~photo by Mariah McClain~
I found myself browsing the internet, cruising around various papers to think about our standard belief that the only risk of powdered infant formula in developed countries is the risk of unsafe water in reconstituting the powder and/or unsafe hygiene practices in preparation of the formula. We cannot fathom that the product itself might be unsafe, that we might have cases of intrinsic contamination. We have such faith in our industry, in food manufacturing that we can only believe that the caregivers or hospital environment must be at fault, if a baby sickens from enterobacter sakazakii or salmonella. Certainly, that is a real possibility. Parents may fix formula by methods that put their infant at risk for pathogens that sicken or kill their infants. Hospital environments are known for their mix of virulent pathogens. Yet, no one seems to get their heads around the idea that a food product itself could be the vehicle of pathogens.
Salmonella? I didn't realize until I read a paper called, "Powderd Infant Formula as a Source of Salmonella Infection in Infants," by Sarah M. Cahill et al in Clinical Infectious Diseases medical journal 2008 that salmonella is another serious pathogen found in powdered infant formulas.
http://cid.oxfordjournals.org/content/46/2/268.full
There seems to be the same problems regarding this pathogen as enterobacter sakazakii. The low levels of the pathogen make it difficult to detect in powdered infant formula. Vulnerable infants are the most likely to sicken and die. Both pathogens in outbreaks have low levels in the product samples making it difficult to detect. This contamination is sporadic and it is believed that there is an under-reporting of these infections.
The journal article on salmonella in PIF makes the following statement, "In the United States, the incidence of salmonellosis (from all sources) among infants (121.6 laboratory-confirmed infections per 100,000 infants) was ~8 times greater than the incidence among other age groups." and
"In terms of public health, it is worth noting that other pathogenic bacteria also contaminate PIF and may cause disease through consumption of PIF (table1)." and,
"A review of peer-reviewed literature revealed several large recent outbreaks of Salmonella infection among infants that were attributable to contaminated PIF, resulting in diarrhea and, in some infants, bacteremia and meningitis. Such outbreaks occurred even when the consumed PIF appeared to be in compliance with current international standards."
In Kokuritsu Iyakuhin Shokuhin Eisei Kenkyusho Hokoku. 2006;9124):74-9. authors H. Toyofuku et al.
"Experts from two FAO/WHO Expert Consultations, held in 2004 and 2006, concluded that intrinsic contamination of PIF with Enterobacter sakazakii and Salmonella has been a cause of infection and illness in infants, including severe disease which can lead to serious developmental sequelae and death."
In an article in Pediatric Infectious Disease Journal in 2007 entitled, "Two consecutive large outbreaks of Salmonella enterica serotype Agona infections in infants linked to the consumption of powdered infant formula," with authors C. Brouard et al,
"Powdered infant formulas are not sterile products and may contain low levels of Salmonella. Routine microbiologic controls are insufficient to detect a low-grade contamination, which may cause serious illness and outbreaks among infants."
One would suppose that some people might question their whole-hearted faith that the risks of infant formula are for those infants who reside in developing nations. How easy it is to blame a parent for mixing the formula wrong. I once read that even the well-educated (college degrees) measure powdered infant formula wrong, sometimes over scooping the powder and sometimes under scooping it. The consequences can impact an infant's health and well-being.
I think the main tragic thought that I mull over in these early hours of the morning is the statement in the paper from Clinical Infectious Diseases
under Risk Management, "Although the World Health Organization recommends that infants should be exclusively breast-fed for the first 6 months of life to achieve optimal growth, development, and health, there is recognition that this is not always feasible..."
I believe it could be feasible. I have this hope, this faith that we can turn this around. Society must make a 180 degree turn and decide to create birth environments that support breastfeeding. Birth environments that empower women who are the ones giving birth. Birth environments that respect the infant and its need for skin-to-skin contact. Birth environments that give mothers and babies and their families privacy. Greater access for all women to midwifery care and breastfeeding assistance. Mothers need to feel supported and comfortable nursing in public. And society needs to give mother and babies more time together (financial support in the early days so that our future, our children have more human contact with people who are emotionally connected to them). May this New Year bring more thought and action into supporting mothers and babies.
Copyright 2012 Valerie W. McClain
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