Pediatric Nutrition in Practice

Food Safety 81

1

Infectious Foodborne Diseases

Microbial contamination of food can occur
throughout the chain of food production, pro-
cessing and storage. Microbial diseases which can
be transferred from animals to man are zoonoses,
the most important agents being salmonellae,
mycobacteria, brucellae, campylobacter, listeria,
toxoplasma, yersiniae and parasites like trichinel-
la and echinococci.
Foodborne viral illnesses, e.g. noroviruses
and hepatitis A, are on the increase. They relate
predominantly to fresh produce rather than to

industrially produced foods, and/or are linked to

contamination of the food by an infected food

handler.

The impact of infectious diseases on mortal-

ity of children under 5 years of age is more than

2 times greater in malnourished children. Apart

from attempts to improve both the quality and

the quantity of food, continued frequent breast-

feeding or, when possible, relactation are im-

portant measures [13] to minimize the risk

from pathogens in foods or f luids and to profit

from the protective factors provided by breast

milk.

I n f a n t F o r m u l a e

Feeding breast milk substitutes requires the

availability of clean and safe water and cooking

facilities [14]. A typical example of the impor-

tance of HACCP principles in the production of

foods and of sanitary measures to be applied by

the consumer is the case of Enterobacter sakaza-

kii ( Cronobacter spp.) in powdered infant for-

mulae. This microorganism has caused out-

breaks of sepsis, meningitis or necrotizing en-

terocolitis especially in premature infants and

those less than 2 months old. Although the over-

all incidence seems to be low, mortality rates be-

tween 20–50% were reported. Powdered infant

formula is not sterile, and even when manufac-

tured under strict hygiene, the occurrence of low

counts (1–3/g) of coliform bacteria cannot be

prevented. E. sakazakii does not grow in the dry

powder but starts to replicate after preparation

with water and at temperatures >5 ° C. It can be

destroyed by temperatures >60 ° C. Measures to

reduce the risk of infection include preparation

in a sterile environment with boiled water

(>70 ° C), feeding immediately after appropriate

cooling, limitation of feeding duration and of in-

fusion via feeding tubes at room temperature to

less than 4 h, and discarding uneaten residues

[15–17].

Ta b l e 2. Recommendations for safe handling, prepara-
tion and storage of foods

• Wash hands before preparing and feeding


• Wash hands after going to toilet


• Use safe water or treat it to make it safe


• Wash and clean surfaces and equipment used for
  food preparation


• Use clean utensils to prepare and serve food


• Wash fruits and vegetables, especially if eaten raw


• Separate raw and cooked food and use separate
  utensils for preparing them


• Cook fresh, unpasteurized milk


• Cook food thoroughly, particularly meat, poultry,
  eggs and seafood (internal temperature at least
  70° C)


• Serve foods immediately after preparation


• Keep cooked food hot (>60° C) prior to serving


• Do not leave cooked food for more than 2 h at room
  temperature


• Discard uneaten prepared food or refrigerate,
  preferably <5° C


• Refrigerate all cooked and perishable food
  immediately (preferably <5° C)


• Store raw and cooked food in separate containers


• Store food preferably dry


• Do not store food too long (even in refrigerator) and
  do not use beyond expiry date


• Do not thaw frozen food at room temperature


• Heat stored prepared food thoroughly (>70° C)

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 78–82
DOI: 10.1159/000360319