European Centre for Disease Prevention and Control

On 10 September 2008, ProMED issued a request for information concerning 14 cases of kidney stones in infants hospitalised in Gansu province, China, in the previous two months [1]. On 21 September, Chinese authorities reported 39,965 cases of kidney stones in infants, including three deaths related to the consumption of melamine-contaminated powdered infant formula. On that day, 12,892 of them were hospitalised, 104 with severe illness. Most of these cases (82%) affected children under two years of age. A large melamine contamination of milk-containing products, including infant formula, was reported from China. The level of contamination is variable but reaches high levels among certain producers. Contaminated food items include infant formula, liquid milk, frozen yoghurt dessert, coffee creamer, ice-cream, chocolate cookies and candies [2,3]. Food safety agencies in Hong Kong and Taiwan as well as in several other countries and locations have identified locally sold contaminated products originating from China, including: Singapore, New Zealand, Indonesia, South Korea, Vietnam and Canada [4]. Contaminated products were also exported to Bangladesh, Burundi, Myanmar, Gabon and Yemen. Media in the European Union (EU) have reported that milk products originating from China had been found in Spain and Portugal [5,6]. Ireland has withdrawn confectionary from sales outlets that had been identified by New Zealand health authorities as contaminated [7]. On 17 September, China recalled tons of milk powder produced by Sanlu Group Co since March 2008. The importation in the EU of milk products from China has been prohibited under EU legislation since 2002. However, certain amounts of composite products (i.e. products which contain a processed product of animal origin and a product of non-animal origin) containing processed milk components may have reached the EU in the past, including confectionary, biscuits, chocolate, toffee or cakes. On 26 September 2008, the European Commission extended this ban to all Chinese composite products containing milk or milk products, primarily intended for infants and young children, which could contain traces of milk powder [8]. As a result, systematic tests (threshold 2.5 mg/kg) will be performed on Chinese products containing more than 15% of milk products, and on all consignments of such composite products whose amount of milk product content cannot be established. The tolerable daily intake (TDI) of melamine is 0.5 mg/kg body weight in the EU [9]. Repeated exposures above the TDI require a more detailed assessment of all the data to determine the possibility of adverse effects …