News Release
HUNTERSVILLE, N.C., May 29 /PRNewswire/ -- Microban International, Ltd., the global leader in built-in antimicrobial technology, has extended their existing partnership with Rubbermaid Consumer Products to Rubbermaid Commercial Products, the market leader in safety and productivity solutions for the foodservice industry.
Rubbermaid Commercial Products launched its new Sturdy Chair(TM) Youth Seat with Microban(R) antimicrobial product protection at the National Restaurant Association Show, May 19-22, in Chicago, IL. This innovative high chair is the first product introduction resulting from the exclusive alliance, and is the only high chair product available to the foodservice industry with Microban(R) antimicrobial protection. Microban technology works continuously to help prevent the growth of bacteria that can cause stains and odors, giving new peace of mind to food service operators and their patrons.
Under the right conditions, such as those commonly found on untreated high chairs, bacteria can double in number every 20 minutes. With the added protection of Microban(R) antimicrobial technology, the Sturdy Chair(TM) Youth Seat will stay cleaner between cleanings, making this a smart investment for food service operators.
"We are very excited about the addition of Microban(R) antimicrobial protection to Rubbermaid high chairs," said David J. Meyers, CEO of Microban International, Ltd. "As the foodservice industry continues to respond to pressure from consumers for a cleaner dining environment, products with Microban(R) technology will help fill this need by keeping foodservice products cleaner for longer. "
Rubbermaid Commercial's Product Director, Virginia Murray, noted, "We are especially excited as this exclusive partnership is groundbreaking within the commercial foodservice industry, and we are hopeful that it will lead to new opportunities for both companies."
About Microban International
Microban International, Ltd. is a global technology and marketing company dedicated to enhancing high quality consumer, industrial and medical products with branded built-in protection from microbes. Microban International licenses the Microban(R) global brand name, sells custom-engineered compounds, and provides a range of services, including regulatory and marketing support. The Microban(R) brand promises continuous and durable antimicrobial product protection, built-in during manufacture to not wear out for the useful life of the product. Microban International is headquartered in North Carolina with operations in North America, Europe and Asia. For more information, please contact (704) 875-0806 or visit http://www.microban.com/ . About Rubbermaid Commercial Products
Rubbermaid Commercial Products, headquartered in Winchester, VA, is an ISO 9001 manufacturer of innovative, solution-based products for commercial and institutional markets worldwide. Since 1968, RCP has pioneered technologies and system solutions in the categories of food service, sanitary maintenance, waste handling, material transport and safety products. Rubbermaid Commercial Products is a business unit of Newell Rubbermaid Inc., a global marketer of consumer and commercial products with annual sales of approximately $6 billion. For more information, please visit Rubbermaid Commercial Product's web site at http://www.rcpworksmarter.com/ . CONTACT: Sarah Hoxie
(704) 766-1068
Microban International, Ltd.
CONTACT: Sarah Hoxie for Microban International, Ltd., +1-704-766-1068Web site: http://www.microban.com/ http://www.rcpworksmarter.com/
Wednesday, May 30, 2007
Resistant Gens in Food
Recent Studies presented in the 107th General Meeting of the American Society for Microbiology, indicates that we humans may be eating food that is causing a rise in antibiotic resistant infections.
Dr. Hua Wang (Ohio State university) who presented the study said that the food we eat could be an important source of this antibiotic resistant evolution in microbes. Over the past few years, normal infection like malaria, flu and many more are becoming more and more dangerous as the microbes have been developing antibiotic resistance. This makes it harder to treat the patient as the regular antibiotics are to able to fight the disease causing microbes. Earlier on this rise in resistance was attributed to the fact that doctors and physicians were more easily prescribing powerful antibiotic to patients thus flooding the general population with these drugs. Thus it allowed the very few number of resistant varieties of microbes to grow in number and now cause the problem we face.
Studies now show that food intake may also be a key factor that has led to rise in these resistant varieties. The way microbes may gain antibiotic resistance is through a process called Horizontal Gene Transfer." this is a process by which bacteria in close proximity to each other can share genetic information thus making non resistant varieties, resistant. This problem is not being studied further in greater detail as it may present a huge problem for Modern Medicine.
Another scary fact is that is has also been shown that babies who have been feed only on breast milk also show the presence of these resistant varieties of microbes in their intestines. This, means that he source of these microbes can also be outside the food supply. Thus now environmental factors are also being studies as a vector form to transfer genetic information from resistant varieties to non-resistant varieties.
Dr. Hua is currently working on methods by which resistant genes can be minimized in our foods. So next time you buy something from the supermarket make sure you cook it nicely and you know exactly what is the source of your food products.
Dr. Hua Wang (Ohio State university) who presented the study said that the food we eat could be an important source of this antibiotic resistant evolution in microbes. Over the past few years, normal infection like malaria, flu and many more are becoming more and more dangerous as the microbes have been developing antibiotic resistance. This makes it harder to treat the patient as the regular antibiotics are to able to fight the disease causing microbes. Earlier on this rise in resistance was attributed to the fact that doctors and physicians were more easily prescribing powerful antibiotic to patients thus flooding the general population with these drugs. Thus it allowed the very few number of resistant varieties of microbes to grow in number and now cause the problem we face.
Studies now show that food intake may also be a key factor that has led to rise in these resistant varieties. The way microbes may gain antibiotic resistance is through a process called Horizontal Gene Transfer." this is a process by which bacteria in close proximity to each other can share genetic information thus making non resistant varieties, resistant. This problem is not being studied further in greater detail as it may present a huge problem for Modern Medicine.
Another scary fact is that is has also been shown that babies who have been feed only on breast milk also show the presence of these resistant varieties of microbes in their intestines. This, means that he source of these microbes can also be outside the food supply. Thus now environmental factors are also being studies as a vector form to transfer genetic information from resistant varieties to non-resistant varieties.
Dr. Hua is currently working on methods by which resistant genes can be minimized in our foods. So next time you buy something from the supermarket make sure you cook it nicely and you know exactly what is the source of your food products.
Tuesday, May 29, 2007
Sustainability, Infection Prevention, Evidence-Based Design Among Trends in $41 Billion Healthcare Construction Industry
SAN FRANCISCO--The $41 billion healthcare construction industry is going green as it anticipates growing 11 percent in 2007, according to a Health Technology Center (HealthTech) study. HealthTech reports that sustainability principles are lowering energy costs, creating environments less prone to the spread of infection, and reducing the carbon footprint of health facilities.
U.S. hospitals are discovering that sustainable design practices not only reduce energy costs, but lower infection rates, according to the study. Technologies – such as motion sensors for lights, faucets, and doorways – reduce the transmission of infections as well as lowering the $5.3 billion spent annually on energy.
“The high cost of energy and operations, coupled with increasing environmental consciousness, has elevated the importance of green design for healthcare facilities,” said Molly J. Coye, MD, CEO of HealthTech. “Green technology investment has become cost-effective and pays for itself within a few years.”
Principles that reduce hospital acquired infection rates and manage the prevalence of multi-drug resistant organisms is another critical trend in healthcare facility design. Wireless communications, RFID tracking, anti-microbial surfaces, negative pressure isolation rooms, single patient rooms, and emergency department entrance alternatives are used to reduce infections, which claim up to 100,000 lives every year.
Another trend is the use of evidence-based design to assure that facilities support clinical efficiency, patient safety, and deployment of emerging information and clinical technologies.
“Hospital CEO’s face significant financial challenges. They want evidence that care environments are improving patient outcomes and workforce efficiency,” said Steven DeMello, director of research and forecasting for HealthTech.
Design research databases, modeling and simulation, virtual environments, process software, and manufacturing quality techniques (e.g. LEAN, Six Sigma) are among the tools increasingly used by hospitals and design firms, according to DeMello.
The report profiles several organizations that have successfully acted on these trends, including:
The Patrick H. Dollard Discovery Health Center in upstate New York which is saving $50,000 annually more than projected after designing the facility to become a Leadership in Energy and Environment Design certified facility;
Sutter Health’s in California and in Seattle Virginia Mason’s use of LEAN principles to design a hospital and improve process flow, respectively;
Peace Health in the Pacific Northwest participated in the Pebble Project (researching effect of facility design on quality of care and financial performance) to install patient lifts and booms, resulting in 99% fewer injuries;
Multi-state Kaiser Permanente development with a carpet manufacturer of a PVC-free carpet with the same performance as vinyl carpeting.
HealthTech (healthtech.org) is a research organization and expert network that offers its partner hospitals and health systems proprietary reports, decision support tools, and educational events for adopting care delivery innovations and deploying emerging technologies. Partners develop a competitive advantage by using HealthTech’s resources to redesign care, plan future facilities, prioritize technology investments and avoid costly errors.
U.S. hospitals are discovering that sustainable design practices not only reduce energy costs, but lower infection rates, according to the study. Technologies – such as motion sensors for lights, faucets, and doorways – reduce the transmission of infections as well as lowering the $5.3 billion spent annually on energy.
“The high cost of energy and operations, coupled with increasing environmental consciousness, has elevated the importance of green design for healthcare facilities,” said Molly J. Coye, MD, CEO of HealthTech. “Green technology investment has become cost-effective and pays for itself within a few years.”
Principles that reduce hospital acquired infection rates and manage the prevalence of multi-drug resistant organisms is another critical trend in healthcare facility design. Wireless communications, RFID tracking, anti-microbial surfaces, negative pressure isolation rooms, single patient rooms, and emergency department entrance alternatives are used to reduce infections, which claim up to 100,000 lives every year.
Another trend is the use of evidence-based design to assure that facilities support clinical efficiency, patient safety, and deployment of emerging information and clinical technologies.
“Hospital CEO’s face significant financial challenges. They want evidence that care environments are improving patient outcomes and workforce efficiency,” said Steven DeMello, director of research and forecasting for HealthTech.
Design research databases, modeling and simulation, virtual environments, process software, and manufacturing quality techniques (e.g. LEAN, Six Sigma) are among the tools increasingly used by hospitals and design firms, according to DeMello.
The report profiles several organizations that have successfully acted on these trends, including:
The Patrick H. Dollard Discovery Health Center in upstate New York which is saving $50,000 annually more than projected after designing the facility to become a Leadership in Energy and Environment Design certified facility;
Sutter Health’s in California and in Seattle Virginia Mason’s use of LEAN principles to design a hospital and improve process flow, respectively;
Peace Health in the Pacific Northwest participated in the Pebble Project (researching effect of facility design on quality of care and financial performance) to install patient lifts and booms, resulting in 99% fewer injuries;
Multi-state Kaiser Permanente development with a carpet manufacturer of a PVC-free carpet with the same performance as vinyl carpeting.
HealthTech (healthtech.org) is a research organization and expert network that offers its partner hospitals and health systems proprietary reports, decision support tools, and educational events for adopting care delivery innovations and deploying emerging technologies. Partners develop a competitive advantage by using HealthTech’s resources to redesign care, plan future facilities, prioritize technology investments and avoid costly errors.
Sunday, May 27, 2007
Processors called to arms in anti-biotic resistance battle
By Neil Merrett
5/25/2007- Food processing must play a role in preventing the evolutionary shifts that lead to bacterial antibiotic resistance, according to new research from the US.
Hua Wang, who is helping oversee the study at Ohio University, says that manufacturers within the food industry will have to face up to the growing dangers posed by the spread of bacterial resistance in the food chain.
"Data indicates that food could be an important avenue for antibiotic-resistant bacterial evolution and dissemination," she said, speaking at the 107th General Meeting of the American Society for Microbiology (ASM) in Toronto this week.
"The role of commensals [bacteria found normally in the gut], especially food-borne microbes, in transmitting resistance genes are becoming a concern to the scientific community," she added.
The growth in antibiotic resistance has been blamed on a process known as horizontal gene transfer, in which bacteria strains within close proximity can share genetic information, says the ASM. This shared material has been found to include coding for antibiotic resistance.
The ASM add that the process has already been identified with hospital environments, and is now being linked to food processing.
According to studies conducted last year by Hua and her colleagues, ready to eat food products carried bacteria with some form of antibiotic-resistance.
Though resistance was not linked to pathogens in processed cheese and yoghurt, it was found in a variety of products like seafood, meats, dairy and deli items.
However, the findings that horizontal gene transfer can also occur within both commensal and beneficial strains of bacteria are of particular concern for food processors and formulators.
While establishing that food processing may be aiding antibiotic resistance in bacteria, Hua suggests that it could be used to prevent further spreads.
