A world perspective on Cronobacter A world perspective on Cronobacter

research and surveillanceresearch and surveillance

1st International Conference on Cronobacter

January 22-23rd 2009

Dublin, Ireland

Peter Karim Ben Embarek

World Health Organization (WHO),

Geneva, Switzerland

Department of Food Safety, Zoonoses & Foodborne Diseases

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Cronobacter: Assessing and managing risks

� Data for Assessments activities

� Data for management activities

� Surveillance.

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NoveltyNovelty productsproducts

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Cronobacter : sudden international concern

2003 Alert from certain countries to the problem.

2004 Scientific assessment of E.sakazakii and other pathogens in PIF.

2004 Codex initiate revision of the Code of Practice for infant formula

2005 World Health Assembly Resolution

2006 FAO/WHO Risk Assessment on E.sakazakii in PIF.

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Cronobacter : International concern (2)

2007 WHO/FAO guidelines on safe preparation, handling & storage of PIF

2007 Codex finalize code of practice, sampling plans and micro criteria.

2007 FAO/WHO web based user friendly risk management tool.

2008 Codex adopt revised Code of Practice and Micro Criteria

2008 FAO/WHO Expert meeting on Cronobacter in follow up formula

2008 Codex develop micro criteria for follow up formula.

2009 1st International scientific conference on Cronobacter, Dublin.

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What was different?What was different?

� Urgency – High mortality in infants

– World Health Assembly requested rapid action

– Risk managers defined needs

– PIF meeting existing standards implicated in cases of illness

� Very specific product

� Product in international trade –

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20032003--2009 Major discoveries2009 Major discoveries

� Detection methods– Development of wide range of methods (traditional and molecular-

based)

� Sources of Cronobacter spp.– PIF linked (milk powder and ingredients issues)

– Environment,…

� Taxonomy – 2008 name change E. sakazakii to Cronobacter spp.– Evolving situation– Cronobacter new genus with several new spp.

� Prevalence and control measures during production– Role of wet environment for the maintenance and spread of in plant

contamination– Role of dry cleaning in reducing prevalence

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Surveillance Surveillance --20092009

� Approx 120 recorded cases of E.sakazakii

(Cronobacter spp.) infections and

colonisations in infants and young children

from some 19 countries.

� Other age groups also affected (e.g. elderly)

� Embryonic and emerging information from

developing countries

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Key factors for successful future research & Key factors for successful future research &

surveillancesurveillance

� Probably first time we have had a risk

assessment identifying data gaps to guide

research.

� Committed industry organizations and

consumer organizations supporting data

collection.

� Critical mass of research groups.

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Research and surveillance needsResearch and surveillance needs

� Data from other parts of the world.

– Some presented here but more needed

– Prevalence data

– Incidence of disease

� Surveillance systems

– No active surveillance systems anywhere in the world

– Need for lab-based systems

– Raising awareness of public health workers

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Research and surveillance needs (2)Research and surveillance needs (2)

� Epidemiology.

– Different patterns of disease (severity)

– Differences between age groups

– Incidence/under-reporting

– Exposure of young children (6 month >)

– Role/impact of immunodeficiency in infants and young children (malnutrition, underweight, Vitamin deficiencies, co-infection, HIV/AIDS,…)

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Research and surveillance needs (3)Research and surveillance needs (3)

� Developments of standardized and affordable

methods for surveillance and monitoring

� Dissemination of recent R&D outcomes

– Taxonomy

– Ecology

– At risk groups

– Epidemiology

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CommunicationCommunication

- For at-risk groups

- Interventions available for risk reduction

- Translation into national guidance

- New languages for wider dissemination

- Validation of current guidance for FUF

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Cronobacter : International concern (2)

2009 1st International scientific conference on Cronobacter, Dublin.

2009 UCD-Center for Food Safety : WHO

Collaborating Center for E.sakazakii

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Internet :

http://www.who.int/foodsafety

http://www.fao.org/ag/agn

� E. sakazakii tool www.mramodels.org

E.mail:

benembarekp@who.int

Sarah.cahill@fao.org

For further information :For further information :