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The typically foodborne illness, Cronobacter, has been added to the nationally notifiable conditions list. Largely in part due to the illness’s tragic toll on infants during previous years’ infant formula Cronobacter outbreak.
What exactly is Cronobacter? Why is it such a big deal? And what does it mean to be added to the national notifiable conditions list?
Follow along as we explore this topic.
Cronobacter is a germ that can cause human illness. It is a microscopic bacteria too small to be seen with your eyes. Strong microscopes or specialized laboratory tests are required to identify this bad bug.
It likes to live in dry foods like herbal teas, starches, and powdered infant formula. Most notably, infant formula. In fact, most infant formula recalls are due to contamination with this germ.
Cronobacter infections may be rare, (only around 18 cases in the United States each year) but they are very serious. The true number of cases, however, is actually unknown. That is because, until now, reporting Cronobacter infections to the Centers for Disease Control and Prevention (CDC) has been voluntary.
Only Minnesota and Michigan have state policies that previously required reporting.
These infections are most common in infants younger than two months old and often fatal for those in this age group. For this reason, mandatory reporting has been put into effect for children under two months old.
Now that Cronobacter has been added to the nationally notifiable conditions list, healthcare providers must report invasive Cronobacter illness.
Why is this change taking place?
Following the recent Cronobacter outbreaks linked to infant formula, the CDC discovered a need to learn more about the true number of cases occurring each year.
Was this outbreak an isolated event? Or have there been previous trends that have fallen under the radar.
Historically, the CDC only receives around two to four cases of severe Cronobacter infections each year. A report that included 32 states. From January 2002 to July 2022, the agency received 76 reports of severe Cronobacter illness.
These cases are often deadly. Around 20% of infants with meningitis or bloodstream Cronobacter infections in the United States have died. Worldwide, that statistic kisses 40%.
With Cronobacter added to the nationally notifiable conditions list, reporters must understand what criteria warrants that notification.
For reporting purposes, there are three different levels of Cronobacter infections to report.
Suspected illnesses, probable illnesses, and confirmed illnesses.
For a Cronobacter infection to be reported as a “suspected illness,” it must meet one of two criteria.
It either must meet both clinical criteria and supportive laboratory evidence or clinical criteria and epidemiologic linkage.
In other words, the patient must either show symptoms consistent with Cronobacter illness and have preliminary laboratory results or show symptoms consistent with Cronobacter illness and have similar contact situations as others who have confirmed illnesses.
For a Cronobacter infection to be reported as a “probable illness,” it must meet three criteria.
The patient must show symptoms consistent with Cronobacter illness, have similar contact as others who have confirmed illnesses, and have preliminary laboratory results.
All three criteria must be met.
For a Cronobacter infection to be reported as “confirmed illness,” it must meet two criteria.
The patient must show symptoms consistent with Cronobacter illness and have supporting confirmatory laboratory results.
Not all Cronobacter illnesses are subject to mandatory reporting.
At this time, only invasive Cronobacter infections in infants are indicated on the nationally notifiable conditions list.
According to the new policy, “reporting is recommended within 48 hours of genus-level identification, or in accordance with jurisdictional submission rules.” With “genus-level” meaning that preliminary laboratory results indicate some species of Cronobacter is present in the sample.
If criteria is met and the case is reported to the appropriate authority, there are a few more steps included in the guidelines.
“CDC requests that all Cronobacter isolates be forwarded to the Enteric Diseases Laboratory Branch for further characterization.”
They want to also run their own tests to confirm the presence of Cronobacter bacteria.
In addition to patient clinical samples, other tests can be performed, reported, or samples sent to the Enteric Diseases laboratory Branch for additional testing.
Requested samples include primary sources like opened cans of infant formula, breast milk, pump parts, or other suspected samples.
While Cronobacter illness can impact people of all ages (including older children and adults), those under one year old are most susceptible to infection and severe symptoms.
Symptoms of Cronobacter infection in infants often presents early with a fever and poor feeding. The infant may also show low energy or excessive crying. In some cases, babies may experience seizures.
Babies experiencing these symptoms should be taken to a medical care provider as soon as possible!
Meningitis is common for Cronobacter infections in infants less than two months old. The bacteria can get in their blood stream and cause swelling in the lining of the brain or spine.
In addition to acute illness, babies with meningitis often develop serious, long-lasting problems with their brains.
Cronobacter bacteria can also cause illness in older children and adults.
These infections often involve cuts, scrapes, or places where people have had surgeries. Infections may also impact the urinary tract.
Older people (65 years and older) and those with a weakened immune system are more likely to experience Cronobacter blood infections.
While not directly aimed at the infant formula industry, this move may have potential impacts to the market. Could adding Cronobacter to the nationally notifiable conditions list make infant formula safter?
Possibly.
Early illness identification may prompt a closer look at the cause for infant Cronobacter infections. Discovery of an infant formula connection could prompt quicker recall activities, which may prevent additional infant illnesses. A win-win-win situation!
If you’d like to know more about food safety topics in the news, like “Cronobacter Has Been Added to the nationally Notifiable Conditions List?,” check out the Make Food Safe Blog. We regularly update trending topics, foodborne infections in the news, recalls, and more! Stay tuned for quality information to help keep your family safe, while The Lange Law Firm, PLLC strives to Make Food Safe!
By: Heather Van Tassell (contributing writer, non-lawyer)
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