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Criminal threat to infant formula


There have been recent reports of a threat to contaminate a range of milk formula products with 1080 (fluoroacetate), including infant formula.

New Zealand milk formula products are safe to consume at the time of manufacture and distribution - either for retail in New Zealand or export. The ability for anybody to deliberately contaminate infant and other formula during manufacturing is very low, and there is no evidence this has occurred.

About 1080 (fluoracetate)

1080 (fluoroacetate) is a pesticide used on targeted pests in New Zealand. It is highly toxic to humans.

Fluoroacetate is a white, tasteless and odourless fine powder that can look like icing sugar or fine salt. Diluted solutions may taste like vinegar.

The poison acts rapidly and disturbs the production of energy for cells and organs. Toxicity occurs in organs in the body that require a lot of energy (eg, heart, brain, kidneys). As these organs do not receive the energy they require, they begin to fail leading to potentially life-threatening illness.

Further information on fluoroacetate poisoning is available on the TOXINZ website.

Testing regime

The Ministry for Primary Industries (MPI) have put a new 1080 testing regime in place that gives the Government a high degree of confidence that the products covered by the threat do not contain traces of 1080.

Products covered by the testing include:

- infant formula
-nutritional base powder
-standard milk powders (such as skim and whole milk powder)
-other formulated milk products manufactured in New Zealand (such as products for pregnant or lactating mothers, or for people with special dietary needs)
-other dried milk ingredients, such as protein powders.

As further protection, milk formula products are usually sold in tamper-evident packaging, which is designed to help you see if someone has opened or interfered with the packaging.

Symptoms

Fluoroacetate acts rapidly. Depending on the dose ingested, symptoms usually occur within 30 minutes of exposure and progress rapidly. Lower doses may take longer (up to 3 hours) to produce symptoms.

Symptoms of ingestion are that of an unwell infant, child, or adult and are initially non-specific.

The early and late signs of fluoroacetate poisoning are:

Infants and children

Early signs
- Irritable or inconsolable
- Rapid shallow breathing
- Abdominal pain
- Vomiting

Late signs
- Collapse or unresponsiveness
- Seizures

The infant or child may also be flushed in the cheeks, sweaty, or appear pale and apprehensive, or have glazed eyes and not focussing on anything.

Adults

Early signs
- Apprehension and agitation
- Rapid shallow breathing
- Abdominal pain
- Vomiting

Late signs 

- Confusion and decreasing lack of consciousness
- Coma
- Seizures

Adult patients may also be flushed in the cheeks, sweaty, appear pale, apprehensive, and may appear glazed or unresponsive.

Treatment

There is no antidote for fluoroacetate poisoning. Clinicians evaluating a sick infant, child or adult should follow normal referral criteria.

Treatment of infants or children

If an infant or child is mildly unwell, has been symptomatic for several hours but is not becoming progressively worse, it is extremely unlikely that this illness is due to fluoroacetate poisoning. Other diagnoses need to be considered, investigated and treated accordingly.

If the infant or child is asymptomatic at presentation or 4 hours after last feed, and you are confident the child will be adequately observed, it is reasonable to allow the child home.

Parents should be provided with information about recognition of illness. This information is available at Sick baby danger signs and in the back section and back cover of the Well Child Tamariki Ora - My Health Book (Danger Signs - Baby and Child Sickness).

Treatment of adults

If the patient is asymptomatic at presentation or 4 hours after consumption of the formula, and you are confident the patient will be adequately observed, it is reasonable to discharge for 24-hour home observation. It is important the key home care carer/observer is fully briefed about warning symptoms and signs indicating fluoroacetate poisoning and should have a low threshold for seeking ED review on suspicion.

If an adult is mildly unwell, has been symptomatic for several hours but is not becoming progressively worse, it is extremely unlikely that this illness is due to fluoroacetate poisoning. Other diagnoses need to be considered in the differential diagnosis.

Management of suspected poisoning is supportive and requires hospital level care.

Reporting suspected fluoroacetate poisoning

Medical practitioners are asked to urgently notify their medical officer of health of suspected or confirmed cases.

Medical officers of health are then asked to urgently inform the Ministry of Health of suspected or confirmed cases via normal channels.

Management of suspect milk formula product

Any suspected milk formula should be kept in a safe place at home, away from human of animal contact, in case it is required for further testing.

Resources for health professionals

Visit www.health.govt.nz/our-work/environmental-health/contamination-infant-and-other-formula-products

Prevention

Consumers/parents/caregivers should follow Ministry for Primary Industries (MPI) advice on how to ensure milk formula products are free from contamination or tampering.

MPIs advice to consumers is that if any food product appears to have been tampered with - for example, seals broken or punctured - then it should not be consumed and it should be reported to the Ministry for Primary Industries on 0800 008 333 or info@foodprotection.govt.nz.

MPI provides useful guidance on how to check for tampering on the MPI website.

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