Thanks to Evi for the report from the Codex meeting. It seems that they  
still refuse to get it right about warning parents of the possible intrinsic  
contamination of powdered infant formula with Enterobacter sakazakii (and  other 
bacteria).
 
"There was also controversy regarding the need to alert parents   through 
warnings on labels to the presence of intrinsic contamination of  Enterobacter 
Sakazakii and other  disease-causing pathogens in powdered  infant formula.  WHO 
informed the meeting of the serious risks to health  and the need to make up 
feeds with  previously boiled water.  The  industry – eager to promote not 
only  formula but also bottled water   insisted that it a reference to ‘safe water
’ was sufficient.  Finally it  was agreed to include a reference to boiled 
water, but not agreed to include a  warning of intrinsic contamination."
 
During the Code monitoring NABA just finished conducting in the US, we  
noticed that both Ross and Mead Johnson have changed the preparation  instructions 
on their labels of powdered infant formula. Both warn that powdered  formula 
is not sterile and should not be fed to premature infants or infants who  might 
have immune problems, in keeping with the FDA warning letter sent to  
neonatal intensive care nurseries. Most other brands of formula do not carry  this 
statement. None of the labels contain the correct preparation instructions  
which call for water to be brought to a rolling boil, cooled to 70-90C or  
158-194F and added to the formula, then cooled to body temperature before  feeding to 
the baby. This is not to make the water bacteriologically safe  but to 
reconstitute the formula at a high enough temperature to kill the E  sakazakii 
within the formula without denaturing or altering its  nutritional composition. All 
labels should warn not to feed the powdered  version of formula to any infant 
under 4 weeks of age (Drudy 2006). 
 
 
Drudy D,  Mullane NR, Quinn T, et al. Enterobacter sakazakii: an emerging 
pathogen in  powdered infant formula. Clin Infect Dis 2006;  42:996-1002 
Marsha  Walker, RN, IBCLC 
Weston,  MA


In a message dated 11/3/2006 1:03:40 P.M. Eastern Standard Time,  
[log in to unmask] writes:

There  was also controversy regarding the need to alert parents  through  
warnings on labels to the presence of intrinsic contamination of Enterobacter  
Sakazakii and other  disease-causing pathogens in powdered infant  formula.  WHO 
informed the meeting of the serious risks to health and the  need to make up 
feeds with  previously boiled water.  The industry –  eager to promote not 
only  formula but also bottled water  insisted  that it a reference to ‘safe water
’ was sufficient.  Finally it was  agreed to include a reference to boiled 
water, but not agreed to include a  warning of intrinsic contamination. 





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