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180 N Michigan Ave Ste 1200 Chicago IL 60601

Illinois Association of Public Health Administrators 2833 S Grand Avenue E Springfield IL 62703

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223 S Third St Springfield IL 62701

ILLINOIS ASSOCIATION OF LOCAL ENVIRONMENTAL HEALTH ADMINISTRATORS co LaSalle County Health Dept 717 Etna Rd Ottawa IL 61350

Illinois Environmental Health Association PO Box 7505 Rockford IL 61126

July 29 2015

Joint Committee on Administrative Rules (lCAR) 700 Stratton Office Bldg Springfield IL 62706

RE Second Reading of the Grade A Pasteurized Milk and Milk Products Rules Code Citation 77 Ill Adm Code 775 Register Citation to Notice of Proposed Rules 38 III Reg 18346 September 5 2014

Dear Honorable Members of JCAR

The Northern Illinois Public Health Consortium Illinois Association of Public Health Administrators Illinois Public Health Association Illinois Association of Local Environmental Health Administrators and Illinois Environmental Health Association - which together represent all local public health departments in Illinois and a large share of the states Environmental Health practitioners- would like to share our thoughts on the proposed raw milk rules and urge you to reject them as currently proposed

We would like to start by pointing out that we support reasonable tools to manage the sale of unpasteurized milk (also known as raw milk) Regulating the sale of raw milk is especially critical because its consumption presents significant health risks Our public health organizations worked closely with the Illinois Department of Public Health (IDPH) in developing the rules that were presented at the first reading The public health community in Illinois was supportive of those rules The currently proposed rules still contain a number of elements that will enable raw milk production and distribution while minimizing risk to consumers We support the parts of the currently proposed rules pertaining to permitting testing and quality standards labeling educating consumers as to the risks involved with consuming unpasteurized milk purchasing logs and batch sample storage

It is important however for the members of JCAR to be aware of several critical parts of the proposed rules that were removed from the first reading draft the result of which is that the currently proposed rules in the second reading draft are not protective ofthe publics health The specific areas of concern are

1) The currently proposed rules greatly expand the location where raw milk may be sold and would allow the retail sale of raw milk in population centers

The enabling legislation for these rules [the Grade A Pasteurized Milk and Milk Products Act (410 ILCS 6351)] allows the sale of raw milk on the premises of the dairy farm which is expanded in the proposed rules to

include one receiving station The expansion of the premises of the dairy farm was to take modem farming operations into consideration In the first reading draft the expansion of the premises to include a receiving station did not restrict a farmer to selling raw milk on the property where the herd is kept but did restrict sales in densely populated areas in locations that clearly were not associated with the farm Language was included in the first reading of the rules (but was subsequently removed) indicating that The premises ofa dairy farm does not include any property located within the incorporated area ofa municipality within 15 miles ofan incorporated municipality or within an unincorporated urban area Removing these restrictions is not acceptable and the former limits proposed in the first reading of the rules should be reinstated

During a live webinar on July 22 2015 Dr Nirav Shah Director of the Illinois Department of Public Health confirmed that the removal of this language in the second reading draft of the proposed rules would open up the possibility that a receiving station for raw milk could be located anywhere in State The only restriction would be that the receiving station will need to be at a location that is under the control and responsibility of the dairy farmer For example under the language of the second reading a receiving station for a dairy farm located in LaSalle County may be permitted in downtown Chicago To make matters worse language that would have required mPH to notify local health departments when they permitted a receiving station was removed Additionally language prohibiting monetary transactions (retail sales) at receiving stations was also removed so local health departments will not be made aware of retail sales of a risky food in their jurisdiction

In addition to being a threat to public health this change in the rules exceeds the language and clear intent of the enabling legislation which states that unpasteurized milk may only be sold on the premises of the dairy farm While the first reading draft of the proposed rules made a concession to modem farming operations by expanding the definition of premises the second reading draft would essentially allow the retail sale of unpasteurized milk anywhere in the State of Illinois

2) The currently proposed rules diminish the quality standards required for raw milk sold to consumers

