May 05

Ternyata, kasus bakteri Enterobacter sakazakii dalam susu formula terus berlanjut sampai ke tingkat Mahkamah Agung. Sebagai anggota komunitas akademik, saya menyayangkan kenapa kasus ini tidak ditangani dengan baik saat gugatan terhadap IPB, BPOM, dan Depkes  diajukan, sehingga harus sampai ke tingkat kasasi yang kemudian diterima oleh Mahkamah Agung.

Akibatnya, sekarang, IPB berada dalam posisi melawan hukum. Saya tidak yakin apa yang akan terjadi secara hukum, akan tetapi secara sosial, saya melihat masyarakat kehilangan kepercayaan terhadap dunia akademik yang dianggap berkonspirasi untuk menutupi informasi penting tentang kondisi dunia industri

Saya coba serta kutipan sebuah email dari rekan saya di IPB tentang kasus Enterobacter sakazakii:

Pengambilan sampel untuk penelitian ini dilakukan tahun 2004 dan risetnya sendiri dilakukan tahun 2004 dan 2005 sebagai kerjasama Jerman-Indonesia yang dipublikasikan di Journal Of Food Protection V0l 69 N0 12, 2006, Pages 3013-3017 di bawah judul Enterobacteriaceae in Dehydrated Powdered Infant Formula Manufactured in Indonesia and Malaysia. Jadi data yang positif dan negatif yang disajikan pada tabel di di jurnal ini menurut saya bukanlah “lontaran informasi”, tetapi penyajian data ilmiah.

Isolat dari hasil penelitian di ataslah yang dites lebih lanjut dengan menggunakan mencit dan diseminarkan pada seminar terbuka hibah bersaing di tahun 2008. Jadi yang diujikan pada penelitian ini adalah isolat yang diisolasi dari saampel yang dibeli pada tahun 2004-2005. Perlu diketahui, pada tahun ini tema ini masih emerging dan belum ada satu negara pun yang memiliki aturan tentang ini. WHO sendiri baru mengeluarkan guideline pada tahun 2008.

Berdasarkan hasil penelitian ini peneliti diundang oleh Badan POM pada tahun 2006-2007 dan BPOM telah menindak lanjutinya dalam bentuk pengendalian yang lebih ketat terhadap cemaran dan regulasi khusus pada tahun 2009. Dengan kata lain tanggung jawab peneliti yang melakukan hazard identification telah ditransfer ke ranah policy atau risk management jika kita tinjau dalam kerangka berpikir risk analysis in food safety. Jadi justru sebelum konsumen ribut, peneliti sudah menjalankan perannya dalam mengawal kesehatan massyarakat. Penelitian lebih lanjut menunjukkan bahwa praktek di rumah tangga yang baik (suhu air di atas 70 derajat) cukup untuk membunuh mikroba ini.

Alhasil tidak ditemukan lagi cemaran ini pada tahun 2009 dan 2010 sebagaimana yang telah dirilis oleh BPOM. Ini adalah contoh konkrit bagaimana penelitian berkontribusi positif untuk pengaturan.

Saya pikir informasi ini harus sampai ke masyarakat, sehingga pada saat diumumkan sesuai dengan amar putusan MA mereka sudah lebih pandai. Sekarang kita tinggal melakukan hitung-hitungan antara ancaman terhadap kesehatan karena sakazakii (yang notabene setelah tahun 2009 sudah tidak ada lagi berdasarkan surveillance BPOM) dengan kehebohan yang mungkin terjadi dari penyebutan merek tersebut. Semoga bermanfaat.

Jadi bagaimana kita harus bersikap? Begini, saat ini, standar-standar yang ditetapkan oleh BPOM maupun Depkes, sudah sangat ketat dan BPOM sebagai agen berwenang juga sudah mengadakan surveillance.  Tentu saja bahaya kontaminasi selalu ada, tapi tidak selalu dari bahan baku susu. Bisa saja dari air yang digunakan, atau wadah botol yang tidak bersih. Oleh karena itu, selalu perhatikan kebersihan dalam pengolahan makanan, terutama apabila menyangkut makanan bayi, yang sistem kekebalan tubuhnya belum sekuat orang dewasa.

Apr 09

An article published in the latest edition of Nature, widely quoted by various news media,   has given me a new reason to love microbiology even more. The main findings suggest that the bacteria in the food we eat (in this case, sushi) may play an important role  in providing the gut microorganisms with enhanced capabilities for food digestion. This accomplished through horizontal gene transfer, a mechanism especially well documented in prokaryotes. You are what you eat, indeed.

What does this mean for us? Well, this is a message to continuously maintain a high level of biodiversity in the environment because it is more than likely providing us with many benefits including for our health.

For a link to the abstract of the article please click here. For the full article you need to pay for access. If you don’t feel like reading the scientific article, here are some articles:

  1. BBC news: Sushi may ‘transfer genes’ to gut
  2. The Guardian: Sushi munching bacteria found in the guts of Japanese people
  3. The Scientist.com: Gut bacteria are what we eat

So let’s hit those sushi bars this weekend!

Apr 08

The controversy on Enterobacter sakazakii contamination continues. The National Agency For Drug and Food Control has carried out testing for Enterobacter sakazakii on 96 baby formula samples. You can read the information on their website. The news is good.

