tag:blogger.com,1999:blog-9023257094302501802024-02-20T02:11:21.888-08:00MRSATerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-902325709430250180.post-25053744480471236502021-01-15T10:10:00.003-08:002021-01-15T10:10:47.867-08:00Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) colonisation and infection among livestock workers and veterinarians: a systematic review and meta-analysis<p> <span style="background-color: white; font-family: arial; font-size: 13.3333px;">Systematic review</span></p><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) colonisation and infection among livestock workers and veterinarians: a systematic review and meta-analysis</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">http://orcid.org/0000-0003-2599-8332Chen Chen1, Felicia Wu1,2</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Author affiliations</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Abstract</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Objectives Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing public health concern worldwide. The objective of this study was to calculate a summary odds ratio (OR) of livestock-associated MRSA colonisation and infection in humans, and to determine specific risk factors in livestock production contributing to MRSA colonisation.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Methods We screened PubMed and Embase for studies published from 2005 to 2019 inclusive, reporting livestock-associated (LA)-MRSA colonisation and infection among livestock workers/veterinarians, their families, and community members not regularly exposed to livestock. The primary outcome of interest was the OR of LA-MRSA colonisation comparing exposed and control groups. Quality was assessed according to the Newcastle-Ottawa quality assessment scale. A meta-analysis using a random-effects model was conducted to calculate a pooled OR. The heterogeneity in the meta-analysis was assessed using the I² method, and publication bias was evaluated using funnel plots.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Results A total of 3490 studies were identified by the search, with 37 studies including 53 matched exposed-control groups and 14 038 participants eligible for the meta-analysis. The pooled OR for LA-MRSA among livestock workers and veterinarians is 9.80 (95% CI 6.89 to 13.95; p=0.000; I2=73.4), with no significant publication bias (Egger’s p=0.66). The OR for swine workers was highest at 15.41 (95% CI 9.24 to 25.69), followed by cattle workers (11.62, 95% CI 4.60 to 29.36), veterinarians (7.63, 95% CI 3.10 to 18.74), horse workers (7.45, 95% CI 2.39 to 23.25), livestock workers (5.86, 95% CI 1.14 to 30.16), poultry workers (5.70, 95% CI 1.70 19.11), and industrial slaughterhouse workers (4.69, 95% CI 1.10 to 20.0).</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Conclusions Livestock workers, particularly swine farmers, are at significantly higher risk for LA-MRSA colonisation and subsequent infection. These results support the need for preventive practices to reduce LA-MRSA risk among those who handle and treat livestock.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">Trial registration number CRD42019120403.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">View Full Text</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">http://dx.doi.org/10.1136/oemed-2020-106418</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><a fg_scanned="1" href="https://oem.bmj.com/content/early/2020/10/23/oemed-2020-106418" rel="nofollow noopener noreferrer" style="color: #0096ef; cursor: pointer; text-decoration-line: none;" target="_blank">https://oem.bmj.com/content/early/2020/10/23/oemed-2020-106418</a></div>Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-89026153786160253672020-10-13T07:52:00.004-07:002020-10-13T07:52:29.045-07:00NATIONAL ACTION PLAN FOR COMBATING ANTIBIOTIC-RESISTANT BACTERIA, 2020-2025<p><span style="background-color: white; font-family: arial; font-size: 13.3333px;">NATIONAL ACTION PLAN FOR COMBATING ANTIBIOTIC-RESISTANT BACTERIA, 2020-2025 </span></p><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">10/09/2020</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">HOME NATIONAL ACTION PLAN FOR COMBA... SIMILAR CONTENT National Action Plan for Combating Antibiotic-Resistant Bacteria Progress Report for Years 1 and 2 National Action Plan for Combating Antibiotic-Resistant Bacteria Progress Report: Year 3 National Action Plan for Combating Antibiotic-Resistant Bacteria Progress Report: Year 4 Economic Incentives for the Development of Rapid Point-of-Care (POC) Diagnostic Devices for C.Difficile, Carbapenem-Resistant Enterobacteriaceae (CRE), and Neisseria Gonorrhoeae CDC — Fluoroquinolone: Request for Correction (RFC) The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), 2020-2025, presents coordinated, strategic actions that the United States Government will take in the next five years to improve the health and wellbeing of all Americans by changing the course of antibiotic resistance. This Plan is based on the U.S. Government’s 2014 National Strategy for CARB, and builds on the first National Action Plan released in 2015 by expanding evidence-based activities that have already been shown to reduce antibiotic resistance, such as optimizing the use of antibiotics in human and animal health settings.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">This Plan continues to prioritize infection prevention and control to slow the spread of resistant infections and reduce the need for antibiotic use. To ensure that patients receive the right antibiotic care, the Plan supports innovative approaches to developing and deploying diagnostic tests and treatment strategies. A One Health approach, which recognizes the relationships between the health of humans, animals, plants, and the environment, is integrated throughout the Plan, with an expanded effort to understand antibiotic resistance in the environment. The Plan also focuses on collecting and using data to better understand where resistance is occurring, support the development of new diagnostics and treatment options, and advance international coordination.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">The U.S. Government will report annually on progress toward the objectives set in the Plan.</span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><a fg_scanned="1" href="https://aspe.hhs.gov/pdf-report/carb-plan-2020-2025?ACSTrackingID=USCDC_426-DM39396&ACSTrackingLabel=New%20U.S.%20Action%20Plan%20for%20Antibiotic%20Resistance&deliveryName=USCDC_426-DM39396" style="color: #0096ef; cursor: pointer; text-decoration-line: none;">https://aspe.hhs.gov/pdf-report/carb-plan-2020-2025?ACSTrackingID=USCDC_426-DM39396&ACSTrackingLabel=New%20U.S.%20Action%20Plan%20for%20Antibiotic%20Resistance&deliveryName=USCDC_426-DM39396</a><br /></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><a href="https://aspe.hhs.gov/system/files/pdf/264126/CARB-National-Action-Plan-2020-2025.pdf" style="color: #0096ef; cursor: pointer; text-decoration-line: none;">https://aspe.hhs.gov/system/files/pdf/264126/CARB-National-Action-Plan-2020-2025.pdf</a><br /></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;"><br /></span></div><div style="background-color: white; font-family: arial; font-size: 13.3333px;"><span style="font-size: 13.3333px;">tss</span></div>Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-5762215796071366902017-11-06T06:25:00.001-08:002017-11-06T06:25:12.382-08:00Livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) among MRSA from humans across the EU/EEA, 2013: ECDC survey<h1 class="h1" style="background-color: white; border-bottom: 3px solid rgb(124, 189, 193); box-sizing: border-box; color: #333333; font-family: MetaPro, Georgia, "Times New Roman", Times, serif; font-size: 2.5em; line-height: 1.1; margin: 0px 0px 10px;">
<span style="box-sizing: border-box;">Livestock-associated meticillin-resistant Staphylococcus aureus (LA-MRSA) among MRSA from humans across the EU/EEA, 2013: ECDC survey</span></h1>
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The survey results show more frequent detections and geographical dispersion of LA-MRSA in humans in the EU/EEA since 2007, and highlight the public health and veterinary importance of LA-MRSA as a ‘One Health’ issue. The ECDC advocates for periodic systematic surveys or integrated multi-sectorial surveillance to facilitate control measures.</div>
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Livestock-associated meticillin-resistant <em style="box-sizing: border-box;">Staphylococcus aureus</em> (LA-MRSA) poses a zoonotic risk, particularly for those working in close contact with livestock. Nonetheless, surveillance of LA-MRSA in humans in Europe is currently not systematic, but mainly event-based.</div>
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In 2014, the European Centre for Disease Prevention and Control (ECDC) initiated a questionnaire survey to collect data on the numbers of LA-MRSA from human samples at national or regional reference laboratories in EU/EEA countries in 2013. ECDC received responses from 28 reference laboratories from 27 (90%) EU/EEA countries.</div>
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Overall, respondents reported receiving MRSA isolates from 14,291 patients in 2013, of which 13,756 (96%) were typed. LA-MRSA was identified by 17 (89%) of 19 countries with MRSA typing data. Overall, the percentage of typed MRSA isolates that were LA-MRSA was 3.9% (535/13,756). Seven countries reported that MRSA typing was not performed, in 2013, in the responding reference laboratory.</div>
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<strong style="box-sizing: border-box;">A need for systematic surveillance</strong></h4>
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This survey documents the increasing detection and geographical dispersion of LA-MRSA in humans in the EU/EEA since 2007. Moreover, 2014 and 2015 reports from the Nordic countries, Germany, the Netherlands and the UK have subsequently indicated an upward trend in the spread of LA-MRSA across Europe. The absence, in 2013, of MRSA typing in national/regional laboratories in seven countries is therefore of concern.</div>
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The results and overall high response rate for this survey highlight both the actual and perceived public health importance of LA-MRSA as a ‘One Health’ issue in EU/EEA countries. ECDC therefore recommends that EU/EEA countries consider repeating this survey periodically to monitor for changes and systematically map potential reservoirs and transmission pathways. Linkage of multi-sectorial, ‘One Health’ MRSA data is also encouraged, in order to enable appropriate targeting and monitoring of the effectiveness of control measures.</div>
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<a href="https://ecdc.europa.eu/en/news-events/livestock-associated-meticillin-resistant-staphylococcus-aureus-la-mrsa-among-mrsa" style="color: #0096ef; cursor: pointer; text-decoration-line: none;">https://ecdc.europa.eu/en/news-events/livestock-associated-meticillin-resistant-staphylococcus-aureus-la-mrsa-among-mrsa</a></div>
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Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-87980046612814715362016-06-16T12:28:00.005-07:002016-06-16T12:28:45.208-07:00Discovery of first mcr-1 gene in E. coli bacteria found in a human in United States<div class="artInfoWrapper">
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Proactive Efforts by U.S. Federal Agencies Enable Early Detection of New
Antibiotic Resistance </div>
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May 26, 2016</div>
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By: U.S. Department of Health and Human Services (HHS)</div>
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Summary: </div>
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Our three departments take the emergence of this resistance gene very
seriously. A coordinated response is underway to try to prevent its spread.
