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What is Enterobacter sakazakii ? What diseases can the bacteria cause?

Enterobacter sakazakii is a bacterium belonging to the family Enterobacteriaceae , which contains a number of bacterial species found in the human and animal gut and the environment. The microorganism has been implicated in outbreaks causing meningitis or enteritis, especially in infants.

In the few outbreaks reported 20% to >50% of the infants who contracted the disease died. For survivors, severe lasting complications can result including neurological disorders. The outcome related to adult disease seems to be significantly milder.

Which are the main groups at risk for Enterobacter sakazakii ?

Enterobacter sakazakii has caused disease in all age groups. From the age distribution of reported cases it is deduced that infants (children less than 1 year old) are at particular risk. Among infants those at greatest risk for Enterobacter sakazakii infection are neonates (first 28 days), particularly pre-term infants, low birth weight infants or immunocompromised infants. Infants of HIV-positive mothers are also at risk both because they may specifically require infant formula and may be more susceptible to infection. This, and low birth weight, may be of particular concern for some developing countries, where the proportion of such infants is higher than in developed countries .

Enterobacter sakazakii come from? Does it also exist in the human gut?

The natural habitat of Enterobacter sakazakii is not well understood. The bacterium can be detected in the gut of healthy humans, most probably as an intermittent guest. It can also be found in the gut of animals as well as in the environment.

How does infant formula get contaminated with Enterobacter sakazakii ? Can other foods also be contaminated?

Basically there are three routes by which Enterobacter sakazakii can enter infant formula:

• through the raw material used for producing the formula;
• through contamination of the formula or other dry ingredients after pasteurization; and
• through contamination of the formula as it is being reconstituted by the caregiver just prior to feeding.

Enterobacter sakazakii has been detected in other types of food, but only powdered infant formula has been linked to outbreaks of disease.

Could there be other bacteria in infant formula that could cause problems, or is it only the Enterobacter sakazakii ?

The current world standards do not allow pathogens such as Salmonella , in powdered infant formula.

The current WHO Codex specification for Salmonella is the absence of Salmonella in 60 samples of 25 grams each. These rules are strictly enforced within the EU. However, there have been reported outbreaks associated with Salmonella in powdered infant formula, the causes thereof are not very clear and are probably partly due to re-contamination at home or daycare center.

Is there a risk for Enterobacter sakazakii when breast-feeding ?

In the current state of knowledge, no exclusively breastfed infants have been reported to have Enterobacter sakazakii infections. Based on the available information, in 50-80 % of cases, powdered infant formula is both the vehicle and the source (direct or indirect) of E. sakazakii induced illness.

Is the risk for Enterobacter sakazakii similar in all regions and countries?

There have been reported cases of Enterobacter sakazakii infections due to contaminated infant formula in only a few developed countries. It is likely that there is a significant underreporting of infections in all countries. The absence of reports is probably due to a lack of awareness of the problem rather than an absence of illness. In general, the limitations of current surveillance systems in most countries would add to the explanation for the lack of reported cases. Since infant formula is widely used, the presence of Enterobacter sakazakii in infant formula and its potential effects in infants could well be a significant public health problem in most countries.

Is there a risk for Enterobacter sakazakii infection in day-care centers ?

It is recommended by the WHO that caregivers to infants, particularly those at high risk (children less than 1 year old), should be regularly alerted to the fact that powdered infant formula is not a sterile product. In situations where the mother cannot breastfeed, or chooses not to breastfeed for any reason, caregivers should use, whenever possible and feasible, commercially sterile liquid formula or include a decontamination step in the preparation of powdered infant formula (such as reconstituting with boiling water or heating reconstituted formula) .

A preliminary risk assessment further indicated that reduced holding (time between rehydration of the formula and consumption) and feeding times for the reconstituted formula decrease the risk of infecting infants. A combination of control measures would have the greatest impact on reducing the risk. With current technology it seems not to be possible to produce sterile powdered infant formula. However, recommendations are being made to the industry by for example the WHO on how they can improve the safety of powdered infant formula.

Source: Food-Info.net