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Cronobacter Statistics

Posted in Our Blog on October 31, 2021

Formerly known as Enterobacter sakazakii—Cronobacter is a group of gram-negative bacteria that cause serious health problems and even death in newborns, children, and elders. Cronobacter survives in very dry conditions and is well known for being particularly dangerous for infants who are fed powdered formulas.

Who is at Risk of Cronobacter Infection?

All age groups are at risk of developing cronobacter infection. However, infants, tube-fed elderly people, and those with weakened immune systems are at the greatest risk and often suffer more severe symptoms. Since its initial discovery, the association between cronobacter infections and infants has been most commonly researched due to the severity of infections and higher death rates, reaching as high as 40 to 50 percent of newborns killed by the bacteria when infected.

Cronobacter’s natural habitat is still unknown. For infants, the only confirmed transmission of the infection is through powdered infant formula (PIF) after it has been contaminated either in the factory where it is made or after it has been opened by consumers. The bacterium has also been found in a variety of foods, including milk powder, herbal teas, and wastewater. If you or a loved one has suffered from a Cronobacter infection from contaminated food, speak with a Cronobacter attorney to explore your legal options.

How Common Are Cronobacter Infections?

Cronobacter is a rare but deadly bacteria. The U.S. Centers for Disease Control and Prevention (CDC) reports an average of four to six cases per year. However, this number may not be accurate since most hospitals and laboratories do not have to report Cronobacter to local or state health departments. The CDC also estimates that 1.8 in 100,000 infants suffer from infections each year.

A 2002 national FoodNet survey estimated that invasive Cronobacter infected one infant per 100,000 below the age of one each year and 8.7 per 100,000 low-birth-weight infants (less than 5.5 lbs). The CDC also reports that unpublished FoodNet data suggests Cronobacter infections are more common among older adults, but they are milder. How children and adults become infected, other than through PIF, is still unknown, but there are no reports of infections occurring due to person-to-person contact.

How Cronobacter Infection is Diagnosed and Treated

A physician will perform an examination then test a sample of blood to check for infection. A Cronobacter infection is usually treatable with antibiotics unless it is a drug-resistant strain. Because infants under two months of age are prone to experience severe complications, if they are suspected of having Cronobacter sepsis or meningitis, they must undergo a complete clinical evaluation. That will involve testing blood, urine, and cerebrospinal fluid culture, and the infant should also immediately be given empiric therapy for sepsis. Brain imaging may also be done on infants with meningitis to determine whether there are brain abscesses and other complications.

The Prevalence of Cronobacter in Dry Processing Facilities

To understand the prevalence of Cronobacter and Salmonella in dry dairy facilities, the U.S. Food and Drug Administration (FDA) conducted a sampling assignment in 55 plants in 2014. Cronobacter was detected in 69 percent of the facilities, and in the 38 that had positive findings, there was an average of 4.4% positives overall and 6.25% positives. In the results, the highest Cronobacter rates were found in zone 4 then decreased progressively:

  • Zone 4 (14.3%): Generally considered a remote area outside of food production areas (e.g., employee locker room, dry goods storage warehouse, cafeterias, hallways, loading docks, finished product warehouse). If this zone is contaminated, then zone 3 can become contaminated by humans or machinery, and so on.
  • Zone 3 (8.7%): This includes areas surrounding zone 2, such as corridors and doorways that lead to food production areas or areas in a large production room that are further away from food handling equipment than typical zone 2 areas (e.g., walls, phones, forklifts, and “mules,” etc.)
  • Zone 2 (4.5%): Any area that is directly next to food contact surfaces (zone 1).
  • Zone 1 (1.1%): All direct food contact surfaces (e.g., mixers, utensils, conveyors, racks, work tables, etc.)

In contrast, of all the 55 plants tested, Salmonella was found in only three (5.5%). In the facilities that had positive samples, there was a similar trend, with zone 4 having the highest positive rate. The rate decreased in zone 3 samples, and there were no positive samples for Salmonella in zone 2 or zone 1.

How to Prevent Cronobacter Infection

Cronobacter is killed at temperatures above 60°C (140°F). Although PIFs are heat-treated during processing, they are not subjected to high temperatures long enough to make the final product commercially sterile. Here are some recommended tips for protecting your infant:

  • Breastfeed: Breastfeeding provides many benefits to infants and young children and prevents many foodborne illnesses and other health problems.
  • Liquid Formula: If you can, choose a liquid infant formula (i.e., both concentrated and ready-to-use), especially for infants at most significant risk (pre-term, low-birth weight, immunocompromised). These products are sterile and should not contain Cronobacter germs.
  • Preparing Powdered Formula: Follow the CDC’s recommendations for safe Infant Formula Preparation and Storage:
    • Wash hands with soap and water before preparation.
    • Clean bottles in a dishwasher or in hot, soapy water.
    • Clean surfaces where you prepare (e.g., countertops, sinks)
    • Keep formula lids and scoops clean
    • Close PIF containers as soon as possible
      • Use the World Health Organization’s guidance for hot water to prepare PIF:
        • Water used should be brought to a rolling boil for 2 minutes and cooled down to no less than 158°F before adding the powder.
    • Use the formula within two hours of preparation and discard any unused formula.
    • Refrigerate formula immediately if you do not plan to use it right away, but use it within 24 hours.
  • Always wash your hands carefully with soap and water at critical times, and if soap and water aren’t available, use an alcohol-based hand sanitizer.
    • Before preparing and feeding bottles or foods to an infant.
    • Before touching an infant’s mouth.
    • Before touching pacifiers or other things that go into an infant’s mouth.
    • After changing diapers or using the bathroom.