By working with her colleagues, she hopes to establish conditions that can minimize horizontal gene transfer within the fermentation of products. It is hoped that the research could lead to breakthroughs in other types of food production.
"Given the proper investment of money, effort and time we can identify the steps that need to be taken at the processing level to minimize the emergence of antibiotic resistance genes in our food supply," says Hua.
5/25/2007- Food processing must play a role in preventing the evolutionary shifts that lead to bacterial antibiotic resistance, according to new research from the US.
Hua Wang, who is helping oversee the study at Ohio University, says that manufacturers within the food industry will have to face up to the growing dangers posed by the spread of bacterial resistance in the food chain.
"Data indicates that food could be an important avenue for antibiotic-resistant bacterial evolution and dissemination," she said, speaking at the 107th General Meeting of the American Society for Microbiology (ASM) in Toronto this week.
"The role of commensals [bacteria found normally in the gut], especially food-borne microbes, in transmitting resistance genes are becoming a concern to the scientific community," she added.
The growth in antibiotic resistance has been blamed on a process known as horizontal gene transfer, in which bacteria strains within close proximity can share genetic information, says the ASM. This shared material has been found to include coding for antibiotic resistance.
The ASM add that the process has already been identified with hospital environments, and is now being linked to food processing.
According to studies conducted last year by Hua and her colleagues, ready to eat food products carried bacteria with some form of antibiotic-resistance.
Though resistance was not linked to pathogens in processed cheese and yoghurt, it was found in a variety of products like seafood, meats, dairy and deli items.
However, the findings that horizontal gene transfer can also occur within both commensal and beneficial strains of bacteria are of particular concern for food processors and formulators.
While establishing that food processing may be aiding antibiotic resistance in bacteria, Hua suggests that it could be used to prevent further spreads.
By working with her colleagues, she hopes to establish conditions that can minimize horizontal gene transfer within the fermentation of products. It is hoped that the research could lead to breakthroughs in other types of food production.
"Given the proper investment of money, effort and time we can identify the steps that need to be taken at the processing level to minimize the emergence of antibiotic resistance genes in our food supply," says Hua.
Scientists have unveiled a new weapon which could help speed up wound healing in diabetics - water.
Slowed wound healing, mainly due to damage to small blood vessels, can be a serious complication of the condition which effects more than two million sufferers in Britain.
According to researchers a form of "super-oxidised" water can accelerate healing by killing bugs more effectively than bleach - without harming tissue.
The healing of wounds is a problem for diabetics who do not have good blood glucose control or have circulatory problems.
The key ingredient of the product called Microcyn - which was presented at biomedical business conference Global Healthcare in Monte Carlo - is electrically charged atoms called oxychlorine ions which destroy viruses, bacteria and fungi.
Wounds of diabetics treated with the product and an antibiotic healed within 43 days on average - compared with 55 days for patients given the standard treatment of iodine plus an antibiotic.
Hoji Alimi, chief executive of the California-based developers Oculus, said human cells are spared because they are tightly bound together in a matrix.
He said: "Microcyn only kills cells it can completely surround."
The vital atoms are formed by exposing purified water to sodium chloride, reports New Scientist.
These kill microbes and viruses but are present in much lower amounts than in bleach which also contains a slightly different combination of ions - including large amounts of the highly reactive hypochlorite ion.
Despite containing 300 times less hypochlorite than bleach Microcyn killed 10 strains of bleach-resistant bacteria, according to a study.
Professor Eileen Thatcher, of Sonoma State University in Rohnert Park, California, who carried out the research, said: "It may be that other unusual ions in Microcyn but not bleach are instantly lethal to bugs."
Mr Alimi has also found a way to stabilise the ions by making them react with and regenerate each other during storage so the fluid remains active for up to two years.
Microcyn was officially approved in the US for cleaning wounds two years ago but some physicians have also been using it off label to accelerate healing.
Dr Cheryl Bongiovanni, director of wound care at the Lake District Hospital in Lakeview, Oregon, has used Microcyn on around 1,000 diabetic patients with leg and foot wounds over the past 18 months.
She said: "When you spray it on you see the treated tissue 'pink up' and go beefy which is good because it means the oxygen supply has resumed."
Official phase II trials to test the product's wound-healing potential are currently taking place in the US and Europe.
Professor Andrew Boulton, of the Manchester Royal Infirmary who is conducting one such study, said: "It does seem promising. Hopefully it will confirm our initial good experience."
Tracy Kelly, care advisor at Diabetes UK, said 15 per cent of people with diabetes who develop foot ulcers eventually suffer amputations.
She said: "We would welcome any safe, effective treatment which could help hasten recovery."
Copyright © 2006 National News +44(0)207 684 3000
According to researchers a form of "super-oxidised" water can accelerate healing by killing bugs more effectively than bleach - without harming tissue.
The healing of wounds is a problem for diabetics who do not have good blood glucose control or have circulatory problems.
The key ingredient of the product called Microcyn - which was presented at biomedical business conference Global Healthcare in Monte Carlo - is electrically charged atoms called oxychlorine ions which destroy viruses, bacteria and fungi.
Wounds of diabetics treated with the product and an antibiotic healed within 43 days on average - compared with 55 days for patients given the standard treatment of iodine plus an antibiotic.
Hoji Alimi, chief executive of the California-based developers Oculus, said human cells are spared because they are tightly bound together in a matrix.
He said: "Microcyn only kills cells it can completely surround."
The vital atoms are formed by exposing purified water to sodium chloride, reports New Scientist.
These kill microbes and viruses but are present in much lower amounts than in bleach which also contains a slightly different combination of ions - including large amounts of the highly reactive hypochlorite ion.
Despite containing 300 times less hypochlorite than bleach Microcyn killed 10 strains of bleach-resistant bacteria, according to a study.
Professor Eileen Thatcher, of Sonoma State University in Rohnert Park, California, who carried out the research, said: "It may be that other unusual ions in Microcyn but not bleach are instantly lethal to bugs."
Mr Alimi has also found a way to stabilise the ions by making them react with and regenerate each other during storage so the fluid remains active for up to two years.
Microcyn was officially approved in the US for cleaning wounds two years ago but some physicians have also been using it off label to accelerate healing.
Dr Cheryl Bongiovanni, director of wound care at the Lake District Hospital in Lakeview, Oregon, has used Microcyn on around 1,000 diabetic patients with leg and foot wounds over the past 18 months.
She said: "When you spray it on you see the treated tissue 'pink up' and go beefy which is good because it means the oxygen supply has resumed."
Official phase II trials to test the product's wound-healing potential are currently taking place in the US and Europe.
Professor Andrew Boulton, of the Manchester Royal Infirmary who is conducting one such study, said: "It does seem promising. Hopefully it will confirm our initial good experience."
Tracy Kelly, care advisor at Diabetes UK, said 15 per cent of people with diabetes who develop foot ulcers eventually suffer amputations.
She said: "We would welcome any safe, effective treatment which could help hasten recovery."
Copyright © 2006 National News +44(0)207 684 3000
Friday, May 25, 2007
Resistance genes in our food supply
Could the food we eat be contributing to the continuing rise of antibiotic-resistant infections? Harmless and even beneficial bacteria that exist in our food supply may also be carrying genes that code for antibiotic resistance. Once in our bodies, could they transmit the resistance genes to disease-causing bacteria?
"The data indicate that food could be an important avenue for antibiotic-resistant bacterial evolution and dissemination. The role of commensals, especially food-borne microbes, in transmitting resistance genes are becoming a concern to the scientific community," says Hua Wang of the Ohio State University, presenting May 23, 2007 at the 107th General Meeting of the American Society for Microbiology (ASM) in Toronto.
The culprit is a process known as horizontal gene transfer, in which bacteria in close proximity to each other can share genetic information, including genes that code for antibiotic resistance. Horizontal gene transfer between disease-causing bacteria in the hospital setting has already been recognized as an important avenue for the exchange of antibiotic-resistance genes among pathogens.
Research has also already demonstrated that pathogenic bacteria have the ability to engage in horizontal gene transfer with various commensal bacteria and even beneficial bacteria, including those from the food chain. What concerns scientists is that the size and diversity of the gene pool represented by commensal bacteria increases the likelihood of gene transfer and some commensals possess high frequency gene transfer mechanisms.
"We have demonstrated not only that organisms carrying such intrinsic mechanisms have the potential to become an important reservoir for antibiotic resistance genes but, more importantly, that these intermediate organisms can disseminate antibiotic resistance genes in subsequent events much more effectively than the parental donor strain," says Hua.
"Once we no longer limit ourselves to foodborne pathogens and look at commensal bacteria, we will find that the magnitude of antibiotic-resistant bacterial contamination in the food chain is tremendous," says Hua.
In a study published last year, she and her colleagues tested a variety of ready-to-eat food samples including seafood, meats, dairy, deli items and fresh produce purchased from several grocery chain stores. With the exception of processed cheese and yogurt, antibiotic-resistance gene-carrying bacteria were found in many food samples examined.,
"Despite the fact that this study only screened for a limited number of resistance markers, it illustrated the prevalence of antibiotic-resistant commensals and antibiotic-resistance genes in retail foods," says Hua. "While further research is needed to establish the direct correlation between the antibiotic-resistant microbes from foods and the antibiotic-resistant population in host ecosystems, it is evident that a constant supply of antibiotic-resistant bacteria, partnered with occasional colonization and horizontal gene transfer, are at least partially responsible for the increased antibiotic resistance profiles seen in humans."
Antibiotic resistant infections are an increasing public health problem, says Marilyn Roberts of the University of Washington. Depending on the disease and the patient, an antibiotic-resistant infection could triple a hospital stay. A methicillin-resistant Staphylococcus aureus infection in a hospital patient can cost thousands of dollars more to treat. In some cases, such as the new extensively resistant tuberculosis, antibiotics are no longer effective, forcing doctors to take extreme measures like removing an infected lung.
The problem is not just confined to the food supply. Recent studies have shown antibiotic resistance genes in bacteria in the digestive tract of young infants. Since these children were still breast- or formula-feeding and had not eaten solid food yet, they must have acquired these genes somewhere other than the food supply. This suggests that resistance genes from the environment might have played an important role, says Hua.
"Antibiotics and the contamination of the environment is a medical problem, an agricultural problem and a human problem. Everybody plays a role in it. They also have a stake in it," says Roberts.
But there are things that can be done to minimize resistance genes in our food. Hua is currently working on characterizing the optimum conditions and processing parameters to minimize the emergence of these genes in fermented products. In time, and with a little help, she hopes to expand this research to other food industries as well.
"Given the proper investment of money, effort and time we can identify the steps that need to be taken at the processing level to minimize the emergence of antibiotic resistance genes in our food supply," says Hua.
"The data indicate that food could be an important avenue for antibiotic-resistant bacterial evolution and dissemination. The role of commensals, especially food-borne microbes, in transmitting resistance genes are becoming a concern to the scientific community," says Hua Wang of the Ohio State University, presenting May 23, 2007 at the 107th General Meeting of the American Society for Microbiology (ASM) in Toronto.
The culprit is a process known as horizontal gene transfer, in which bacteria in close proximity to each other can share genetic information, including genes that code for antibiotic resistance. Horizontal gene transfer between disease-causing bacteria in the hospital setting has already been recognized as an important avenue for the exchange of antibiotic-resistance genes among pathogens.
Research has also already demonstrated that pathogenic bacteria have the ability to engage in horizontal gene transfer with various commensal bacteria and even beneficial bacteria, including those from the food chain. What concerns scientists is that the size and diversity of the gene pool represented by commensal bacteria increases the likelihood of gene transfer and some commensals possess high frequency gene transfer mechanisms.
"We have demonstrated not only that organisms carrying such intrinsic mechanisms have the potential to become an important reservoir for antibiotic resistance genes but, more importantly, that these intermediate organisms can disseminate antibiotic resistance genes in subsequent events much more effectively than the parental donor strain," says Hua.
"Once we no longer limit ourselves to foodborne pathogens and look at commensal bacteria, we will find that the magnitude of antibiotic-resistant bacterial contamination in the food chain is tremendous," says Hua.
In a study published last year, she and her colleagues tested a variety of ready-to-eat food samples including seafood, meats, dairy, deli items and fresh produce purchased from several grocery chain stores. With the exception of processed cheese and yogurt, antibiotic-resistance gene-carrying bacteria were found in many food samples examined.,
"Despite the fact that this study only screened for a limited number of resistance markers, it illustrated the prevalence of antibiotic-resistant commensals and antibiotic-resistance genes in retail foods," says Hua. "While further research is needed to establish the direct correlation between the antibiotic-resistant microbes from foods and the antibiotic-resistant population in host ecosystems, it is evident that a constant supply of antibiotic-resistant bacteria, partnered with occasional colonization and horizontal gene transfer, are at least partially responsible for the increased antibiotic resistance profiles seen in humans."