The second reading draft ofthe proposed rules was amended to increase the maximum allowable somatic cell count to 750000 from 400000 as was established in the first reading draft of the rules The somatic cell count is a very important quality standard for unpasteurized milk Somatic cells are white blood cells that the animal produces to fight infections in their udders H_igher somatic cell counts indicate an animal that is less healthy than an animal with a lower somatic cell count Increased somatic cell counts indicate increased inflammation very likely caused by infection Somatic cell counts are a direct indicator of the health of the animal producing the milk and an indirect indicator of the presence of disease-causing microorganisms in unpasteurized milk which if consumed may result in human infection and illness Higher somatic cells counts indicate a greater risk to the consumer

The proposed standard of 750000 somatic cells per milliliter for cows milk (and 1000000 for goats milk) is an unacceptably risky standard as it is based not on evidence-based quality and safety standards but on requirements in Federal Pasteurized Milk Ordinance for milk to be pasteurized Somatic cell counts that exceed these levels are in violation of standards for milk that is to be mixed with higher quality milk and then pasteurized Milk that is to be directly consumed by humans should be held to a stricter safer standard At the request of the Illinois Department of Health the Illinois Department of Agriculture produced data indicating that the statewide average for the somatic cell count throughout Illinois was in the range of 400000 cells per milliliter The quality standard in the rules should be returned to 400000 somatic cells per milliliter for cows milk (and a comparable data

point should be detennined for goats milk) because this milk is intendedor direct human consumption Having the same standard for raw milk to be pasteurized and raw milk to be consumed directly would be like having the same standard for bacterial levels in lunchmeat and in raw hamburger

3) Campylobacteriosis must be reinstated as a reportable disease in Illinois

While not directly related to these proposed rules we believe it is nonetheless important to infonn you to fully be able to understand to potential effects of the rules that campylobacteriosis must be reinstated as a mandated reportable disease in Illinois Campylobacter species of bacteria are the most common types of bacteria that cause human illness in outbreaks associated with unpasteurized mi lk (identified in approximately 80 of unpasteurized milk associated outbreaks in the United States during 2007-2012) Campylobacteriosis is not however currently a mandated reportable disease in Illinois Because of that fact the number of cases is not known since individual cases are currently not reported Other diseases caused by unpasteurized milk are already reportable in Illinois Requiring campylobacteriosis to be a reportable disease in Illinois will provide local health departments with the timely means by which to be notified of individual cases as well as outbreaks (eg multiple cases) so they may conduct investigations and implement measures to prevent additional human illness from unpasteurized milk

In 2014 the Council of State and Territorial Epidemiologists (CSTE) approved a position statement to add campylobacteriosis to the CSTE Nationally Notifiable Conditions (NNC) list Effective January 12015 campylobacteriosis is a nationally reportable condition with an updated case definition

2established in collaboration with Centers for Disease Control and Prevetion 1

In summary we respectfully request that JCAR recommend to IDPH that language from the first reading of the rules be reinstated namely that

bull The rules clearly indicate that the premises of the dairy fann does not include any property located within the incorporated area of a municipality within 15 miles of an incorporated municipality or within an unincorporated urban area

bull The quality standard should be returned to 400000 somatic cells per milliliter for cows milk and a comparable quality standard should be determined for goats milk

bull The requirement for IDPH to notify the local health department when a receiving station is pennitted in its jurisdiction that was removed should be reinstated

bull The prohibition against monetary transactions taking place at a receiving station that was removed should be reinstated and

bull Though not directly addressed in these rules campylobacteriosis should be mandated to be a reportable disease in Illinois to align Illinois reporting with national standards toward prompt investigation and prevention offurther human infections and illness due to unpasteurized milk consumption

If IDPH rejects any of the above recommendations we request JCAR reject these proposed rules Thank you for your time and consideration of this very important public health matter

include one receiving station The expansion of the premises of the dairy farm was to take modem farming operations into consideration In the first reading draft the expansion of the premises to include a receiving station did not restrict a farmer to selling raw milk on the property where the herd is kept but did restrict sales in densely populated areas in locations that clearly were not associated with the farm Language was included in the first reading of the rules (but was subsequently removed) indicating that The premises ofa dairy farm does not include any property located within the incorporated area ofa municipality within 15 miles ofan incorporated municipality or within an unincorporated urban area Removing these restrictions is not acceptable and the former limits proposed in the first reading of the rules should be reinstated

