FAO/WHO Meeting Warn of Contaminated Infant Formula

People caring for infants at high risk of infection should be warned that powdered infant formula is not a sterile product, a joint Food and Agricultural Organisation (FAO) and World Health Organisation (WHO) meeting has concluded, and recently highlighted in a BMJ news piece¹.

Attended by experts, the joint FAO/WHO workshop on Enterobacter sakazakii and other micro-organisms in powdered infant formula found that intrinsic contamination of powdered infant formula with E sakazakii and Salmonella had caused cases of infection and illness in infants, including severe disease, and could lead to serious developmental sequelae and death.

Neonates (up to 4 weeks of age), particularly those born prematurely, with low birthweight, or immunocompromised babies, were considered to be at greatest risk of E sakazakii infection. Infants of HIV positive mothers were also at risk because they may require infant formula and may be more susceptible to infection. E sakazakii has been implicated in outbreaks causing meningitis or enteritis. In the few outbreaks reported, the death rate among infants who contracted the disease ranged from 20% to over 50%, while some survivors experienced severe lasting complications. The bacterium has been detected in a range of foods, but only powdered infant formula has been linked to outbreaks of disease. Its prevalence is unknown.

The expert meeting recommended that carers, particularly of high risk infants, should be encouraged to use commercially sterile liquid formula or formula that has undergone an effective decontamination procedure, such as using boiling water to reconstitute formula or heating reconstituted formula.

The meeting was called in response to a request made by the Codex Committee on Food Hygiene for scientific advice to be used in the revision of the Recommended International Code of Hygienic Practice for Foods for Infants and Children. On the basis of its findings, the workshop recommended that the code should include microbiological specification for E sakazakii in powdered infant formula.

A summary report of the joint FAO/WHO workshop on E sakazakii and other microorganisms in powdered infant formula is available at http://www.who.int/foodsafety/micro/meetings/feb2004/en/

¹News extra. FAO/WHO meeting warns of contamination of powdered infant formula. BMJ 2004;328:426 (21 February). See online at http://bmj.bmjjournals.com/cgi/content/full/328/7437/4 26-d?etoc