Antibiotic resistant infections are an increasing public health problem, says Marilyn Roberts of the University of Washington. Depending on the disease and the patient, an antibiotic-resistant infection could triple a hospital stay. A methicillin-resistant Staphylococcus aureus infection in a hospital patient can cost thousands of dollars more to treat. In some cases, such as the new extensively resistant tuberculosis, antibiotics are no longer effective, forcing doctors to take extreme measures like removing an infected lung.
The problem is not just confined to the food supply. Recent studies have shown antibiotic resistance genes in bacteria in the digestive tract of young infants. Since these children were still breast- or formula-feeding and had not eaten solid food yet, they must have acquired these genes somewhere other than the food supply. This suggests that resistance genes from the environment might have played an important role, says Hua.
"Antibiotics and the contamination of the environment is a medical problem, an agricultural problem and a human problem. Everybody plays a role in it. They also have a stake in it," says Roberts.
But there are things that can be done to minimize resistance genes in our food. Hua is currently working on characterizing the optimum conditions and processing parameters to minimize the emergence of these genes in fermented products. In time, and with a little help, she hopes to expand this research to other food industries as well.
"Given the proper investment of money, effort and time we can identify the steps that need to be taken at the processing level to minimize the emergence of antibiotic resistance genes in our food supply," says Hua.
Tuesday, May 8, 2007
Defenceless against a tiny bug
Andrew Pollack
The E.coli still has the last laugh.Despite many approaches, prevention still seems the best way out of a deadly infection.
Shousun C. Szu, a scientist at the National Institutes of Health, says the best way to prevent people from being poisoned by deadly E. coli would be to vaccinate all infants against the bacteria. Graeme McRae, a Canadian biotechnology executive, says it would be more practical to inoculate cows instead. Vaccines for people and for cattle are just two approaches under development to prevent or treat food poisoning by the strain E. coli O157:H7.
Right now, scientists can do little medically to fight the pathogen, which was responsible for two severe outbreaks in the US. The main approach has been to try to prevent contamination through careful handling of food, rigorous inspections and government regulation. Slaughterhouses have already sharply reduced contamination through practices like washing carcasses with hot water, steam or acids. Now the focus is on new procedures and regulations for the fresh-produce industry. On the animal side, a vaccine for cattle developed by McRae’s company, Bioniche Life Sciences, was approved in December for distribution to veterinarians in Canada. Studies have shown that the vaccine can reduce but not eliminate the E. coli shed into manure. Not only does that make the cows cleaner as they go into the slaughterhouse, but it could also conceivably reduce the risk that the germ will spread from a feedlot to a nearby produce field though water or wild animals. Cows and their manure are considered the major sources of the pathogen. “If we can reduce the likelihood that animals are going to carry the bacteria, then we might reduce over time what they put out into the environment,” said Guy Loneragan, a veterinary epidemiologist at West Texas A&M University. Other methods being tested include cattle antibiotics, an industrial chemical, bacterial-killing viruses and friendly bacteria to displace the evil ones. Efforts to develop drugs and vaccines for people also face barriers. Because outbreaks are rare and sporadic, for instance, it would be difficult to test such treatments in clinical trials. E. coli O157:H7 causes 75,000 cases of infection and 61 deaths in the United States each year, according to a 1999 estimate by the Centers for Disease Control and Prevention posted on its Web site. Dr. Phillip I. Tarr, an expert at Washington University in St. Louis, says treatment is difficult because the bloody diarrhea that signals infection may not occur until three to four days after ingestion of the bacteria. By then, a patient could be well on the way to kidney failure. Antibiotics, the usual treatment for bacterial infection, only make things worse by killing the bacteria and releasing more of their toxin, Tarr said. He added that the sole treatment shown to reduce the severity of kidney problems was intravenous fluids. Other scientists are trying. Thallion Pharmaceuticals of Montreal and Teijin Pharma of Japan have separately developed monoclonal antibodies that can latch on to the toxin molecules and neutralize them. Monoclonal antibodies, a synthetic version of the body's own infection fighters, are commonly used to treat cancer and other diseases. Thallion and Teijin have shown that the antibodies can protect laboratory animals from lethal doses and have conducted preliminary safety testing in people. But at the recent FDA advisory committee meeting, both said it would be prohibitively expensive to test whether their drugs could prevent hemolytic uremic syndrome. Some outside scientists question whether a treatment that starts after the toxin is already in the bloodstream would be effective. One approach already in use is probiotics, the idea that friendly bacteria fed to cattle will displace O157. The Nutrition Physiology Corp. of Guymon, Okla., sells a feed additive with lactobacillus, the same type of bacterium used in yogurt. The additive is sold to aid cattle digestion, but some studies suggest that it also reduces O157 in manure. An experimental approach is to feed cows sodium chlorate, a chemical used in the pulp and paper industry. This idea takes advantage of the fact that O157 has an enzyme that allows it to survive without oxygen, which is not true for most desirable bacteria. That enzyme will convert sodium chlorate to sodium chlorite, which poisons the pathogen. “It’s like a suicide pill to the E. coli,” said Robin C. Anderson, a microbiologist for the Agriculture Department in College Station, Texas. Anderson said the treatment did not harm the cow. The antibiotic neomycin has also been shown to reduce O157 levels in manure. Using antibiotics in animals raises concerns of spurring development of human pathogens resistant to the medicines. Another approach being studied involves phages, viruses that infect and kill bacteria. Experts say multiple approaches might be used in parallel, because no single approach works perfectly. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said: “What really is a concern to me about this issue is we always have a tendency to want high-tech responses to what in many cases are common-sense low-tech solutions,” Osterholm said. In any case, even if a high-tech solution was desired, there does not seem to be a vaccine for spinach as there is for cattle. Greens are now often rinsed in chlorine solution, but that is not always effective because surface nooks and crannies can shelter the bacteria, said James Gorney, senior vice president for food safety and technology at the United Fresh Produce Association, a trade group. A possible alternative is to use a gas like chlorine dioxide instead of a liquid wash, Gorney said. Irradiation can also kill the bacteria. But he said the amount of radiation needed could damage fruits or vegetables. And some consumers object to the technique. “Any one of these technologies doesn't offer us a pasteurization step," Gorney said. "So we are left with prevention, prevention and prevention, preventing the contamination from ever occurring.” Szu of the health institutes and colleagues have developed a vaccine made of the complex sugar that is on the surface of the bacteria, the very O-type polysaccharide that gives O157 its name. The sugar is linked to a protein taken from another bacterium to make it more potent in stimulating the immune system. Szu and collaborators have tested the vaccine on adult volunteers and on children 2 to 5 years old. The volunteers were not exposed to O157 -- that would be unethical -- but they developed antibodies to it. Moreover, when the bacteria were exposed in the laboratory to blood samples from vaccinated people, the microbes were killed. Szu said the next test would be in infants. The vaccine is years from the market. As with drugs, testing effectiveness would be difficult, and some experts say it may not make sense to vaccinate every child to protect a small number. The cattle vaccine developed by Bioniche is based on the work of B. Brett Finlay of the University of British Columbia, who helped discover how O157 bacteria attach themselves to the cattle intestines, where they can then multiply. The bacteria use a type of microscopic syringe to shoot proteins into the cells lining the intestine, and the cells erect a protein pedestal, to which the bacteria can bind. The Bioniche vaccine consists of proteins involved in the attachment. The idea is that the cow's immune system would make antibodies to attack the proteins, thereby blocking the attachment. The bacteria could still pass through the cow and into manure. But if they could not colonize, their levels should remain low. Tests at the University of Nebraska found that the vaccine reduced by 70 percent the number of cows shedding O157 into their manure, said Rodney A. Moxley, a professor of veterinary science there. As few as 10 bacteria can make someone ill. The bacteria release one or two potent toxins that cause bloody diarrhea. In 15 percent of children younger than 10, and more rarely for adults, the infection causes hemolytic uremic syndrome, in which red blood cells are destroyed and the kidneys fail. In a small percentage of such cases, the syndrome proves fatal. NYT News Service
The E.coli still has the last laugh.Despite many approaches, prevention still seems the best way out of a deadly infection.
Shousun C. Szu, a scientist at the National Institutes of Health, says the best way to prevent people from being poisoned by deadly E. coli would be to vaccinate all infants against the bacteria. Graeme McRae, a Canadian biotechnology executive, says it would be more practical to inoculate cows instead. Vaccines for people and for cattle are just two approaches under development to prevent or treat food poisoning by the strain E. coli O157:H7.
Right now, scientists can do little medically to fight the pathogen, which was responsible for two severe outbreaks in the US. The main approach has been to try to prevent contamination through careful handling of food, rigorous inspections and government regulation. Slaughterhouses have already sharply reduced contamination through practices like washing carcasses with hot water, steam or acids. Now the focus is on new procedures and regulations for the fresh-produce industry. On the animal side, a vaccine for cattle developed by McRae’s company, Bioniche Life Sciences, was approved in December for distribution to veterinarians in Canada. Studies have shown that the vaccine can reduce but not eliminate the E. coli shed into manure. Not only does that make the cows cleaner as they go into the slaughterhouse, but it could also conceivably reduce the risk that the germ will spread from a feedlot to a nearby produce field though water or wild animals. Cows and their manure are considered the major sources of the pathogen. “If we can reduce the likelihood that animals are going to carry the bacteria, then we might reduce over time what they put out into the environment,” said Guy Loneragan, a veterinary epidemiologist at West Texas A&M University. Other methods being tested include cattle antibiotics, an industrial chemical, bacterial-killing viruses and friendly bacteria to displace the evil ones. Efforts to develop drugs and vaccines for people also face barriers. Because outbreaks are rare and sporadic, for instance, it would be difficult to test such treatments in clinical trials. E. coli O157:H7 causes 75,000 cases of infection and 61 deaths in the United States each year, according to a 1999 estimate by the Centers for Disease Control and Prevention posted on its Web site. Dr. Phillip I. Tarr, an expert at Washington University in St. Louis, says treatment is difficult because the bloody diarrhea that signals infection may not occur until three to four days after ingestion of the bacteria. By then, a patient could be well on the way to kidney failure. Antibiotics, the usual treatment for bacterial infection, only make things worse by killing the bacteria and releasing more of their toxin, Tarr said. He added that the sole treatment shown to reduce the severity of kidney problems was intravenous fluids. Other scientists are trying. Thallion Pharmaceuticals of Montreal and Teijin Pharma of Japan have separately developed monoclonal antibodies that can latch on to the toxin molecules and neutralize them. Monoclonal antibodies, a synthetic version of the body's own infection fighters, are commonly used to treat cancer and other diseases. Thallion and Teijin have shown that the antibodies can protect laboratory animals from lethal doses and have conducted preliminary safety testing in people. But at the recent FDA advisory committee meeting, both said it would be prohibitively expensive to test whether their drugs could prevent hemolytic uremic syndrome. Some outside scientists question whether a treatment that starts after the toxin is already in the bloodstream would be effective. One approach already in use is probiotics, the idea that friendly bacteria fed to cattle will displace O157. The Nutrition Physiology Corp. of Guymon, Okla., sells a feed additive with lactobacillus, the same type of bacterium used in yogurt. The additive is sold to aid cattle digestion, but some studies suggest that it also reduces O157 in manure. An experimental approach is to feed cows sodium chlorate, a chemical used in the pulp and paper industry. This idea takes advantage of the fact that O157 has an enzyme that allows it to survive without oxygen, which is not true for most desirable bacteria. That enzyme will convert sodium chlorate to sodium chlorite, which poisons the pathogen. “It’s like a suicide pill to the E. coli,” said Robin C. Anderson, a microbiologist for the Agriculture Department in College Station, Texas. Anderson said the treatment did not harm the cow. The antibiotic neomycin has also been shown to reduce O157 levels in manure. Using antibiotics in animals raises concerns of spurring development of human pathogens resistant to the medicines. Another approach being studied involves phages, viruses that infect and kill bacteria. Experts say multiple approaches might be used in parallel, because no single approach works perfectly. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said: “What really is a concern to me about this issue is we always have a tendency to want high-tech responses to what in many cases are common-sense low-tech solutions,” Osterholm said. In any case, even if a high-tech solution was desired, there does not seem to be a vaccine for spinach as there is for cattle. Greens are now often rinsed in chlorine solution, but that is not always effective because surface nooks and crannies can shelter the bacteria, said James Gorney, senior vice president for food safety and technology at the United Fresh Produce Association, a trade group. A possible alternative is to use a gas like chlorine dioxide instead of a liquid wash, Gorney said. Irradiation can also kill the bacteria. But he said the amount of radiation needed could damage fruits or vegetables. And some consumers object to the technique. “Any one of these technologies doesn't offer us a pasteurization step," Gorney said. "So we are left with prevention, prevention and prevention, preventing the contamination from ever occurring.” Szu of the health institutes and colleagues have developed a vaccine made of the complex sugar that is on the surface of the bacteria, the very O-type polysaccharide that gives O157 its name. The sugar is linked to a protein taken from another bacterium to make it more potent in stimulating the immune system. Szu and collaborators have tested the vaccine on adult volunteers and on children 2 to 5 years old. The volunteers were not exposed to O157 -- that would be unethical -- but they developed antibodies to it. Moreover, when the bacteria were exposed in the laboratory to blood samples from vaccinated people, the microbes were killed. Szu said the next test would be in infants. The vaccine is years from the market. As with drugs, testing effectiveness would be difficult, and some experts say it may not make sense to vaccinate every child to protect a small number. The cattle vaccine developed by Bioniche is based on the work of B. Brett Finlay of the University of British Columbia, who helped discover how O157 bacteria attach themselves to the cattle intestines, where they can then multiply. The bacteria use a type of microscopic syringe to shoot proteins into the cells lining the intestine, and the cells erect a protein pedestal, to which the bacteria can bind. The Bioniche vaccine consists of proteins involved in the attachment. The idea is that the cow's immune system would make antibodies to attack the proteins, thereby blocking the attachment. The bacteria could still pass through the cow and into manure. But if they could not colonize, their levels should remain low. Tests at the University of Nebraska found that the vaccine reduced by 70 percent the number of cows shedding O157 into their manure, said Rodney A. Moxley, a professor of veterinary science there. As few as 10 bacteria can make someone ill. The bacteria release one or two potent toxins that cause bloody diarrhea. In 15 percent of children younger than 10, and more rarely for adults, the infection causes hemolytic uremic syndrome, in which red blood cells are destroyed and the kidneys fail. In a small percentage of such cases, the syndrome proves fatal. NYT News Service
Saturday, May 5, 2007
New Approach Could Lower Antibiotic Requirements By 50 Times
Antibiotic doses could be reduced by up to 50 times using a new approach based on bacteriophages.