During a live webinar on July 22 2015 Dr Nirav Shah Director of the Illinois Department of Public Health confirmed that the removal of this language in the second reading draft of the proposed rules would open up the possibility that a receiving station for raw milk could be located anywhere in State The only restriction would be that the receiving station will need to be at a location that is under the control and responsibility of the dairy farmer For example under the language of the second reading a receiving station for a dairy farm located in LaSalle County may be permitted in downtown Chicago To make matters worse language that would have required mPH to notify local health departments when they permitted a receiving station was removed Additionally language prohibiting monetary transactions (retail sales) at receiving stations was also removed so local health departments will not be made aware of retail sales of a risky food in their jurisdiction

In addition to being a threat to public health this change in the rules exceeds the language and clear intent of the enabling legislation which states that unpasteurized milk may only be sold on the premises of the dairy farm While the first reading draft of the proposed rules made a concession to modem farming operations by expanding the definition of premises the second reading draft would essentially allow the retail sale of unpasteurized milk anywhere in the State of Illinois

2) The currently proposed rules diminish the quality standards required for raw milk sold to consumers

The second reading draft ofthe proposed rules was amended to increase the maximum allowable somatic cell count to 750000 from 400000 as was established in the first reading draft of the rules The somatic cell count is a very important quality standard for unpasteurized milk Somatic cells are white blood cells that the animal produces to fight infections in their udders H_igher somatic cell counts indicate an animal that is less healthy than an animal with a lower somatic cell count Increased somatic cell counts indicate increased inflammation very likely caused by infection Somatic cell counts are a direct indicator of the health of the animal producing the milk and an indirect indicator of the presence of disease-causing microorganisms in unpasteurized milk which if consumed may result in human infection and illness Higher somatic cells counts indicate a greater risk to the consumer

The proposed standard of 750000 somatic cells per milliliter for cows milk (and 1000000 for goats milk) is an unacceptably risky standard as it is based not on evidence-based quality and safety standards but on requirements in Federal Pasteurized Milk Ordinance for milk to be pasteurized Somatic cell counts that exceed these levels are in violation of standards for milk that is to be mixed with higher quality milk and then pasteurized Milk that is to be directly consumed by humans should be held to a stricter safer standard At the request of the Illinois Department of Health the Illinois Department of Agriculture produced data indicating that the statewide average for the somatic cell count throughout Illinois was in the range of 400000 cells per milliliter The quality standard in the rules should be returned to 400000 somatic cells per milliliter for cows milk (and a comparable data

point should be detennined for goats milk) because this milk is intendedor direct human consumption Having the same standard for raw milk to be pasteurized and raw milk to be consumed directly would be like having the same standard for bacterial levels in lunchmeat and in raw hamburger

3) Campylobacteriosis must be reinstated as a reportable disease in Illinois

While not directly related to these proposed rules we believe it is nonetheless important to infonn you to fully be able to understand to potential effects of the rules that campylobacteriosis must be reinstated as a mandated reportable disease in Illinois Campylobacter species of bacteria are the most common types of bacteria that cause human illness in outbreaks associated with unpasteurized mi lk (identified in approximately 80 of unpasteurized milk associated outbreaks in the United States during 2007-2012) Campylobacteriosis is not however currently a mandated reportable disease in Illinois Because of that fact the number of cases is not known since individual cases are currently not reported Other diseases caused by unpasteurized milk are already reportable in Illinois Requiring campylobacteriosis to be a reportable disease in Illinois will provide local health departments with the timely means by which to be notified of individual cases as well as outbreaks (eg multiple cases) so they may conduct investigations and implement measures to prevent additional human illness from unpasteurized milk

In 2014 the Council of State and Territorial Epidemiologists (CSTE) approved a position statement to add campylobacteriosis to the CSTE Nationally Notifiable Conditions (NNC) list Effective January 12015 campylobacteriosis is a nationally reportable condition with an updated case definition

