Fatal case of bacterial infection in formula-fed baby in the USA increases urgency of circulating correct information about harmful bacteria
In June 2016, a baby less than one month old died from meningitis and sepsis in Michigan, USA. These invasive infections were caused by the rare but dangerous bacteria called Enterobacter sakazakii. As the baby’s parents said when describing the effects of the Enterobacter infection: « We have never heard of this infection, ever … Nobody has. » .
Confusion reigns : What is Enterobacter sakazakii and why is it such a serious problem in powdered formula?
Enterobacter sakazakii has had a confusing name change to Cronobacter sakazakii , but there is no confusion about the severity of infections it can cause in babies fed powdered formulas. The World Health Organization and the Food and Agriculture Organization of the United Nations have both recognized the problem and in 2007 issued Guidelines on preparation, storage and handling of powdered infant formula. Insert hyperlink here:
The need for safer methods of powdered formula preparation is due to the immense capacity for survival and resistance of these bacteria, and to their potential for causing life-threatening infections. These are summarised here
Vital importance of testing for harmful bacteria in powdered formulas and developing methods to inactivate them
Like all industrially processed foods, powdered formulas are not sterile products because there is no final sterilization procedure. Powdered formulas may become contaminated at factory level by bacteria such as Cronobacter species, particularly Cronobacter (formerly Enterobacter) sakazakii, and species of Salmonella introduced during manufacturing processes. Once the formula powder is mixed with water to make up the feed, even tiny amounts of these bacteria can multiply and rapidly form colonies in the warm milk and can cause severe invasive infections.
It is imperative that packages of powdered formulas should be tested regularly and reliably for the presence of Enterobacter sakazakii. But there is also confusion about testing : the Michigan baby was fed Enfamil Gentlease powdered formula but the manufacturers, Mead Johnson, assert that there were no bacteria in the can of formula that was tested.
The article cited above at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489094/ explains that Enterobacter sakazakii is difficult to detect in powdered formula because it forms clumps and is not uniformly distributed throughout the batches « Cronobacter species tend to be non-homogeneously distributed …This property limits the utility of random sampling of powdered infant formula batches for quality assurance and public health surveillance. » See this article for discussion of the different measures for testing : “ How to tackle the problems of safety and quality of formula: examining effective measures ”
Research alerts on new methods for rapid detection or inactivation of harmful bacteria
To tackle the difficulties of detection, researchers in many countries are working to identify improved methods, for example in South Korea.
Other researchers are developing combined treatments to kill these harmful bacteria. But because the bacteria are so resistant, a combination of three treatments is needed to prevent the bacteria from multiplying and causing infection. However, it can be asked how the average parent or care-giver could possibly combine these complex treatments, and thus whether they are intended for use by manufacturers, if indeed they are proven to be effective.
Urgency of informing about methods for safer preparation
All the above cited articles provide robust evidence that it is more important than ever to address the problem of contamination of powdered formulas by Enterobacter sakazakii. It is not only formula-fed premature or immuno-compromised infants and newborns who can be at risk but also infants up to one year and older babies. See WHO/FAO Enterobacter sakazakii in powdered follow-up formulae: Meeting Report:
In 2016 the US CDC therefore issued a renewed alert : See 2016 alert by the US Centers for Disease Control and Prevention on the risks of harmful bacteria in formulas:
It is significant that, also in 2016, researchers in Italy published research on precautions to be taken to protect infants fed powdered formulas, with the rationale « Powdered infant formulas are usually not sterile and may frequently be contaminated by several bacteria strains. « They note « Contamination of powdered milk cans has been reported to range from 6.6% in Brazil to 29 % in China. » They therefore discuss the advice to parents, care-givers and health professionals to prevent foodborne infectious diseases when preparing and storing formula.
First and foremost, parents, care-givers and health professionals must be fully informed that powdered formula is not a sterile product and may contain harmful bacteria. Therefore, extra precautions must be taken to prepare, store and handle powdered formula to avoid infections that may have serious consequences ;
Education to raise awareness of the risks of formula feeding, especially powdered formulas, must be increased to raise awareness and explain the reasons why it is vital that parents, care-givers and health professionals follow the WHO Guidelines : http://www.who.int/foodsafety/publications/powdered-infant-formula/en/
Manufacturers bear the responsibility for marketing a safe product and must therefore implement « effective environmental monitoring programs, good manufacturing practice guidelines, and procedures and hazard analysis and critical control point systems to control the risk of microbiological contamination along the entire production chain. » (see Cronobacter Species Contamination of Powdered Infant Formula and the Implications for Neonatal Health )
Governments should ensure that manufacturers place clear and visible warning notices on product packaging to alert product users to potential risks ;
Surveillance of Enterobacter sakazakii related illnesses must be intensified. As FAO and WHO note : « Globally, there appear to be very few surveillance data for E. sakazakii (Cronobacter spp.)-related illnesses. Although a couple of passive surveillance systems exist, no active surveillance system for E. sakazakii (Cronobacter spp.) disease has been identified. « See WHO/FAO Enterobacter sakazakii (Cronobacter spp.) in powdered follow-up formulae: Meeting Report, page xi :
Research to develop more effective methods of testing for harmful bacteria in powdered formula should be prioritized as well as methods to inactivate any bacteria present in these products ;
Breastfeeding provides anti-infective agents and boosts the infant’s immature immune system. Breastfeeding must be protected, promoted and supported by governments, health care services, employers and society as a whole, so that mothers are able to breastfeed optimally.
 Enterobacter sakazakii was redefined in 2008 as a species in a new genus named Cronobacter. This means that it is also referred to as Cronobacter sakazakii, or as Cronobacter species (spp.) Cronos or Cronus was the name of the Greek Titan who devoured his own children: https://en.wikipedia.org/wiki/Cronus