Steven Hagens, previously at the University of Vienna, told Chemistry & Industry, the magazine of the SCI, that certain bacteriophages, a type of virus that infects bacteria, can boost the effectiveness of antibiotics gentamicin, gramacidin or tetracycline.
It is the phages' ability to channel through bacterial cell membranes that boosts antibiotic effectiveness. 'Pseudomonas bacteria for example are particularly multi-resistant to antibiotics because they have efflux pump mechanisms that enable them to throw out antibiotics. A pore in the cell wall would obviously cancel the efflux effect,' Hagens explains.
Pseudomonas bacteria cause pneumonia and are a common cause of hospital-acquired infections.
Experiments in mice revealed that 75% of those infected with a lethal dose of Pseudomonas survived if the antibiotic gentamicin was administered in the presence of bacteriophages. None survived without the phages (Microb. Drug Resist., 2006, 12 (3), 164).
The bacteriophage approach would also be particularly useful for treating cases of food poisoning, because the lower doses of antibiotic needed would not disrupt the friendly bacteria in the gut - a big problem with conventional antibiotic treatments.
'The prospect of using such treatments to prolong the life of existing agents and delay the onset of widespread resistance is to be welcomed,' said Jim Spencer a lecturer in microbial pathogenesis at the University of Bristol.
The overuse of antibiotics since the 1940s had slowly created a host of infections that are resistant to antibiotics. MRSA (Methicillin-resistant Staphylococcus aureus) for example is rapidly spreading through hospitals, affecting more than 8,000 people in the UK every year. MRSA infection can lead to septic shock and death.
Note: This story has been adapted from a news release issued by Society of Chemical Industry.
Steven Hagens, previously at the University of Vienna, told Chemistry & Industry, the magazine of the SCI, that certain bacteriophages, a type of virus that infects bacteria, can boost the effectiveness of antibiotics gentamicin, gramacidin or tetracycline.
It is the phages' ability to channel through bacterial cell membranes that boosts antibiotic effectiveness. 'Pseudomonas bacteria for example are particularly multi-resistant to antibiotics because they have efflux pump mechanisms that enable them to throw out antibiotics. A pore in the cell wall would obviously cancel the efflux effect,' Hagens explains.
Pseudomonas bacteria cause pneumonia and are a common cause of hospital-acquired infections.
Experiments in mice revealed that 75% of those infected with a lethal dose of Pseudomonas survived if the antibiotic gentamicin was administered in the presence of bacteriophages. None survived without the phages (Microb. Drug Resist., 2006, 12 (3), 164).
The bacteriophage approach would also be particularly useful for treating cases of food poisoning, because the lower doses of antibiotic needed would not disrupt the friendly bacteria in the gut - a big problem with conventional antibiotic treatments.
'The prospect of using such treatments to prolong the life of existing agents and delay the onset of widespread resistance is to be welcomed,' said Jim Spencer a lecturer in microbial pathogenesis at the University of Bristol.
The overuse of antibiotics since the 1940s had slowly created a host of infections that are resistant to antibiotics. MRSA (Methicillin-resistant Staphylococcus aureus) for example is rapidly spreading through hospitals, affecting more than 8,000 people in the UK every year. MRSA infection can lead to septic shock and death.
Note: This story has been adapted from a news release issued by Society of Chemical Industry.
Germs: Understand and protect against bacteria, viruses and infection
You live in a world of germs. Some keep you healthy — others make you sick. Protect yourself by understanding which ones are harmless and which ones pose a threat.
Germs were behind every fever, runny nose, ache, pain and other sign and symptom of every cold and flu you've ever had. When you're in the midst of such symptoms, you might not stop to think about the germs (microbes) that are causing them. Not all germs will harm you, but knowing more about germs — including bacteria, viruses and parasites — can increase your chances of avoiding infection.
Germs: A multitude of microscopic invaders
Bacteria, viruses and other infectious organisms — germs — live everywhere. You can find them in the air, on food, plants and animals, in the soil, in the water, and on just about every other surface — including your own body. These microbes range in size from microscopic single-celled organisms to parasitic worms that can grow to several feet in length.
Most of these organisms won't harm you. Your immune system protects you against a multitude of infectious agents. However, some bacteria and viruses are formidable adversaries because they're constantly mutating to breach your immune system's defenses.
E. coli O157:H7 is a bacterium responsible for food-borne infections often linked to eating undercooked ground beef or improperly washed vegetables.
BacteriaBacteria are one-celled organisms visible only with a microscope. They're so small that if you lined up a thousand of them end to end, they could fit across the end of a pencil eraser. They're shaped like short rods, spheres or spirals. Bacteria are self-sufficient — they don't need a host to reproduce and they multiply by subdivision.
Among the earliest forms of life on earth, bacteria have evolved to thrive in a variety of environments. Some can withstand searing heat or frigid cold, and others can survive radiation levels that would be lethal to humans. Many bacteria, however, prefer the mild environment of a healthy body.
Not all bacteria are harmful. In fact, less than 1 percent cause disease, and some bacteria that live in your body are actually good for you. For instance, Lactobacillus acidophilus — a harmless bacterium that resides in your intestines — helps you digest food, destroys some disease-causing organisms and provides nutrients to your body.
But when infectious bacteria enter your body, they can cause illness. They rapidly reproduce, and many produce toxins — powerful chemicals that damage specific cells in the tissue they've invaded. That's what makes you ill. The organism that causes gonorrhea (gonococcus) is an example of a bacterial invader. Others include some strains of the bacterium Escherichia coli — better known as E. coli — which cause severe gastrointestinal illness and are most often contracted via contaminated food. If you've ever had strep throat, bacteria caused it.
The influenza virus takes over healthy cells, spreads through your body and causes illness. Signs and symptoms include fever, chills, muscle aches and fatigue.
VirusesIn its simplest form, a virus is a capsule that contains genetic material — DNA or RNA. Viruses are even tinier than bacteria. To put their size into perspective, consider that, according to the American Society for Microbiology, if you were to enlarge an average virus to the size of a baseball, the average bacterium would be about the size of the pitcher's mound. And just one of your body's millions of cells would be the size of the entire ballpark.
The main mission of a virus is to reproduce. However, unlike bacteria, viruses aren't self-sufficient — they need a suitable host to reproduce. When a virus invades your body, it enters some of your cells and takes over, instructing these host cells to make what it needs for reproduction. Host cells are eventually destroyed during this process. Polio, AIDS and the common cold are all viral illnesses.
Infection with candida fungus can lead to problems such as diaper rash, vaginal yeast infections and oral thrush.
FungiMolds, yeasts and mushrooms are types of fungi. For the most part, these single-celled organisms are slightly larger than bacteria, although some mushrooms are multicelled and plainly visible to the eye. Mushrooms can't infect you, but certain yeasts and molds can.
Fungi live in the air, water, soil and on plants. They can live in your body, usually without causing illness. Some fungi have beneficial uses. For example, penicillin — an antibiotic that kills harmful bacteria in your body — is derived from fungi. Fungi are also essential in making certain foods, such as bread, cheese and yogurt.
Other fungi aren't as beneficial and can cause illness. One example is candida — a yeast that can cause infection. Candida can cause thrush — an infection of the mouth and throat — in infants and in people taking antibiotics or who have an impaired immune system. It's also responsible for most types of infection-related diaper rash.
Cryptosporidium is a protozoan that can survive outside the body for long periods of time.
ProtozoaProtozoa are single-celled organisms that behave like tiny animals — hunting and gathering other microbes for food. Protozoa can live within your body as a parasite. Many protozoa call your intestinal tract home and are harmless. Others cause disease, such as the 1993 Cryptosporidium parvum invasion of the Milwaukee water supply, sickening more than 400,000 people. Often, these organisms spend part of their life cycle outside of humans or other hosts, living in food, soil, water or insects.
Most protozoa are microscopic, but there are some exceptions. One type of ocean-dwelling protozoa (foraminifer) can grow to more than 2 inches in diameter.
Some protozoa invade your body through the food you eat or the water you drink. Others can be transmitted through sexual contact. Still others are vector-borne, meaning they rely on another organism to transmit them from person to person. Malaria is an example of a disease caused by a vector-borne protozoan parasite. Mosquitoes are the vector transmitting the deadly parasite plasmodium, which causes the disease.
Infection by one type of roundworm, known as a hookworm, can cause problems in your small intestine or lungs. The average hookworm is about half an inch long.
HelminthsHelminths are among the larger parasites. The word "helminth" comes from the Greek for "worm." If this parasite — or its eggs — enters your body, it takes up residence in your intestinal tract, lungs, liver, skin or brain, where it lives off the nutrients in your body. The most common helminths are tapeworms and roundworms.
The largest of the roundworms can be more than 12 inches long. And the largest of the tapeworms can grow to be 25 feet or longer. Tapeworms are made up of hundreds of segments, each of which is capable of breaking off and developing into a new tapeworm.
Understanding infection vs. disease
There's a distinct difference between infection and disease. Infection, often the first step, occurs when bacteria, viruses or other microbes enter your body and begin to multiply. Disease occurs when the cells in your body are damaged — as a result of the infection — and signs and symptoms of an illness appear.
In response to infection, your immune system springs into action. An army of white blood cells, antibodies and other mechanisms goes to work to rid your body of whatever is causing the infection. For instance, in fighting off the common cold, your body might react with fever, coughing and sneezing.
Warding off germs and infection
What's the best way to stay disease-free? Prevent infections from happening in the first place. You can prevent infection through simple tactics such as regular hand washing, vaccinations and appropriate medications.
Hand washing. Often overlooked, hand washing is one of the easiest and most effective ways to protect yourself from germs and most infections. Wash your hands thoroughly before preparing or eating food, after coughing or sneezing, after changing a diaper and after using the toilet. When soap and water aren't readily available, alcohol-based hand-sanitizing gels can offer protection.
Vaccines. Vaccination is your best line of defense for certain diseases. As researchers understand more about what causes disease, the list of vaccine-preventable diseases continues to grow. Many vaccines are given in childhood, but adults still need to be routinely vaccinated to prevent some illnesses, such as tetanus and influenza.
