Abbott recalls the product involved, how does the pathogenic bacteria enter the milk powder?

Abbott infant formula sold in a large supermarket in Beijing on February 21, 2022. (Visual China/Photo)

On February 21, 2022, China's General Administration of Customs issued an announcement reminding consumers to "temporarily do not purchase through any channels" and "immediately suspend" the consumption of related infant and toddler products of Abbott.

A week earlier, on Feb. 18, the U.S. Food and Drug Administration (FDA) issued a statement saying it was investigating complaints of four infants infected with Cronobacteria and Salmonella incidents. The four babies reportedly consumed infant formula (PIF) produced by Abbott at Sturges, Michigan, under brands including Similac, Alimentum and EleCare, the FDA said.

Cronobacterium, also known as Enterobacter sakazaki, has few cases of infection with Cronobacterium in infants aged 0 to 12 months, but it has attracted much attention because it can endanger the lives of infants. According to the U.S. Centers for Disease Control and Prevention's October 2009 Weekly Morbidity and Mortality Report, Cronobacterium was detected in open cans of milk powder consumed by two newborns infected with the disease in New Mexico. A 2020 article in the American Journal of Novel Infectious Diseases surveyed 71 newborns infected with Cronobacteria, and 44% of the bacteria were isolated from the environment or food, and 30% found milk powder contamination, and the article concluded that "contaminated open-cap infant formula is the most common vector of transmission."

Abbott China replied to the Southern Weekend reporter that among the products sold by Abbott China in the Chinese mainland, there is only one product - Xikang Baby Tim Baby Nutritional Supplements affected by this incident and has started the recall work, such as holding the above date of Xikang Baby Tim, please do not eat it for the time being, you can call the official customer service hotline to consult the return.

Xikang Baby Tim Baby Supplement is a nutritional supplement for premature, low birth weight babies, with a specification of 50 pieces a box. On the afternoon of February 21, Southern Weekend reporters searched for this product on e-commerce platforms such as JD.com and Tmall, showing that they had been removed from the shelves.

The bacteria have not been detected in Abbott products

"All four cases related to the complaint have been hospitalized and one of them may have died from Cronobacterium." The U.S. Food and Drug Administration (FDA) said in a statement that Abbott found Cronobacterium in non-product contact areas at the Sturgis plant.

The revised Code of International Codex on Hygiene Practices for Infant and Young Children's Food, published in 2008 by the Food and Agriculture Organization of the United Nations and the World Health Organization, strictly regulates the content of Cronobacterium in formula milk powder: 30 samples of 10 grams per 10 grams must not be detected. The current standards in the mainland are similar, according to the national standard "National Standard for Food Safety Infant Formula", Cronobacterium shall not be detected in infant formula, and the method is to sample 3 samples of 100g each in the same batch of products, and the requirements must not be detected.

But at present, there is no evidence that the three infant formulas recalled by Abbott contain Cronobacterium.

Abbott replied to the Southern Weekend reporter that at present, in any of Abbott's products and retained samples, it has not been detected to contain the above two microorganisms, and the relevant investigation and testing are still in progress. All Abbott infant formula must be tested for Cronobacterium, Salmonella Newport and other pathogens and must be negative before leaving the factory to ensure product safety.

Although only one product is sold in China, consumers can still buy the remaining milk powders produced at the Sturgis plant in Michigan through haitao, daigou and other means.

Abbott's official customer service told Southern Weekend reporters that whether it is milk powder sold domestically, as long as it meets the three conditions in the recall requirements, it can take photos of the product and the production date, and then send it to the "Abbott Mother Club" WeChat public account, and there will be follow-up contact with the staff. "If it is the US and Canadian version of the proposal, first ask the purchase channel, but considering that it is inconvenient abroad, you can also contact the domestic customer service."

Abbott staff said that recently mothers are more nervous, customer service consultation is large, wiring waiting time is much longer.

In addition to consumers contacting Abbott on their own, Abbott also launched a preventive voluntary recall at the same time, immediately freezing all inventory of Xikang Baby's warehouse in Abbott China. The Company expects the recall to be fully completed within 30 working days, i.e., by April 1, 2022.

Deadly Cronobacterium

Cronobacterium is already a "regular" in infant milk powder.

According to a survey published on the website of the Chinese Center for Disease Control and Prevention, from 2006 to 2013, Beijing, Shenzhen, Guangzhou, Chengdu and other places conducted pollution surveys on Cronobacteria in infant formula milk powder, and its pollution rate was between 1.4% and 7.2%, which shows that infant formula milk powder sold everywhere has different degrees of pollution.

Cronobacterium is most dangerous for babies up to two months of age. Zhong Kai, director of the Science and Technology Food and Health Information Exchange Center, told Southern Weekend that the sensitive population of this bacterium is a special group of preterm babies and immunodeficient babies.

Once infected, it is unimaginable, it can cause infantile bacteremia or meningitis, and the fatality rate is as high as 40% to 80%.

In 2011, there were three cases of infection with Cronobacterium in infants and young children in the United States, one of which died. Since the bacterium was first reported in the United Kingdom in 1961, there have been reports of neonatal infection with Cronobacterium in the United States, Greece, the Netherlands, Iceland, Canada, Belgium and other countries. According to 2015 data from the National Health Commission, since 1958, a total of 120 cases of infections caused by Cronobacteria have been reported worldwide.

In 2004, after the "big head baby" incident in Fuyang, Anhui Province, the Chinese Center for Disease Control and Prevention detected 11 positive samples of Cronobacterium from 87 samples of inferior milk powder in Fuyang, with a positive pollution rate of 12.6%. This is the first time in China that a Cronobacter strain has been isolated from infant formula.

However, the incidence of Cronobacterium infection is not high. According to data from the United States in 2006 by the World Health Organization, there is about one case per 100,000 babies.

"Cronobacterium is a widely distributed bacterium in nature, and its vitality is relatively tenacious." Zhong Kai said. Raw material pollution and factory environmental pollution are the two major reasons for the containment of Cronobacterium in infant milk powder, pasteurization can generally kill The Cronobacterium in raw materials, but in the processing process of milk powder, it is also necessary to add ingredients that cannot be heated after pasteurization, which is easy to bring secondary pollution of Cronobacterium. "In the contact area of non-milk powder in the factory found Cronobacterium, the probability of contaminating milk powder is relatively low, and the production enterprise mainly implements good manufacturing practices in production, and at the same time does product inspection and verification."

Due to the widespread presence of Cronobacterium in the natural environment, the possibility of pathogens entering the milk powder preparation process cannot be ruled out. In its Guiding Principles for the Safe Preparation, Storage and Handling of Infant Formula issued by the World Health Organization in 2007, the World Health Organization states that, in general, sterile liquid infant formula is recommended for infants most at risk of infection. Where there is no liquid infant formula, the use of water of not less than 70 °C to prepare infant formula can significantly reduce the risk.

Zhong Kai also suggested that parents need to keep the milk powder storage and flushing area and utensils hygienic and clean, "the probability of contamination of pathogenic bacteria in the home is much greater than the probability of milk powder contamination."

Southern Weekend reporter Song Bingchen Southern Weekend intern Fu Wenxin