Since the spring of 2008, an increase of urinary tract stones in infants and young children were noticed by pediatricians in Gansu, Hebei, Beijing, and other cities/provinces. This was followed by an epidemic of urinary tract stones in infants and young children in more than 10 provinces in the mainland of China. In September 2008, the cause of this unusual epidemic was identified, i.e. the illegal use of “protein essence” (melamine, an industrially synthesized chemical) in raw milk (the main ingredient of infant formula) to falsely increase the protein content of raw milk after dilution with water. This was a typical case of raw milk adulteration. When melamine concentration was high enough in the infant formula, because of its very low solubility, it formed crystals or stones in the urinary tract of infants and young children. The names of the 22 dairy companies whose infant formula products have been found tainted with melamine were immediately released by the State Council. The Sanlu Company was identified as the one most seriously violated the law.1,2 According to the report by the Ministry of Health of the People's Republic of China, 294 000 infants and young children in China had been diagnosed to have urinary tract stone by the end of November 2008. Although most patients have no symptoms and signs, acute renal failure did occur in a small proportion of patients. More than 50 000 infants have been hospitalized, and six deaths have been confirmed.3 This outstanding food safety issue has immediately become the top priority in the agenda of the State Council. Several vigorous measures were taken to control this crisis after September 14, 2008.1 On one hand, raw milk collection and infant formula production were subject to intensive regulatory control and inspection measures, including special inspectors were stationed in every major dairy product manufacturer, each batch of raw milk was tested for melamine and interim control limits for melamine were set up for infant formula and other dairy products. As a result, all dairy products, including infant formula, are in compliance with the control limits of melamine. All the inspection data were published regularly by the government, as a means of risk communication. On the other hand, free check up was provided by the hospitals for any children who have consumed those “problematic milk powder” and within 3 months more than 20 million children have been examined by ultrasound B. Free hospitalization and treatment were also provided to those diagnosed cases. Doctors, nurses, technicians and other staff in all the hospitals have worked extremely hard to overcome the difficulties and meet the challenges. Numerous sleepless nights and countless days of irregular meal times caused intensive stress to hospital workers. However, by the end of November, they won the battle. Most hospitalized patients recovered and were discharged. The major work moved to follow-up of the patients according to their disease conditions. While the criminals in this case of melamine adulteration of milk remain to be pronounced by the court and the compensation to the affected children will be completed in late January 2009, there are some lessons that we could learn from the melamine crisis. First, honesty and credibility of food industry is the key to safe food. Food safety covers a long chain from farm to table, and the final safe food product is the result of many safe steps. Food and agriculture industry should have social responsibility to ensure the safety of food products. Second, the government food safety control system should cover the whole food chain without any possible holes or gaps. Obviously, the raw milk collection station was the crime site of melamine adulteration and no single government agency had clearly identified responsibility for controlling the numerous private raw milk collection stations. Third, proper risk communication among all the stakeholders relevant to food safety is very important in crisis management. Continuous information release during the crisis from the government on the toxicological characteristics of melamine, testing results of melamine in dairy products, control actions taken by government agencies, interim control limits for melamine, and policies on free check up and treatment of patients, made the consumers aware of the details of the crisis and reduced unnecessary concerns among consumers.4 Frequent press conferences organized by the State Council and Ministry of Health since September 2008 were considered as a successful way of risk communication, which should be maintained after the melamine crisis is over. The melamine crisis was a bad thing for China and Chinese people; but it could be turned out to be a good thing. We have every reason to believe that the quality and safety of our dairy products, including infant formula are now much improved than before and it will continue improving. The agriculture and other food industries will also learn the lessons from this crisis and improve the quality and safety of their products. In addition, the government will certainly improve the food safety legal system, including the new food safety law and standards, and strengthen the regulatory control and inspection of the whole food chain. And last, our public health scientists have improved their capability in laboratory analysis, epidemiologic study and risk assessment in this crisis; and our clinicians have learned new knowledge about the diagnosis and treatment of urinary tract stone disease, a rare disease in infants and young children. The more we learned from this melamine event, the better we could ensure the safety of our foods.
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Junshi Chen (2009) studied this question.