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Just over a year ago, President Obama released a National Action Plan for
Combating Antibiotic Resistant Bacteria. As part of that plan, he also charged
the Department of Defense (DoD), Department of Agriculture (USDA) and Department
of Health and Human Services (HHS) with co-chairing a Presidential Advisory
Council on Combating Antibiotic-Resistant Bacteria (Advisory Council). In the
past year, our three agencies and the Council have held numerous stakeholder
meetings, made new discoveries, and undertaken new research to preserve the
effectiveness of antibiotics.</div>
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In recent weeks, our three agencies have made some important discoveries
regarding antibiotic resistance in the United States. Earlier this week, the
Department of Defense notified stakeholders that its Multidrug-resistant
Organism Repository and Surveillance Network (MRSN) at the Walter Reed Institute
of Research had identified the first colistin-resistant mcr-1 E. coli in a
person in the United States. A USDA and HHS search for colistin-resistant
bacteria in food animals, retail meats and people also has found
colistin-resistant E. coli in a single sample from a pig intestine.</div>
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These discoveries are of concern because colistin is used as a last-resort
drug to treat patients with multi-drug resistant infections. Finding
colistin-resistant bacteria in the United States is important, as it was only
last November that scientists in China first reported that the mcr-1 gene in
bacteria confers colistin resistance. Following the revelation in China,
scientists across the globe began searching for other bacteria containing the
mcr-1 gene, and the bacteria have since been discovered in Europe and Canada.
The mcr-1 gene exists on a plasmid, a small piece of DNA that is not a part of a
bacterium’s chromosome. Plasmids are capable of moving from one bacterium to
another, spreading antibiotic resistance between bacterial species.</div>
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The patient with colistin-resistant E. coli was treated in an outpatient
military treatment facility in Pennsylvania. Biologic samples were sent to the
Walter Reed National Military Medical Center for initial testing and then to
MRSN for genetic sequencing to identify the mcr-1 gene.</div>
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Our three departments take the emergence of this resistance gene very
seriously. A coordinated public health response is underway to try to prevent
its spread. </div>
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For example, to respond to the DoD finding of mcr-1 in a human isolate,
HHS’s Centers for Disease Control and Prevention is working with DoD, the
Pennsylvania Department of Health, local health departments, and others to
identify close contacts, including household and healthcare contacts, of the
Pennsylvania patient to determine whether any of them may have been at risk for
transmission of the bacteria containing the mcr-1 gene. Similarly, USDA is
conducting traceback work to determine the sampled pig's farm of origin.</div>
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<div>
At the same time, the National Antimicrobial Resistance Monitoring System
(NARMS) is continuing its search for evidence of colistin-resistant bacteria in
the United States. For the past 20 years, NARMS has detected emerging resistance
to clinically important antibiotics. NARMS is a partnership between HHS and
USDA, as well as state and local public health departments, dedicated to
tracking changes in the antimicrobial susceptibility of intestinal bacteria
found in ill people, in retail meats, and in food animals.</div>
<div>
</div>
<div>
After the detections in China, the NARMS teams began a two-pronged approach
to search for evidence of colistin-resistant bacteria caused by mcr-1 in the
United States. First, USDA’s Agricultural Research Service (ARS) scientists took
on a proactive study that used a modified technique to look for bacteria with
the mcr-1 gene, employing a targeted and extremely sensitive method to examine
whole bacterial populations found in intestinal samples from food-producing
animals. In the still-ongoing study, USDA scientists analyzed the samples by
first exposing them to colistin at a concentration that would kill sensitive
bacteria and allow any bacteria carrying mcr-1 to survive. Out of 949 animal
samples screened so far, one strain of colistin-resistant E. coli was found in a
pig intestinal sample. The DNA sequence of this isolate revealed that the strain
contained the mcr-1 gene on a plasmid. The scientists also determined that the
mcr-1 carrying colistin-resistant E. coli is resistant to other antibiotics
including ampicillin, streptomycin, sulfisoxazole, and tetracycline.</div>
<div>
</div>
<div>
Second, HHS’ Centers for Disease Control and Prevention (CDC) and the Food
and Drug Administration used whole genome sequencing technology to search for
the gene in Salmonella, E. coli and Klebsiella taken from human and retail meat
sources. As of April 2016, more than 44,000 Salmonella and 9,000 E.
coli/Shigella isolates from NARMS as well as the National Center for
Biotechnology Information genomic database did not show the presence of the
mcr-1 gene.</div>
<div>
</div>
<div>
Although the findings suggest that mcr-1-mediated colistin resistance might
be rare, HHS and USDA remind consumers that cooking all meat, poultry and fish
to its proper internal temperature kills bacteria, viruses and other foodborne
pathogens, whether or not they are antibiotic-resistant.</div>
<div>
</div>
<div>
The NARMS partners will continue to study the newly isolated E. coli strain
to better understand the mcr-1 gene, as well as continue to analyze the
remaining food animal samples for the presence of colistin resistance. Once
USDA’s ARS completes this study, the findings could help determine any
additional steps necessary to further understand the mechanisms and
dissemination of mcr-1 and associated genes.</div>
<div>
</div>
<div>
Beginning in fall 2016, CDC’s Antibiotic Resistance lab network will
provide the infrastructure and lab capacity for seven to eight regional labs,
and labs in all states and seven major cities/territories, to detect and respond
to resistant organisms recovered from human samples. State labs will be able to
detect new forms of antibiotic resistance—including mutations that allow
bacteria to survive the effects of the last-resort drugs like colistin—and
report these findings to CDC in near real-time. With this comprehensive lab
capacity, state health labs and regional labs that are part of the network will
be able to investigate emerging resistance in ways currently unavailable,
generating better data for stronger infection control among patients to prevent
and combat future resistance threats.</div>
<div>
</div>
<div>
And consistent with the National Action Plan for Combating Antibiotic
Resistant Bacteria, CDC, FDA, USDA, DOD and other government agencies will
continue efforts to track, slow and respond to the emergence of antibiotic
resistance.</div>
<div>
</div>
<div>
The two detections of the mcr-1 gene in the U.S. provide a new clue into
the antibiotic resistance landscape, and it also highlights how much we still do
not understand. Colistin is rarely used in human medicine compared to other
antibiotics. It is often used to treat multi-drug resistant infections and its
use is increasing. It is not used in animals in this country. As such, the new
detection underscores the urgent need for more research in this area, and that’s
why the President’s 2017 budget request also calls for Congress to fund the
Agriculture and Food Research Initiative at its full level, allowing our
nation’s best and brightest scientists to help the NARMS partners get ahead of
the fight to keep antibiotics effective and available. Earlier this month, USDA
announced that it is seeking applications for $6 million in research funding to
address antibiotic resistance through this program, but currently USDA must
leave nine in ten applications for AFRI grants unfunded, keeping meaningful
projects off the table.</div>
<div>
</div>
<div>
David J. Smith, M.D., is the Deputy Assistant Secretary of Defense for
Health Readiness Policy and Oversight. </div>
<div>
</div>
<div>
Cathie Woteki, Ph. D., is USDA Under Secretary for Research, Education
& Economics.</div>
<div>
</div>
<div>
Beth P. Bell, MD MPH, is Director of CDC’s National Center for Emerging and
Zoonotic Infectious Diseases </div>
<div>
</div>
<div>
Posted In: Public Health and Safety </div>
<div>
</div>
<div>
Tagged: antibiotic resistance</div>
<div>
</div>
<div>
<a href="http://www.hhs.gov/blog/2016/05/26/early-detection-new-antibiotic-resistance.html#" title="http://www.hhs.gov/blog/2016/05/26/early-detection-new-antibiotic-resistance.html#">http://www.hhs.gov/blog/2016/05/26/early-detection-new-antibiotic-resistance.html#</a></div>
<div>
</div>
<div>
</div>
<div>
Discovery of first mcr-1 gene in E. coli bacteria found in a human in
United States</div>
<div>
</div>
<div>
MCR-1 causes resistance to colistin, a last-resort drug for treating
resistant infections </div>
<div>
</div>
<div>
Media Statement</div>
<div>
</div>
<div>
For Immediate Release: Tuesday, May 31, 2016 Contact: Media Relations,
(404) 639-3286 The Centers for Disease Control and Prevention is part of a
coordinated public health response after the Department of Defense (DoD)
announced the discovery of the first mcr-1 gene found in bacteria in a human in
the United States. CDC is working with DoD, the Pennsylvania Department of
Health, local health departments, and others to identify people who have had
contact with the patient and take action to prevent local spread.</div>
<div>
</div>
<div>
E. coli bacteria carrying the MCR-1 gene was found in a urine sample from a
Pennsylvania woman with no recent travel outside of the U.S. The mcr-1 gene
makes bacteria resistant to the antibiotic colistin, which is used as a
last-resort drug to treat patients with multi-drug-resistant infections,
including carbapenem-resistant Enterobacteriaceae (CRE). The mcr-1 gene exists
on a plasmid, a small piece of DNA that is capable of moving from one bacterium
to another, spreading antibiotic resistance among bacterial species. The CDC and
federal partners have been hunting for this gene in the U.S. ever since its
emergence in China in 2015. </div>
<div>
</div>
<div>
Despite some media reports, the Pennsylvania State Health Department
