U.S. health officials will soon start tracking infections from a deadly germ that killed two infants and caused a massive baby formula recall in 2022.

Cronobacter will be added to the National Notifiable Diseases Surveillance System watchlist starting in 2024, joining about 120 other serious illnesses, according to the group that advises the Centers for Disease Control and Prevention.

The Council of State and Territorial Epidemiologists worked closely with CDC experts, the U.S. Food and Drug Administration and the Association of Public Health Laboratories to craft the reporting and tracking recommendation. 

“These efforts will assist public health agencies in quantifying and identifying the cause of Cronobacter infections, and coupled with education efforts, will help protect the health of those most vulnerable,” CSTE Executive Director Janet Hamilton said in a statement. “Ultimately, we want these infections to be prevented.” 

States will be asked, but not required, to start notifying the CDC about Cronobacter infections next year, but some may begin reporting those illnesses sooner. Only Michigan and Minnesota require mandatory reporting. 

The naturally occurring bacteria can be deadly for young or sick babies. Contamination can happen in the home or in a baby formula processing plant. 

Deadly Cronobacter Outbreak Sparks Changes

During a Cronobacter outbreak last year, two babies died and two others were sickened after contracting the bacterium, according to the CDC. The babies had consumed powdered baby formula made by Abbott Nutrition at its factory in Sturgis, Michigan, the CDC reported. Abbott is the maker of Similac, EleCare and Alimentum baby formulas. It has several state contracts to provide formula for the federal Women, Infants and Children supplemental nutrition program.

Abbott recalled 7 million pounds of formula and its Sturgis plant was shut down after health investigators found contamination and other issues. The closure touched off a nationwide infant formula shortage that lasted months and had far-reaching effects. 

The U.S. government has since required more oversight of the formula industry and called for studies, guidance and better regulation. New FDA guidance for baby formula makers asks them to report contamination issues to the agency, even if the product is destroyed and does not make it to the market.

Other issues plagued the formula industry when premature babies were fed cow’s milk formula and developed NEC, or necrotizing enterocolitis, a rare and serious intestinal tract disease that can cause tissue damage and deadly infections. Parents have been filing baby formula lawsuits after their children were harmed.

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What Is Cronobacter?

Cronobacter is a naturally occurring germ that can be found in the environment and can live in dry foods such as powdered infant formula and powdered milk. It has also been found in contaminated feeding items, including breast pump equipment. 

Infections in babies who are younger than 2 months or born prematurely can cause serious infections or death. The bacterium can cause bloodstream infections or meningitis. While infections are rare, nearly 40% of babies who are sickened will die, Dr. Julie Haston, who has studied Cronobacter infection at the CDC, told The Associated Press earlier this year. 

Unlike other foodborne illnesses, Cronobacter infections did not have to be reported to the CDC prior to the recent recommendation. While the CDC receives two to four reports of Cronobacter infections annually, Haston said, she estimates that occurrence is much higher.

“Because we don’t routinely perform surveillance, we don’t know the true incidence of infection or the number of deaths per year,” Haston said.