitier.
Résultats
Trente-deux éclosions étaient liées à la consommation des produits laitiers. Les produits non pasteurisés étaient impliqués dans 20 éclosions, avec 449 cas de maladie confirmés, 124 hospitalisations et 5 morts. Les produits pasteurisés étaient impliqués dans 12 éclosions, avec 174 cas de maladie confirmés, 134 hospitalisations, 17 morts et sept morts fœtales. Listeria comptait pour 10 des 12 éclosions des produits pasteurisés de 2007 à 2020.
Conclusion
Les avis publics au sujet du risque de la consommation des produits laitiers non pasteurisés devraient continuer et les femmes enceintes et les hôtes immunodéprimés devraient être informés de la nourriture à haut risque de la contamination avec Listeria.
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Acknowledgements
The authors acknowledge the contribution of Tara Landry for her peer review of the search strategy, and those of Liza Bialy and Shelly Jun for quality assessment of the included studies. We also acknowledge Judy D. Greig and Mariola Mascarenhas with the Public Health Agency of Canada for their assistance in searching the Publicly Available International Foodborne Outbreak Database (PAIFOD).
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This work was supported by the Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, which is funded by Alberta Innovates (G201900663) and the Canadian Institutes of Health Research (201305).
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MS, RF, and JLR conceived the project and undertook the data collection and analysis; MS and NAB wrote the first draft; all the authors contributed toward the intellectual content of the manuscript.
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Sebastianski, M., Bridger, N.A., Featherstone, R.M. et al. Disease outbreaks linked to pasteurized and unpasteurized dairy products in Canada and the United States: a systematic review. Can J Public Health 113, 569–578 (2022). https://doi.org/10.17269/s41997-022-00614-y
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DOI: https://doi.org/10.17269/s41997-022-00614-y