E.Sakazakii Meningitis to become a notifiable disease

A potentially fatal form of meningitis in premature babies linked to contaminated milk powder should be made a notifiable disease according to a report released today.

The internationally peer reviewed report into Government agencies' response to infant formula contamination follows the death in July last year of a premature Waikato infant who died of meningitis. The death was caused by Enterobacter sakazakii sourced to powdered infant formula used in providing care for the baby.

Along with any notification of any instances of the disease, the report also recommends each notification be investigated and efforts made to trace and isolate the source of infection.

In 2004 the Ministry and the New Zealand Food Safety Authority advised all neonatal intensive care units against using powdered formula for pre-term babies where an alternative was available and reinforcing good hygiene practices when preparing formula.

The latest report puts under the spotlight the actions of the Ministry of Health, and later the New Zealand Food Safety Authority, following warnings in 2002 by United States based agencies the Centres of Disease Control (CDC) and the Food and Drug Administration (FDA).

The CDC and FDA warned US health care providers of a fatal case of E.sakazakiiwhich had occurred in the US the previous year and recommended against using powdered infant formulas in neonatal intensive care settings unless there was no alternative available. They also made handling recommendations to minimise infection risk when powdered formula had to be used.

However, in New Zealand there had been no reported cases of meningitis from E.sakazakii, the risks of infection were regarded as very small and the product implicated in the death in the US was not available here, and so the US alerts in 2002 were not passed on.

The alerts were emphasised in January 2004 by the World Health Organization (WHO) following an international workshop on the issue. The WHO advice was considered by the Ministry and the New Zealand Food Safety Authority and a local response to the WHO recommendations was being developed.

Unfortunately within a few months of this work being commenced a case of E.sakazakii meningitis occurred in a neonatal intensive care unit in New Zealand.

As soon as the Ministry was notified, the Ministry and the Food Safety Authority issued advice recommending against powdered formula for pre-term babies where an alternative was available and reinforcing good handling practices when the formula was being prepared.

Director of Public Health Dr Mark Jacobs, one of the authors of the report, said the key findings of the report are that the Ministry and Food Safety Authority acted appropriately in August last year and overall the Ministry acted reasonably in 2002 given what was known at the time. However, the report found that the Ministry could have passed on the FDA recommendations in 2002 to hospitals with neonatal intensive care units.

The main recommendations of the report include the Ministry and Authority agreeing clearer roles and accountabilities for food borne illness; formalising communications between the two agencies; identifying a clear risk management pathway within the Ministry for international alerts on food safety and reviewing relevant public health advice and promotional material.

The final recommendation, to make meningitis infection from E.sakazakii a notifiable disease will help provide good information to help assess the effectiveness of these steps.

Dr Jacobs said there is still much we don't know about this disease and both the Ministry and the Food Safety Authority will ensure future international recommendations to further limit risk of infection are considered and implemented here as quickly as possible.

He said it was particularly unfortunate that the process of providing appropriate advice within New Zealand was overtaken before it was completed by the tragic death of a premature baby.

Dr Jacobs said it's hoped that the recommendations from this report, along with steps already taken, should help reduce the risk of similar tragedies in the future.

He said the review also provides a reminder to both health professionals and the public that powdered infant formula is a food and like most foods is not sterile. He says it reinforces the importance of good hygiene when anyone is preparing infant formula to minimise the risk of infection from possible contaminants.

Dr Jacobs said as a good rule of thumb any infant formula should be prepared immediately before use and any prepared formula that is not used should be discarded.