Missouri Department of Health & Senior Services
03/16/05

Tuberculosis Cases Prompt Warning on Raw-Milk Cheese By MARC SANTORA

One infant has died and dozens of New Yorkers have contracted tuberculosis from 2001 through 2004 by eating cheese made from raw milk that was contaminated with bacteria, city and federal officials said yesterday.

In an alert sent last night to all medical providers in the area, the city's Department of Health and Mental Hygiene warned that several types of cheese imported from Mexico, particularly queso fresco, might be
contaminated with Mycobacterium bovis, which causes tuberculosis.

Alerted about the outbreak by city officials, the federal Food and Drug Administration issued a warning against eating "any unripened raw-milk soft cheeses from Mexico, Nicaragua, or Honduras."

Investigators from the city's health department believe that over the four years, at least 35 people - 22 adults and 13 children - have gotten tuberculosis from contaminated cheese or raw milk. Seven of the
children were younger than 6.

A 15-month-old child who died in March 2004 was later determined to have died of complications of the disease.

All the adults with tuberculosis were born outside the United States, most in Mexico. Health officials began an investigation four months ago after determining that all the younger children who had tuberculosis had been born in the United States, raising the possibility that contaminated
products were crossing the border.

Thomas R. Frieden, the commissioner of the city health department, cited the surge in the city's Mexican population, to 186,872 in 2000 from 61,722 in 1990, in suggesting that many more New Yorkers today could be exposed to tainted cheese. "Don't buy or eat or consume milk or cheese products
unless they are clearly labeled in English," Dr. Frieden said.

Cases of tuberculosis from contaminated cheese have been found in all five boroughs, and health inspectors are focusing on stores that cater to Hispanic customers. So far, health officials said, they have taken improperly labeled or unlabeled cheeses from Mexican grocers in Brooklyn and Queens.

Health officials are also worried about courier services called paqueterías that transport food to and from Mexico without going through any inspection process. The patients interviewed said they also received
the food from family and friends who traveled from Mexico.

The tuberculosis organism is primarily found in cattle but can infect other animals, including deer, pigs and goats, as well as humans. In people, the bacterium usually affects areas outside the lungs, but then it cannot be transmitted through the air.

While tuberculosis is curable, it often goes unrecognized when it is not in the lungs, which is part of the reason the department issued its alert, Dr. Frieden said. And, in some cases, Mycobacterium bovis can
infect the lungs. Health investigators in New York City have found that the disease affected the lungs of 14 patients. So far, their investigation has not found that any of those patients passed the disease through the air.

Dr. Philip Lobue, a tuberculosis expert at the Centers for Disease Control and Prevention in Atlanta, said there was a debate in the medical community about whether the form of the disease now seen in New York can be as easily transmitted as the more common form of tuberculosis.

Health officials have long warned of the health risks posed by drinking milk that is not pasteurized. The use of raw milk to make cheese has been associated with several serious infections, including listeriosis, brucellosis and salmonella.

Eating cheese made from raw milk is common in Latin America, and immigrants remain attached to the product, health officials said. Queso fresco, or fresh cheese, is soft, moist and mild, crumbling easily over dishes like enchiladas.

Daphne Zepos, an official at the Artisanal Cheese Center in Manhattan, said professional cheesemakers used products that are tested for disease and let cheese made from raw milk age for 60 days. Typically, the Hispanic cheeses the health department is worried about are aged for only days. Homemade cheese, she said, is often derisively called "bathtub cheese."

Ms. Zepos, who helped found the Cheese of Choice Coalition, which advocates the use of raw milk, said, "It is detrimental to the whole industry when these outbreaks happen."

She said that it was important to use milk only from healthy cattle.

The United States program to eradicate Mycobacterium bovis in livestock began in 1917, and Joe Baca, a spokesman for the Food and Drug Administration, said it was now rare for cattle here to be infected
with the bacteria.

Go Back to where you were.