Hospitals.SG

The recent revelation of melamine contamination in milk supplies in China has rocked the food and health industries not only in China but also throughout many countries in the world. This is not surprising because milk is not only a common dietary drink but a common ingredient in many food derivatives and processed foods, and China is a major international food manufacturer and exporter.

Melamine is used in manufacturing dishes, plastic resins, flame-retardant fibres, paper and industrial coatings. In normal usage of these products, exposure and leaching of melamine into food through contact are very limited and would not produce the high contamination levels seen in this recent scandal. It is believed that the China milk sources had melamine added to bulk up diluted milk so as to raise the apparent protein content. The harmful effects of melamine ingestion are still undergoing studies, but animal tests and the China cases indicate problems related to the kidneys and urinary bladder systems - in particular, stone(crystal) formation and renal failure.

The US Federal Drug Agency (FDA) has derived a tolerable daily intake (TDI) of 2.5mg/kg (2.5ppm or parts per million by weight) of food product based on normal adult food consumption. Hong Kong's Centre for Food Safety has adopted a similar 2.5mg/kg safety level for non-infant-related foods, and a 1.0mg/kg level for infant foods. Malaysia has also adopted similar threshold levels, while Singapore did not reveal its testing and allowance standards uses 5ppm (see below) as its allowance limit for melamine contamination levels.

In the case of infant formula milk and other infant/baby foods, the FDA notably states that it cannot determine a level for melamine and its analogues that "does not raise public health concerns". In other words, there are no recommended TDI or detected melamine levels that it explicitly deems to be a safe level for consumption when it comes to infants. However, it notes that this does not mean that "any exposure to any detectable level of melamine and melamine-related compounds in formula will result in harm to infants."

Reasons that infants and children are at higher risk than adults include their lower body weights, which affect (lower) their total tolerable daily intake (TDI) for melamine; their undeveloped/developing renal systems; and the likelihood of greater milk consumption in their diet.

The rest of this article summarises the current situation (as of 10th October 2008) and the responses of the governments of Singapore, Malaysia and Hong Kong to this public health crisis.

Country Sections:

• Hong Kong
• Singapore
• Malaysia

Hong Kong

China's Special Administrative Region (SAR) of Hong Kong conducts its food safety and quality checks through its Centre for Food Safety (CFS). CFS has been one of the region's most active in testing and issuing public notices on the melamine incident.  This is not surprising considering the city's proximity to southern mainland China, though it is noted that the scandal originated in China's northern Hebei province near to Beijing.

As at 29th October 2008:  The Centre's test results showed that the following products were contaminated:

• Natural Choice Yogurt Flavoured Ice Bar with Real Fruit 伊利牧場大果粒酸奶味雪條
• Yili Super Bean Red Bean Chestnut Ice Bar 伊利伊豆  紅豆/板栗 (雪條)
• Yili Bean Club- Matcha red bean ice bar 伊利佰豆集 抹茶紅豆(雪條)
• Yili High Calcium Milk Beverage 伊利高鈣奶類飲品
• Yili Bean Club- Red bean milk bar 伊利佰豆集 牛奶蜜豆(雪條)
• Yili Prestige Chocliz - Dark Chocolate Bar 伊利臻品巧樂茲-黑朱古力味(雪條)
• Yili Pure Milk 伊利純牛奶
• Yili High calcium low fat milk beverage 伊利高鈣低脂奶類飲品
• Nestle Dairy Farm UHT Pure Milk 1L (Catering) 雀巢牛奶公司純牛奶
• White Rabbit Creamy Candies 大白兔奶糖
• Four Seas Cake (Strawberry Flavour) 四洲蛋糕士多啤梨味
• Heinz DHA+AA Vegetable Formula Cereal 亨氏金裝智多多 DHA+AA蔬菜嬰兒配方營養米粉 (適合7個月或以上嬰兒) [translation: suitable for 7month-old and older babies]
• Silang House of Steamed Potato Wasabi Cracker 思朗蒸薯坊芥末味餅乾
• Lotte Koala Strawberry Biscuit (Family Pack) 樂天小熊餅 (草莓忌廉夾心) (家庭庄)
• Lotte Koala's March Chocolate Biscuit (Family Pack) 樂天小熊餅(朱古力夾心)(家庭庄)
• Lotte Koala Biscuit (Family Pack) (Chocolate Filled) (Double Chocolate Flavor) 樂天小熊餅(朱古力夾心)(家庭庄)(特濃朱古力新口味)
• 利誠干吃奶片
• Licheng Milk Slice (Original) 利誠實業干吃奶片(原味)
• 東望洋Coconut  Cakes 東望洋椰蓉酥
• 東望洋Walnut Cakes 東望洋核桃酥
• Glico Pocky Men's Coffee Cream Coated Biscuit Stick (Net 52g) 固力果百奇咖啡味忌廉餅乾條
• Lotte Cream Cheese Cake 樂天奶油芝士夾心蛋糕
• Cadbury Dairy Milk Cookies Chocolate (5kg bulk pack) 吉百利香酥曲奇牛奶巧克力
• 吉百利香脆榛仁牛奶巧克力
• EDO Pack Almond Cacao Biscuit Sticks 可可杏仁餅干條
• Doraemon Chocolate Gummy Muscat Flavour 多啦A夢朱古力橡皮糖青提味
• 菓子達人 Strawberry Flavor Cream Malt Biscuits 菓子達人草莓味忌廉麥芽餅
• Munchy's Mini Crackers With Peanut Butter Munchy's 迷你花生夾心餅
• Munchy's Mini Crackers With Cheese Cream Munchy's 迷你芝士夾心餅
• Julie's Wheat Crackers Julie's 麥香蘇打餅
• Munchy's The Original Sugar Crackers Munchy's 原味梳打餅
• 美心大酒樓 (香港小西灣藍灣廣場) 馬拉糕 {dim sum sponge cake from a restaurant}
• Croley Foods Sunflower Crackers (Blueberry Cream Sandwich) - manufactured in Philippines
• Select Fresh Brown Eggs (Extra Large) 佳之選新鮮啡蛋 (特大裝) - from Dalian, Lianing Province, China 大连, 辽宁, 中国
• Fresh Hen Eggs 鮮雞蛋 (Star Seafood Restaurant Ngau Tau Kok Road, Kowloon 明星海鮮酒家九龍牛頭角道) - from Hubei Province, China 湖北, 中国
• Fresh Hen Eggs 鮮雞蛋 360 eggs/box Stall No. E2-E3, Western Wholesale Food Market 西區副食品市場E2-E3號榮記蛋行 - from Hubei Province, China 湖北, 中国

30th September 2008: Unilever Hong Kong Limited initiated recalls of Lipton Milk Tea Power products after its own internal quality checks found melamine. It appealed to the public to stop consumption of these products. The specific products are:

• Lipton Milk Tea Powder Original (17g x 20 sachets) - Best Before Date: 17112009
• Lipton Milk Tea Powder Gold (18.5g x 10 sachets) –Best Before Date: 17112009
• Lipton Milk Tea Powder Gold (18.5g x 20 sachets) - Best Before Date: 18112009
• Lipton Milk Tea Powder Gold (18.5g x 20 sachets) - Best Before Date: 19112009

29th September 2008: Cadbury Asia Pacific initiated a precautionary recall of 11 chocolate products. It appealed to the public to stop consumption of these products which were manufactured in its Beijing plant and distributed to Hong Kong. The specific products are:

• Cadbury Dark Chocette 45g
• Cadbury Dark Chocette 80g
• Cadbury Eclairs 180g
• Cadbury Dairy Milk Chocolate 150g Pumpkin
• Cadbury Dark Chocolate 40g
• Cadbury Dairy Milk Chocolate Bulk Pack 5kg
• Cadbury Dark Chocolate Bulk Pack 5kg
• Cadbury Dairy Milk Hazelnut Chocolate Bulk Pack 5kg
• Cadbury Dairy Milk Cookies Chocolate Bulk Pack 5kg
• Cadbury Hazelnut Praline Chocolate 312g (2008 Chinese New Year)
• Cadbury Dairy Milk Chocolate 300g (2008 Chinese New Year)

23rd September 2008: Hong Kong government updated its food regulations to add allowable maximum detected Melamine levels as follows:

1. Milk, food intended for children below 3 years old, and food intended principally for pregnant or lactating women - 1 milligram per kilogram of food (1ppm by weight).
2. Other foods - 2.5 milligram per kilogram of food (2.5ppm by weight).
   

