In December 2016, Public Health England investigated an outbreak of campylobacteriosis in North West England, with 69 cases in total. Epidemiological, microbiological and environmental investigations associated the illness with the consumption of unpasteurised cows' milk from Farm X, where milk was predominantly sold from a vending machine. Campylobacter was detected in milk samples which, when sequenced, were identical in sequence type as pathogens isolated from cases (Clonal Complex ST-403, Sequence Type 7432). The farm was served with a Hygiene Emergency Prohibition Order to prevent further cases. To our knowledge, this is the first outbreak of campylobacter associated with unpasteurised milk in England since 1996. Our findings highlighted several important lessons, including that the current testing regime in England for unpasteurised milk is not fit for purpose and that the required warning label should include additional wording, underscoring the risk to vulnerable groups. There has been a substantial increase in both the volume of unpasteurised milk consumed in England and the use of vending machines to sell unpasteurised milk over the last 10 years, making unpasteurised milk more readily accessible to a wider population. The evidence generated from outbreaks like this is therefore critical and should be used to influence policy development.

The aim of this study was to review microbiology results from testing >2500 raw drinking milk and dairy products made with unpasteurised milk examined in England between 2013 and 2019. Samples were collected as part of incidents of contamination, investigation of infections or as part of routine monitoring and were tested using standard methods for a range of both pathogens and hygiene indicators. Results from testing samples of raw cow's milk or cheese made from unpasteurised milk for routine monitoring purposes were overall of better microbiological quality than those collected during incident or investigations of infections. Results from routine monitoring were satisfactory for 62% of milks, 82% of cream, 100% of ice-cream, 51% of butter, 63% of kefir and 79% of cheeses, with 5% of all samples being considered potentially hazardous. Analysis of data from cheese demonstrated a significant association between increasing levels of indicator Escherichia coli with elevated levels of coagulase positive staphylococci and decreased probability of isolation of Shiga toxin-producing E. coli. These data highlight the public health risk associated with these products and provide further justification for controls applied to raw drinking milk and dairy products made with unpasteurised milk.

We thank Percival and colleagues for their comments in response to our paper 'Microbiological quality of raw drinking milk and unpasteurised dairy products: results from England 2013-2019' published in Epidemiology and Infection in May of 2020 [1]. Following an e-mail correspondence with Dr Percival in 2020 which covered similar ground to that in the letter, two of us (CW and JMcL) virtually met with Dr Percival in October 2020 to discuss her concerns. Whilst this demonstrates our willingness to engage with industry, it is not possible for us to contact all the individual single interest groups on a pre-publication basis, however reputable these organisations may be. We certainly shared the data in this publication with food regulators who, in any event, have closer ties to trade associations than ourselves. Percival and colleagues should note that the subject of the paper is 'Microbiological quality of raw drinking milk and unpasteurised dairy products' and not just cheese made from raw milk. The paper concludes by stating 'This group of products is a concern for public health, and there is a need for continued surveillance and implementation of controls during production and throughout the food chain': we did not single out cheese from other raw milk products or raw drinking milk itself in this sentence. It is worth noting that there is a very limited range of food products for which there is dietary advice for specific risk groups to avoid consumption. Such advice is in place in England for unpasteurised milk and other unpasteurised dairy products [2,3] and provides evidence of the public health concerns applied to these products.

Pest Scene Investigators is a new Oregon State University Extension education program designed to provide current Master Woodland Managers with specialized knowledge and skills in forest health assessment, diagnosis, and management. Seventy-nine volunteers participated in this pilot program from 2008-2010. The program effectively changed participant behavior on their own properties, with over 80% having thinned, planted alternative species, or assessed their land for forest pests and disease. However, participants showed little interest or confidence in helping other landowners or in doing forest health education. The program will re-tool to incorporate increased support and collaboration to increase confidence in providing volunteer service.