Cronobacter Support
06-11-2009, 04:26 PM
Enterobacter sakazakii & other microorganisms in powdered infant formula
Posted from ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf
Acknowledgments
The Food and Agriculture Organization of the United Nations and the World Health Organization would like to express their appreciation to all those who contributed to the preparation of this report through the provision of their time and expertise, data and other relevant information and by reviewing the document and providing comments. In particular, the assistance of Martin Cole as meeting rapporteur was much appreciated.
Appreciation is also extended to all those who responded to the call for data that was issued by FAO and WHO and brought to our attention information that was not readily available in the mainstream literature and official documentation.
The preparatory work and expert meeting convened to prepare this report was coordinated by the Joint FAO/WHO Secretariat on Risk Assessment of Microbiological Hazards in Foods. This included Sarah Cahill, Maria de Lourdes Costarrica and Jean Louis Jouve in FAO, and Peter Karim BenEmbarek, Jocelyne Rocourt, Hajime Toyofuku and Jørgen Schlundt in WHO. The secretariat was supported by Kaye Wachsmuth who coordinated the preparation of background papers for the meeting and assisted in the finalization of the report. During the meeting and the preparation of the report, additional support and feedback were provided by James Akre and Rajiv Bahl in WHO. Publication of the report was coordinated by Sarah Cahill. Ruth Duffy edited the report. The work was supported and funded by the FAO Food Quality and Standards Service and the WHO Food Safety Department.
Executive Summary
Consistent with the need to provide safe feeding for all infants, 1the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) jointly convened an expert meeting on Enterobacter sakazakii and other microorganisms in powdered infant formula (WHO, Geneva, 2-5 February 2004). The meeting was organized in response to a specific request to FAO/WHO for scientific advice from the Codex Committee on Food Hygiene to provide input for the revision of the Recommended International Code of Hygienic Practice for Foods for Infants and Children. It also aimed to provide pertinent information to the member countries of both organizations.
After reviewing the available scientific information, the expert meeting concluded that intrinsic contamination of powdered infant formula with E. sakazakii and Salmonella has been a cause of infection and illness in infants, including severe disease which can lead to serious developmental sequelae and death. No link has been established between illness and other microorganisms in powdered infant formula, although such a link was considered plausible for other Enterobacteriaceae. E. sakazakii has caused disease in all age groups. From the age distribution of reported cases, it is deduced that infants (children <1 year) are at particular risk. Among infants, those at greatest risk for E. sakazakii infection are neonates (<28 days), particularly pre-term infants, low-birth-weight infants or immunocompromised infants. Infants of HIV-positive mothers are also at risk, because they may specifically require infant formula and they may be more susceptible to infection.2 This, and low birth weight, may be of particular concern for some developing countries where the proportion of such infants is higher than in developed countries.
It is important to note that powdered infant formula meeting current standards is not a sterile product and may occasionally contain pathogens. The meeting did not identify a feasible method, using current technology, to produce commercially sterile powders or completely eliminate the potential of contamination.
E. sakazakii is an opportunistic pathogen emerging as a public health concern. Little is known about its ecology, taxonomy, virulence and other characteristics. Recent data, however, point to differences in the microbial ecology of Salmonella and E. sakazakii.
Data from the infant food industry and national control authorities indicate that the detection of Salmonella in finished powdered infant formula is rare. The current Codex specification for Salmonella is the absence of organisms in 60 samples of 25 g each. E. sakazakii is more commonly found than Salmonella in the manufacturing environment, which is a potential source of post-heat-treatment contamination. Specific criteria for E. sakazakii are not included in the current Codex Code.
Even low levels of contamination of E. sakazakii in powdered infant formula were considered to be a risk factor, given the potential for multiplication during the preparation and holding time prior to consumption of reconstituted formula.
Based on a preliminary risk assessment, the inclusion of a lethal step at the point of preparation and a decrease in the holding and feeding times effectively reduced risk. Acombination of intervention measures had the greatest impact.
