Swine flu is a new version of the H1N1 strain of influenza type A. Most people do not have immunity to it and may become ill or even die. This brochure will review the current recommendations to clean your home to reduce contamination in the event of an outbreak of H1N1 or seasonal flu. Download the document Cleaning for H1N1 in the Home.

The H1N1 (swine) flu is a new variant of influenza type A that appeared in Mexico in the Spring of 2009 and quickly spread across the world. Most people do not have immunity to this flu virus, and it can be transmitted from person to person. Cleaning, janitorial, and maintenance staff are on the front line in reducing the spread of H1N1, especially since it will likely remain a threat during the Fall-Winter influenza season. To learn about the current cleaning guidelines for H1N1, download the document: Professional Cleaning for H1N1.

Fishing is a favorite American recreational activity, especially during the lazy summer months. Whether fishing in fresh or salt water, the catch can make a healthy and nutritious meal for the whole family. But is all freshly-caught fish safe to eat? To learn the current recommendations about catching, storing, preparing, and eating fish, download the brochure Fishing: Should You Eat What You Catch?

In the last few years, the US has suffered a number of recalls and outbreaks of foodborne illness from contaminated food products. New legislation to improve the safety of food was introduced in congress on June 8, 2009. Named the Food Safety Enhancement Act, the bill would amend the Food, Drug, and Cosmetic Act and aims to strengthen the Food and Drug Administration’s (FDA) authority to oversee food safety. Some of the bill’s stipulations include:

• Requiring more frequent inspections of food processing facilities by the FDA. (Currently some plants may only be inspected every 10 years.)

• Requiring food companies to develop and manage food safety programs.

• Giving the FDA the authority to order companies to recall potentially contaminated food.

The FDA commissioner Dr. Margaret A. Hamburg has testified to congress in support of the Food Safety Enhancement Act. Read her comments online at: http://www.fda.gov/NewsEvents/Testimony/ucm164186.htm.

The Food Safety Enhancement Act can be viewed in its entirety at: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111congbills&docid=f:h759ih.txt.pdf . This may not be the final version of the bill, since amendments are frequently added by legislators.

The Center for Science in the Public Interest (CSPI) is following the course of this bill through congress closely and can assist consumers in contacting their congressperson. Visit the CSPI website at: http://www.cspinet.org, click on the June 3, 2009 article, and find the Safe Food Coalition icon.

With the start of summer, we should all be more vigilant about staying hydrated. Dehydration is the loss of body fluids and electrolytes (e.g. salt.) It can occur from sweating, but also bleeding, vomiting, or diarrhea. To learn more about the what, when, where and how to drink, download the brochure: Hydration and Water Safety

With the current H1N1 (swine) flu outbreak, everyone should be practicing good hygiene in the workplace to minimize transmission of this virus. What can you do to protect yourself from the flu while at work? What can you do to protect your co-workers if you become ill?
Find the answers to these questions and more by downloading the brochure: Preventing Flu in the Workplace.

Reusable cloth grocery bags have become very popular among shoppers. By reducing the consumption of plastic grocery bags, shoppers believe that they are helping to lessen environmental pollution. Recently, however, a study funded by the Environment and Plastics Industry Council has questioned the safety of cloth grocery bags to our health.

Should we use paper, plastic or cloth grocery bags? Find out more about proper cloth grocery bag use and getting food home safely by downloading the brochure: Paper, Plastic, or Cloth Grocery Bags.

With the current H1N1 (Swine) flu epidemic, proper handwashing technique should be used every time. According to the CDC, some scientists estimate that up to 80% of all infections are transmitted by our hands. Handwashing is the SINGLE most important thing we can do to stay healthy every day. Find out more about what germs we carry on our hands and how to clean them properly on the brochure: Proper Hand Washing.

The WHO’s decision to raise the pandemic alert level is a reflection of the spread of the virus, not the severity of illness caused by the virus. However, because H1N1 is a new virus, many people may have little or no immunity against it. Therefore, CDC anticipates that the number of H1N1 flu cases, hospitalizations, and deaths will continue to grow in the coming days and weeks. Also, H1N1 could cause significant illness in the fall and winter during the U.S. influenza season.

