Cronobacter Support
06-25-2009, 08:35 AM
2.2 SCOPE/CASE DESCRIPTION
The meeting considered illnesses in infants (i.e. children <1 year) linked to microorganisms (or their toxins) associated with powdered infant formula either epidemiologically or microbiologically.
2.2.1 Identification of products considered
The products under consideration were those in powdered form, specially manufactured and presented to be used by infants, either as a breastmilk substitute after preparation with water, or to modify prepared breastmilk substitutes or fortify human milk. Included products are, therefore, infant formula (as defined in Codex Stan 72-19811), follow-up formula (as defined in Codex Stan 156-19872), formula for special medical purposes intended for infants (as defined in Appendix V of Codex Alinorm 04/27/263), formulas for special medical purposes for the partial feeding of infants (covered by Codex Stan 180-19914) and human milk fortifiers.
Breastmilk substitutes are needed when infants do not have access to breastmilk for various reasons. Commercial infant formulas are usually used as breastmilk substitutes for normal healthy infants under 6 months, and are formulated industrially in accordance with the appropriate Codex standards. Formulas for special medical purposes intended for infants are breastmilk substitutes for sick infants (patients). Although other milks may be used after 6 months, follow-up formulas can substitute for breastmilk in the older infant who also eats complementary food. These three types of formula only need the addition of water to be ready for consumption and, therefore, are often also available in liquid, ready-to-feed form. However, formulas for special medical purposes for the partial feeding of infants require the addition of measured amounts of other foods, quite often also in powdered form, to satisfy the special nutritional needs of the individual infant patient.
Human milk fortifiers are powdered supplements which can be added to expressed human milk when the nutritional requirements of low-birth-weight infants (<2 500 g) and especially very lowbirth-weight infants (<1 500 kg) are not satisfied by human milk alone. This can include thickening agents, such as starches or simple cereals which are specially manufactured for the purpose of increasing the consistency of the liquid food, and can be added to formula intended for infants with gastro-oesophageal reflux.
Throughout the following report, the term “powdered infant formula” includes all of the products mentioned above, but excludes cereals.
2.2.2 Case definition
The meeting considered illnesses in infants (i.e. children <1 year) due to microorganisms (or their toxins) associated with powdered infant formula consumption either epidemiologically or microbiologically. Figure 1 provides a graphic account of the issues included and excluded in the scope of the work. The area of intersection of all three circles, i.e. area 7, represents the scope of the meeting.
It should be noted that certain illnesses in infants caused by powdered infant formula may have been excluded, including those for which no microorganism has been reliably identified (area 5 in Figure 1) and those for which the microorganism has not been reliably associated with powdered infant formula (area 4 in Figure 1). In addition, bacteria detected in infant formula were not considered by the meeting if there was no evidence that these bacteria are associated with illness in infants (area 6 in Figure 1).
Young children (i.e. >1 year) consume powdered formula and may experience illness associated with the microbiological contamination of powdered formula. However, these illnesses were not considered by the meeting, as it was believed that the spectrum of illness could be adequately represented by infants under 1 year (and subpopulations of infants <1 year) and these same groups were considered to be the populations most at risk.
(Figure 1 available at ftp://ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf)
Figure 1. Graphic representation of the issues considered in defining the scope of the meeting.
1. Cases of illness in infants
2. Consumption of powdered infant formula
3. Identified pathogens
4. Illness in infants caused by a specific microorganism (powdered infant formula not related to illness)
5. Illness in infants associated with consumption of powdered infant formula (microorganism unknown)
6. Specific microorganisms in powdered infant formula but not causing illness
7. Specific microorganisms in powdered infant formula that resulted in cases of illness in infants = scope
2 Available at: ftp://ftp.fao.org/codex/standard/en/CXS_156e.pdf.
3 Available at: ftp://ftp.fao.org/codex/alinorm04/al04_26e.pdf.
4 Available at: ftp://ftp.fao.org/codex/standard/en/CXS_180e.pdf.
Posted from: ftp://ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf
The meeting considered illnesses in infants (i.e. children <1 year) linked to microorganisms (or their toxins) associated with powdered infant formula either epidemiologically or microbiologically.