Medicines. Some medicines can help you from becoming susceptible to germs. For example, taking an anti-parasitic medication might protect you from contracting malaria if you travel to or live in an area where your risk is high. Or when you are at high risk of exposure to certain organisms — such as those that cause bacterial meningitis — your doctor may prescribe antibiotics to lower your risk of infection. Using over-the-counter antibiotic creams can decrease the chance of infection of minor cuts and scrapes. But long-term, indiscriminate use of antibiotics isn't recommended in most cases. It won't prevent bacterial infections and instead may result in a more resistant, harder-to-treat strain of bacteria when infections do occur.
When to seek medical care
Although some infectious diseases, such as the common cold, might not require a visit to the doctor, others might.
Seek medical care if you suspect that you have an infection and you have experienced any of the following:
An animal or human bite
Difficulty breathing
A cough lasting longer than a week
A fever of 100.4 F (38.0 C) or more
Periods of rapid heartbeat
A rash, especially if it's accompanied by a fever
Swelling
Blurred vision or other difficulty seeing
Persistent vomiting
An unusual or severe headache
Your doctor can perform diagnostic tests to find out if you're infected, the seriousness of the infection, and how best to treat that infection.
RELATED
Viral infections and bacterial infections: What's the difference?
Are infectious diseases on the rise? Editor's note
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Germs were behind every fever, runny nose, ache, pain and other sign and symptom of every cold and flu you've ever had. When you're in the midst of such symptoms, you might not stop to think about the germs (microbes) that are causing them. Not all germs will harm you, but knowing more about germs — including bacteria, viruses and parasites — can increase your chances of avoiding infection.
Germs: A multitude of microscopic invaders
Bacteria, viruses and other infectious organisms — germs — live everywhere. You can find them in the air, on food, plants and animals, in the soil, in the water, and on just about every other surface — including your own body. These microbes range in size from microscopic single-celled organisms to parasitic worms that can grow to several feet in length.
Most of these organisms won't harm you. Your immune system protects you against a multitude of infectious agents. However, some bacteria and viruses are formidable adversaries because they're constantly mutating to breach your immune system's defenses.
E. coli O157:H7 is a bacterium responsible for food-borne infections often linked to eating undercooked ground beef or improperly washed vegetables.
BacteriaBacteria are one-celled organisms visible only with a microscope. They're so small that if you lined up a thousand of them end to end, they could fit across the end of a pencil eraser. They're shaped like short rods, spheres or spirals. Bacteria are self-sufficient — they don't need a host to reproduce and they multiply by subdivision.
Among the earliest forms of life on earth, bacteria have evolved to thrive in a variety of environments. Some can withstand searing heat or frigid cold, and others can survive radiation levels that would be lethal to humans. Many bacteria, however, prefer the mild environment of a healthy body.
Not all bacteria are harmful. In fact, less than 1 percent cause disease, and some bacteria that live in your body are actually good for you. For instance, Lactobacillus acidophilus — a harmless bacterium that resides in your intestines — helps you digest food, destroys some disease-causing organisms and provides nutrients to your body.
But when infectious bacteria enter your body, they can cause illness. They rapidly reproduce, and many produce toxins — powerful chemicals that damage specific cells in the tissue they've invaded. That's what makes you ill. The organism that causes gonorrhea (gonococcus) is an example of a bacterial invader. Others include some strains of the bacterium Escherichia coli — better known as E. coli — which cause severe gastrointestinal illness and are most often contracted via contaminated food. If you've ever had strep throat, bacteria caused it.
The influenza virus takes over healthy cells, spreads through your body and causes illness. Signs and symptoms include fever, chills, muscle aches and fatigue.
VirusesIn its simplest form, a virus is a capsule that contains genetic material — DNA or RNA. Viruses are even tinier than bacteria. To put their size into perspective, consider that, according to the American Society for Microbiology, if you were to enlarge an average virus to the size of a baseball, the average bacterium would be about the size of the pitcher's mound. And just one of your body's millions of cells would be the size of the entire ballpark.
The main mission of a virus is to reproduce. However, unlike bacteria, viruses aren't self-sufficient — they need a suitable host to reproduce. When a virus invades your body, it enters some of your cells and takes over, instructing these host cells to make what it needs for reproduction. Host cells are eventually destroyed during this process. Polio, AIDS and the common cold are all viral illnesses.
Infection with candida fungus can lead to problems such as diaper rash, vaginal yeast infections and oral thrush.
FungiMolds, yeasts and mushrooms are types of fungi. For the most part, these single-celled organisms are slightly larger than bacteria, although some mushrooms are multicelled and plainly visible to the eye. Mushrooms can't infect you, but certain yeasts and molds can.
Fungi live in the air, water, soil and on plants. They can live in your body, usually without causing illness. Some fungi have beneficial uses. For example, penicillin — an antibiotic that kills harmful bacteria in your body — is derived from fungi. Fungi are also essential in making certain foods, such as bread, cheese and yogurt.
Other fungi aren't as beneficial and can cause illness. One example is candida — a yeast that can cause infection. Candida can cause thrush — an infection of the mouth and throat — in infants and in people taking antibiotics or who have an impaired immune system. It's also responsible for most types of infection-related diaper rash.
Cryptosporidium is a protozoan that can survive outside the body for long periods of time.
ProtozoaProtozoa are single-celled organisms that behave like tiny animals — hunting and gathering other microbes for food. Protozoa can live within your body as a parasite. Many protozoa call your intestinal tract home and are harmless. Others cause disease, such as the 1993 Cryptosporidium parvum invasion of the Milwaukee water supply, sickening more than 400,000 people. Often, these organisms spend part of their life cycle outside of humans or other hosts, living in food, soil, water or insects.
Most protozoa are microscopic, but there are some exceptions. One type of ocean-dwelling protozoa (foraminifer) can grow to more than 2 inches in diameter.
Some protozoa invade your body through the food you eat or the water you drink. Others can be transmitted through sexual contact. Still others are vector-borne, meaning they rely on another organism to transmit them from person to person. Malaria is an example of a disease caused by a vector-borne protozoan parasite. Mosquitoes are the vector transmitting the deadly parasite plasmodium, which causes the disease.
Infection by one type of roundworm, known as a hookworm, can cause problems in your small intestine or lungs. The average hookworm is about half an inch long.
HelminthsHelminths are among the larger parasites. The word "helminth" comes from the Greek for "worm." If this parasite — or its eggs — enters your body, it takes up residence in your intestinal tract, lungs, liver, skin or brain, where it lives off the nutrients in your body. The most common helminths are tapeworms and roundworms.
The largest of the roundworms can be more than 12 inches long. And the largest of the tapeworms can grow to be 25 feet or longer. Tapeworms are made up of hundreds of segments, each of which is capable of breaking off and developing into a new tapeworm.
Understanding infection vs. disease
There's a distinct difference between infection and disease. Infection, often the first step, occurs when bacteria, viruses or other microbes enter your body and begin to multiply. Disease occurs when the cells in your body are damaged — as a result of the infection — and signs and symptoms of an illness appear.
In response to infection, your immune system springs into action. An army of white blood cells, antibodies and other mechanisms goes to work to rid your body of whatever is causing the infection. For instance, in fighting off the common cold, your body might react with fever, coughing and sneezing.
Warding off germs and infection
What's the best way to stay disease-free? Prevent infections from happening in the first place. You can prevent infection through simple tactics such as regular hand washing, vaccinations and appropriate medications.
Hand washing. Often overlooked, hand washing is one of the easiest and most effective ways to protect yourself from germs and most infections. Wash your hands thoroughly before preparing or eating food, after coughing or sneezing, after changing a diaper and after using the toilet. When soap and water aren't readily available, alcohol-based hand-sanitizing gels can offer protection.
Vaccines. Vaccination is your best line of defense for certain diseases. As researchers understand more about what causes disease, the list of vaccine-preventable diseases continues to grow. Many vaccines are given in childhood, but adults still need to be routinely vaccinated to prevent some illnesses, such as tetanus and influenza.
Medicines. Some medicines can help you from becoming susceptible to germs. For example, taking an anti-parasitic medication might protect you from contracting malaria if you travel to or live in an area where your risk is high. Or when you are at high risk of exposure to certain organisms — such as those that cause bacterial meningitis — your doctor may prescribe antibiotics to lower your risk of infection. Using over-the-counter antibiotic creams can decrease the chance of infection of minor cuts and scrapes. But long-term, indiscriminate use of antibiotics isn't recommended in most cases. It won't prevent bacterial infections and instead may result in a more resistant, harder-to-treat strain of bacteria when infections do occur.
When to seek medical care
Although some infectious diseases, such as the common cold, might not require a visit to the doctor, others might.
Seek medical care if you suspect that you have an infection and you have experienced any of the following:
An animal or human bite
Difficulty breathing
A cough lasting longer than a week
A fever of 100.4 F (38.0 C) or more
Periods of rapid heartbeat
A rash, especially if it's accompanied by a fever
Swelling
Blurred vision or other difficulty seeing
Persistent vomiting
An unusual or severe headache
Your doctor can perform diagnostic tests to find out if you're infected, the seriousness of the infection, and how best to treat that infection.
RELATED
Viral infections and bacterial infections: What's the difference?
Are infectious diseases on the rise? Editor's note
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New Hope for Antibiotic Resistance
Source: University of Nebraska
A surprising new cell suicide theory developed at the University of Nebraska Medical Center, suggesting that some bacterial cells act as “suicide bombers,” could aid future research in developing drugs that can skirt the potentially catastrophic problem of bacterial resistance to antibiotics.
A surprising new theory developed at the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska, suggests that some bacterial cells act as “suicide bombers” in cell communities, with the altruistic intention of dying for the common good – and in the process, strengthening other cells that then become resistant to antibiotic drugs.
The finding could aid future research into developing drugs that can skirt the potentially catastrophic problem of bacterial resistance to antibiotics.
In a paper published April 23 in Proceedings of the National Academy of Science, Kenneth Bayles, Ph.D., of UNMC, writes that “programmed cell death” in bacterial communities is a form of altruism that benefits the larger community of cells and helps strengthen them.
“People get caught up in the idea that altruism is a behavior that requires deep thought, planning, and feelings such as caring,” Bayles said. But he argues through his research that altruism appears to be an innate function in cell death, or “lysis.”
Three years ago, Dr. Bayles, a professor of pathology and microbiology at UNMC, began growing cells in biofilm to observe how communication between cells – known as “quorum sensing” – affects their survival.
He observed that when cells are forming a biofilm – a colony of bacteria that contains resistant organisms and is involved in many antibiotic-resistant infections – they perform a function that enables them to leave a unique imprint on the world: their DNA. A small percentage of cells explode in a process called “lysis,” leaving behind a sticky residue that contains DNA and other cellular bioproducts which are then incorporated into the larger cell community to build a stronger biofilm.
“For a long time, microbiologists viewed bacteria as wholly simplistic organisms that lived alone and died alone,” said Dr. Bayles, noting that the discovery of “quorum sensing” nearly 40 years ago was a giant leap forward in understanding the complexity of communication and interaction between cells. “My research takes the concept to the extreme, with the idea that a fraction of the bacterial population actually dies for the good of the community.”
Dr. Bayles’ hypothesis could represent a paradigm shift in one of the cornerstones of microbiology, because understanding how cells die naturally – or how they commit “suicide” – could yield entirely new ways of killing them clinically. Previously, programmed cell death has been observed only in higher species.
He compares the process to what happens in a colony of honeybees or ants, which share 75 percent of their DNA. If something endangers one of them, a few others react altruistically – stinging intruders to defend the colony. “Sting once, and you’re dead, but it’s for the good of the colony,” Dr. Bayles said. Because bacteria in a biofilm share 100 percent of their DNA, their “suicide mission” is more pronounced; instead of just a few cells dying, many die and leave behind their DNA, thus strengthening the survivors.
Researchers have struggled with the question of why biofilms are extremely resistant to antibiotic drugs. “We don’t know why, but we think it’s because the cell death function is suppressed in the cells that don’t commit suicide, making them tolerant to antibiotics,” Dr. Bayles said. “In biofilm infections, if we can turn the cell death function back on, we can make them less resistant to antibiotics. Our research uncovers new targets for antibiotics, which we desperately need.”
Programmed cell death in mammals is a major topic in cancer research, and Bayles said his findings could potentially aid researchers trying to develop cancer drugs.
Bayles’ findings are bound to be controversial, because he assigns a highly intellectual characteristic to these bacterial cells, although he says this altruistic behavior is likely an innate function.