investigation has determined that the woman did not have CRE and the bacteria
identified is not resistant to all antibiotics (referred to as a pan-resistant
infection). The presence of the mcr-1 gene, however, and its ability to share
its colistin resistance with other bacteria such as CRE raise the risk that
pan-resistant bacteria could develop. </div>
<div>
</div>
<div>
The investigation is currently focused on identifying close contacts,
including household and healthcare contacts, of the Pennsylvania patient to
determine whether any of them may have been at risk for transmission of the
bacteria containing the mcr-1 gene.</div>
<div>
</div>
<div>
Beginning in fall 2016, CDC’s Antibiotic Resistance Lab Network will
provide the infrastructure and lab capacity for seven to eight regional labs,
and labs in all states and seven major cities/territories, to detect and respond
to resistant organisms recovered from human samples . State labs will be able to
detect new forms of antibiotic resistance—including mutations that allow
bacteria to survive the effects of the last-resort drugs like colistin—and
report these findings to CDC. With this comprehensive lab capacity, state health
labs and regional labs that are part of the network will be able to investigate
emerging resistance faster and more effectively, generating better data for
stronger infection control among patients to prevent and combat future
resistance threats. CDC will also provide new resources to state health
departments to support their efforts to stop antibiotic-resistant outbreaks and
prevent the spread of antibiotic-resistant pathogens across communities. </div>
<div>
</div>
<div>
Consistent with the National Action Plan for Combating Antibiotic-Resistant
Bacteria, CDC and other government agencies will continue efforts to track, slow
and respond to the emergence of antibiotic resistance.</div>
<div>
</div>
<div>
For more information on the mcr-1 discovery, see <a href="http://www.hhs.gov/blog/2016/05/26/early-detection-new-antibiotic-resistance.html">http://www.hhs.gov/blog/2016/05/26/early-detection-new-antibiotic-resistance.html</a>.</div>
<div>
</div>
<div>
### U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES </div>
<div>
</div>
<div>
<a href="http://www.cdc.gov/media/releases/2016/s0531-mcr-1.html" title="http://www.cdc.gov/media/releases/2016/s0531-mcr-1.html">http://www.cdc.gov/media/releases/2016/s0531-mcr-1.html</a></div>
<div>
</div>
<div>
Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in
animals and human beings in China: a microbiological and molecular biological
study</div>
<div>
</div>
<div>
Yi-Yun Liu </div>
<div>
x </div>
<div>
Yi-Yun Liu</div>
<div>
</div>
<div>
snip...</div>
<div>
</div>
<div>
Affiliations</div>
<div>
</div>
<div>
Beijing Advanced Innovation Center for Food Nutrition and Human Health,
College of Veterinary Medicine, China Agricultural University, Beijing,
China</div>
<div>
</div>
<div>
Correspondence</div>
<div>
</div>
<div>
Prof Jianzhong Shen, Beijing Advanced Innovation Center for Food Nutrition
and Human Health, College of Veterinary Medicine, China Agricultural University,
Beijing 100094, China</div>
<div>
, PhDcorrespondence </div>
<div>
</div>
<div>
Correspondence</div>
<div>
Prof Jianzhong Shen, Beijing Advanced Innovation Center for Food Nutrition
and Human Health, College of Veterinary Medicine, China Agricultural University,
Beijing 100094, China</div>
<div>
email</div>
<div>
</div>
<div>
†Contributed equally</div>
<div>
</div>
<div>
Published Online: 18 November 2015</div>
<div>
</div>
<div>
Article has an altmetric score of 1630 DOI: <a href="http://dx.doi.org/10.1016/S1473-3099(15)00424-7">http://dx.doi.org/10.1016/S1473-3099(15)00424-7</a>
</div>
<div>
</div>
<div>
Publication History </div>
<div>
</div>
<div>
Published Online: 18 November 2015</div>
<div>
© 2016 Elsevier Ltd. All rights reserved.</div>
<div>
This article can be found in the following collections: Anti-infective
therapy; Healthcare-associated infections; Infectious diseases-other </div>
<div>
To view the full text, please login as a subscribed user or purchase a
subscription. Click here to view the full text on ScienceDirect.</div>
<div>
</div>
<div>
Figures </div>
<div>
</div>
<div>
Figure 1</div>
<div>
</div>
<div>
Map of China</div>
<div>
</div>
<div>
</div>
<div>
Figure 2</div>
<div>
</div>
<div>
Structure of plasmid pHNSHP45 carrying mcr-1 from Escherichia coli strain
SHP45</div>
<div>
</div>
<div>
Figure 3</div>
<div>
</div>
<div>
Hydropathy plot predicting five transmembrane α-helices in the N-terminal
200 aminoacids of MCR-1 (A) and i-Tasser homology modelling analysis of MCR-1
based on models from LptA (Neisseria meningitidis; Protein Data Bank ID 4KAY)
and EptC (Campylobacter jejuni; Protein Data Bank ID 4TNO; B)</div>
<div>
</div>
<div>
Figure 4</div>
<div>
</div>
<div>
In-vivo effects of colistin treatment (7·5 mg/kg of colistin sulfate per 12
h) in a murine thigh model showing 106 CFU infection with Escherichia coli with
mcr-1 (363R, red circles) and without mcr-1 (363S, blue circles)</div>
<div>
</div>
<div>
p value calculated by a two-sample t test for the log difference in CFUs
between 363S and 363R after treatment was also indicated. CFU=colony forming
unit.</div>
<div>
</div>
<div>
Summary</div>
<div>
</div>
<div>
Background</div>
<div>
</div>
<div>
Until now, polymyxin resistance has involved chromosomal mutations but has
never been reported via horizontal gene transfer. During a routine surveillance
project on antimicrobial resistance in commensal Escherichia coli from food
animals in China, a major increase of colistin resistance was observed. When an
E coli strain, SHP45, possessing colistin resistance that could be transferred
to another strain, was isolated from a pig, we conducted further analysis of
possible plasmid-mediated polymyxin resistance. Herein, we report the emergence
of the first plasmid-mediated polymyxin resistance mechanism, MCR-1, in
Enterobacteriaceae.</div>
<div>
</div>
<div>
Methods</div>
<div>
</div>
<div>
The mcr-1 gene in E coli strain SHP45 was identified by whole plasmid
sequencing and subcloning. MCR-1 mechanistic studies were done with sequence
comparisons, homology modelling, and electrospray ionisation mass spectrometry.
The prevalence of mcr-1 was investigated in E coli and Klebsiella pneumoniae
strains collected from five provinces between April, 2011, and November, 2014.
The ability of MCR-1 to confer polymyxin resistance in vivo was examined in a
murine thigh model.</div>
<div>
</div>
<div>
Findings</div>
<div>
</div>
<div>
Polymyxin resistance was shown to be singularly due to the plasmid-mediated
mcr-1 gene. The plasmid carrying mcr-1 was mobilised to an E coli recipient at a
frequency of 10−1 to 10−3 cells per recipient cell by conjugation, and
maintained in K pneumoniae and Pseudomonas aeruginosa. In an in-vivo model,
production of MCR-1 negated the efficacy of colistin. MCR-1 is a member of the
phosphoethanolamine transferase enzyme family, with expression in E coli
resulting in the addition of phosphoethanolamine to lipid A. We observed mcr-1
carriage in E coli isolates collected from 78 (15%) of 523 samples of raw meat
and 166 (21%) of 804 animals during 2011–14, and 16 (1%) of 1322 samples from
inpatients with infection.</div>
<div>
</div>
<div>
Interpretation</div>
<div>
</div>
<div>
The emergence of MCR-1 heralds the breach of the last group of antibiotics,
polymyxins, by plasmid-mediated resistance. Although currently confined to
China, MCR-1 is likely to emulate other global resistance mechanisms such as
NDM-1. Our findings emphasise the urgent need for coordinated global action in
the fight against pan-drug-resistant Gram-negative bacteria.</div>
<div>
</div>
<div>
Funding</div>
<div>
</div>
<div>
Ministry of Science and Technology of China, National Natural Science
Foundation of China.</div>
<div>
</div>
<div>
<a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00424-7/abstract">http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00424-7/abstract</a></div>
<div>
</div>
<div>
Tuesday, September 17, 2013</div>
<div>
</div>
<div>
Antibiotic resistance threats in the United States, 2013 THREAT REPORT
</div>
<div>
</div>
<div>
<a href="http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html">http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html</a></div>
<div>
</div>
<div>
MRSA</div>
<div>
</div>
<div>
<a href="http://staphmrsa.blogspot.com/2007/10/mrsa.html">http://staphmrsa.blogspot.com/2007/10/mrsa.html</a></div>
<div>
</div>
<div>
<a href="http://staphmrsa.blogspot.com/2015/02/design-of-endoscopic-retrograde.html">http://staphmrsa.blogspot.com/2015/02/design-of-endoscopic-retrograde.html</a></div>
<div>
</div>
<div>
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a>
</div>
<div>
</div>
<div>
</div>
<div>
Terry S. Singeltary Sr.</div>
<div>
</div>
<div>
</div>
</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-5539440046828521642015-02-21T19:06:00.001-08:002015-02-23T08:04:53.555-08:00Design of Endoscopic Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective Cleaning: FDA Safety Communication<h1 class="head1_body">
<span style="font-family: Times New Roman;">Design of Endoscopic
Retrograde Cholangiopancreatography (ERCP) Duodenoscopes May Impede Effective
Cleaning: FDA Safety Communication</span></h1>
<br />
<span style="font-family: Times New Roman;"><strong>Date Issued:</strong> February 19,
2015</span><br />
<br />
<strong><span style="font-family: Times New Roman;">Audience: </span></strong><br />
<br />
<ul>
<li><span style="font-family: Times New Roman;">Gastroenterologists</span></li>
<li><span style="font-family: Times New Roman;">Gastrointestinal surgeons</span></li>
<li><span style="font-family: Times New Roman;">Endoscopy nurses</span></li>
<li><span style="font-family: Times New Roman;">Staff working in endoscopy reprocessing units
in health care facilities</span></li>
<li><span style="font-family: Times New Roman;">Infection control practitioners</span></li>
<li><span style="font-family: Times New Roman;">Patients considering endoscopic retrograde
cholangiopancreatography (ERCP) procedures</span></li>
</ul>
<br />
<span style="font-family: Times New Roman;"><strong>Medical Specialties:</strong>
Gastroenterology, Infection Control</span><br />
<br />
<span style="font-family: Times New Roman;"><strong>Device:</strong> All ERCP endoscopes
(side-viewing duodenoscopes)</span><br />
<br />
<div align="center">
<img alt="Close-up view of an ERCP endoscope tip" src="http://www.fda.gov/ucm/groups/fdagov-public/documents/image/ucm434882.jpg" title="Close-up view of an ERCP endoscope tip" /><br />