19th September 2008: In a Letter to Doctors, CFS asked doctors to report cases of child renal diseases including urinary calculi to the Department of Health. CFS also revealed that they found neither Sanlu brand infant formula milk nor other mainland China milk powder brands being available in the local market. However, sample testing of other milk and milk products found some cases of low contamination levels between 2.2mg/kg to 21mg/kg.

16th September 2008: CFS started daily testing for melamine contamination on samples of milk and food products containing milk ingredients.

Singapore

Singapore's Agri-Food & Veterinary Authority (AVA) oversees food import testing. AVA's press releases and responses to the China milk melamine contamination issue are summarised here.

As at 29th October 2008: The following food products were found to have melamine (detected contamination levels are indicated for each product in square brackets []; ppm indicates parts per million):

• Yi Li Choice Dairy Fruit Bar Yogurt Flavoured Ice Confection [39 - 60.8ppm]
• Dutch Lady Strawberry Flavoured Milk [33.9 - 46.4ppm]
  
• White Rabbit Creamy Candy [67 - 160ppm]
• Dutch Lady Banana Flavoured Milk [36.7 - 48.7ppm]
• Dutch Lady Honeydew Flavoured Milk [9.43 - 58.7 ppm]
• Silang - House of Steamed Potato - Potato Cracker [11.96ppm]
• 徐福记 Puffed Rice Rolls - Butter Corn Flavour [10.7ppm]
• 徐福记 Puffed Rice Rolls - Cheese Flavour [8.5ppm]
• New Sshmallows Mallow Dippers-Strawberry Flavour [24.8ppm]
• Silang - House of Steamed Potato - Potato & Tomato Cracker [8.1ppm]
• Cadbury Choclairs – Blueberry Flavour [21.4 - 33.9ppm]
• Cadbury Choclairs – Coffee Flavour [92.3ppm]
• Panda Dairy Whole Milk Powder (industrial pack) [163.8ppm]
• Lotte Koala’s March Cocoa Chocolate Biscuit [17.3ppm] - made in China
• Hello Kitty Strawberry Cream Filled Biscuit [5.5ppm] - made in China
• Unbranded non-dairy creamer in industrial pack [415.4 - 6,694ppm] - made in China

  The following Malaysia-made products were announced on 24th Oct:

• Julie’s Golden Kaka Crackers [11.8 - 12.8ppm]
• Julie’s Cocoro Crispy Chocolate Wafer Rolls with Vanilla Cream Filling [8.04ppm]
• Julie’s Le-Mond Puff Sandwich with Lemon Flavoured Cream [up to 10.5ppm]
• Julie’s Wheat Crackers [4.9 - 23.4ppm]
• Julie’s Cottage Crackers (Vegetable Yeast Cracker) [0.6 - 10.8ppm]
• Julie’s Cottage Crackers (Original Yeast Cracker) [10.6ppm]
• Julie's Chez Creamy Cheese Sandwich [172.4ppm]
• Julie's Sugar Crackers (extra flaky) [18.8ppm]
• Julie's Waferico Chocolate Coated Wafers with Chocolate Cream Filling [up to 16.0ppm]
• Julie's Cream Crackers [33.8ppm]
• Julie's Minico Rich Chocolate Chip Cookies [20.0ppm]
• Julie's Peanut Butter Sandwich [0.7 - 12.6ppm]
• Khong Guan Assorted Biscuits [5.4 - 6.6ppm]
• Khian Guan Biscuit Osborne [5.3 - 10.8ppm]
• Leo Gold Finger Choco [0.6 - 6.2ppm]
• Santa Chocolate Gold Fingers [0.7 - 50.8ppm]
• Swan Chocolate Fingers [4.2 - 12.3ppm]

17th October 2008: An online article on AsiaOne reports that Khong Guan and Pokka products in Singapore are safe and free from melamine. This follows reports that Vietnam had found melamine in Singapore-manufactured Pokka milk coffee/drinks, and Malaysia had found melamine-tainted Malaysia-made biscuits from brands Khong Guan and Khian Guan.