2established in collaboration with Centers for Disease Control and Prevetion 1

In summary we respectfully request that JCAR recommend to IDPH that language from the first reading of the rules be reinstated namely that

bull The rules clearly indicate that the premises of the dairy fann does not include any property located within the incorporated area of a municipality within 15 miles of an incorporated municipality or within an unincorporated urban area

bull The quality standard should be returned to 400000 somatic cells per milliliter for cows milk and a comparable quality standard should be determined for goats milk

bull The requirement for IDPH to notify the local health department when a receiving station is pennitted in its jurisdiction that was removed should be reinstated

bull The prohibition against monetary transactions taking place at a receiving station that was removed should be reinstated and

bull Though not directly addressed in these rules campylobacteriosis should be mandated to be a reportable disease in Illinois to align Illinois reporting with national standards toward prompt investigation and prevention offurther human infections and illness due to unpasteurized milk consumption

If IDPH rejects any of the above recommendations we request JCAR reject these proposed rules Thank you for your time and consideration of this very important public health matter

point should be detennined for goats milk) because this milk is intendedor direct human consumption Having the same standard for raw milk to be pasteurized and raw milk to be consumed directly would be like having the same standard for bacterial levels in lunchmeat and in raw hamburger

3) Campylobacteriosis must be reinstated as a reportable disease in Illinois

While not directly related to these proposed rules we believe it is nonetheless important to infonn you to fully be able to understand to potential effects of the rules that campylobacteriosis must be reinstated as a mandated reportable disease in Illinois Campylobacter species of bacteria are the most common types of bacteria that cause human illness in outbreaks associated with unpasteurized mi lk (identified in approximately 80 of unpasteurized milk associated outbreaks in the United States during 2007-2012) Campylobacteriosis is not however currently a mandated reportable disease in Illinois Because of that fact the number of cases is not known since individual cases are currently not reported Other diseases caused by unpasteurized milk are already reportable in Illinois Requiring campylobacteriosis to be a reportable disease in Illinois will provide local health departments with the timely means by which to be notified of individual cases as well as outbreaks (eg multiple cases) so they may conduct investigations and implement measures to prevent additional human illness from unpasteurized milk

In 2014 the Council of State and Territorial Epidemiologists (CSTE) approved a position statement to add campylobacteriosis to the CSTE Nationally Notifiable Conditions (NNC) list Effective January 12015 campylobacteriosis is a nationally reportable condition with an updated case definition

2established in collaboration with Centers for Disease Control and Prevetion 1

In summary we respectfully request that JCAR recommend to IDPH that language from the first reading of the rules be reinstated namely that

bull The rules clearly indicate that the premises of the dairy fann does not include any property located within the incorporated area of a municipality within 15 miles of an incorporated municipality or within an unincorporated urban area

bull The quality standard should be returned to 400000 somatic cells per milliliter for cows milk and a comparable quality standard should be determined for goats milk

bull The requirement for IDPH to notify the local health department when a receiving station is pennitted in its jurisdiction that was removed should be reinstated

bull The prohibition against monetary transactions taking place at a receiving station that was removed should be reinstated and

bull Though not directly addressed in these rules campylobacteriosis should be mandated to be a reportable disease in Illinois to align Illinois reporting with national standards toward prompt investigation and prevention offurther human infections and illness due to unpasteurized milk consumption

If IDPH rejects any of the above recommendations we request JCAR reject these proposed rules Thank you for your time and consideration of this very important public health matter

d Terry~D~~ President Northern Illinois Public Health Consortium

Miriam Link-Mullison President Illinois Public Health Association

Craig Beintema MS LEHP CPHA President Illinois Association of Pub] ic Health Administrators

Douglas F Toole President Illinois Association of Local Environmental Health Administrations

Lenore Killam MA Illinois Environmental Health Association

CC Nirav D Shah MD JD David W Culp PhD Molly 10 Lamb MPH MPA LEHP CHES

References I httpcymcdncomsiteswwwcsteorgiresourceresmgrI20 14PS 14 ID 09updpdf 2 wwwcdcgovnndssscriptcasedefaspxCondYrID=956ampDatePub= t I 20 15