What we know: There have been four sick with two dead from Cronobacter sakazakii

The recall: The recall began on February 17, 2022 and expanded on February 28, 2020. The FDA is advising consumers not to use recalled Similac, Alimentum, or EleCare powdered infant formulas. Recalled products can be identified by the 7-to-9-digit code and expiration date on the bottom of the package (see image below). Products are included in the recall if they have all three items below:

  • the first two digits of the code are 22 through 37 and
  • the code on the container contains K8, SH, or Z2, and
  • the expiration date is 4-1-2022 (APR 2022) or later, and
  • Abbott Nutrition has recalled Similac PM 60/40 with a lot code 27032K80 (can) / 27032K800 (case).

The inspection: Abbott Nutrition did not establish a system of process controls covering all stages of processing that was designed to ensure that infant formula does not become adulterated due to the presence of microorganisms in the formula or in the processing environment. Abbott Nutrition did not ensure that all surfaces that contacted infant formula were maintained to protect infant formula from being contaminated by any source. Cronobacter was found in the plant both environmental and product samples.

The questions:  Given that illnesses began in early September 2021, did that fact that Cronobacter sakazakii is only reportable in Minnesota hamper the investigation and delay the outbreak announcement and recall?

According to the CDCCronobacter infections are rare, but they can be deadly in newborns. Infections in infants usually occur in the first days or weeks of life. About two to four cases are reported to CDC every year, but this figure may not reflect the true number of illnesses because most hospitals and laboratories are not required to reportCronobacter infections to health departments. Although, not specifically listed as reportable in all states, in some states it is reportable under bacterial meningitis (e.g., California). It is reportable in Minnesota.

I must admit, until the announcement of this most current Cronobacter sakazakii outbreak, I thought Cronobacter sakazakii was a reportable bacteria illness in all states, much like E. coli O157:H7 has been since at least 1993-1994.  However, for E. coli O157:H7 it was not always that way.

For a bit of history; most recall that the Jack-in-the-Box E. coli O157:H7 outbreak as hitting the public’s conscious in January 1993 after it was linked to several hundred sickened, dozens with acute kidney failure and three deaths – all children – with all illnesses sharing the same genetic E. coli O157:H7 in their stools which matched E. coli O157:H7 found in frozen hamburger patties.  At first, most illnesses were tied to people that consumed undercooked hamburgers in Oregon, Idaho, Nevada and Washington – most of all the illnesses and all three deaths were in the greater Seattle area.  Prior to 1993 in all four states shared more than just borders – E. coli O157:H7 was a reportable bacteria illness in all four states.

Unknown when the outbreak exploded in those four states in January was cluster of just over forty E. coli O157:H7, including several with acute kidney failure and one six-year-old girl name Lauren, in California that occurred in November and December of 1992.  In 1992 E. coli O157:H7 was not a reportable bacteria illness in California so public health was flying blind to these illnesses, and, because it was not reported, the meat was shipped North, and a terrible history was not avoided.

In 1994 Lauren’s Law was enacted making E. coli O157:H7 a reportable bacteria illness in California.  It is time to pay attention.



The Council of State and Territorial Epidemiologists and CDC identify the list of notifiable diseases and conditions.


While the list of reportable conditions varies by state, the Council of State and Territorial Epidemiologists (CSTE) has recommended that state health departments report cases of selected diseases to CDC’s National Notifiable Diseases Surveillance System (NNDSS).  Every year, case definitions are updated using CSTE’s Position Statements.  They provide uniform criteria of national notifiable infectious and non-infectious conditions for reporting purposes.