<em><span style="font-family: Times New Roman;">Figure 1: Close-up view of an ERCP endoscope
tip.</span></em></div>
<br />
<br />
<br />
<div>
Purpose:</div>
<br />
<div>
</div>
<br />
<div>
The FDA wants to raise awareness among health care professionals, including
those working in reprocessing units in health care facilities, that the complex
design of ERCP endoscopes (also called duodenoscopes) may impede effective
reprocessing. Reprocessing is a detailed, multistep process to clean and
disinfect or sterilize reusable devices. Recent medical publications and adverse
event reports associate multidrug-resistant bacterial infections in patients who
have undergone ERCP with reprocessed duodenoscopes, even when manufacturer
reprocessing instructions are followed correctly. Meticulously cleaning
duodenoscopes prior to high-level disinfection should reduce the risk of
transmitting infection, but may not entirely eliminate it.</div>
<br />
<div>
</div>
<br />
<div>
Summary of Problem and Scope: </div>
<br />
<div>
</div>
<br />
<div>
More than 500,000 ERCP procedures using duodenoscopes are performed in the
United States annually. The procedure is the least invasive way of draining
fluids from pancreatic and biliary ducts blocked by cancerous tumors,
gallstones, or other conditions. Duodenoscopes are flexible, lighted tubes that
are threaded through the mouth, throat, stomach, and into the top of the small
intestine (the duodenum). They contain a hollow channel that allows the
injection of contrast dye or the insertion of other instruments to obtain tissue
samples for biopsy or treat certain abnormalities. Unlike most other endoscopes,
duodenoscopes also have a movable “elevator” mechanism at the tip. The elevator
mechanism changes the angle of the accessory exiting the accessory channel,
which allows the instrument to access the ducts to treat problems with fluid
drainage.</div>
<br />
<div>
</div>
<br />
<div>
Although the complex design of duodenoscopes improves the efficiency and
effectiveness of ERCP, it causes challenges for cleaning and high-level
disinfection. Some parts of the scopes may be extremely difficult to access and
effective cleaning of all areas of the duodenoscope may not be possible. In
addition, a recent FDA engineering assessment and a growing body of literature
have identified design issues in duodenoscopes that complicate reprocessing of
these devices. For example, one step of the manual cleaning instructions in
device labeling is to brush the elevator area. However, the moving parts of the
elevator mechanism contain microscopic crevices that may not be reached with a
brush. Residual body fluids and organic debris may remain in these crevices
after cleaning and disinfection. If these fluids contain microbial
contamination, subsequent patients may be exposed to serious infections.</div>
<br />
<div>
</div>
<br />
<div>
The FDA is closely monitoring the association between reprocessed
duodenoscopes and the transmission of infectious agents, including
multidrug-resistant bacterial infections caused by Carbapenem-Resistant
Enterobacteriaceae (CRE) such as Klebsiella species and Escherichia coli. In
total, from January 2013 through December 2014, the FDA received 75 MDRs
encompassing approximately 135 patients in the United States relating to
possible microbial transmission from reprocessed duodenoscopes. It is possible
that not all cases have been reported to the FDA. The agency is continuing to
evaluate information about documented and potential infections from multiple
sources, including Medical Device Reports (MDRs) submitted to the FDA, the
medical literature, the health care community, professional medical societies,
and the Centers for Disease Control and Prevention (CDC).</div>
<br />
<div>
</div>
<br />
<div>
Recommendations for Facilities and Staff that Reprocess ERCP Duodenoscopes:
</div>
<br />
<div>
</div>
<br />
<div>
Follow closely all manufacturer instructions for cleaning and processing.
The FDA recommends adherence to general endoscope reprocessing guidelines and
practices established by the infection control community and endoscopy
professionals, as described in the Additional Resources section, below. In
addition, it is important to follow specific reprocessing instructions in the
manufacturer’s labeling for each device. Even though duodenoscopes are
inherently difficult to reprocess, strict adherence to the manufacturer’s
reprocessing instructions will minimize the risk of infection. Deviations from
the manufacturer's instructions for reprocessing may contribute to
contamination. The benefit of using cleaning accessories not specified in the
manufacturer’s instructions, such as channel flushing aids, brushes, and
cleaning agents, is not known. Report problems with reprocessing the device to
the manufacturer and to the FDA, as described below. Follow these additional
general best practices: Meticulously clean the elevator mechanism and the
recesses surrounding the elevator mechanism by hand, even when using an
automated endoscope reprocessor (AER). Raise and lower the elevator throughout
the manual cleaning process to allow brushing of both sides. Implement a
comprehensive quality control program for reprocessing duodenoscopes. Your
reprocessing program should include written procedures for monitoring training
and adherence to the program, and documentation of equipment tests, processes,
and quality monitors used during the reprocessing procedure. Refer to the
Multisociety Guideline on Reprocessing Flexible Gastrointestinal Endoscopes:
2011 disclaimer icon consensus document for evidence-based recommendations for
endoscope reprocessing. Recommendations for Health Care Providers:</div>
<br />
<div>
</div>
<br />
<div>
Inform patients of the benefits and risks associated with ERCP procedures.
Discuss with your patients what they should expect following the ERCP procedure
and what symptoms (such as fever or chills, chest pain, severe abdominal pain,
trouble swallowing or breathing, nausea and vomiting, or black or tarry stools)
should prompt additional follow-up. Consider taking a duodenoscope out of
service until it has been verified to be free of pathogens if a patient develops
an infection with a multidrug-resistant organism following ERCP, and you suspect
that there may be a link between the duodenoscope and the infection. Submit a
report to the manufacturer and to the FDA via MedWatch, as described below, if
you suspect that problems with reprocessing a duodenoscope have led to patient
infections. Recommendations for Patients:</div>
<br />
<div>
</div>
<br />
<div>
Discuss the benefits and risks of procedures using duodenoscopes with your
physician. For most patients, the benefits of ERCP outweigh the risks of
infection. ERCP often treats life-threatening conditions that can lead to
serious health consequences if not addressed. Ask your doctor what to expect
following the procedure and when to seek medical attention. Following ERCP, many
patients may experience mild symptoms such as a sore throat or mild abdominal
discomfort. Call your doctor if, following your procedure, you have a fever or
chills, or other symptoms that may be a sign of a more serious problem (such as
chest pain, severe abdominal pain, trouble swallowing or breathing, nausea and
vomiting, or black or tarry stools). FDA Activities:</div>
<br />
<div>
</div>
<br />
<div>
The FDA is actively engaged with other government agencies, including CDC,
and the manufacturers of duodenoscopes used in the United States to identify the
causes and risk factors for transmission of infectious agents and develop
solutions to minimize patient exposure. Recent FDA activities include:</div>
<br />
<div>
</div>
<br />
<div>
Collaboration with CDC and the Environmental Protection Agency (EPA) to
test the antibiotic-resistant organisms to assess their susceptibility to
high-level disinfectants. Exploration, with CDC, of additional potential
strategies to reduce the risk of infections, such as microbiological
surveillance testing of duodenoscopes. Communication with international public
health agencies to study the extent of the problem and identify possible
solutions being considered outside the United States. Reviews of reprocessing
validation data from each of the three manufacturers marketing duodenoscopes in
the United States (FUJIFILM, Olympus, and Pentax). The FDA continues to actively
monitor this situation and will provide updates as appropriate.</div>
<br />
<div>
</div>
<br />
<div>
Reporting Problems to the FDA: </div>
<br />
<div>
</div>
<br />
<div>
Device manufacturers and user facilities must comply with the applicable
Medical Device Reporting (MDR) regulations.</div>
<br />
<div>
</div>
<br />
<div>
Health care personnel employed by facilities that are subject to the FDA's
user facility reporting requirements should follow the reporting procedures
established by their facilities.</div>
<br />
<div>
</div>
<br />
<div>
Prompt reporting of adverse events can help the FDA identify and better
understand the risks associated with medical devices. Health care providers
should submit voluntary reports of the transmission of an infection due to an
inadequately cleaned duodenoscope to the agency via the Medical Device Reporting
(MDR) process.</div>
<br />
<div>
</div>
<br />
<div>
If, after following the manufacturer’s reprocessing instructions, a health
care provider suspects bacterial contamination—either because of an increase in
infections after ERCP, or because of the results of bacterial surveillance
culturing of duodenoscopes—we encourage the health care provider to file a
voluntary report through MedWatch, the FDA Safety Information and Adverse Event
Reporting program.</div>
<br />
<div>
</div>
<br />
<div>
Additional Resources: </div>
<br />
<div>
</div>
<br />
<div>
American Society for Gastrointestinal Endoscopy: Multisociety Guideline on
Reprocessing Flexible Gastrointestinal Endoscopes: 2011 disclaimer icon Society
of Gastroenterology Nurses and Associates: Standards of Infection Control in
Reprocessing of Flexible Gastrointestinal Endoscopes disclaimer icon FDA:
Reprocessing of Reusable Medical Devices FDA: Preventing Cross-Contamination in
Endoscope Processing: FDA Safety Communication References:</div>
<br />
<div>
</div>
<br />
<div>
Alrabaa SF, Nguyen P, Sanderson R, et al. June 2013. Early Identification
and Control of Carbapenemase-Producing Klebsiella Pneumoniae, Originating from
Contaminated Endoscopic Equipment. Retrieved from <a href="http://www.ncbi.nlm.nih.gov/pubmed/23171594">http://www.ncbi.nlm.nih.gov/pubmed/23171594</a></div>
<br />
<div>
</div>
<br />
<div>
Aumeran C, Poincloux L, Souweine B, et al. November 2010.
