Building the Evidence Base for the Prevention of Raw Milk-Acquired Brucellosis: A Systematic Review

Abstract

Background: The scientific evidence of the health risks associated with the consumption of raw milk has been known for a long time. However, less clear is the impact of acquiring infectious diseases from raw milk consumption in the United States (US) due to incomplete reporting of cases and the complex factors associated with the sale and consumption of raw milk. Investigations of this current study focused on human brucellosis, one of the infectious diseases commonly acquired through the consumption of raw milk and milk products, and which continues to be a public health threat worldwide.Methodology: A qualitative systematic review of the sources of opinions that contribute to the increased trend of raw milk sales and consumption in the US was conducted.Results: Interestingly, opinions about the sale of raw milk and/or the benefits arising from its consumption varied by US region, with the proportion of messages supporting raw milk consumption being highest in the Northeast compared to other US regions. Several evidence gaps and factors that possibly contribute to the increased prevalence of raw milk-acquired brucellosis were identified including inadequate monitoring of the raw milk sales process and lack of approved diagnostic methods for validating the safety of raw milk for human consumption. Conclusions:The unavailability of data specifying brucellosis cases acquired from raw milk consumption have precluded the direct association between raw milk and increased brucellosis prevalence in the United States. Nevertheless, the evidence gaps identified in this study demonstrate the need for intensified surveillance of raw-milk acquired infectious diseases including human brucellosis; establishment of safety and quality control measures for the process of selling raw milk; and design of an effective strategy for the prevention of raw milk-acquired infectious diseases including brucellosis. Overall, for the first time, this study has not only shown the gaps in evidence that require future investigations, but also, variations in the perception of raw milk consumption that may impact disease acquisition in different US regions.

Activation of mucosal immunity as a novel therapeutic strategy for combating brucellosis

“…Brucellosis poses an occupational hazard common to abattoir workers, or by needle-stick by laboratory workers and veterinarians administering live brucellosis vaccines ( Buswell et al, 2016 ; Pereira et al, 2020 ). Human brucellosis is more often acquired subsequent to consumption of unpasteurized dairy products ( Chomel et al, 1994 ; Pappas et al, 2005 ; Baldi and Giambartolomei, 2013 ; Dadar et al, 2019 ; Adetunji et al, 2020 ). The American Academy of Pediatrics recommends against the consumption of unpasteurized milk by pregnant women and children ( American Academy of Pediatrics, 2014 ).…”

“…The incidence of disease varies among the endemic regions ( Pappas et al, 2006 ; Franco et al, 2007 ), but actual case numbers may be higher by as much as 26-fold due to misdiagnosis and underreporting ( Franco et al, 2007 ; Hull and Schumaker, 2018 ). The high incidence of Brucella infections is attributed to the sustained prevalence of brucellosis in infected livestock ( Young, 1983 ), that are the source of unpasteurized milk consumed in various dairy products ( Pappas et al, 2005 ; Baldi and Giambartolomei, 2013 ; Dadar et al, 2019 ; Adetunji et al, 2020 ). In addition, a number of cases have been attributed to an aerosol exposure from Brucella -infected livestock ( Corbel, 1997 ), laboratory acquired ( Traxler et al, 2013 ), or an accidental biopharmaceutical release ( Pappas, 2022 ).…”

A health promotion perspective for the control and prevention of Brucellosis (Brucella melitensis); Israel as a case study

“…Prevention and control of brucellosis can be divided into two distinct areas of intervention: the prevention and control of the disease in animals; and the prevention and control of the transfer of the disease to humans. A wide range of interventions have been proposed to contribute to the control and prevention of brucellosis [2,13,[25][26][27][28][29][30][31][32][33][34] and can be categorized by the five Ottawa charter areas of action:…”

(Re)connecting the food chain: Entangling cattle, farmers and consumers in the sale of raw milk

“…Bovine tuberculosis, Q fever (Halsby et al, 2017) and campylobacteriosis have serious impacts upon human health: precisely the diseases which had been used as political arguments for the justification of mass-scale pasteurisation. While in the UK it remains legal for farmers to sell raw milk, this is not the case in other global regions (for example, Canada, Scotland and some states in the US) where it is prohibited (Adetunji et al, 2020). The Food Standards Agency in the UK describes it as a 'high-risk food' that consumers need to be informed about (FSA, 2017).…”