“This has been brewing for the past 15 years, but now we’ve made this leap and we can say we’ve seen programmed cell death in biofilm,” Dr. Bayles said. “Some microbiologists have been slow to accept that programmed cell death makes sense in bacteria because they are single-celled, but many are now coming around to the idea.”
About the University of Nebraska Medical Center: UNMC is located in Omaha, Nebraska, and is the only public health science center in the state. Its educational programs are responsible for training more health professionals practicing in Nebraska than any other institution. Through its commitment to education, research, patient care and outreach, UNMC has established itself as one of the country's leading centers in cancer, transplantation biology, bioterrorism preparedness, neurodegenerative diseases, cardiovascular diseases, genetics, biomedical technology and ophthalmology. UNMC’s research funding from external sources is now nearly $80 million annually and has resulted in the creation of more than 2,400 highly skilled jobs in the state. UNMC's physician practice group, UNMC Physicians, includes more than 460 physicians in 50 specialties and subspecialties. They practice primarily in The Nebraska Medical Center, UNMC's teaching hospital.
For more information, go to UNMC’s Web site at http://www.unmc.edu.
A surprising new cell suicide theory developed at the University of Nebraska Medical Center, suggesting that some bacterial cells act as “suicide bombers,” could aid future research in developing drugs that can skirt the potentially catastrophic problem of bacterial resistance to antibiotics.
A surprising new theory developed at the University of Nebraska Medical Center (UNMC) in Omaha, Nebraska, suggests that some bacterial cells act as “suicide bombers” in cell communities, with the altruistic intention of dying for the common good – and in the process, strengthening other cells that then become resistant to antibiotic drugs.
The finding could aid future research into developing drugs that can skirt the potentially catastrophic problem of bacterial resistance to antibiotics.
In a paper published April 23 in Proceedings of the National Academy of Science, Kenneth Bayles, Ph.D., of UNMC, writes that “programmed cell death” in bacterial communities is a form of altruism that benefits the larger community of cells and helps strengthen them.
“People get caught up in the idea that altruism is a behavior that requires deep thought, planning, and feelings such as caring,” Bayles said. But he argues through his research that altruism appears to be an innate function in cell death, or “lysis.”
Three years ago, Dr. Bayles, a professor of pathology and microbiology at UNMC, began growing cells in biofilm to observe how communication between cells – known as “quorum sensing” – affects their survival.
He observed that when cells are forming a biofilm – a colony of bacteria that contains resistant organisms and is involved in many antibiotic-resistant infections – they perform a function that enables them to leave a unique imprint on the world: their DNA. A small percentage of cells explode in a process called “lysis,” leaving behind a sticky residue that contains DNA and other cellular bioproducts which are then incorporated into the larger cell community to build a stronger biofilm.
“For a long time, microbiologists viewed bacteria as wholly simplistic organisms that lived alone and died alone,” said Dr. Bayles, noting that the discovery of “quorum sensing” nearly 40 years ago was a giant leap forward in understanding the complexity of communication and interaction between cells. “My research takes the concept to the extreme, with the idea that a fraction of the bacterial population actually dies for the good of the community.”
Dr. Bayles’ hypothesis could represent a paradigm shift in one of the cornerstones of microbiology, because understanding how cells die naturally – or how they commit “suicide” – could yield entirely new ways of killing them clinically. Previously, programmed cell death has been observed only in higher species.
He compares the process to what happens in a colony of honeybees or ants, which share 75 percent of their DNA. If something endangers one of them, a few others react altruistically – stinging intruders to defend the colony. “Sting once, and you’re dead, but it’s for the good of the colony,” Dr. Bayles said. Because bacteria in a biofilm share 100 percent of their DNA, their “suicide mission” is more pronounced; instead of just a few cells dying, many die and leave behind their DNA, thus strengthening the survivors.
Researchers have struggled with the question of why biofilms are extremely resistant to antibiotic drugs. “We don’t know why, but we think it’s because the cell death function is suppressed in the cells that don’t commit suicide, making them tolerant to antibiotics,” Dr. Bayles said. “In biofilm infections, if we can turn the cell death function back on, we can make them less resistant to antibiotics. Our research uncovers new targets for antibiotics, which we desperately need.”
Programmed cell death in mammals is a major topic in cancer research, and Bayles said his findings could potentially aid researchers trying to develop cancer drugs.
Bayles’ findings are bound to be controversial, because he assigns a highly intellectual characteristic to these bacterial cells, although he says this altruistic behavior is likely an innate function.
“This has been brewing for the past 15 years, but now we’ve made this leap and we can say we’ve seen programmed cell death in biofilm,” Dr. Bayles said. “Some microbiologists have been slow to accept that programmed cell death makes sense in bacteria because they are single-celled, but many are now coming around to the idea.”
About the University of Nebraska Medical Center: UNMC is located in Omaha, Nebraska, and is the only public health science center in the state. Its educational programs are responsible for training more health professionals practicing in Nebraska than any other institution. Through its commitment to education, research, patient care and outreach, UNMC has established itself as one of the country's leading centers in cancer, transplantation biology, bioterrorism preparedness, neurodegenerative diseases, cardiovascular diseases, genetics, biomedical technology and ophthalmology. UNMC’s research funding from external sources is now nearly $80 million annually and has resulted in the creation of more than 2,400 highly skilled jobs in the state. UNMC's physician practice group, UNMC Physicians, includes more than 460 physicians in 50 specialties and subspecialties. They practice primarily in The Nebraska Medical Center, UNMC's teaching hospital.
For more information, go to UNMC’s Web site at http://www.unmc.edu.
WHAT OTHERS ARE SAYING;-Star Tribune of Minneapolis, on the use of antibiotics in animals:
Wisconsin dairy farmer John Vrieze wants FDA permission to give his cows a powerful antibiotic, cefquinome, that is now the drug of choice and last resort for several difficult-to-treat human conditions. He shouldn’t get that permission.
By all accounts, Vrieze is a very good dairy farmer who embraces advanced techniques for keeping his cows happy, healthy and producing. So when one of his cows comes down with bovine respiratory disease, he’d like to treat the animal with a powerful drug, cefquinome. The manufacturer of cefquinome has petitioned the Food and Drug Administration for permission to begin selling the drug for use in animal husbandry.
That has set up a tug of war between those opposed to wider use of antibiotics in animals and those who favor it. In this battle, the opponents are the good guys; they include the American Medical Association, other health groups and the FDA’s own advisory panel.
The problem is that the disease-causing microbes which antibiotics attack constantly mutate. The wider the use of an antibiotic, the sooner one of those mutations will defeat the drug.
Widespread use of antibiotics in animals accelerates this process tremendously, leaving humans more vulnerable to diseases once controllable. ...
Enter cefquinome. ... Worried that using cefquinome in animals puts the efficacy of cefepime at risk, the advisory board at the FDA’s Center for Veterinary Medicine recommended against approving animal use.
By all accounts, Vrieze is a very good dairy farmer who embraces advanced techniques for keeping his cows happy, healthy and producing. So when one of his cows comes down with bovine respiratory disease, he’d like to treat the animal with a powerful drug, cefquinome. The manufacturer of cefquinome has petitioned the Food and Drug Administration for permission to begin selling the drug for use in animal husbandry.
That has set up a tug of war between those opposed to wider use of antibiotics in animals and those who favor it. In this battle, the opponents are the good guys; they include the American Medical Association, other health groups and the FDA’s own advisory panel.
The problem is that the disease-causing microbes which antibiotics attack constantly mutate. The wider the use of an antibiotic, the sooner one of those mutations will defeat the drug.
Widespread use of antibiotics in animals accelerates this process tremendously, leaving humans more vulnerable to diseases once controllable. ...
Enter cefquinome. ... Worried that using cefquinome in animals puts the efficacy of cefepime at risk, the advisory board at the FDA’s Center for Veterinary Medicine recommended against approving animal use.
FDA turning resistant to the public interest
There exists a class of super antibiotics never approved for use in animals, and for good reason: They are critically needed for treating certain serious life-threatening infections in humans, and any risk of weakening their ability to fight them -- of making bacteria more resistant to drugs through overexposure -- is one most doctors and scientists will not take. But now, despite dire warnings from health groups including the American Medical Association, and even though its own advisory board is against it, the Food and Drug Administration is poised to approve the use of one of those drugs to treat a common respiratory disease in cattle. Use of the drug, cefquinome, in animals also could undermine the effectiveness of a similar drug, cefepime.
''There is reasonable certainty of no harm to public health,'' the product development director of cef-quinome's manufacturer, InterVet, assured the FDA last fall. While "reasonable certainty" is good enough for the people who stand to profit from the drug, it is disturbingly unreasonable for those concerned about individuals paying with their health. A similar scenario unfolded in the mid-'90s when the FDA approved the use of Baytril (produced by Bayer) and SaraFlox (Abbott Laboratories) in poultry. Subsequently, people treated with this antibiotic for a diarrheal disease found the germ began developing resistance to the drug, which also is prescribed for a bacterium that causes anthrax. SaraFlox was pulled from the market after the FDA sought a ban, but not until 2005, after much antagonism, was Baytril withdrawn. By that time, its resistance in humans had increased dramatically.
That InterVet has not withdrawn the drug, the advisory group's opposition notwithstanding, tells us the company has the FDA's assurance it will be approved. What makes the agency's willingness to give the green light to cefquinome even more objectionable is the availability on the market of other medicines that effectively treat the respiratory ailment in cattle. Why not use what is available rather than speed the emergence of microbes resistant to antibiotics that are looked upon as a last resort in humans? And how is it that the FDA is not planning to impose limits on the drug's application to minimize bad consequences?
With the medical and scientific communities angrily calling for the FDA not to approve cefquinome in cattle and pressure against its use in cattle building in Congress, there is a chance the agency will back down and do the right thing. If it thinks the poison pet food scare, which it is currently focused on, is a health crisis, wait until people who could have been saved by an unnecessarily weakened antibiotic start dying.
http://www.suntimes.com/news/commentary/358607,CST-EDT-edits26a.article
''There is reasonable certainty of no harm to public health,'' the product development director of cef-quinome's manufacturer, InterVet, assured the FDA last fall. While "reasonable certainty" is good enough for the people who stand to profit from the drug, it is disturbingly unreasonable for those concerned about individuals paying with their health. A similar scenario unfolded in the mid-'90s when the FDA approved the use of Baytril (produced by Bayer) and SaraFlox (Abbott Laboratories) in poultry. Subsequently, people treated with this antibiotic for a diarrheal disease found the germ began developing resistance to the drug, which also is prescribed for a bacterium that causes anthrax. SaraFlox was pulled from the market after the FDA sought a ban, but not until 2005, after much antagonism, was Baytril withdrawn. By that time, its resistance in humans had increased dramatically.
That InterVet has not withdrawn the drug, the advisory group's opposition notwithstanding, tells us the company has the FDA's assurance it will be approved. What makes the agency's willingness to give the green light to cefquinome even more objectionable is the availability on the market of other medicines that effectively treat the respiratory ailment in cattle. Why not use what is available rather than speed the emergence of microbes resistant to antibiotics that are looked upon as a last resort in humans? And how is it that the FDA is not planning to impose limits on the drug's application to minimize bad consequences?