Multidrug-Resistant Klebsiella Pneumoniae Outbreak After Endoscopic Retrograde
Cholangiopancreatography. Retrieved from <a href="http://www.ncbi.nlm.nih.gov/pubmed/20725887">http://www.ncbi.nlm.nih.gov/pubmed/20725887</a></div>
<br />
<div>
</div>
<br />
<div>
Epstein L, Hunter JC, Arwady MA, et al. October 2014. New Delhi
Metallo-β-Lactamase–Producing Carbapenem-Resistant Escherichia Coli Associated
with Exposure to Duodenoscopes. Retrieved from <a href="http://jama.jamanetwork.com/article.aspx?articleid=1911326">http://jama.jamanetwork.com/article.aspx?articleid=1911326</a></div>
<br />
<div>
</div>
<br />
<div>
Rutala WA and Weber DJ. October 2014. Gastrointestinal Endoscopes: A Need
to Shift From Disinfection to Sterilization? Retrieved from <a href="http://jama.jamanetwork.com/article.aspx?articleid=1911309">http://jama.jamanetwork.com/article.aspx?articleid=1911309</a></div>
<br />
<div>
</div>
<br />
<div>
Verfaillie C, Bruno M, Poley, JW, et al. Withdrawal of a Duodenoscope Stops
Outbreak by A Vim-2 Pseudomonas Aeruginosa. [Abstract] Retrieved from <a href="http://www.icaaconline.com/php/icaac2014abstracts/data/papers/2014/K-1685.htm">http://www.icaaconline.com/php/icaac2014abstracts/data/papers/2014/K-1685.htm</a></div>
<br />
<div>
</div>
<br />
<div>
Contact Information:</div>
<br />
<div>
</div>
<br />
<div>
If you have questions about this communication, please contact the Division
of Industry and Consumer Education (DICE) at DICE@FDA.HHS.GOV, 800-638-2041 or
301-796-7100. </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm">http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm</a></div>
<br />
<div>
</div>
<br />
<div>
Carbapenem-resistant Enterobacteriaceae in Healthcare Settings </div>
<br />
<div>
</div>
<br />
<div>
CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family
of germs that are difficult to treat because they have high levels of resistance
to antibiotics. Klebsiella species and Escherichia coli (E. coli) are examples
of Enterobacteriaceae, a normal part of the human gut bacteria, that can become
carbapenem-resistant. Types of CRE are sometimes known as KPC (Klebsiella
pneumoniae carbapenemase) and NDM (New Delhi Metallo-beta-lactamase). KPC and
NDM are enzymes that break down carbapenems and make them ineffective. Both of
these enzymes, as well as the enzyme VIM (Verona Integron-Mediated
Metallo-β-lactamase) have also been reported in Pseudomonas.</div>
<br />
<div>
</div>
<br />
<div>
Healthy people usually do not get CRE infections – they usually happen to
patients in hospitals, nursing homes, and other healthcare settings. Patients
whose care requires devices like ventilators (breathing machines), urinary
(bladder) catheters, or intravenous (vein) catheters, and patients who are
taking long courses of certain antibiotics are most at risk for CRE
infections.</div>
<br />
<div>
</div>
<br />
<div>
Some CRE bacteria have become resistant to most available antibiotics.
Infections with these germs are very difficult to treat, and can be deadly—one
report cites they can contribute to death in up to 50% of patients who become
infected.</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.cdc.gov/HAI/organisms/cre/">http://www.cdc.gov/HAI/organisms/cre/</a>
</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
*** just looking over the recent enforcement reports from FDA on Endoscopy
Equipment, I recall a recent report just a few months ago, a lengthy one, but I
don’t recall what the concern was? something about ;</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
‘’The parameters provided in the Laparoscopic Manual Instruments
Instructions for Use (IFU 1000-401-070 Revision G or prior) do not support the
unwrapped Gravity cycle and the Ethylene Oxide cycle sterilization
methods’’</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
to many to list here, they all take up about 4/5 of the page. please see
link below and scroll down, you can’t miss all of them ;</div>
<br />
<div>
</div>
<br />
<div>
Enforcement Report - Week of December 24, 2014</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.accessdata.fda.gov/scripts/enforcement/enforce_rpt-Product-Tabs.cfm?action=Expand+Index&w=12242014&lang=eng" title="http://www.accessdata.fda.gov/scripts/enforcement/enforce_rpt-Product-Tabs.cfm?action=Expand+Index&w=12242014&lang=eng">http://www.accessdata.fda.gov/scripts/enforcement/enforce_rpt-Product-Tabs.cfm?action=Expand+Index&w=12242014&lang=eng</a></div>
<br />
<div>
</div>
<br />
<div>
see other FDA enforcement reports here ;</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://google2.fda.gov/search?q=enforcement+endoscope&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*" title="http://google2.fda.gov/search?q=enforcement+endoscope&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*">http://google2.fda.gov/search?q=enforcement+endoscope&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*</a></div>
<br />
<div>
<br />
<br />
</div>
<h1>
<span style="font-family: Times New Roman;">CDC Statement: Los Angeles County/UCLA
investigation of CRE transmission and duodenoscopes</span></h1>
<br />
<div class="c33r columns">
<div class="subcr">
<div class="cdc-caption drawn">
<a href="https://www.blogger.com/null" title="CRE"><img alt="CRE" height="280" src="http://www.cdc.gov/hai/images/CRE.jpg" width="240" /></a></div>
</div>
</div>
<br />
<span style="font-family: Times New Roman;">Currently, CDC is providing consultation to the
Los Angeles County Health Department as it investigates, in collaboration with
the University of California, Los Angeles (UCLA) Medical Center, a cluster of
carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) cases. In this
investigation, exposure to duodenoscopes—a device inserted down the throat and
used in a lifesaving procedure called endoscopic retrograde
cholangiopancreatography (ERCP)—was associated with transmission of
CRE.</span><br />
<br />
<span style="font-family: Times New Roman;">The duodenoscope is different than the endoscope
used for routine upper gastrointestinal endoscopy or colonoscopy. The
duodenoscope is more intricate than other endoscopes and can be difficult to
clean and disinfect.</span><br />
<br />
<span style="font-family: Times New Roman;">Infections caused by CRE are generally found in
hospitalized patients or residents in long-term-care facilities. ERCP is an
important and potentially lifesaving medical procedure that allows doctors to
evaluate and remove blockages from the channels (bile and pancreatic ducts) that
drain a patient’s liver. Use of this device can potentially avoid the need for
more invasive procedures such as surgery. </span><br />
<br />
<span style="font-family: Times New Roman;">Investigators of previous outbreaks of CRE
related to duodenoscopes have identified recognized breaches of approved
cleaning protocols. In other <span class="cdc-decorated"><a class="external" href="https://www.blogger.com/null" style="href: "http://jama.jamanetwork.com/article.aspx?articleid=1911326";">outbreaks</a><a class="external" href="https://www.blogger.com/null" style="href: "http://www.cdc.gov/Other/disclaimer.html";" target="_blank"><img alt="External Web Site Icon" class="externalImg" src="http://www.cdc.gov/TemplatePackage/images/icon_out.png" title="External Web Site Icon" /></a></span>,
including this cluster, investigators reported finding no breach in duodenoscope
reprocessing and no evidence of defects in the duodenoscope. </span><br />
<br />
<span style="font-family: Times New Roman;">This investigation highlights the challenging
and complicated nature of duodenoscope reprocessing and the potential for CRE
transmission. Today, the Food and Drug Administration (FDA) released a safety
communication about duodenoscopes: <span class="cdc-decorated"><a class="external" href="https://www.blogger.com/null" style="href: "http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm";">http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm</a><a class="external" href="https://www.blogger.com/null" style="href: "http://www.cdc.gov/Other/disclaimer.html";" target="_blank"><img alt="External Web Site Icon" class="externalImg" src="http://www.cdc.gov/TemplatePackage/images/icon_out.png" title="External Web Site Icon" /></a></span>. The
FDA is aware of and closely monitoring the association between reprocessed
endoscopes and multidrug-resistant bacterial infections caused by CRE, such as
<em>Klebsiella </em>species and <em>Escherichia coli</em>. </span><br />
<br />
<span style="font-family: Times New Roman;">CDC continues to investigate and work with FDA
and others on the optimal protocols for endoscope reprocessing. At this time,
CDC recommends facilities reprocess endoscopes as directed by the manufacturer,
typically high-level disinfection. Although sterilization is the definitive
mechanism to eradicate all microorganisms during reprocessing, several issues
potentially limit its widespread use, including longer processing and aeration
time than with disinfection, toxicity of some sterilizing agents, and potential
incompatibility with some duodenoscope devices. Until more is known, it is
important for facilities to be aware of the potential risk of CRE transmission
and that they adhere strictly to the recommended reprocessing practices,
particularly manual cleaning and drying.</span><br />
<br />
<span style="font-family: Times New Roman;">CDC is working with partners including FDA, the
device manufacturers, specialty societies, subject matter experts, and state and
local health departments to further understand and address the possibility of
CRE transmission related to duodenoscopes in the following ways: </span><br />
<br />
<ul>
<li><span style="font-family: Times New Roman;">investigate potential CRE
transmission</span></li>
<li><span style="font-family: Times New Roman;">determine which duodenoscope models are
potentially impacted; </span></li>
<li><span style="font-family: Times New Roman;">evaluate duodenoscope cleaning, drying, and
disinfection; </span></li>
<li><span style="font-family: Times New Roman;">assess the feasibility of using microbiologic
sampling cultures to evaluate a facility’s duodenoscope cleaning methods and
identify if bacterial contamination remains after cleaning; and
</span></li>
</ul>
<br />
<span style="font-family: Times New Roman;">The risk to patients of CRE infection following
ERCP is low and, for most patients, the benefits of this potentially lifesaving
procedure outweigh the risks. </span><br />
<br />
<span style="font-family: Times New Roman;">Combating antibiotic-resistant infections is a
top priority of the Administration. The President’s FY 2016 Budget nearly
doubles the amount of federal funding for combating and preventing antibiotic
resistance to more than $1.2 billion. In September 2014, President Obama signed
Executive Order 13676 launching Federal efforts to combat the rise in
antibiotic-resistant bacteria. The Administration has also issued its National
Strategy on Combating Antibiotic-Resistant Bacteria, which outlines steps the
U.S. government will take to improve prevention, detection, and control of
resistant pathogens. </span><br />
<br />
<span style="font-family: Times New Roman;">This outbreak also highlights the importance of
CDC and state health departments working collaboratively to identify and stop
outbreaks of antibiotic resistant pathogens. In the FY 16 budget, CDC has
requested funding to support State Antibiotic Resistance Prevention Programs in
all 50 states and 10 large cities and a regional lab network to help identify
and to respond faster to these outbreaks. This funding would provide critical
national infrastructure to prevent the growing threat of CRE and other
drug-resistant pathogens.</span><br />
<br />
<span style="font-family: Times New Roman;"></span><br />
<br />
<a href="http://www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html" title="http://www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html">http://www.cdc.gov/hai/outbreaks/cdcstatement-LA-CRE.html</a><br />
<br />
<span style="font-family: Times New Roman;"></span><br />
<br />
<div class="contentHeaderContainer" style="background: rgb(255, 255, 255);">
<div class="contentSection">
<span style="font-family: Times New Roman;"><span class="articleType" id="scm6MainContent_lblArticleType">Original
Investigation</span> <span class="separator">|</span> <span class="contentDate"><span id="scm6MainContent_lblArticleDate"><span class="ppub"><span class="month">October </span><span class="day">8, </span><span class="year">2014</span></span></span> </span></span><span id="lblSuperClass"></span></div>
<h1 class="aTitle">
<span style="font-family: Times New Roman;"><span id="scm6MainContent_lblArticleTitle">New Delhi Metallo-β-Lactamase–Producing
Carbapenem-Resistant <i>Escherichia coli</i> Associated With Exposure to
Duodenoscopes</span> </span></h1>
<div class="authorSection sans" id="scm6MainContent_dvAuthorSection">
<span style="font-family: Times New Roman;"><span class="authorNames" id="scm6MainContent_lblAuthors">Lauren Epstein, MD, MSc<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_0">1,2</sup>; Jennifer
