Revised guidance on powdered infant formula
Friday 01 December 2006.
The Department of Health and the Food Standards Agency have issued revised guidance for health professionals on the preparation and storage of powdered infant formula milk.
Health professionals should update their advice to people preparing infant formula milk at home and in other care settings, including nurseries and child minders.
Powdered infant and follow-on formulas are not sterile, which means they can contain harmful bacteria. So it is important to take care when preparing and storing formula, to reduce the risk of babies becoming ill. Bacteria will be killed if formula is made up following the advice, which includes using water that is at least 70°C.
( 70 c This temperature will NOT kill MAP )
The main change to the guidance is to include options on what people can do if they are going out, or want to take a feed to a nursery or childminder and are not able to follow best practice. In these situations, people should take hot water ( boiled ) in a vacuum flask to make up a feed when needed. If this is not possible, they should prepare the feed and cool it in the fridge before transporting it in a cool bag and using it within four hours.
" Please Boil All Waters Used In The Preparation Of Baby Milk Formulas, 70 c / 72 c degrees -These Pasteurisation Temperatures WILL NOT KILL MAP...........................
Tim Page @ TCCCUK."
The Science Behind The Story.
The Department of Health and Food Standards Agency originally issued advice on preparing infant formula in November 2005 following an opinion from the European Food Safety Authority’s Scientific Panel on Biological Hazards on the microbiological risks of infant and follow-on formulas. This advice was revised in February 2006 to mention liquid ready-to-feed formula.
Opinion adopted by the BIOHAZ Panel related to the microbiological risks in infant formulae and follow-on formulae*.
Last updated: 17 March 2006
Publication Date: 17 November 2004 .
Summary of the Opinion.
Salmonella and Enterobacter sakazakii are the microorganisms of greatest concern in infant formula. This Opinion concentrates on infant formula and E. sakazakii, rather than Salmonella, for which much information is available elsewhere (e.g. SCVPH Opinion on Salmonellae in Foodstuffs, adopted 14-15 April 2003).
Contamination of powdered infant formula with E. sakazakii and with salmonellae has been the cause of infection in infants, sometimes with serious sequelae or death. Although E. sakazakii has caused illness in all age groups of neonates (up to ca 4-6 weeks of age), pre-term or low birth weight infants and those immunocompromised are at greatest risk. There are no experimental or epidemiological studies on the specific dose/response relationships of E. sakazakii infections in humans. As is the case for other microorganisms, the dose/response relationship may vary according to the characteristics and physiological state of the organism, the state of the host and the food matrix. The widespread distribution of E. sakazakii suggests that consumption of low numbers in infant formula and follow-on formula by healthy infants and children does not lead to illness.
Salmonella and E. sakazakii do not survive the pasteurization processes used during manufacture but recontamination of the powdered infant formula during handling and filling processes may occur. E. sakazakii, due to its ubiquitous character, seems to be more difficult to control in the processing environment than Salmonella. Control measures at the manufacturing process for E. sakazakii include: the microbiological quality of ingredients; reducing the level of Enterobacteriaceae in the production environment; and avoiding recontamination of the final product. The presence of E. sakazakii in the processing environment can be minimized by strict hygiene measures including control of movement of personnel; the separation of wet and dry processes; and avoiding condensation and water ingress in dry areas.
Environmental microbiological testing in the processing area is necessary to monitor the effectiveness of the hygiene measures. Testing the processing environment for Enterobacteriaceae is the most effective method of monitoring the efficacy of processing and hygiene since Enterobacteriaceae are more often present than Salmonella and E. sakazakii.
Salmonella and E. sakazakii can grow in the reconstituted product if stored above 5 ºC for a sufficient time and multiply very rapidly at room temperatures. Good Hygienic Practices at reconstitution, storage and feeding are essential to avoid recontamination and/or multiplication of the pathogens in the reconstituted formula. The most effective control measure to minimise risks of Salmonella and E. sakazakii in high-risk infants (pre-term, underweight, immunocompromised), would be to use commercial sterile liquid formula.
It is recommended that a Performance Objective (PO) for powdered infant formula and follow-on formula, aiming at very low levels of Salmonella and E. sakazakii (e.g. absence in 1, 10 or 100 kg) is introduced and that verification of compliance with the PO is confirmed by testing for Enterobacteriaceae in the environment and in the product. In addition it is recommended that guidelines for preparation, handling, storage and use of infant formula in the home and in hospitals are developed.
*For citation purposes: Opinion of the Scientific Panel on Biological Hazards on a request from the Commission related to the microbiological risks in infant formulae and follow-on formulae. The EFSA Journal (2004)113, 1-34