US paediatricians renew call to ban raw milk sales as H5N1 adds a new zoonotic risk

The American Academy of Pediatrics (AAP) has renewed its call for a nationwide ban on the sale and distribution of raw milk and raw dairy products, warning that the emergence of H5N1 in dairy cattle adds a new viral hazard to the well-established bacterial risks of unpasteurised milk. The updated policy particularly targets protection of children and pregnant people.

The new AAP statement updates guidance first issued in 2014 and reaffirmed in 2025. It argues that claimed nutritional or health advantages of raw milk are not supported by evidence, while the infectious risks are well documented. Raw dairy can transmit Campylobacter, pathogenic E. coli, Listeria, Salmonella and Brucella, among other pathogens.

H5N1 changes the risk assessment

The major new concern is highly pathogenic avian influenza A(H5N1). Since the virus entered US dairy cattle, studies have shown that infected cows can shed large quantities of virus into milk. According to the AAP summary, infectious H5N1 was detected in nearly one-quarter of raw milk samples collected in affected areas during the 2024 dairy outbreak, and viral material can remain detectable in refrigerated raw milk for several weeks.

There have still been no confirmed human H5N1 infections attributed to drinking contaminated raw milk. CDC nevertheless considers exposure more likely among people consuming unpasteurised milk from infected animals and notes that cats and experimental animals have become infected after consuming H5N1-contaminated milk.

Children bear a disproportionate burden

The AAP stresses that children are particularly vulnerable to foodborne disease. Nearly half of illnesses linked to raw dairy consumption occur in people under 20, with a substantial proportion among children younger than five. Severe infections can lead to haemolytic uraemic syndrome, neurological complications, kidney failure or death.

Pregnancy also substantially increases the consequences of infection. The AAP cites listeriosis rates around 12–14 times higher during pregnancy than in the general population, with possible miscarriage, stillbirth, premature delivery or severe neonatal disease.

Pasteurisation remains the central recommendation

CDC and FDA continue to recommend avoiding raw milk and products made from it. Pasteurisation inactivates H5N1 as well as the major bacterial pathogens associated with milk, while preserving the nutritional value of dairy products. The AAP goes further, calling for a ban on the sale and distribution of raw milk and raw-milk products rather than relying solely on consumer advice. Raw milk nevertheless remains legally available in at least 27 US states under varying rules.