C. Hunter, DrPH<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_1">1,2</sup>; M.
Allison Arwady, MD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_2">2,3</sup>;
Victoria Tsai, MPH<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_3">3</sup>;
Linda Stein, MPH<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_4">4</sup>;
Marguerite Gribogiannis, MPA<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_5">4</sup>;
Mabel Frias, MPH<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_6">5</sup>; Alice
Y. Guh, MD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_7">1</sup>;
Alison S. Laufer, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_8">1</sup>;
Stephanie Black, MD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_9">6</sup>;
Massimo Pacilli, MS<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_10">6</sup>;
Heather Moulton-Meissner, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_11">1</sup>; J.
Kamile Rasheed, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_12">1</sup>; Johannetsy
J. Avillan, BS<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_13">1</sup>;
Brandon Kitchel, MS<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_14">1</sup>; Brandi
M. Limbago, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_15">1</sup>;
Duncan MacCannell, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_16">1</sup>;
David Lonsway, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_17">1</sup>;
Judith Noble-Wang, PhD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_18">1</sup>;
Judith Conway, RN<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_19">3</sup>;
Craig Conover, MD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_20">3</sup>;
Michael Vernon, DrPH<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_21">5</sup>; Alexander
J. Kallen, MD<sup id="scm6MainContent_rptAuthors_supAuthorAffiliations_22">1</sup></span>
</span></div>
<div class="disclosures" id="scm6MainContent_divDisclosures">
<a class="disclosureLink special" href="https://www.blogger.com/null" id="jama.jamanetwork.com/article.aspx?articleid=1911326#-scm6MainContent_divDisclosures" style="href: "http://jama.jamanetwork.com/article.aspx?articleid=1911326#";"><span style="font-family: Times New Roman;">[<span class="spanPlus">+</span><span class="spanMinus" style="display: none;">-</span>] Author Affiliations</span></a>
<div class="disclosureText" id="scm6MainContent_DisclosureAndother">
<div class="auhtorAff" id="scm6MainContent_divAffiliations">
<span style="font-family: Times New Roman;"><sup>1</sup>Division of Healthcare Quality Promotion,
Centers for Disease Control and Prevention, Atlanta, Georgia
<br /><sup>2</sup>Epidemic Intelligence Service, Division of Scientific Education
and Professional Development, Centers for Disease Control and Prevention,
Atlanta, Georgia <br /><sup>3</sup>Illinois Department of Public Health, Chicago,
Illinois <br /><sup>4</sup>Advocate Lutheran General Hospital, Park Ridge,
Illinois <br /><sup>5</sup>Cook County Department of Public Health, Oak Forest,
Illinois <br /><sup>6</sup>Chicago Department of Public Health, Chicago, Illinois
</span></div>
</div>
</div>
<div class="doi clearfix">
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<span id="scm6MainContent_lblClientName"><span style="font-family: Times New Roman;"><i>JAMA. </i>2014;312(14):1447-1455.
doi:10.1001/jama.2014.12720. </span></span></div>
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</span></div>
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<a class="next" href="https://www.blogger.com/null" id="scm6MainContent_ucArticleContent_rptSections_hlkNext_0" style="href: "http://jama.jamanetwork.com/article.aspx?articleid=1911326#Introduction";"></a></div>
</div>
</div>
</div>
<div class="contentBody clearfix">
<span class="Abstract 0" id="scm6MainContent_ucArticleContent_rptSections_lblSection_0">
<span style="font-family: Times New Roman;"><strong>Importance</strong>
<span>Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi
metallo-β-lactamase (NDM) are rare in the United States, but have the potential
to add to the increasing CRE burden. Previous NDM-producing CRE clusters have
been attributed to person-to-person transmission in health care
facilities.</span></span><br />
<br />
<br />
<span style="font-family: Times New Roman;"><strong>Objective</strong> <span>To identify a
source for, and interrupt transmission of, NDM-producing CRE in a northeastern
Illinois hospital.</span></span><br />
<br />
<br />
<span style="font-family: Times New Roman;"><strong>Design, Setting, and
Participants</strong> <span>Outbreak investigation among 39 case patients at a
tertiary care hospital in northeastern Illinois, including a case-control study,
infection control assessment, and collection of environmental and device
cultures; patient and environmental isolate relatedness was evaluated with
pulsed-field gel electrophoresis (PFGE). Following identification of a likely
source, targeted patient notification and CRE screening cultures were
performed.</span></span><br />
<br />
<br />
<span style="font-family: Times New Roman;"><strong>Main Outcomes and Measures</strong>
<span>Association between exposure and acquisition of NDM-producing CRE; results
of environmental cultures and organism typing.</span></span><br />
<br />
<br />
<span style="font-family: Times New Roman;"><strong>Results</strong> <span>In total, 39
case patients were identified from January 2013 through December 2013, 35 with
duodenoscope exposure in 1 hospital. No lapses in duodenoscope reprocessing were
identified; however, NDM-producing <i>Escherichia coli</i> was recovered from a
reprocessed duodenoscope and shared more than 92% similarity to all case patient
isolates by PFGE. Based on the case-control study, case patients had
significantly higher odds of being exposed to a duodenoscope (odds ratio [OR],
78 [95% CI, 6.0-1008], <i>P</i> < .001). After the hospital changed its
reprocessing procedure from automated high-level disinfection with
ortho-phthalaldehyde to gas sterilization with ethylene oxide, no additional
case patients were identified.</span></span><br />
<br />
<br />
<span style="font-family: Times New Roman;"><strong>Conclusions and Relevance</strong>
<span>In this investigation, exposure to duodenoscopes with bacterial
contamination was associated with apparent transmission of NDM-producing <i>E
coli</i> among patients at 1 hospital. Bacterial contamination of duodenoscopes
appeared to persist despite the absence of recognized reprocessing lapses.