On the same day, the Straits Times print version report (an expanded version of the online article) also pointed out that the official "satisfactory" level for melamine limit is 5ppm. This seems to be the first public announcement of Singapore's standard for melamine testing. As at 23rd October, the AVA press release quoted by the report was still not found on the AVA website.

As at 9th October 2008, there were no reported cases of patients suffering from diseases caused or linked directly to the recent milk melamine contamination. In its FAQ document, AVA advises parents to look out for the following symptoms in children and babies:

• Irritability and persistent crying, especially when passing urine.  
• Babies seem to be in pain
• Young children complaining of pain when passing urine.  
• Fever, nausea and vomiting
• Blood found in the urine  
• Signs of kidney infection

19th September 2008: AVA issues directive to all food importers to withhold and remove from sale all milk, milk products and dairy products manufactured in China.

Malaysia

The responsibility for food melamine testing falls under the Food Safety and Quality Divison (FSQD) of the Ministry of Health (Kementerian Kesihatan Malaysia or KKM).  The melamine safety levels set by FSQD are:

1. 1.0mg/kg (ppm) for infant food,
   
2. 2.5mg/kg (ppm) for other foods (normal adult consumption).

As of 23rd Oct 2008:  Latest Press Release from FSQ Division - The following products were found to have failed the melamine contamination testing:

• Ego White Rabbit Creamy Candy [135ppm].
• Vigour 888 Roll Filling (Sergestid Shrimp flavor) [4.71ppm].
• Taro Biscuits (Bairong) [75ppm].
• Khong Guan Brand (12 nos) :- Biskut Soda, Biskut Lemon Puff, Biskut Lemon Pof, Biskut Butter Cream, Biskut Baby Fish, Biskut Healthy Cracker, Biskut Cocoa Puff, Biskut Sandwich Oren, Biskut Family Crackers, Biskut Bentuk Binatang, Biskut Rokok and Biskut Mini Puff. [2.93 - 22 ppm]
• Khian Guan Brand (6 nos) :- Biskut Creamy Chocolate, Biskut Lemon Puff, Biskut Square Puff, Biskut Cocoa Puff, Biskut Jagung Puff and Biskut Campuran (Party). [3.66 - 7.99 ppm]
• House of Steamed Potato - Potato Cracker (Silang), imported from China [17 ppm]
• Khong Guan Brand : Iced Gem (Ais Jem) [3.33 ppm]
• Khong Guan Brand : Biskut Marie Besar [6.64 ppm]
• Khong Guan Brand : Tasty Cracker [2.57 ppm]
• Khong Guan Brand : Biskut ABC [12.6 ppm]
• Khong Guan Brand : Zoological Biscuit [5.16 ppm]
• Khong Guan Brand : Supercrown Cracker [9.11 ppm]
• Khong Guan Brand : Biskut Healthy Puff [8.55 ppm]

Food products found to have passed the melamine tests are listed here.

24th September 2008: Malaysia's Ministry of Health called on retailers and wholesalers of products manufactured using milk from China to remove them until further notice. Failure to comply subjected offenders to a maximum fine of RM100,000 or a jail term of up to 10 years.  The ministry also put medical personnel on alert to look out for signs of kidney malfunction in babies.  Symptoms include crying while urinating, blood in the urine and high blood pressure.

Links to Governmental Websites:

Hong Kong's Centre for Food Safety (CFS): http://www.cfs.gov.hk/eindex.html. Tel: 2381-6096 (from 9:00am to 6:00pm daily) .

Malaysia Ministry of Health's Food Safety and Quality Division: http://fsq.moh.gov.my/modules/news/index.php?sel_lang=english. Tel: 03-8883-3655 / 8883-3503.

Singapore's Agri-Food & Veterinary Authority (AVA): http://www.ava.gov.sg/. Tel: 6325-7625 during office hours (8.30am - 6.00pm, Monday - Friday).