With the medical and scientific communities angrily calling for the FDA not to approve cefquinome in cattle and pressure against its use in cattle building in Congress, there is a chance the agency will back down and do the right thing. If it thinks the poison pet food scare, which it is currently focused on, is a health crisis, wait until people who could have been saved by an unnecessarily weakened antibiotic start dying.
http://www.suntimes.com/news/commentary/358607,CST-EDT-edits26a.article
Scientists Look to Vaccines in the War on E. Coli
Shousun C. Szu, a scientist at the National Institutes of Health, says the best way to prevent people from being poisoned by deadly E. coli would be to vaccinate all infants against the bacteria. Graeme McRae, a Canadian biotechnology executive, says it would be more practical to inoculate cows instead. Vaccines for people and for cattle are just two approaches under development to prevent or treat food poisoning by the strain E. coli O157:H7. Right now, scientists can do little medically to fight the pathogen, which was responsible for two severe outbreaks last fall, one from contaminated bagged spinach and a second from tainted lettuce served in chain taco restaurants. The main approach has been to try to prevent contamination through careful handling, rigorous inspections and government regulation. Slaughterhouses have already sharply reduced contamination through practices like washing carcasses with hot water, steam or acids. Now the focus is on new procedures and regulations for the fresh-produce industry. Some researchers say medical approaches could eventually supplement food-processing measures. To pave the way, an advisory committee of the Food and Drug Administration met on April 12 to discuss how to run clinical trials of drugs to treat E. coli infections. On the animal side, a vaccine for cattle developed by Mr. McRae’s company, Bioniche Life Sciences, was approved in December for distribution to veterinarians in Canada. Studies have shown that the vaccine can reduce but not eliminate the E. coli shed into manure. Not only does that make the cows cleaner as they go into the slaughterhouse, but it could also conceivably reduce the risk that the germ will spread from a feedlot to a nearby produce field though water or wild animals. Cows and their manure are considered the major sources of the pathogen. “If we can reduce the likelihood that animals are going to carry the bacteria, then we might reduce over time what they put out into the environment,” said Guy Loneragan, a veterinary epidemiologist at West Texas A&M University, who has received financing from the beef industry. Other methods being tested include cattle antibiotics, an industrial chemical, bacterial-killing viruses and friendly bacteria to displace the evil ones. One big potential barrier is that ranchers and feedlots may have little incentive to pay for such treatments, because they do not make the cows grow faster. Nor do they keep the cows healthy, because O157 does not sicken the cows that harbor it. “The cattle industry is within pennies of making a profit or not,” said Carolyn Hovde Bohach, a professor of microbiology at the University of Idaho who is working on a different E. coli vaccine for cattle. “Would it be their responsibility to protect vegetables?” Efforts to develop drugs and vaccines for people also face barriers. Because outbreaks are rare and sporadic, for instance, it would be difficult to test such treatments in clinical trials. It might be hard to diagnose the infection in time to intervene medically. And any treatment would have to be very safe, because it would be given to children and because most people improve without any intervention. E. coli O157:H7 causes 75,000 cases of infection and 61 deaths in the United States each year, according to a 1999 estimate by the Centers for Disease Control and Prevention posted on its Web site. The actual number of confirmed cases has dropped since then, particularly in 2003 and 2004, but increased in 2005 and 2006, in part because of the outbreaks tied to spinach and lettuce. As few as 10 bacteria can make someone ill. The bacteria release one or two potent toxins that cause bloody diarrhea. In 15 percent of children younger than 10, and more rarely for adults, the infection causes hemolytic uremic syndrome, in which red blood cells are destroyed and the kidneys fail. In a small percentage of such cases, the syndrome proves fatal. Dr. Phillip I. Tarr, an expert at Washington University in St. Louis, says treatment is difficult because the bloody diarrhea that signals infection may not occur until three to four days after ingestion of the bacteria. By then, a patient could be well on the way to kidney failure. Antibiotics, the usual treatment for bacterial infection, only make things worse by killing the bacteria and releasing more of their toxin, Dr. Tarr said. He added that the sole treatment shown to reduce the severity of kidney problems was intravenous fluids. Other scientists are trying. Thallion Pharmaceuticals of Montreal and Teijin Pharma of Japan have separately developed monoclonal antibodies that can latch on to the toxin molecules and neutralize them. Monoclonal antibodies, a synthetic version of the body’s own infection fighters, are commonly used to treat cancer and other diseases. Thallion and Teijin have shown that the antibodies can protect laboratory animals from lethal doses and have conducted preliminary safety testing in people. But at the recent F.D.A. advisory committee meeting, both said it would be prohibitively expensive to test whether their drugs could prevent hemolytic uremic syndrome. Some outside scientists question whether a treatment that starts after the toxin is already in the bloodstream would be effective. Dr. Szu of the health institutes said a better approach would be to vaccinate people so their immune systems could dispense with the bacteria before they had a chance to multiply and release their toxin in the bloodstream. She and colleagues have developed a vaccine made of the complex sugar that is on the surface of the bacteria, the very O-type polysaccharide that gives O157 its name. The sugar is linked to a protein taken from another bacterium to make it more potent in stimulating the immune system. Dr. Szu and collaborators have tested the vaccine on adult volunteers and on children 2 to 5. The volunteers were not exposed to O157 — that would be unethical — but they developed antibodies to it. Moreover, when the bacteria were exposed in the laboratory to blood samples from vaccinated people, the microbes were killed. Dr. Szu said the next test would be in infants. The vaccine is years from the market. As with drugs, testing effectiveness would be difficult, and some experts say it may not make sense to vaccinate every child to protect a small number. “A lot of the economics of it would not be very favorable,” said James B. Kaper, an expert on O157 at the Center for Vaccine Development at the University of Maryland. Dr. Szu disagreed, saying, “All human lives are precious, especially if you talk to parents who lost their children.” The cattle vaccine developed by Bioniche is based on the work of B. Brett Finlay of the University of British Columbia, who helped discover how O157 bacteria attach themselves to the cattle intestines, where they can then multiply. The bacteria use a type of microscopic syringe to shoot proteins into the cells lining the intestine, and the cells erect a protein pedestal, to which the bacteria can bind. The Bioniche vaccine consists of proteins involved in the attachment. The idea is that the cow’s immune system would make antibodies to attack the proteins, thereby blocking the attachment. The bacteria could still pass through the cow and into manure. But if they could not colonize, their levels should remain low. Tests at the University of Nebraska found that the vaccine reduced by 70 percent the number of cows shedding O157 into their manure, said Rodney A. Moxley, a professor of veterinary science there. Mr. McRae, president of Bioniche in Belleville, Ontario, said the company would begin to distribute the vaccine in Canada in June or July after it increases manufacturing capacity. The approval there is conditional, and the company has to provide more data showing that the vaccine works. Mr. McRae said he hoped to obtain approval to sell the vaccine in the United States from the Agriculture Department this year. He said feedlots would be charged no more than $2.20 a dose, with two doses needed. Randall D. Huffman, vice president for scientific affairs at the American Meat Institute, which represents beef processors, said that the cost was “not trivial” and that the vaccine “might not be right for everyone,” because it was not 100 percent effective. Still, Mr. Huffman said, “If there is technology that is proven effective and is reasonable in cost, I think you’ll see it adopted.” His organization and the National Cattlemen’s Beef Association helped pay for the research on the vaccine and other approaches to reducing the shedding of O157. One approach already in use is probiotics, the idea that friendly bacteria fed to cattle will displace O157. The Nutrition Physiology Corporation of Guymon, Okla., sells a feed additive with lactobacillus, the same type of bacterium used in yogurt. The additive is sold to aid cattle digestion, but some studies suggest that it also reduces O157 in manure. An experimental approach is to feed cows sodium chlorate, a chemical used in the pulp and paper industry. This idea takes advantage of the fact that O157 has an enzyme that allows it to survive without oxygen, which is not true for most desirable bacteria. That enzyme will convert sodium chlorate to sodium chlorite, which poisons the pathogen. “It’s like a suicide pill to the E. coli,” said Robin C. Anderson, a microbiologist for the Agriculture Department in College Station, Tex. Dr. Anderson said the treatment did not harm the cow. Eka Chemicals, which makes sodium chlorate for the paper industry, is working to obtain regulatory approval for a cattle treatment. The antibiotic neomycin has also been shown to reduce O157 levels in manure. Using antibiotics in animals raises concerns of spurring development of human pathogens resistant to the medicines. Another approach being studied involves phages, viruses that infect and kill bacteria. Experts say multiple approaches might be used in parallel, because no single approach works perfectly. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said he was skeptical about all the approaches. “What really is a concern to me about this issue is we always have a tendency to want high-tech responses to what in many cases are common-sense low-tech solutions,” Dr. Osterholm said. He is a consultant to Fresh Express, the leading seller of bagged salads, and is head of a committee that will disburse $2 million from the company for research on how the produce industry should handle E. coli. He said stringent safety procedures had kept that company from having any contamination incidents. In any case, even if a high-tech solution was desired, there does not seem to be a vaccine for spinach as there is for cattle. Greens are now often rinsed in chlorine solution, but that is not always effective because surface nooks and crannies can shelter the bacteria, said James Gorney, senior vice president for food safety and technology at the United Fresh Produce Association, a trade group. A possible alternative is to use a gas like chlorine dioxide instead of a liquid wash, Dr. Gorney said. Irradiation can also kill the bacteria. But he said the amount of radiation needed could damage fruits or vegetables. And some consumers object to the technique. “Any one of these technologies doesn’t offer us a pasteurization step,” Dr. Gorney said. “So we are left with prevention, prevention and prevention, preventing the contamination from ever occurring.”
Sanitary Surfaces Create Healthier Kitchens
First, people were warned to steer clear of spinach, then it was scallions and later, romaine lettuce. The food recalls of recent memory proved one thing to us: Sanitary measures can be a matter of life or death.
A cursory look around the Internet will show that we’re still in the infancy of truly innovative sanitary surface design. Most of the attention on that subject has been focused on commercial manufacture for the hospitality industry or in spaces where germs are an especially significant threat, such as hospitals and nursing homes.
But specifying or suggesting to a health-conscious client the inclusion of products that promote an environment hostile to germs and other bacteria is not just another potential profit center, it’s good sense. The consumer can’t always control what comes into the kitchen, but making sanitary surfaces part of the design can provide the user with a healthier kitchen experience.
Countertops are not the only surfaces to consider; any place a client’s next meal or exposed skin might possibly touch should be as easy to keep clean as possible, which means making sure to include low-Volatile Organic Compound (VOC) emitting products, sinks that are resistant to water absorption and specialty appliances that aid the client in maintaining a germ-hostile environment.
Careful Countertops
Anyone who has ever had to scrub a tile shower can testify that tiles, while offering almost unlimited design potential, can become unsanitary over time, and this common wisdom applies to tile in the kitchen as well. The grout that holds countertop or backsplash tiles in place is nook-and-cranny central, and there will always be places a client’s scrubber sponge won’t be able to reach. This is the perfect breeding ground for mildew growth, which can activate allergies and aggravate asthma.
But what if your client loves tile and nothing else will do? A simple solution is to include a waterproofing acrylic finish in the tile application process: After installation, coat the grout with the colorless finish to cut the risk of mold, mildew and other bacterial growth.
Another option is to select tiles that have antibacterial treatments added in during the mixing process. Rutland, VT-based Questech’s Q-Seal tiles are natural stone tiles featuring permanent waterproofing and the inclusion of Ultra-Fresh, the firm’s signature antimicrobial protection.
Microban, an antimicrobial that works at the cellular level to disrupt key cell functions within bacterial microbes, is included in Laticrete’s SpectraLock grouts, which are available in 40 colors, and are resistant to stain-causing mold and mildew.
Additionally, SpectraLock is Greenguard certified for low-VOC emissions and does not require any additional sealants.Microban is also a component of Cosentino’s Silestone natural quartz surfaces. Quartz has long been lauded for its sanitary properties and ease of maintenance since, unlike “natural” stones like granite, quartz is non-porous and requires no chemical sealing to make it stain resistant. With Silestone, Cosentino sees the built-in antimicrobial protection as adding yet another layer of protection.
Soapstone, too, is non-porous, requires no chemical sealing and does not absorb stains or liquids. It is also resistant to acids and alkalis. If the client is concerned about maintaining the luster of a soapstone countertop but does not want to use chemicals, advise the person that soapstone can be maintained organically by applying mineral oil to bring out its natural patina.
Non-Porous, No Problem
When it comes to keeping surfaces sanitary, non-porosity is key. Using porous materials that can absorb water and subsequently hold onto it increases the chances of cross-contamination from growing bacteria. By contrast, materials that have withstood long-term firing under intense heat, such as vitreous china, fire clay, glass and porcelain, have extremely low rates of water absorption. Most residential tiles specified for use in the kitchen – be it on a backsplash or on a high-traffic floor – have between 0.5-3% rate of absorption, making them virtually waterproof, according to Tile of Spain.
Glass is another natural option. “Glass countertops don’t require any long-term maintenance such as sealants, polishing, stain removal or burn repair,” says Doris Rocklin of Boisbriand, Quebec, Canada-based ThinkGlass. “Maintenance is as simple as wiping the surface with any common glass cleaning product,” she adds.
Finally, stainless steel has long been a popular choice for appliances, and in recent years, has increasingly been on countertops. It is relatively easy to clean and has been touted by health professionals for its antibacterial properties. But for the client who wants the sanitary benefits of stainless steel yet desires a warmer look, copper offers a more traditional aesthetic. Products like Frigo Design’s copper countertops and line of “fingerprintless” stainless steel for countertop applications can address this need.
