AN OUTBREAK OF HYPERVITAMINOSIS-D ASSOCIATED WITH THE OVERFORTIFICATION OF MILK FROM A HOME-DELIVERY DAIRY

Objectives. The purpose of the study was to identify cases of hypervit aminosis D caused by the inadvertent overfortification of milk from a home-delivery dairy and to identify risk factors for this illness. Met hods. Hospital discharge, laboratory, and state health department data were used to define, identify, and describe cases of hypervitaminosis D diagnosed in the exposed communities between January 1, 1985, and J une 30, 1991. To identify disease risk factors, community-based sex- a nd age-matched controls were used in a case-control study. Results. Of the 56 case patients identified, at least 41 were hospitalized; 2 die d. The study included 33 case patients and 93 control subjects. Ninete en of the 33 case patients had been customers of the implicated dairy. Risk of illness rose with increasing consumption of the dairy's milk and was also associated with vitamin D supplement use, sunburn suscept ibility, and cancer history. Accounting for these factors did not alte r the association between drinking the dairy's milk and developing hyp ervitaminosis D. Conclusions. Overfortification of milk with vitamin D can lead to hypervitaminosis D, manifested by severe illness and deat h. The episode highlights the need for monitoring the fortification pr ocess and enforcing the upper limit for vitamin D addition to milk.