other Microorganisms in Powdered Infant Formula - Meeting Report
MICROBIOLOGICAL RISK ASSESSMENT SERIES 6

MICROBIOLOGICAL RISK ASSESSMENT SERIES 6


Enterobacter sakazakii
and other microorganisms
in powdered infant formula

MEETING REPORT

WORLD HEALTH ORGANIZATION
FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS
2004
 
Table of Contents

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Cover design:

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and the World Health Organization

Cover picture:
© Dennis Kunkel Microscopy, Inc.

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WHO Library Cataloguing-in-Publication Data

FAO/WHO Expert Meeting on Enterobacter sakazakii and Other Microorganisms in Powdered Infant Formula.
Enterobacter sakazakii and other microorganisms in powdered infant formula: meeting report.

(Microbiological Risk Assessment Series No. 6)
1 Enterobacter sakazakii - pathogenicity 2. Enterobacteriaceae - pathogenicity
3. Infant formula 4. Infant food - microbiology 5. Food contamination 6. Risk assessment
I. Title II. Series

ISBN 92 4 156262 5 (WHO) (LC/NLM classification: QW 138.5.E5)
ISBN 92 5 105164 X (FAO)
ISSN 1726-5274

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© FAO/WHO 2004


CONTENTS

Acknowledgments

Contributors

Foreword

Abbreviations

EXECUTIVE SUMMARY

1. INTRODUCTION

1.1 Background and objectives

2. EPIDEMIOLOGYAND PUBLIC HEALTH ASPECTS

2.1 Organisms of concern

2.1.1 Enterobacter sakazakii
2.1.2 Other relevant organisms of concern

2.2 Scope/case description

2.2.1 Identification of products considered
2.2.2 Case definition

3. HAZARD IDENTIFICATION

3.1 Category “A” organisms - Clear evidence of causality
3.2 Category “B” organisms - Causality plausible, but not yet demonstrated
3.3 Category “C” organisms - Causality less plausible or not yet demonstrated

4. HAZARD CHARACTERIZATION

4.1 Populations at risk
4.2 Dose-response

5. EXPOSURE ASSESSMENT

5.1 Exposure to infant formula/breastfeeding rates
5.2 Developing countries
5.3 Microbialaspects of manufacture and use of powdered infant formula

5.3.1 Manufacture
5.3.2 Control of ingredient quality
5.3.3 Processing
5.3.4 Post-processing and packaging
5.3.5 Hazard Analysis Critical Control Point (HACCP) in the manufacture of powdered infant formula
5.3.6 Monitoring
5.3.7 Microbiological specifications
5.3.8 Reconstitution and use
5.3.9 Labelling and preparation
5.3.10 Storage and handling of prepared formula
5.3.11 Education

6. RISK CHARACTERIZATION

6.1 Approaches and outputs
6.2 Evaluation of potential risk reduction options for formula-fed infants

7. RISK REDUCTION STRATEGIES FOR FORMULA-FED INFANTS

7.1 Reducing the concentration/prevalence of intrinsic contamination of powdered infant formula by E. sakazakii
7.2 Reducing the level of contamination through heating reconstituted powdered infant formula prior to use
7.3 Minimizing the chance of contamination of reconstituted formula during preparation
7.4 Minimizing the growth of E. sakazakii following reconstitution prior to consumption

8. KEY FINDINGS AND RECOMMENDATIONS

8.1 Key findings
8.2 Recommendations

8.2.1 To member countries, NGOs, FAO and WHO
8.2.2 To Codex (e.g. CCFH)
8.2.3 To member countries, FAO, WHO, Codex and NGOs
8.2.4 To FAO, WHO and the scientific community

REFERENCES

APPENDIX A LIST OF BACKGROUND PAPERS

APPENDIX B DATA RECEIVED IN RESPONSE TO THE FAO/WHO CALL FOR DATA

APPENDIX C RISK ASSESSMENT

BACK COVER