Facilities should be aware of the potential for transmission of bacteria
including antimicrobial-resistant organisms via this route and should conduct
regular reviews of their duodenoscope reprocessing procedures to ensure optimal
manual cleaning and disinfection.</span></span><br />
<span style="font-family: Times New Roman;"><span></span></span><br />
<a href="http://jama.jamanetwork.com/article.aspx?articleid=1911326" title="http://jama.jamanetwork.com/article.aspx?articleid=1911326">http://jama.jamanetwork.com/article.aspx?articleid=1911326</a><br />
<br />
<br />
<div>
not that it matters much, but I tried warning the fda and manufactures of
endoscopy equipment over 14 years ago of risk factors from the TSE Prion aka mad
cow type disease and endoscopy equipment. again, nobody listened.</div>
<div>
</div>
<div>
you might want to look at the December 2014 FDA recall list I listed in
this blog. I do not advertise or make money from this research I do on the
science. it is for educational use. just made a promise to mom, never forget,
and never let them forget...</div>
<div>
</div>
<div>
kind regards, terry</div>
<div>
</div>
<div>
</div>
<span style="font-family: Times New Roman;"></span> </span> </div>
</div>
</div>
</div>
<br />
<div>
see other super bugs i.e. MRSA ;</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Sunday, September 22, 2013</div>
<br />
<div>
</div>
<br />
<div>
Livestock Origin for a Human Pandemic Clone of Community-Associated
Methicillin-Resistant Staphylococcus aureus </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2013/09/livestock-origin-for-human-pandemic.html">http://staphmrsa.blogspot.com/2013/09/livestock-origin-for-human-pandemic.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
Tuesday, September 17, 2013</div>
<br />
<div>
</div>
<br />
<div>
Antibiotic resistance threats in the United States, 2013 THREAT REPORT
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html">http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html</a>
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a>
</div>
<br />
<div>
</div>
<br />
<div>
Thursday, September 18, 2014</div>
<br />
<div>
</div>
<br />
<div>
New Executive Actions to Combat Antibiotic Resistance and Protect Public
Health </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2014/09/new-executive-actions-to-combat.html">http://staphmrsa.blogspot.com/2014/09/new-executive-actions-to-combat.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/" style="href: "http://staphmrsa.blogspot.com/2014/09/new-executive-actions-to-combat.html";">http://staphmrsa.blogspot.com/</a></div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
what about Transmissible Spongiform Encephalopathy TSE PRION disease (aka
mad cow type disease) and Endoscopy Equipment ? </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
*** 1: J Neurol Neurosurg Psychiatry 1994 Jun;57(6):757-8</div>
<br />
<div>
</div>
<br />
<div>
Transmission of Creutzfeldt-Jakob disease to a chimpanzee by electrodes
contaminated during neurosurgery.</div>
<br />
<div>
</div>
<br />
<div>
Gibbs CJ Jr, Asher DM, Kobrine A, Amyx HL, Sulima MP, Gajdusek DC.</div>
<br />
<div>
</div>
<br />
<div>
Laboratory of Central Nervous System Studies, National Institute of</div>
<br />
<div>
</div>
<br />
<div>
Neurological Disorders and Stroke, National Institutes of Health,</div>
<br />
<div>
</div>
<br />
<div>
Bethesda, MD 20892.</div>
<br />
<div>
</div>
<br />
<div>
Stereotactic multicontact electrodes used to probe the cerebral cortex of a
middle aged woman with progressive dementia were previously implicated in the
accidental transmission of Creutzfeldt-Jakob disease (CJD) to two younger
patients. The diagnoses of CJD have been confirmed for all three cases. More
than two years after their last use in humans, after three cleanings and
repeated sterilisation in ethanol and formaldehyde vapour, the electrodes were
implanted in the cortex of a chimpanzee. Eighteen months later the animal became
ill with CJD. This finding serves to re-emphasise the potential danger posed by
reuse of instruments contaminated with the agents of spongiform
encephalopathies, even after scrupulous attempts to clean them. </div>
<br />
<div>
</div>
<br />
<div>
PMID: 8006664 [PubMed - indexed for MEDLINE] </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8006664&dopt=Abstract">http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8006664&dopt=Abstract</a>
</div>
<br />
<div>
</div>
<br />
<div>
Monday, November 3, 2014 </div>
<br />
<div>
</div>
<br />
<div>
Persistence of ovine scrapie infectivity in a farm environment following
cleaning and decontamination</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2014/11/persistence-of-ovine-scrapie.html">http://transmissiblespongiformencephalopathy.blogspot.com/2014/11/persistence-of-ovine-scrapie.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
Friday, January 30, 2015</div>
<br />
<div>
</div>
<br />
<div>
*** Scrapie: a particularly persistent pathogen ***</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://veterinaryrecord.bmj.com/content/176/4/97.extract">http://veterinaryrecord.bmj.com/content/176/4/97.extract</a></div>
<br />
<div>
</div>
<br />
<div>
full text and more here ;</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2015/01/scrapie-particularly-persistent-pathogen.html">http://transmissiblespongiformencephalopathy.blogspot.com/2015/01/scrapie-particularly-persistent-pathogen.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
Infectious agent of sheep scrapie may persist in the environment for at
least 16 years</div>
<br />
<div>
</div>
<br />
<div>
Gudmundur Georgsson1, Sigurdur Sigurdarson2 and Paul Brown3 </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://jgv.sgmjournals.org/content/87/12/3737.full">http://jgv.sgmjournals.org/content/87/12/3737.full</a></div>
<br />
<div>
</div>
<br />
<div>
New studies on the heat resistance of hamster-adapted scrapie agent:
Threshold survival after ashing at 600°C suggests an inorganic template of
replication </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.pnas.org/content/97/7/3418.full">http://www.pnas.org/content/97/7/3418.full</a>
</div>
<br />
<div>
</div>
<br />
<div>
Prion Infected Meat-and-Bone Meal Is Still Infectious after Biodiesel
Production </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493038/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493038/</a>
</div>
<br />
<div>
</div>
<br />
<div>
Detection of protease-resistant cervid prion protein in water from a
CWD-endemic area </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.tandfonline.com/doi/pdf/10.4161/pri.3.3.9819">http://www.tandfonline.com/doi/pdf/10.4161/pri.3.3.9819</a></div>
<br />
<div>
</div>
<br />
<div>
A Quantitative Assessment of the Amount of Prion Diverted to Category 1
Materials and Wastewater During Processing </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1539-6924.2012.01922.x/abstract">http://onlinelibrary.wiley.com/doi/10.1111/j.1539-6924.2012.01922.x/abstract</a>
</div>
<br />
<div>
</div>
<br />
<div>
Rapid assessment of bovine spongiform encephalopathy prion inactivation by
heat treatment in yellow grease produced in the industrial manufacturing process
of meat and bone meals </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2013/07/rapid-assessment-of-bovine-spongiform.html">http://transmissiblespongiformencephalopathy.blogspot.com/2013/07/rapid-assessment-of-bovine-spongiform.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
PPo4-4: </div>
<br />
<div>
</div>
<br />
<div>
Survival and Limited Spread of TSE Infectivity after Burial </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.prion2010.org/bilder/prion_2010_program_latest_w_posters_4_.pdf?139&PHPSESSID=a30a38202cfec579000b77af81be3099">http://www.prion2010.org/bilder/prion_2010_program_latest_w_posters_4_.pdf?139&PHPSESSID=a30a38202cfec579000b77af81be3099</a>
</div>
<br />
<div>
</div>
<br />
<div>
*** The potential impact of prion diseases on human health was greatly
magnified by the recognition that interspecies transfer of BSE to humans by beef
ingestion resulted in vCJD. While changes in animal feed constituents and
slaughter practices appear to have curtailed vCJD, there is concern that CWD of
free-ranging deer and elk in the U.S. might also cross the species barrier.
Thus, consuming venison could be a source of human prion disease. Whether BSE
and CWD represent interspecies scrapie transfer or are newly arisen prion
diseases is unknown. Therefore, the possibility of transmission of prion disease
through other food animals cannot be ruled out. There is evidence that vCJD can
be transmitted through blood transfusion. There is likely a pool of unknown size
of asymptomatic individuals infected with vCJD, and there may be asymptomatic
individuals infected with the CWD equivalent. These circumstances represent a
potential threat to blood, blood products, and plasma supplies. </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://cdmrp.army.mil/prevfunded/nprp/NPRP_Summit_Final_Report.pdf">http://cdmrp.army.mil/prevfunded/nprp/NPRP_Summit_Final_Report.pdf</a>
</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
some old history on Endoscopy equipment and CJD TSE Prion concerns ;</div>
<br />
<div>
</div>
<br />
1999 <br />
<br />
<div>
</div>
<br />
<div>
Subject: CJD * Olympus Endoscope </div>
<br />
<div>
</div>
<br />
<div>
Date: Sun, 10 Oct 1999 16:41:49 –0500 </div>
<br />
<div>
</div>
<br />
<div>
From: "Terry S. Singeltary Sr." </div>
<br />
<div>
</div>
<br />
<div>
To: GOLDSS@... </div>
<br />
<div>
</div>
<br />
<div>
Dear Dr. Goldstine, </div>
<br />
<div>
</div>
<br />
<div>
Hello Sir, I understand that Olympus has issued a letter to the medical
institutions and the CDC, about the dangers of _not_ being able to decontaminate
the instruments (endoscope's) via modern autoclaving techniques (boil 3 minutes
in 3% SDS or another ionic detergent and autoclave for 1 hour at 134 degrees C).
I understand that; "Olympus" has issued a warning, _not_ to attempt to
decontaminate the instrument, that they are instructed to destroy them. </div>
<br />
<div>
</div>
<br />
<div>
(very very wise move); </div>
<br />
<div>
</div>
<br />
<div>
Please Sir, it is imminent that I receive a copy of this letter, it is very
important. This could lead to other company's following through, and lead to
awareness of the potential health threats from human T.S.E.'s and the risks
through surgery, and not just from endoscopes. It would be most appreciated, if
you could send a copy of this document to; </div>
<br />
<div>
</div>
<br />
<div>
Fax: xxxxx </div>
<br />
<div>
</div>
<br />
<div>
I look forward, to hearing back from you.... </div>
<br />
<div>
</div>
<br />
<div>
Many Thanks, </div>
<br />
<div>
</div>
<br />
<div>
Terry S. Singeltary Sr./ Mom DOD 12-14-97 hvCJD </div>
<br />
<div>
</div>
<br />
<div>
Subject: Re: CJD * Olympus Endoscope </div>
<br />
<div>
</div>
<br />
<div>
Date: Tue, 12 Oct 1999 15:57:03 –0500 </div>
<br />
<div>
</div>
<br />
<div>
From: "Terry S. Singeltary Sr." </div>
<br />
<div>
</div>
<br />
<div>
To: GOLDSS@... </div>
<br />
<div>
</div>
<br />
<div>
References: 1 </div>
<br />
<div>
</div>
<br />
<div>
Dear Mr. Goldstine, Hello again, I hope the CDC has not changed your mind,
since our phone call, about sending me the information, in which we spoke of. I
am still waiting for the information, re-fax. Someone had told me, you would not
send me the information, but I told them you would, due to the importance of it
pertaining to public safety, and the fact, you are a Doctor. I hope you don't
disappoint me, and the rest of the public, and hide the facts, as the CDC and
NIH have for years. Olympus can be part of the Truth, or you can be part of the
cover-up. We are going to find out, sooner or later. </div>
<br />
<div>
</div>
<br />
<div>
I already know, as do many more. </div>
<br />
<div>
</div>
<br />
<div>
<<a href="http://hometown.aol.com/stacy91434/cjd/cjd.htm">http://hometown.aol.com/stacy91434/cjd/cjd.htm</a>>
</div>
<br />
<div>
</div>
<br />
<div>
Still waiting, </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Kind Regards, </div>
<br />
<div>
</div>
<br />
<div>
Terry S. Singeltary Sr. </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
"Terry S. Singeltary Sr." wrote: </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Dear Dr. Goldstine, </div>
<br />
<div>
</div>
<br />
<div>
Hello Sir, I understand that Olympus has issued a letter to the medical
institutions and the CDC, about the dangers of _not_ being able to decontaminate
the instruments (endoscope's) via modern autoclaving techniques (boil 3 minutes
in 3% SDS or another ionic detergent and autoclave for 1 hour at 134 degrees C).
