Cronobacter (formerly known as Enterobacter sakazakii) is a type of bacteria that is sometimes found in food.

What is Cronobacter?

Cronobacter is a type of bacteria found in the environment. These bacteria are not commonly linked to human illness, but in rare cases they can cause serious or fatal infections. Cronobacter can cause rare bloodstream and central nervous system infections and has been associated with severe intestinal infection (necrotizing enterocolitis) and blood poisoning (sepsis), especially in newborns.

How do people get sick?

While the natural source for Cronobacter remains unknown, it has been found in a number of foods, including powdered infant formula.

Powdered infant formulas (PIF) are not sterile products. Cronobacter is able to survive in PIF creating a risk of infection when the powdered infant formula is mixed with water and kept at room temperature or higher for long periods of time. Cronobacter grows very quickly at room temperature.

Infant formula can become contaminated with Cronobacter:

  • through the raw materials used for producing the PIF
  • through contamination of the formula as it is being mixed by the caregiver

Cronobacter can cause illness in vulnerable individuals of all ages, however infants (children less than 1 year old) who are fed reconstituted formula are at higher risk. Those at greatest risk for Cronobacter infection are pre-term and low birth weight infants under two months of age or immuno-compromised infants. Infants of HIV-positive mothers are also at risk because they may specifically require infant formula and may be more susceptible to infection.

Cronobacter may infect the mouths of patients who just had a stroke causing resistance to the antibiotics used to treat pneumonia. Cronobacter has also been found in starch powders that are used to thicken food for stroke patients as well as other food supplements.

What are the symptoms and treatment?

While Cronobacter illness is rare, it can be life-threatening for infants and newborns. Infection with Cronobacter can cause inflammation of the lining of the brain (meningitis), blood poisoning (sepsis), and severe intestinal infection (necrotizing enterocolitis). These infections can be accompanied by developmental delays, seizures and in some cases, death.

Cronobacter illness usually responds to antibiotic treatment, though antibiotic resistance is increasing. Survivors of the illness can experience severe long term complications, including neurological disorders. Adult symptoms and complications are significantly milder.

How do I avoid getting sick?

Cronobacter is killed at temperatures above 60°C (140°F). PIFs are heat-treated during processing, but unlike liquid formula products, they are not subjected to high temperatures for long enough to make the final product commercially sterile.

These tips will help protect you and your family from Cronobacter:

  • Health Canada strongly supports breastfeeding and encourages the promotion of its benefits for infants and young children. Breastfeeding prevents many foodborne illnesses and other health problems.
  • Infant formulas should be chosen based on the nutritional requirements and the medical needs of the individual when a substitute for breast milk is needed.
  • For infants at greatest risk i.e., pre-term, low-birth weight, immunocompromised, commercially produced liquid infant formulas (i.e., both concentrated and ready-to-use) are recommended to be used unless otherwise advised by a physician or dietitian, as these products are sterile.
  • Wash your hands for at least 20 seconds with soap and water before preparing and serving formula, and after going to the bathroom or changing diapers.
  • Follow Health Canada's Recommendations for the Preparation and Handling of Powdered Infant Formula (PIF)
  • For pre-term and low birth-weight infants under two months of age or immunocompromised infants, water used for preparing PIF should be brought to a rolling boil for 2 minutes and cooled down to no less than 70°C (158°F) before adding the powder.
  • For all other infants, previously boiled water that has been cooled to room or body temperature (37°C) can be used to prepare PIF, but it should be served immediately to the infant.
  • Once feeding has begun, the feeding should be done within 2 hours. Any formula remaining after a feeding should be discarded.
  • Do not leave prepared formula at room temperature. Either use it right away or refrigerate. Refrigerated formula should be thrown out after 24 hours.

What does the Government do to protect me?

In Canada, several government organizations work together every day to keep your food safe:

  • Health Canada makes food safety standards and policies to help minimize the risk of foodborne illnesses.
  • The Canadian Food Inspection Agency (CFIA) enforces these policies and standards and carries out inspections to make sure the food industry meets its food safety responsibilities. The CFIA works with Health Canada to make sure that foodborne illness is detected early and warnings go out to the public quickly.
  • The Public Health Agency of Canada studies the incidence and causes of diseases in Canada, conducts outbreak surveillance, and coordinates outbreak response.

The Government of Canada works very hard to protect your health and safety:

  • We are carrying out a five-year Food and Consumer Safety Action Plan, to strengthen and modernize Canada's safety system and make sure you can have confidence in the quality and safety of the food, health and consumer products you buy.
  • We are investing in Canada's food safety system by enhancing prevention, early detection, active surveillance, swift response to emerging food safety threats, and effective communication with Canadians.
  • We support and participate in public awareness campaigns about safe food practices, like the Canadian Partnership for Consumer Food Safety Education's Be Food Safe program, which encourages Canadian consumers to think of food safety at every step of the food handling process, from shopping for groceries to re-heating leftovers.
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