2.2.1 Identification of products considered
The products under consideration were those in powdered form, specially manufactured and presented to be used by infants, either as a breastmilk substitute after preparation with water, or to modify prepared breastmilk substitutes or fortify human milk. Included products are, therefore, infant formula (as defined in Codex Stan 72-19811), follow-up formula (as defined in Codex Stan 156-19872), formula for special medical purposes intended for infants (as defined in Appendix V of Codex Alinorm 04/27/263), formulas for special medical purposes for the partial feeding of infants (covered by Codex Stan 180-19914) and human milk fortifiers.
Breastmilk substitutes are needed when infants do not have access to breastmilk for various reasons. Commercial infant formulas are usually used as breastmilk substitutes for normal healthy infants under 6 months, and are formulated industrially in accordance with the appropriate Codex standards. Formulas for special medical purposes intended for infants are breastmilk substitutes for sick infants (patients). Although other milks may be used after 6 months, follow-up formulas can substitute for breastmilk in the older infant who also eats complementary food. These three types of formula only need the addition of water to be ready for consumption and, therefore, are often also available in liquid, ready-to-feed form. However, formulas for special medical purposes for the partial feeding of infants require the addition of measured amounts of other foods, quite often also in powdered form, to satisfy the special nutritional needs of the individual infant patient.
Human milk fortifiers are powdered supplements which can be added to expressed human milk when the nutritional requirements of low-birth-weight infants (<2 500 g) and especially very lowbirth-weight infants (<1 500 kg) are not satisfied by human milk alone. This can include thickening agents, such as starches or simple cereals which are specially manufactured for the purpose of increasing the consistency of the liquid food, and can be added to formula intended for infants with gastro-oesophageal reflux.
Throughout the following report, the term “powdered infant formula” includes all of the products mentioned above, but excludes cereals.
2.2.2 Case definition
The meeting considered illnesses in infants (i.e. children <1 year) due to microorganisms (or their toxins) associated with powdered infant formula consumption either epidemiologically or microbiologically. Figure 1 provides a graphic account of the issues included and excluded in the scope of the work. The area of intersection of all three circles, i.e. area 7, represents the scope of the meeting.
It should be noted that certain illnesses in infants caused by powdered infant formula may have been excluded, including those for which no microorganism has been reliably identified (area 5 in Figure 1) and those for which the microorganism has not been reliably associated with powdered infant formula (area 4 in Figure 1). In addition, bacteria detected in infant formula were not considered by the meeting if there was no evidence that these bacteria are associated with illness in infants (area 6 in Figure 1).
Young children (i.e. >1 year) consume powdered formula and may experience illness associated with the microbiological contamination of powdered formula. However, these illnesses were not considered by the meeting, as it was believed that the spectrum of illness could be adequately represented by infants under 1 year (and subpopulations of infants <1 year) and these same groups were considered to be the populations most at risk.
(Figure 1 available at ftp://ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf)
Figure 1. Graphic representation of the issues considered in defining the scope of the meeting.
1. Cases of illness in infants
2. Consumption of powdered infant formula
3. Identified pathogens
4. Illness in infants caused by a specific microorganism (powdered infant formula not related to illness)
5. Illness in infants associated with consumption of powdered infant formula (microorganism unknown)
6. Specific microorganisms in powdered infant formula but not causing illness
7. Specific microorganisms in powdered infant formula that resulted in cases of illness in infants = scope
2 Available at: ftp://ftp.fao.org/codex/standard/en/CXS_156e.pdf.
3 Available at: ftp://ftp.fao.org/codex/alinorm04/al04_26e.pdf.
4 Available at: ftp://ftp.fao.org/codex/standard/en/CXS_180e.pdf.
Posted from: ftp://ftp.fao.org/docrep/fao/007/y5502e/y5502e00.pdf