International Cronobacter Conference, Dublin 2009

In one of the most hospitable cities in the world, Dublin, Ireland, a two day symposium on Cronobacter concluded Friday with much excitement and optimism regarding the progress made in identifying and combating the danger posed by the dangerous bacteria, Cronobacter.

The UCD Centre for Food Safety co-hosted the conference in collaboration with the Food & Agriculture Organization (FAO) of the United Nations, the World Health Organization (WHO), the Irish Society for Microbiology (SGM), Teagsac and Science Foundation Ireland (SFI). At this conference researchers with prestigious academic credentials reported the results of their scientific research projects regarding Cronobacter to the audience. Government regulators enlightened the attendees on food safety efforts being undertaken and experts from the food industry reported on their efforts to eradicate Cronobacter from powdered infant formula at their manufacturing facilities. Most of the 200 in attendance likewise had similar backgrounds and came from around the world.

Ireland’s Minister of Agriculture, Mr. Brendan Smith, kicked off the event proudly proclaiming that Ireland exported 15% of the world’s powdered infant formula. Citing food safety as a paramount concern, he informed us that Ireland had invested over 100,000,000 Euros to ensure the safety of food products. He exclaimed “Your health is your wealth,” and the conferenced commenced.

Perhaps the most important fact about this conference is that it occurred. There have been sporadic reports from around the world since 1958 about the association of powdered infant formula with Cronobacter infection in neonates and premature infants. Only in the last several years has the number of reports increased to the point where it is taken more seriously sparking efforts by government regulators, food industry experts and academia to seek to better understand this dangerous bug and figure out how to eradicate it from powdered infant formula.

The University College of Dublin (UCD), our gracious host, advanced numerous papers at the conference. For their efforts in spearheading this initiative and in recognition of their dedication to ethics and professionalism in their academic presentations, Dr. Peter Ben Embarek from the WHO nominated them for the prestigious title of a “Collaborating University on Enterobacter Sakazakii.” It was a proud moment for Prof. Seamus Fanning, Dr. Carol Iverson, Mr. Brendan Healy, Dr. Cliodhna Foley-Nolan, Dr. Lorraine Kyne, Prof. Francis Butler, Assoc. Prof. Patrick wall, all of the UCD, and Dr. Geraldine Duffy (Teagsac) and their helpful staff.

World renowned speakers share their knowledge about the dangers of Powdered Infant Formula (PIF) with 200 attendees.

The keynote speaker was Professor Jim Farmer, Director USPHS (retired) USA. Undoubtedly one of the most knowledgeable on the subject, he gave a history of Cronobacter, commencing in 1958 with the first known case of infection in an infant with Enterobacter Sakazakii, which occurred in St. Albins, England. He briefly advised of other reported cases from Denmark, and several cities in the USA, including Indianapolis, Memphis, Macon, and most recently, from the state of New Mexico. As for new challenges, he suggested retesting all E-sak strains, conducting more research on how widely distributed Cronobacter is in the environment and continuing efforts to kill the pathogen before PIF (powdered infant formula) is ingested. His presentation aptly described the history of the bacteria and its danger to babies who consume PIF.

A good part of the conference was devoted to better identification of the bug and progress that is being made in isolating it. Suffice it to say that the problem is so serious that a whole new genus, Cronobacter, has been coined more accurately identifying this pathogen. New and more accurate isolation methods have been discovered further assisting the researchers in their endeavor to get to the root of the problem.

Several speakers from around the world described their experience with the bug in the countries. Dr. Saki from the University of Malaysia stated that it was important to take more care in the preparations of PIF. She noted that Cronobacter had been found in PIF in her country and that proper preparation and refrigeration of PIF would reduce the risk of infection. Prof. Kunho Seo from Konkuk University in Seoul, Korea stated that no cases of infected infants had been reported in this country. He did say that Cronobacter had been found in samples of PIF and when this knowledge became public, sales of PIF plummeted. The government adopted a “zero tolerance” policy and apparently sales have regained their former status. Dr. Norma Binztein from the Malbran Institute in Argentina recommended including Cronobacter in international data networks and admonished all associated with Cronobacter to share information more readily.

Other speakers like Geraldine Duffy presented research that showed Cronobacter was found in the environment associated with PIF. Still other speakers noted Cronobacter was found in the mouths of the elderly, usually in a hospital or nursing home setting. It was suggested that this could be due to the fact that the institutionalized elderly are often fed mild products supplemented with powdered products. Prof. Forsythe from Trent University in the UK showed evidence of the bug originating in herbs and spices. Dr. Angelika Lehner from the University of Zurich, found Cronobacter in the roots of tomato plants.

Two food industry representatives, Dr. Niall Mullane from Danone Baby, Ireland, and Dr. Jean-Louis Cordier from Nestle Nutrition, Switzerland, presented information concerning their companies’ efforts to eradicate Cronobacter from the manufacturing process. Dr. Mullane described how successful they were in reducing Cronobacter in their plants. In particular, they found that keeping moisture away from PIF production was of paramount importance. He noted by zoning the PIF production area, eradication of all moisture, vacuum cleaning everything instead of wet cleaning, and better staff hygiene, had reduced the amount of Cronobacter to zero in the platform area and decreased Cronobacter in the finished product. While these efforts are admirable, and apparently above and beyond government mandated procedures, the fact remains that the finished product, i.e., PIF, is produced and distributed by these companies to be consumed by infants with the companies’ full knowledge of the presence of Cronobacter in some of the product.

PIF is still distributed by these two companies and others with their full knowledge of the devastating effects on neonates and immune compromised babies. It was acknowledged by almost all at this conference that there is a strong association between PIF, immune compromised infants and Cronobacter infection usually resulting in catastrophic injury or death. And as just mentioned above, the food companies, try as they may, simply cannot eradicate Cronobacter from the manufacturing process. Well, then what is to be done?

The danger of feeding powdered infant formula to neonates and premature infants remains. What is to be done?

It is imperative that all in attendance at this conference, the food industry reps, the government regulators, and members of academia with knowledge on this subject, make every effort to properly, timely and fully inform expectant mothers of the risk associated with PIF. Dr. Anna Bowen of the CDC acknowledged that while there have been advances in the identification, isolation, detection of Cronobacter and in the manufacturing process, the fact remains that non-sterile, Cronobacter infested PIF is still being marketed and consumed by unknowing infants the world over. Dr. Bowen advised, as she had previously in a paper entitled “Invasive Enterobacter sakazakii Disease in Infants” in August 2006, that infant care givers should be advised of the risks associated with nonsterile powdered infant formula! Dr. Peter Ben Embark from the World Health Organization, in closing the conference, also noted the importance of disseminating the research exhibited at this conference and the need to “raise the awareness of public health workers.”

The powdered infant formula industry is a very lucrative industry in Ireland, Switzerland, and the USA and provides many babies much needed nutrition. Unfortunately, PIF presents a well-documented danger to unsuspected infants the world over. Since to date it is impossible to eradicate Cronobacter from the manufacturing process, it should be the goal of this conference to inform every expectant mother of the risks associated with PIF. No premature infant, neonate, nor immune compromised baby should consume this dangerous product. Formula companies the world over should be more proactive in educating the public in general and healthcare providers in particular of this serious threat to infants.

Contact us or call us at (800) 948-6000 if you have additional questions concerning Cronobacter or Enterobacter Sakazakii.