CDC has activated its emergency operations center to coordinate the agency’s emergency response. CDC ’s goals are to reduce transmission and illness severity, and provide information to help health care providers, public health officials and the public address the challenges posed by this swine influenza virus. CDC continues to issue interim guidance daily on the website and through health alert network notices. CDC’s Division of the Strategic National Stockpile (SNS) has released one-quarter of its antiviral drugs, personal protective equipment, and respiratory protection devices to help states respond to the outbreak. The swine influenza A (H1N1) virus is susceptible to the prescription antiviral drugs oseltamivir and zanamivir. CDC has developed a precise PCR diagnostic test to detect H1N1 virus. Additionally, CDC has prepared a candidate vaccine virus and provided it to industry for the production of a vaccine - though this will likely require several months.

What You Can Do to Stay Healthy

There are everyday actions people can take to stay healthy:

*Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

*Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

*Avoid touching your eyes, nose or mouth. Germs spread that way.

*Try to avoid close contact with sick people.

Influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people.

If you are sick with a flu-like illness, CDC recommends that you stay home from work or school for 7 days or until you are symptom-free for 24 hours; also, limit contact with others to keep from infecting them.

World Health Organization (WHO) Disease Outbreak News: http://www.who.int/csr/don/en/

Also, the CDC website is constantly updated with valuable information:http://www.cdc.gov/h1n1flu/

A combination of epidemiological analysis and laboratory testing by state officials in Minnesota and Connecticut, the Food and Drug Administration (FDA), and the Centers for Disease Control and Prevention (CDC) have enabled FDA to confirm that the sources of the outbreak of illnesses caused by Salmonella Typhimurium are peanut butter and peanut paste produced by the Peanut Corporation of America (PCA) at its Blakely, Georgia processing plant.

Peanut butter is sold by PCA in bulk containers ranging in size from five (5) to 1,700 pounds. The peanut paste is sold in sizes ranging from 35-pound containers to product sold by the tanker container. Neither of these products is sold directly to consumers. However, through its investigation, FDA has determined that PCA distributed potentially contaminated product to more than 100 consignee firms, for use as an ingredient in hundreds of different products, such as cookies, crackers, cereal, candy and ice cream. FDA initiated an inspection of PCA’s Blakely plant on January 9 shortly after learning that this firm might be linked to the ongoing Salmonella outbreak. FDA finished its inspection on January 27. A list of problems observed by FDA investigators during their inspection is available at this link: http://www.fda.gov/ora/frequent/default.htm. This list is not a final agency determination regarding compliance. The deficiencies observed indicate that the plant was not compliant with Current Good Manufacturing Practices required by the FDA. These deficiencies are related to cleaning programs and procedures as well as failure to implement steps to mitigate Salmonella contamination in the facility.

On January 28, PCA issued an expanded voluntary recall of all peanuts and peanut products processed in its Blakely, Georgia facility since January 1, 2007. The expanded recall includes all peanuts (dry and oil roasted), granulated peanuts, peanut meal, peanut butter and peanut paste. All of the recalled peanuts and peanut products were made only at the company’s Blakely, Georgia facility.

On January 30, FDA confirmed that FDA’s Office of Criminal Investigations is involved in a Justice Department investigation of PCA.

FDA has been working with the company and purchasers of PCA’s peanut butter and peanut paste to identify affected products and facilitate their removal from the market. FDA and state officials have visited in excess of 1,000 firms who purchased PCA products. Now, the same type of work is continuing and includes the additional products in the expanded recall.

Companies nationwide that received product made by PCA have issued voluntary recalls of their products. As FDA gathers additional information about these products, the list of recalled products is expected to expand. FDA has created a searchable database for these products, which can be found at: http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm.

Product recalls include some pet food products that contain peanut paste that was made by PCA. While the risk of animals contracting salmonellosis is minimal, there is risk to humans from handling these products. It is important for people to wash their hands—and make sure children wash their hands—before and, especially, after feeding treats to pets. Further information for consumers is located in the Frequently Asked Questions section located on this web site. The pet food products are also included in the searchable data base of recalled products.

Major national brands of jarred peanut butter found in grocery stores are not affected by the PCA recall.

FDA and CDC recommendations for consumers include:

Consumers are urged to check FDA’s web site to determine which products have been recalled and will be recalled in the coming days.

Any product that is on the recall list should be disposed of in a safe manner. Consumers are also urged to wash their hands after handling potentially contaminated products.

If consumers are unsure whether a peanut-containing product is potentially contaminated, they should avoid consuming it or feeding it to their pet until they obtain more information regarding the product.