While stainless steel is known for its germ-repellent/germ-killing properties, a recent study by Dr. Bill Keevil, director of environmental healthcare at Southampton University in England, showed e. coli lived an average of four hours on a copper surface, compared with a stainless steel top, where 10% of the bacteria was still alive after 34 days. Copper is currently being tested to see what effect it has on superviruses such as clostridium difficile and antibiotic-resistant staphylococcus infections, both which can be present in food sources and transmitted through touch.
Avoiding Cross-Contamination
Since no one lives in a vacuum, it’s to be expected that clients often share their homes with children and pets. Likewise, they will likely be handling raw food items in their kitchen. Having a germ-hostile countertop is a good start, but is not the only sanitary measure worth considering.
For clients with special needs, such as immune deficiency disorders, including specialty sanitary appliances can be key. Kitchen-sized autoclaves are one option; Korea-based Nawooel makes a countertop kitchen sterilizer/sanitizer that uses ultraviolet radiation to sterilize items such as implements used to cut, tenderize or that in any way touch raw meats, or utensils and plates used by especially vulnerable groups such as infants, the elderly and those with compromised immune systems. Placing the sterilizer in the work triangle nearest to where the food preparation takes place cuts down on the need to transfer dirty utensils to the sink, cutting down on the risk of cross-contamination.
If the concept of a personal autoclave is not a preferred solution, including a second prep sink in the design has the same effect by confining utensils used in raw food prep to a space away from where dishes and utensils are washed and stored.
Hands-Off Helping
Hands-free is the last line of defense – if they don’t touch it, it won’t get dirty. Many companies now offer hands-free faucets, which have the added eco-bonus of aiding in water conservation by shutting off when the sensor does not detect an object in front of it.
The battery-powered iTouchless hands-free trashcan uses an infrared sensor to detect when something is within 6" of its lid; the lid then opens and closes after the user has deposited trash.
With other hands-free items on the market such as soap dispensers and light switches, it’s easier than ever to prevent the spread of germs and design a truly healthy kitchen.
For more about green design, also read FusionDesign-Themed Showhouse Features ‘Green’ Focus, Breathing Easy, Firm Infuses New Life into Vintage Showhouse, Sleek and Green Define Kitchen and Bath Design, Green Countertops are Wide Ranging, High-Style Appliances Promote Safety and Energy Efficiency, It’s Easier Than Ever Being Green, Taking Steps Toward ‘Greener’ Kitchen Design, ‘Living Home’ Embraces Environmental Elements and Residential Project Featuring 3,000 Sq. Ft. of Italian Tile Honored for Sustainability and Style
For more green design resources, check out the Green Design section of the Helpful Links section.
A cursory look around the Internet will show that we’re still in the infancy of truly innovative sanitary surface design. Most of the attention on that subject has been focused on commercial manufacture for the hospitality industry or in spaces where germs are an especially significant threat, such as hospitals and nursing homes.
But specifying or suggesting to a health-conscious client the inclusion of products that promote an environment hostile to germs and other bacteria is not just another potential profit center, it’s good sense. The consumer can’t always control what comes into the kitchen, but making sanitary surfaces part of the design can provide the user with a healthier kitchen experience.
Countertops are not the only surfaces to consider; any place a client’s next meal or exposed skin might possibly touch should be as easy to keep clean as possible, which means making sure to include low-Volatile Organic Compound (VOC) emitting products, sinks that are resistant to water absorption and specialty appliances that aid the client in maintaining a germ-hostile environment.
Careful Countertops
Anyone who has ever had to scrub a tile shower can testify that tiles, while offering almost unlimited design potential, can become unsanitary over time, and this common wisdom applies to tile in the kitchen as well. The grout that holds countertop or backsplash tiles in place is nook-and-cranny central, and there will always be places a client’s scrubber sponge won’t be able to reach. This is the perfect breeding ground for mildew growth, which can activate allergies and aggravate asthma.
But what if your client loves tile and nothing else will do? A simple solution is to include a waterproofing acrylic finish in the tile application process: After installation, coat the grout with the colorless finish to cut the risk of mold, mildew and other bacterial growth.
Another option is to select tiles that have antibacterial treatments added in during the mixing process. Rutland, VT-based Questech’s Q-Seal tiles are natural stone tiles featuring permanent waterproofing and the inclusion of Ultra-Fresh, the firm’s signature antimicrobial protection.
Microban, an antimicrobial that works at the cellular level to disrupt key cell functions within bacterial microbes, is included in Laticrete’s SpectraLock grouts, which are available in 40 colors, and are resistant to stain-causing mold and mildew.
Additionally, SpectraLock is Greenguard certified for low-VOC emissions and does not require any additional sealants.Microban is also a component of Cosentino’s Silestone natural quartz surfaces. Quartz has long been lauded for its sanitary properties and ease of maintenance since, unlike “natural” stones like granite, quartz is non-porous and requires no chemical sealing to make it stain resistant. With Silestone, Cosentino sees the built-in antimicrobial protection as adding yet another layer of protection.
Soapstone, too, is non-porous, requires no chemical sealing and does not absorb stains or liquids. It is also resistant to acids and alkalis. If the client is concerned about maintaining the luster of a soapstone countertop but does not want to use chemicals, advise the person that soapstone can be maintained organically by applying mineral oil to bring out its natural patina.
Non-Porous, No Problem
When it comes to keeping surfaces sanitary, non-porosity is key. Using porous materials that can absorb water and subsequently hold onto it increases the chances of cross-contamination from growing bacteria. By contrast, materials that have withstood long-term firing under intense heat, such as vitreous china, fire clay, glass and porcelain, have extremely low rates of water absorption. Most residential tiles specified for use in the kitchen – be it on a backsplash or on a high-traffic floor – have between 0.5-3% rate of absorption, making them virtually waterproof, according to Tile of Spain.
Glass is another natural option. “Glass countertops don’t require any long-term maintenance such as sealants, polishing, stain removal or burn repair,” says Doris Rocklin of Boisbriand, Quebec, Canada-based ThinkGlass. “Maintenance is as simple as wiping the surface with any common glass cleaning product,” she adds.
Finally, stainless steel has long been a popular choice for appliances, and in recent years, has increasingly been on countertops. It is relatively easy to clean and has been touted by health professionals for its antibacterial properties. But for the client who wants the sanitary benefits of stainless steel yet desires a warmer look, copper offers a more traditional aesthetic. Products like Frigo Design’s copper countertops and line of “fingerprintless” stainless steel for countertop applications can address this need.
While stainless steel is known for its germ-repellent/germ-killing properties, a recent study by Dr. Bill Keevil, director of environmental healthcare at Southampton University in England, showed e. coli lived an average of four hours on a copper surface, compared with a stainless steel top, where 10% of the bacteria was still alive after 34 days. Copper is currently being tested to see what effect it has on superviruses such as clostridium difficile and antibiotic-resistant staphylococcus infections, both which can be present in food sources and transmitted through touch.
Avoiding Cross-Contamination
Since no one lives in a vacuum, it’s to be expected that clients often share their homes with children and pets. Likewise, they will likely be handling raw food items in their kitchen. Having a germ-hostile countertop is a good start, but is not the only sanitary measure worth considering.
For clients with special needs, such as immune deficiency disorders, including specialty sanitary appliances can be key. Kitchen-sized autoclaves are one option; Korea-based Nawooel makes a countertop kitchen sterilizer/sanitizer that uses ultraviolet radiation to sterilize items such as implements used to cut, tenderize or that in any way touch raw meats, or utensils and plates used by especially vulnerable groups such as infants, the elderly and those with compromised immune systems. Placing the sterilizer in the work triangle nearest to where the food preparation takes place cuts down on the need to transfer dirty utensils to the sink, cutting down on the risk of cross-contamination.
If the concept of a personal autoclave is not a preferred solution, including a second prep sink in the design has the same effect by confining utensils used in raw food prep to a space away from where dishes and utensils are washed and stored.
Hands-Off Helping
Hands-free is the last line of defense – if they don’t touch it, it won’t get dirty. Many companies now offer hands-free faucets, which have the added eco-bonus of aiding in water conservation by shutting off when the sensor does not detect an object in front of it.
The battery-powered iTouchless hands-free trashcan uses an infrared sensor to detect when something is within 6" of its lid; the lid then opens and closes after the user has deposited trash.
With other hands-free items on the market such as soap dispensers and light switches, it’s easier than ever to prevent the spread of germs and design a truly healthy kitchen.
For more about green design, also read FusionDesign-Themed Showhouse Features ‘Green’ Focus, Breathing Easy, Firm Infuses New Life into Vintage Showhouse, Sleek and Green Define Kitchen and Bath Design, Green Countertops are Wide Ranging, High-Style Appliances Promote Safety and Energy Efficiency, It’s Easier Than Ever Being Green, Taking Steps Toward ‘Greener’ Kitchen Design, ‘Living Home’ Embraces Environmental Elements and Residential Project Featuring 3,000 Sq. Ft. of Italian Tile Honored for Sustainability and Style
For more green design resources, check out the Green Design section of the Helpful Links section.
Banning antimicrobials not effective, study says
A team of University of Georgia scientists suggest that curbing the use of antimicrobials on poultry farms will do little to reduce rates of infection with antimicrobial-resistant bacteria that have the potential to threaten human health.
Dr. Margie Lee, professor at the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antimicrobial-free farms, and even those raised under pristine laboratory conditions, have high concentrations of bacteria that are resistant to common antimicrobials. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs.
The study was funded by grants from the Food and Drug Administration and the Department of Agriculture.
"This issue of antibiotic resistance is more complicated than once thought," Dr. Lee said. "These findings suggest that banning antibiotics at the farm level may not be as effective as assumed. We need further studies to identify which management practice would be effective."
The concern over the emergence of microbes resistant to antimicrobials that are used to treat human and animal infections led the European Union to ban the marketing and use of antimicrobials as growth promoters in animal feed. The final step in the phaseout was completed in January 2006.
In the United States, the Food and Drug Administration announced in July 2005 that it would ban the distribution or use of the antimicrobial enrofloxacin for poultry, which was marketed by Bayer Corporation under the name Baytril 3.23% Concentrate Antimicrobial Solution. The FDA said enrofloxacin caused resistance in Campylobacter jejuni when used to treat respiratory infections in poultry.
"They banned Baytril in 2005, and if you look at Baytril resistance in Campylobacter now, it's essentially unchanged," Dr. Lee said.
Currently, Congress is considering legislation to reduce routine use of antimicrobials in animal agriculture. The Preservation of Antibiotics for Medical Treatment Act (S. 549/H.R. 962) would phase out the use of certain antimicrobial drugs in food-producing animals for nontherapeutic purposes such as growth promotion, feed efficiency, weight gain, routine disease prevention, and other routine uses. Turn to page 976 in the April 1 issue of JAVMA News to learn why the AVMA has not supported passage of the legislation in the past.
Dr. Margie Lee, professor at the UGA College of Veterinary Medicine, and her colleagues have found that chickens raised on antimicrobial-free farms, and even those raised under pristine laboratory conditions, have high concentrations of bacteria that are resistant to common antimicrobials. Her findings, published in the March issue of the journal Applied and Environmental Microbiology, suggest that poultry come to the farm harboring resistant bacteria, possibly acquired as they were developing in their eggs.
The study was funded by grants from the Food and Drug Administration and the Department of Agriculture.
"This issue of antibiotic resistance is more complicated than once thought," Dr. Lee said. "These findings suggest that banning antibiotics at the farm level may not be as effective as assumed. We need further studies to identify which management practice would be effective."
The concern over the emergence of microbes resistant to antimicrobials that are used to treat human and animal infections led the European Union to ban the marketing and use of antimicrobials as growth promoters in animal feed. The final step in the phaseout was completed in January 2006.
In the United States, the Food and Drug Administration announced in July 2005 that it would ban the distribution or use of the antimicrobial enrofloxacin for poultry, which was marketed by Bayer Corporation under the name Baytril 3.23% Concentrate Antimicrobial Solution. The FDA said enrofloxacin caused resistance in Campylobacter jejuni when used to treat respiratory infections in poultry.
"They banned Baytril in 2005, and if you look at Baytril resistance in Campylobacter now, it's essentially unchanged," Dr. Lee said.
Currently, Congress is considering legislation to reduce routine use of antimicrobials in animal agriculture. The Preservation of Antibiotics for Medical Treatment Act (S. 549/H.R. 962) would phase out the use of certain antimicrobial drugs in food-producing animals for nontherapeutic purposes such as growth promotion, feed efficiency, weight gain, routine disease prevention, and other routine uses. Turn to page 976 in the April 1 issue of JAVMA News to learn why the AVMA has not supported passage of the legislation in the past.
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