However, the news probably came too late. In mid March, a Jakarta citizen filed a lawsuit against IPB, NA-DFC and the government (Ministry of Health) stating that the brand names of baby formula should be exposed saying that it is against the law to withhold information about the samples. It’s in all newspapers, here is one link while here is another

Now this is wrong. I believe it’s against research ethics to divulge any brands during a research. A researcher is not required to mention the names of the research objects. I must emphasize again that the objective of the research was not to check the quality of the baby formula but to obtain Enterobacter isolates. There is a difference. I hope the courts can see the issue clearly and not force the researchers to expose the research samples. It is unethical

Of course, the general public is not aware of these research objectives and we cannot expect them to understand. We cannot blame them for feeling unsafe about all these contaminated products.

But we can blame the media for misrepresenting the issue and the government for mishandling the issue. Questioning a researcher’s credibility and integrity is the easiest way, and after reserving judgement about the Minister of Health, I now will stop being diplomatic and state this honestly. The Minister of Health is not capable and competent in dealing with national health issues. These issues go beyond the minister’s competence in Medicine (which I am not questioning). In my opinion, the best thing for the Minister to do right now is to resign the post.

And the media continues to spread the twisted issue of contaminated milk which I think is really not helping the issue of food safety in general.

Finally, the public themselves should be more aware and jump to conclusions regarding food safety. After all, we are a community who don’t think too much about eating in questionable places on the side of the road… With proper precautions, we won’t have to worry too much about Enterobacter sakazakii.

Feb 28

Recent research from a neighboring university has again brought attention to the issue of food product contamination, specifically in this case, baby formula. At first I thought there had been an outbreak of some sorts, but it wasn’t. It was “just” a research finding.

And yet, this particular finding sent people into panic. The thought of possibly drinking contaminated milk was so terrifying people demanded that the researchers disclose the brands that were contaminated. The media immediately did their own investigating. The Minister of Health was pressured to make a statement, and make a statement she did. Unfortunately, the comment only created another controversy and did not help with the actual issue.

But what is the actual issue?

The actual title of the study was Potensi Kejadian Meningitis Pada Neonatus Akibat Infeksi Enterobacter sakazakii Yang Diisolasi Dari Makanan Dan Susu Bayi. The team from Faculty of Veterinary Medicine analyzed 22 samples of baby formula and 15 samples of baby food and found that 22,73% of the baby formula samples and 40% of the baby food samples were contaminated with Enterobacter sakazakii. Google the bacterium name and you will find 516,000 references on Enterobacter sakazakii. The bacterium is known to cause neonatal meningitis. Gurtler et al. (2005) wrote that the first cases of neonatal meningitis believed to be caused by Enterobacter sakazakii were first reported in 1961 and research on this bacteria remains active until now. Kim and Park (2007) is just one of the recent publications.

Whenever we read about these research findings, we should keep in mind the original objective of the research. Topic wise, the research carried out by Estuningsih et al. was not really new, meaning that there are already many published research on Enterobacter sakazakii. Dr. Estuningsih herself has been actively researching this for awhile. So why is it now that the findings created a widespread panic? When there have not been any reported cases of bacterial meningitis caused by E.sakazakii in Indonesia?

Blame the sensationalist Indonesian media, I think, especially since the airing a certain program on one TV station that dedicates its content to the sleazy work of food tampering of basically every edible known to man. Now, I don’t mean we shouldn’t pay attention to this research finding, absolutely not. However, I believe that the findings of Estuningsih et al. were not meant to be an investigative report on the quality of baby formula in Indonesia and the poor conditions of food safety in Indonesia. She is a researcher on E. sakazakii and the team is reporting on potential effects of a local E. sakazakii strain found in baby food and baby formula. I should also mention that the findings also mentioned the need for more research to support the findings and not a recall of certain brands of baby formula and baby food. That was not the original objective. And in my scientific opinion, the Indonesian media has somewhat twisted the original objective and turned it into a national scare. Of course, the Minister of Health’s comment was unwarranted and totally unbecoming for a professor of medicine. But, to be fair, sometimes the media likes to take comments out of context. But if I may ask Madam Minister, maybe a neutral “we are looking into it” type of comment would be more appropriate?

The governing body on food safety, The National Agency of Food and Drug Control has already issued a statement about the issue of Enterobacter sakazakii in baby formula. It may not be enough for our already semi-paranoid society which is too bad. Irrational behavior can have damaging effects in the long run. Do we want to deal with baby food manufacturers lay offs if there is a drop in productions? The socio economic aspect is often forgotten in all the uproar.

Yes, we should all be more careful and vigilant on everything that goes into our bodies. We should prepare food and drink properly, keeping the universal precautions in mind. Always boil water at 100 degrees for at least 2-3 minutes after boiling to kill vegetative bacterial cells. Awareness and education is the key, not spreading panic!

References quoted:

Gurtler JB, Kornacki JL, Beuchat LR. 2005. Enterobacter sakazakii: a coliform of increased concern to infant health. Int J Food Microbiol. 2005 Sep 25;104(1):1-34.Click here to read

Kim SH, Park JH. 2007. Thermal resistance and inactivation of Enterobacter sakazakii isolates during rehydration of powdered infant formula. J Microbiol Biotechnol. 2007 Feb;17(2):364-8.