Safety of Ready to Use products GNC Face to Face Meeting January 25, 2013

Background In July and September 2012 low level presence of Cronobacter Sakazakii was detected in RUSF and RUTF respectively through independent testing Supplies were quarantined at country or manufacturer level Final product certification of bacteria free product was required by manufacturers since January 2011 UNICEF/WFP/MSF asked FAO and WHO to convene a technical expert committee to identify the actual risks to the target population Lack of evidence regarding C.s, except for some studies in neonates

Findings from committee More data needed on the physiology of malnourished children RUTF and RUFs considered in same category Industry overall needs work to improve the food safety Profile of hazards was re-worked and a new sampling protocol to address the revise hazards will be put forth by the committee Cronobacter is NOT considered the biggest risk to the population Salmonella is considered a larger risk

Next steps RUFs at country level will remain in quarantine until a final statement is officially released from the committee Draft summary report is available and can be shared in the coming 3-4 weeks Final statement from FAO/WHO (April?) Manufacturer meeting (March 19 th ) organized by WFP/MSF/UNICEF to inform manufacturers in the change in testing UNICEF will begin independent testing for salmonella with a more intensive sampling protocol (according to USFDA protocol for peanut butter)

Hazard Identification for RUTF and RUF Hazard Potentially in ingredients Potentially in processing environment Potentially will survive process Potentially Pathogenic at Low Dose Potential severity Mycotoxins* Nontyphoidal Salmonella serovars ++++Serious Other Enterobacteriaceae (includes Escherichia, Klebsiella, Shigella, Enterobacter, Cronobacter, Citrobacter, and Proteus) ++++Variable Clostridium botulinum++++ **Severe Listeria monocytogenes ++++ ***Serious Bacillus cereus+++--Moderate Enterotoxigenic Staphylococcus aureus +++--Moderate Clostridium perfringens+++--Moderate

RUTF Procurement Volume procured: 29,000 MT Number of suppliers used: 19 Portion sourced in Africa: 45% Destination: 44 countries Received in-kind: 1,200 MT (83% FFP)

UNICEF RUTF needs for 2013 Forecast 1 (July/August 2012): 32,000 MT (10,000 MT – from local sources) Forecast 2 (January 2013): 34,000 MT

Intended Use- at the OTP RUTF used for children 6-59 months without medical complications for outpatient treatment RUTF part of a clinical protocol whereby children repeated medical check-ups, antibiotics, de- worming, micronutrients Mothers receive IYCF counselling Children undergo an appetite test at each session to ensure that they have good appetite and they are observed while consuming RUTF 8