It's a beautiful fall here in New England once again. The change of the seasons brings familiar sights and activities for families. But unfortunately for public health professionals, fall also brings a familiar concern.
In this case, it is not the pumpkin carving, Halloween candy or the leaf peeping that cause worry, but the consumption of unpasteurized apple cider that is still produced by a handful of local orchards.
The good news is that if your favorite cider producer pasteurizes their cider and follows required guidelines, then this article will be of little concern to you. If not, we urge you to give the subject some more thought so you can understand the public health risks.
Drinking hot apple cider is a common ending to a fun day of apple picking or a visit to the local farm, but we don't want those fun times to surprise you with days or weeks of complications from food borne illness. Vomiting, diarrhea, cramps and sometimes hospitalization can result from this simple choice.
We're not trying to scare you away from your old traditions, but let's get right to the truth about unpasteurized apple cider. The truth is there can be NO assurance that unpasteurized cider is safe.
The biggest risk from unpasteurized apple cider is food borne illness caused by E. Coli 0157:H7. You may remember this from the "Jack in the Box" hamburger outbreak in the 1990s. Here in Massachusetts, this bacteria earned its claim to fame in 1991 through sickness caused by unpasteurized apple cider. Twenty-three people were ill, and four children were hospitalized from cider they consumed at a southeast Massachusetts cider mill.
At the time, this seemed surprising to public health investigators, as the pH of cider was generally thought to be too low to support bacteria growth. The investigation found that the farm procedures for cider production included the washing of the apples in potable water and other good practices, but also noted the common use of "drops" in cider production. Drops are apples that were picked up off the ground, where E. Coli and other bacteria exist naturally. Another possible source of contamination was the feces of deer and other mammals that frequent the orchard for those tasty apples. Once the process was understood, the wheels of regulation began to turn.
After the 1991 outbreak, the government began the process of designing a system to bring safe cider to the public. Policies were put into place in Massachusetts in 1994 for the safe production of cider. Sanitation in the old mills was brought to a higher standard, and inspections by local health departments became standardized. All wholesale producers were required to pasteurize their products. Only retail harvesters who sell directly to consumers were allowed to sell unpasteurized cider.
Lastly, as of Nov. 5, 1999, the federal Food and Drug Administration (FDA) and the Massachusetts Department of Public Health's Food Protection Program required the following warning statement on the container label of any juice or beverage containing juice that has not been processed in a manner capable of achieving at least 5-log reduction in pertinent microorganisms (pasteurization): "Warning: this product has not been pasteurized and, therefore, may contain harmful bacteria that can cause serious illness in children, the elderly, and persons with weakened immune systems."
A good system was put into place, but of course there are always the naysayers. The self proclaimed cider connoisseurs don't understand why we must boil everything and kill all of the flavor. They say that pasteurized cider is just not the same — it doesn't have that same tanginess.
Well, the truth is regulation did not take away your choice. As stated, there are some retailers that are allowed by law to produce and sell unpasteurized cider directly to consumers. If you come across one of these retailers, you will find the warning statement on the packaging. You have seen similar warnings appear on restaurant menus over the past years. It is similar to when you choose to eat eggs sunny side up or a medium rare hamburger or raw oyster. Your favorite foods eaten this way may get you sick, but the government has chosen to leave this choice to you. Public health inspection cannot eliminate this risk.
If you are the caretaker of any person who may be in one of the three high-risk population categories, we urge you to choose wisely and provide them with pasteurized cider. The three groups that should not consume unpasteurized cider are: children, the elderly, and those with weakened immune systems (people with cancer, AIDS, other chronic illnesses, or taking certain medications). Educated decisions are what public health is all about. We respect everyone's ability to weigh risk in their decisions, but we also ask that you please respect the potential dangers.
• • •
Susan Sawyer is the director of the North Andover Health Department.