Posted from ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf
Acknowledgments
The Food and Agriculture Organization of the United Nations and the World Health Organization would like to express their appreciation to all those who contributed to the preparation of this report through the provision of their time and expertise, data and other relevant information and by reviewing the document and providing comments. In particular, the assistance of Martin Cole as meeting rapporteur was much appreciated.
Appreciation is also extended to all those who responded to the call for data that was issued by FAO and WHO and brought to our attention information that was not readily available in the mainstream literature and official documentation.
The preparatory work and expert meeting convened to prepare this report was coordinated by the Joint FAO/WHO Secretariat on Risk Assessment of Microbiological Hazards in Foods. This included Sarah Cahill, Maria de Lourdes Costarrica and Jean Louis Jouve in FAO, and Peter Karim BenEmbarek, Jocelyne Rocourt, Hajime Toyofuku and Jørgen Schlundt in WHO. The secretariat was supported by Kaye Wachsmuth who coordinated the preparation of background papers for the meeting and assisted in the finalization of the report. During the meeting and the preparation of the report, additional support and feedback were provided by James Akre and Rajiv Bahl in WHO. Publication of the report was coordinated by Sarah Cahill. Ruth Duffy edited the report. The work was supported and funded by the FAO Food Quality and Standards Service and the WHO Food Safety Department.
Executive Summary
Consistent with the need to provide safe feeding for all infants, 1the Food and Agriculture Organization of the United Nations (FAO) and the World Health Organization (WHO) jointly convened an expert meeting on Enterobacter sakazakii and other microorganisms in powdered infant formula (WHO, Geneva, 2-5 February 2004). The meeting was organized in response to a specific request to FAO/WHO for scientific advice from the Codex Committee on Food Hygiene to provide input for the revision of the Recommended International Code of Hygienic Practice for Foods for Infants and Children. It also aimed to provide pertinent information to the member countries of both organizations.
After reviewing the available scientific information, the expert meeting concluded that intrinsic contamination of powdered infant formula with E. sakazakii and Salmonella has been a cause of infection and illness in infants, including severe disease which can lead to serious developmental sequelae and death. No link has been established between illness and other microorganisms in powdered infant formula, although such a link was considered plausible for other Enterobacteriaceae. E. sakazakii has caused disease in all age groups. From the age distribution of reported cases, it is deduced that infants (children <1 year) are at particular risk. Among infants, those at greatest risk for E. sakazakii infection are neonates (<28 days), particularly pre-term infants, low-birth-weight infants or immunocompromised infants. Infants of HIV-positive mothers are also at risk, because they may specifically require infant formula and they may be more susceptible to infection.2 This, and low birth weight, may be of particular concern for some developing countries where the proportion of such infants is higher than in developed countries.
It is important to note that powdered infant formula meeting current standards is not a sterile product and may occasionally contain pathogens. The meeting did not identify a feasible method, using current technology, to produce commercially sterile powders or completely eliminate the potential of contamination.
E. sakazakii is an opportunistic pathogen emerging as a public health concern. Little is known about its ecology, taxonomy, virulence and other characteristics. Recent data, however, point to differences in the microbial ecology of Salmonella and E. sakazakii.
Data from the infant food industry and national control authorities indicate that the detection of Salmonella in finished powdered infant formula is rare. The current Codex specification for Salmonella is the absence of organisms in 60 samples of 25 g each. E. sakazakii is more commonly found than Salmonella in the manufacturing environment, which is a potential source of post-heat-treatment contamination. Specific criteria for E. sakazakii are not included in the current Codex Code.
Even low levels of contamination of E. sakazakii in powdered infant formula were considered to be a risk factor, given the potential for multiplication during the preparation and holding time prior to consumption of reconstituted formula.
Based on a preliminary risk assessment, the inclusion of a lethal step at the point of preparation and a decrease in the holding and feeding times effectively reduced risk. Acombination of intervention measures had the greatest impact.