[Outbreaks of Salmonella in infants associated with powdered infant formula].

Historically, outbreaks associated with Salmonella-contaminated milk products were recognized as early as the 1950's in the United Kingdom and Bulgaria. In the 1960's and 1970's there were also a number of outbreaks related to Salmonella in various powdered milk products. As a result, Salmonella criterion was included in the Codex Code of hygienic practice for foods for infants and children. Between 1985 and 2005 at least 6 outbreaks of salmonellosis, involving as many as 250 infants, have been associated with powdered infant formula (PIF). In 2005, in France, an outbreak affecting more than 100 infants was associated with PIF contaminated with Salmonella Agona. These reported outbreaks indicated that problems persisted. Experts from two FAO/WHO Expert Consultations, held in 2004 and 2006, concluded that intrinsic contamination of PIF with Enterobacter sakazakii and Salmonella has been a cause of infection and illness in infants, including severe disease which can lead to serious developmental sequelae and death. Most of the Salmonella outbreaks associated with PIF involved unusual Salmonella serotypes, which likely aided in the recognition of these outbreaks. In many regions of the world where Salmonella serotyping is not routinely performed, identification of geographically or temporarily diffused outbreaks could be difficult. It is therefore important to use the appropriate methodology to detect unusual strains of Salmonella that cause illnesses in infants, such as the lactose-positive strain, and to perform serotyping and/or pulsed-field gel electrophoresis (PFGE) genotyping for rapid identification of Salmonella outbreaks and to establish linkages between the illness and implicated food.