Cronobacter spp. (Enterobacter sakazakii): advice, policy and research in Canada.

Although the number of reported cases of Cronobacter infection in Canada is low, Health Canada has been actively studying this organism since 1991. After reviewing the situation at the national level and due to health concerns with powdered formulae and its international trade, in 2003, Health Canada raised this issue at the international level by proposing to revise the Code of Practice for Powdered Formulae for Infants and Young Children at the Codex Alimentarius Committee of Food Hygiene. Canada volunteered to chair the Working Group that would be developing the Code, and the Code was completed in four years. The Code contributed to an improvement in the hygienic conditions in plants manufacturing Powdered Infant Formula (PIF), resulting in a lower level of product contamination with Cronobacter species. Canada has produced a document detailing Good Manufacturing Practices (GMPs) for Infant Formula in Canada. Health Canada uses the GMPs as a basis for assessing the manufacturing information received in pre-market notifications for new or changed infant formulas. Health Canada does not have microbiological criteria for Cronobacter spp. in PIF; however, we are currently working on developing these criteria. At present, there are no active or passive surveillance systems for Cronobacter spp. in Canada, although this has been discussed. Health Canada has recently adapted and condensed FAO/WHO guidelines to develop a draft guidance document for the hygienic preparation and handling of PIF in home and hospitals/care settings, which outline requirements for parents, caregivers, and staff in hospitals and day-care centres. Health Canada's Bureau of Microbial Hazards conducts research on the ecology, biology and pathogenesis of Cronobacter spp. Some of the research projects include specific aspects of molecular typing, virulence studies involving animal models, as well as in vitro tissue culture work to examine adhesion and invasion. Collaborative research is also being done with the Canadian National Research Council, using NMR and mass spectroscopy to reveal the structure of the O-polysaccharide of the various Cronobacter species. This review summarizes and discusses current activities that are being undertaken in Canada with respect to Cronobacter spp.