Persons who think they may have become ill from eating peanut products are advised to consult their health care providers.

For Retailers

Stop selling recalled products.

For Directors of Institutions and Food Service Establishments

Ensure that they are not serving recalled products.

For Manufacturers

Inform consumers about whether their products could contain peanuts or peanut products from the Peanut Corporation of America (PCA). If a manufacturer knows its products do not contain peanuts or peanut products from PCA, it may wish to provide this information to consumers. For specific guidance: Guidance for Industry: Product Recalls, Including Removals and Corrections

The FDA will closely monitor these events by continuing to work with the firms on the details of their actions, conducting follow-up audits and inspections, monitoring the progress of the firms’ actions, working with state and local regulatory authorities, and notifying our foreign regulatory counterparts of products that have now been confirmed as having been distributed internationally.

Ongoing Investigation

FDA has collaborated with the Centers for Disease Control and Prevention (CDC) and public health officials in various states to investigate the multi-state outbreak of human infections due to Salmonella Typhimurium. An epidemiological investigation by the Minnesota Department of Health isolated and tested subsamples from an open five-pound container of King Nut peanut butter obtained at a nursing home where three patients were sickened by the outbreak strain of Salmonella Typhimurium. The Minnesota Health officials found the peanut butter contained the same strain of Salmonella Typhimurium associated with the illnesses linked to the outbreak.

Because it is always possible that the open container was contaminated by someone or something else in the environment, the FDA and the states began testing unopened containers of the same brand of peanut butter. King Nut distributes peanut butter manufactured by the PCA to institutional facilities, food service industries, and private label food companies in several states.

On January 19, 2009, testing by the Connecticut Department of Health of an unopened container of King Nut peanut butter showed that it too contained the same strain of Salmonella Typhimurium associated with illnesses linked to the outbreak. The fact that the Salmonella Typhimurium was confirmed in an unopened container of peanut butter indicates that peanut butter originating from the processing plant was contaminated. FDA has initiated inspections at the direct consignees of PCA and King Nut and continues to follow the distribution points for products.

The FDA has no evidence to suggest that the Salmonella Typhimurium contamination originated with any manufacturing facility other than PCA. The PCA facility in Blakely, Georgia is not operating at this time and the company has recalled all peanuts and peanut products produced there from January 1, 2007, to the present.

The FDA and food manufacturers are working to identify products that may be affected, and to track the ingredient supply chain of those products to facilitate their removal from the marketplace.

Milk is a great source of calcium and protein, both of which are important to bone health and a balanced diet. There are lots of conflicting opinions and news stories about the pasteurization process, the use of growth hormones, and the proposed “benefits” of raw milk. Does pasteurization harm milk? Is raw milk more nutritious? To better answer these questions and learn more about milk safety download our Milk: Pasteurization & Potential Pathogens brochure.

We appreciate the hard work and long hours the subcommittee has invested in scientific peer review of the FDA’s draft safety assessment of the use of BPA in food contact applications. The FDA requested this peer review to provide additional insight into this complex issue. This group of distinguished scientists has devoted their considerable knowledge and experience to this effort.

The subcommittee report to the Science Board raises important questions regarding the draft safety assessment, and the FDA looks forward to the review of the subcommittee’s report by the Science Board on Oct. 31.

The FDA agrees that, due to the uncertainties raised in some studies relating to the potential effects of low dose exposure to bisphenol A, additional research would be valuable. The FDA is already moving forward with planned research to address the potential low dose effects of bisphenol A, and we will carefully evaluate the findings of these studies.

Consumers should know that, based on all available evidence, the present consensus among regulatory agencies in the United States, Canada, Europe, and Japan is that current levels of exposure to BPA through food packaging do not pose an immediate health risk to the general population, including infants and babies.

Regarding Canada, the FDA notes that Health Canada’s assessment of bisphenol A on newborns and infants up to 18 months of age concludes that exposure levels are below the levels that could cause health effects. Out of an abundance of caution, the Government of Canada is taking steps to restrict the use of BPA.

Parents who, as a precaution, wish to use alternatives for their bottle-fed babies can use glass and other substitutes for polycarbonate plastic bottles; avoid heating formula in polycarbonate plastic bottles; and consult their pediatrician about switching to powdered infant formula.

For a copy of the Subcommittee Report, go to: http://www.fda.gov/ohrms/dockets/ac/oc08.html#Scienceboard

Statement of the Acting Surgeon General, Rear Admiral Steven K. Galson, M.D., M.P.H. “The most important thing parents can do for their babies is ensure that they receive adequate nutrition. While the best source of nutrition for babies is the mother’s breast milk, infant formula remains the recommended alternative when breast milk is not an option.”

Description of the event

More than 54 000 infants and young children have sought treatment for urinary problems, possible renal tube blockages and possible kidney stones related to the melamine contamination of infant formula and related dairy products. Three deaths among infants have been confirmed, more than 14 000 infants have been hospitalized and a little less than 13 000 remain so. Kidney stones in infants are very rare.

While the exact onset date of illness resulting from contamination and the beginning of the contamination itself remain unknown, a manufacturer (Sanlu) received a complaint of illness in March 2008.

Chinese media reported at the beginning of September that Sanlu brand infant formula produced by Hebei-based Sanlu Group was contaminated with melamine. Sanlu’s powdered infant formula is widely consumed by infants across China because the product is relatively affordable compared to others.

Following inspections conducted by China’s national inspection agency, at least 22 dairy manufacturers across the country were found to have melamine in some of their products.

Two companies, Guangdong Yashili and Qingdao Suokang, exported their products to Bangladesh, Burundi, Myanmar, Gabon and Yemen. While contamination in those exported products remains unconfirmed, a recall has been ordered from China.

Other countries, however, have also reported finding melamine in dairy products manufactured in China.

So far, contamination has also been found in liquid milk, frozen yogurt dessert and in coffee drink. All these products were most probably manufactured using ingredients made from melamine contaminated milk.

In 2007, melamine was found in pet feed manufactured in China and exported to the United States of America, and caused the death of a large number of dogs and cats due to kidney failure.

Melamine contamination

Presentation of melamine

Melamine is a chemical compound that has a number of industrial uses, including the production of laminates, glues, dinnerware, adhesives, molding compounds, coatings and flame retardants. Melamine is a name used both for the chemical and for the plastic made from it. In this event, all references are to the chemical. There are no approved direct food uses for melamine, nor are there any recommendations in the Codex Alimentarius. Melamine is illegally added to inflate the apparent protein content of food products. Because it is high in nitrogen, the addition of melamine to a food artificially increases the apparent protein content as measured with standard tests.

Source of the contamination

In this event, contamination appears to have happened as fraudulent contamination in primary production. Chinese government officials have pinpointed milk collecting stations as the sites where the melamine was added. According to Sanlu, contaminated milk was used in the manufacture of powdered infant formula processed before 6 August 2008 and the tainted milk powder has also been used in the manufacture of a number of other products.

Contamination levels

There are a total of 175 infant formula manufacturers across China, of which 66 have halted production and the remaining 109 manufacturers have undergone inspection due to the current events of melamine contamination. The inspections’ results presented by the Administration of Quality Supervision, Inspection and Quarantine (AQSIQ) show evidence of the presence of melamine. Out of 491 batches tested, 69 of them, produced by 22 companies, tested positive for Melamine.

According to the State Council of China, the levels found in the batches ranged between 0.09 mg/kg and 619 mg/kg. Batches from the company Shijiangzhuang Sanlu Co. contained the highest levels, up to 2563 mg/kg.

Toxicology of melamine

Based on the previous incidents of melamine contaminated pet food and the development of kidney stones and subsequent acute kidney failure in cats and dogs, it appears that melamine and its structural analogues, such as cyanuric acid, may act together to form crystals. This crystal formation occurs at very high-dose levels and is a threshold and concentration dependent phenomenon, which would not be relevant at low levels of exposure (US FDA/CFSAN Interim Melamine and Analogues safety/risk assessment http://www.cfsan.fda.gov/~dms/melamra.html).

Exposure

Consumer exposure to melamine is considered to be low, but may occur through the extraction of melamine from compression moulds by acidic foods, such as lemon or orange juice or curdled milk, at high temperature. Taking into account these sources the estimated oral uptake of melamine is around 0.007 mg melamine/kg/day (OECD 1998).

Toxicity of melamine

Melamine is not metabolized and is rapidly eliminated in the urine. No human data could be found on the oral toxicity of melamine but there are data from animal studies. These show the compound to have a low acute toxicity, with an oral LD50 in the rat of 3161 mg/kg body weight. In animal feeding studies, high doses of melamine have an effect on the urinary bladder, in particular causing inflammation, the formation of bladder stones and crystals in the urine. Analysis of the bladder stones has shown that these are a mixture of melamine, protein, uric acid and phosphate. Animal studies have generally not shown any renal toxicity or the formation of kidney stones.

Carcinogenicity

The International Agency for Research on Cancer (IARC) has concluded that there is sufficient evidence in experimental animals for the carcinogenicity of melamine under conditions in which it produces bladder stones. There is inadequate evidence for carcinogenicity in humans.

Role of melamine in the formation of kidney stones

Animal data have not shown that melamine alone causes renal failure or the formation of kidney stones. Evidence from an earlier outbreak of acute renal failure in cats and dogs associated with contaminated pet food suggests that a combination of melamine and cyanuric acid does cause renal toxicity. Both of these compounds were found in the pet food together with other triazine compounds. Subsequent experimental studies in animals have shown that when they are fed a mixture of melamine and cyanuric acid this causes the formation of crystals in the tubules of the kidneys, eventually blocking them and causing renal damage and renal failure. The source of the cyanuric acid in the pet food was unknown but it may have been present as a contaminant of the melamine that had been illegally added to wheat gluten used in formulating the petfood. In the current event in China, the presence of cyanuric acid has not yet been confirmed.

Health-based Guidance Values

Following the petfood incident in 2007 described above, several authorities have preformed preliminary risk assessments.

The US FDA has published an interim safety/risk assessment on melamine and structural analogues and has established for melamine a tolerable daily intake TDI of 0.63 mg per kg of body weight per day.

The European Food Safety Authority has published a provisional statement and recommended to apply a TDI of 0.5 mg per kg of body weight per day as tolerable intake value for melamine.

Epidemiology and treatment

Suggested surveillance case definition

Identification of possible cases related to the consumption of melamine-contaminated products from China

Member States should be aware of the possible distribution of the contaminated products either through formal or informal channels, because of the large quantities involved and the seriousness of the public health consequences of this event. The period of production of contaminated product is uncertain and the incriminated raw material and products may have been exported as infant formula or other milk containing products to other Member States. Therefore WHO is suggesting this surveillance case definition to Member States to increase their awareness of signs that their population may be affected.

Clinical description

The following symptoms have been observed in infants affected by the melamine-contaminated infant formula in China:

Unexplained crying in infants, especially when urinating, possible vomiting Macroscopic or microscopic haematuria Acute obstructive renal failure: oliguria or anuria Stones discharged while passing urine. For example, a baby boy with urethral obstruction with stones normally has dysuria High blood pressure, edema, painful when knocked on kidney area

WHO experts believe an additional symptom may be unexplained fever arising from urinary tract infections/bacteraemia secondary to urine stasis resulting from obstruction.

Surveillance case definition

A case is defined as an infant with kidney stones or other kidney problems (e.g. anuria, renal failure) having consumed powdered infant formula produced in China before 6 August 2008, and where other potential causes of kidney stones have been excluded by differential diagnosis.

Treatment

The World Health Organization has agreed to circulate the information contained herein regarding the treatment plan that is being implemented in China by the Ministry of Health. The information below does not reflect the rules, regulations, policies and guidelines of the World Health Organization.

The following regimen has been issued by the Ministry of Health, China.

Clinical manifestations

Unexplained crying, especially when urinating, possible vomiting Macroscopic or microscopic haematuria Acute obstructive renal failure: oliguria or anuria Stones discharged while passing urine. For example, a baby boy with urethral obstruction with stones normally has dysuria High blood pressure, edema, painful when knocked on kidney area

Key diagnostic criteria

Been fed with melamine-contaminated infant milk formula Having one or more of the above clinical manifestations Laboratory test results: routine urine tests with macroscopic or microscopic haematuria; blood biochemistry; liver and kidney function tests; urine calcium/creatinine ratio (usually normal); urinary red blood cell morphology shows normal morphology of red blood cells (not glomerular haematuria); parathyroid hormone test (usually normal). Imaging examination: preferably ultrasound B exam of urinary system. If necessary, abdominal CT scan and intravenous urography (not to be used in case of anuria or renal failure). Kidney radionuclide scans can be used where available to evaluate renal function. Ultrasound examination features: General features: bilateral renal enlargement; increased echo on solid tissue; normal parenchyma thickness; slight pyelectasia and calicectasis; blunt renal calyx. If the obstruction locates in the ureter, then the ureter above the obstruction point dilates. Some cases have edema with perinephric fat and soft tissue around the ureter. As the disease develops, the renal pelvis and ureter wall may have secondary edema. A few cases have ascites. Stone features: most stones affect the collecting system and ureters on both sides. Ureteral stones are mostly at pelviureteral junction, the part where the ureter passes across iliac artery, and ureter-bladder junction. Stones stay collectively, covering massive areas. Lighter echo in the background. Most stones are different from the calcium oxalate stones. Urinary tract is mostly completely obstructed by the stones.

Differential diagnosis

Haematuria differentiation: need to rule out glomerular haematuria. Stone differentiation: the stones are normally radiolucent and have a negative image on urinary tract x-ray. This feature differentiates the stones from those of radiopaque stones of calcium oxalate and calcium phosphate. Differentiation of acute renal failure: need to rule out pre-renal and renal failure.

Clinical treatment

Immediately stop using melamine-contaminated infant formula milk powder. Medical treatment: use infusion and urine alkalinization to dispel the stones. Correct the water, electrolyte and acid-base imbalance. Closely monitor routine urine tests, blood biochemistry, renal functions, ultrasound findings (with particular attention to the renal pelvis, ureter expansion, and the change of the stones in shape and location). If the stones are loose and sand-like, they are very likely to be passed out with urine. Treatment of complicated acute renal failure: priority should be given to the treatment of life-threatening complications such as hyperkalemia. Measures include the administration of sodium bicarbonate and insulin. If possible, blood dialysis and peritoneal dialysis can be used early. Surgical measures can be taken to remove the obstruction if necessary. Surgical treatment: if medical treatment is not effective, and hydrocele and kidney damage present, or blood dialysis and peritoneal dialysis are not available in case of renal failure, surgical methods can be considered to remove the obstruction. Stones can be removed by different methods including cystoscope retrograde intubation into the ureter, percutaneous kidney drainage, surgical removal and percutaneous kidney stone removal. Extracorporeal shock wave lithotripter (ESWL) is greatly limited in its application, because the stones are loose and mainly composed of urate, and the patients are infants.

Follow-up

Once the urinary obstruction is relieved, and the general condition and renal function and urination are back to normal, the children can be discharged.

Key issues to follow-up

Urine routine tests; ultrasound of urinary system; renal function tests; IVP (intravenous pyelogram) if necessary.

Actions taken by INFOSAN

INFOSAN is working directly with Ministry of Health (MoH), China in collaboration with the WHO Country Office in China. Through the INFOSAN Emergency surveillance system, WHO has learned of the contamination of infant formula with melamine and requested further information about the event on the 11 September 2008. MoH confirmed on 12 September 2008 that incriminated products from the Sanlu Company had not been exported and provided WHO with a description of the development of the event. Through further interaction between INFOSAN and MoH the issue of potential other use of the contaminated milk powder as well as parallel (illegal) distribution of contaminated milk powder was raised. An INFOSAN alert was subsequently distributed to the entire network on the 16 September 2008 alerting members of the event and of the possibility of contaminated products finding their way to other markets.

INFOSAN has several times during the past week, kept the entire network informed of developments in relation to this event as well as additional information on other products being found contaminated, information about the toxicity of the melamine and other information to help Member States better understand and assess the potential risks associated with melamine contaminated products.

The Chinese authorities, in their on-going investigation, discovered that 2 producers found to have products contaminated with melamine had exports going to five countries, INFOSAN informed these five countries of the situation.

To print this article:

• Melamine-Contamination Event, China, September 2008 (PDF)

For more information on melamine, contamination, and recalled products:

• World Health Organization (WHO), www.who.int/en
• U.S. Food and Drug Administration, www.fda.gov
• Questions and Answers on Melamine (PDF)
• FDA Detects Melamine Contamination in Flavored Drink

If you are visiting the beach or the swimming pool this summer season, play it safe with good personal hygiene to help prevent the spread of recreational water illnesses (RWI). What are RWI, how are they spread, and how can you protect yourself? Learn more about water safety, the bacteria and viruses lurking in shared water spaces and download tips on preventing water related illnesses: Recreational Water Illness