I understand that; "Olympus" has issued a warning, _not_ to attempt to
decontaminate the instrument, that they are instructed to destroy them. </div>
<br />
<div>
</div>
<br />
<div>
(very very wise move); </div>
<br />
<div>
</div>
<br />
<div>
Please Sir, it is imminent that I receive a copy of this letter, it is very
important. This could lead to other company's following through, and lead to
awareness of the potential health threats from human T.S.E.'s and the risks
through surgery, and not just from endoscopes. It would be most appreciated, if
you could send a copy of this document to; </div>
<br />
<div>
</div>
<br />
<div>
Fax: xxxxxxx </div>
<br />
<div>
</div>
<br />
<div>
I look forward, to hearing back from you.... </div>
<br />
<div>
</div>
<br />
<div>
Many Thanks, </div>
<br />
<div>
</div>
<br />
<div>
Terry S. Singeltary Sr./ Mom DOD 12-14-97 hvCJD </div>
<br />
<div>
</div>
<br />
<div>
================================================================= </div>
<br />
<div>
</div>
<br />
<div>
Something I submitted to GUT previously; </div>
<br />
<div>
</div>
<br />
<div>
Subject: Re: gutjnl_el;21 Terry S. Singeltary Sr. (3 Jun 2002) "CJDs (all
human TSEs) and Endoscopy Equipment" </div>
<br />
<div>
</div>
<br />
<div>
Date: Thu, 20 Jun 2002 16:19:51 –0700 </div>
<br />
<div>
</div>
<br />
<div>
From: "Terry S. Singeltary Sr." </div>
<br />
<div>
</div>
<br />
<div>
To: Professor Michael Farthing </div>
<br />
<div>
</div>
<br />
<div>
CC: lcamp@BMJgroup.com </div>
<br />
<div>
</div>
<br />
<div>
References: 001501c21099$5c8bc620$7c58d182@mfacdean1.cent.gla.ac.uk </div>
<br />
<div>
</div>
<br />
<div>
Greetings again Professor Farthing and BMJ, </div>
<br />
<div>
</div>
<br />
<div>
I was curious why my small rebuttal of the article described below was not
listed in this month's journal of GUT? I had thought it was going to be
published, but I do not have full text access. Will it be published in the
future? Regardless, I thought would pass on a more lengthy rebuttal of mine on
this topic, vCJD vs sCJDs and endoscopy equipment. I don't expect it to be
published, but thought you might find it interesting, i hope you don't mind and
hope to hear back from someone on the questions I posed... </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Here is my short submission I speak of, lengthy one to follow below that:
</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Date submitted: 3 Jun 2002 </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<span style="line-height: 19.2pt;">
<br />
</span><div style="margin: 0px 0px 12px;">
<span style="line-height: 19.2pt;"><span style="color: #333333; font-family: Georgia;">>>
eLetter ID: gutjnl_el;21<br />>> >> Gut eLetter for Bramble and
Ironside 50 (6): 888<br />>> >>Name: Terry S. Singeltary Sr.
>>Email: flounder@wt.net<br />>>Title/position: disabled {neck
injury}<br />>>Place of work: CJD WATCH<br />>>IP address:
216.119.162.85<br />>>Hostname:
216-119-162-85.ipset44.wt.net<br />>>Browser: Mozilla/5.0 (Windows; U;
Win98; en-US; rv:0.9.4)<br />>>Gecko/20011019 Netscape6/6.2<br />>>
>>Parent ID: 50/6/888<br />>>Citation:<br />>> Creutzfeldt-Jakob
disease: implications for gastroenterology<br />>> M G Bramble and J W
Ironside<br />>> Gut 2002; 50: 888-890 (Occasional viewpoint)<br />>>
http://www.gutjnl.com/cgi/content/abstract/50/6/888<br />>> </span><a href="https://www.blogger.com/null" style="href: "http://www.gutjnl.com/cgi/content/full/50/6/888";"><span style="color: #668844; font-family: Georgia;"><strong><span style="text-decoration: none;">http://www.gutjnl.com/cgi/content/full/50/6/888</span></strong></span></a></span></div>
<span style="line-height: 19.2pt;">
<br />
<div>
<br /></div>
<br />
<div style="margin: 0px 0px 12px;">
<span style="color: #333333; font-family: Georgia;">>>-----------------------------------------------------------------<br />>>"CJDs
(all human TSEs) and Endoscopy
Equipment"<br />>>-----------------------------------------------------------------
</span></div>
<br />
<div style="margin: 0px 0px 12px;">
<span style="color: #333333; font-family: Georgia;"></span> </div>
</span><span style="font-family: Calibri;">
</span><br />
<div style="line-height: 19.2pt; margin: 0px 0px 12px;">
<span style="color: #333333; font-family: Georgia;">regarding your
article; </span></div>
<br />
<div>
</div>
<br />
<div style="line-height: 19.2pt; margin: 0px 0px 12px;">
<span style="color: #333333; font-family: Georgia;">Creutzfeldt-Jakob disease: implications for gastroenterology
</span></div>
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<div style="line-height: 19.2pt; margin: 0px 0px 12px;">
<span style="color: #333333; font-family: Georgia;"></span><span style="color: #333333; font-family: Georgia;"><br />>></span><span style="color: #333333; font-family: Georgia;">I belong to
several support groups for victims and relatives<br />>>of CJDs. Several
years ago, I did a survey regarding<br />>>endoscopy equipment and how many
victims of CJDs have<br />>>had any type of this procedure done. To my
surprise, many<br />>>victims had some kind of endoscopy work done on
them.<br />>>As this may not be a smoking gun, I think it
should<br />>>warrant a 'red flag' of sorts, especially since data
now<br />>>suggests a substantial TSE infectivity in the gut
wall<br />>>of species infected with TSEs. If such
transmissions<br />>>occur, the ramifications of spreading TSEs
from<br />>>endoscopy equipment to the general public would
be<br />>>horrible, and could potential amplify the
transmission<br />>>of TSEs through other surgical procedures in
that<br />>>persons life, due to long incubation and
sub-clinical<br />>>infection. Science to date, has well
established<br />>>transmission of sporadic CJDs with
medical/surgical<br />>>procedures.</span></div>
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<div>
Terry S. Singeltary Sr. >>CJD WATCH</div>
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<div>
Again, many thanks, Kindest regards,</div>
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</div>
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<div>
Terry S. Singeltary Sr. P.O. Box 42 Bacliff, Texas USA 77518
flounder@wt.net CJD WATCH</div>
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</div>
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<div>
[scroll down past article for my comments] </div>
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snip... </div>
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</div>
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<div>
were not all CJDs, even nvCJD, just sporadic, until proven otherwise?
</div>
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</div>
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<div>
Terry S. Singeltary Sr., P.O. BOX 42, Bacliff, Texas 77518 USA </div>
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</div>
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<div>
<a href="http://mailhost.rz.uni-karlsruhe.de/warc/bse-l.html">http://mailhost.rz.uni-karlsruhe.de/warc/bse-l.html</a>
</div>
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</div>
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<div>
Professor Michael Farthing wrote: Louise Send this to Bramble (author) for
a comment before we post. Michael </div>
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</div>
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======================================================= </div>
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</div>
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<div>
snip... see full text ; </div>
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<div>
2003 </div>
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</div>
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<div>
Evidence For CJD TSE Transmission Via Endoscopes 1-24-3 re-Singeltary to
Bramble et al </div>
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</div>
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<div>
Evidence For CJD/TSE Transmission Via Endoscopes </div>
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</div>
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<div>
From Terry S. Singletary, Sr flounder@wt.net 1-24-3 </div>
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</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2010/01/evidence-for-cjd-tse-transmission-via.html">http://creutzfeldt-jakob-disease.blogspot.com/2010/01/evidence-for-cjd-tse-transmission-via.html</a>
</div>
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</div>
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<div>
Friday, August 10, 2012 </div>
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</div>
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<div>
Incidents of Potential iatrogenic Creutzfeldt-Jakob disease (CJD) biannual
update (July 2012) </div>
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</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2012/08/incidents-of-potential-iatrogenic.html">http://creutzfeldt-jakob-disease.blogspot.com/2012/08/incidents-of-potential-iatrogenic.html</a>
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SNIP...</div>
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<div>
see more history here ;</div>
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<div>
OLYMPUS ENDOSCOPY CJD</div>
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</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2012_10_01_archive.html" style="href: "http://creutzfeldt-jakob-disease.blogspot.com/2012_10_01_archive.html";">http://creutzfeldt-jakob-disease.blogspot.com/2012_10_01_archive.html</a></div>
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</div>
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<div>
Thursday, January 22, 2015 </div>
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</div>
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<div>
*** Transmission properties of atypical Creutzfeldt-Jakob disease: a clue
to disease etiology? ***</div>
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<div>
</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2015/01/transmission-properties-of-atypical.html">http://creutzfeldt-jakob-disease.blogspot.com/2015/01/transmission-properties-of-atypical.html</a>
</div>
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<div>
</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/">http://creutzfeldt-jakob-disease.blogspot.com/</a></div>
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</div>
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Friday, January 10, 2014 </div>
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</div>
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<div>
vpspr, sgss, sffi, TSE, an iatrogenic by-product of gss, ffi, familial type
prion disease, what it ??? </div>
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<div>
</div>
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<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2014/01/vpspr-sgss-sffi-tse-iatrogenic-by.html">http://transmissiblespongiformencephalopathy.blogspot.com/2014/01/vpspr-sgss-sffi-tse-iatrogenic-by.html</a>
</div>
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<div>
</div>
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<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/">http://transmissiblespongiformencephalopathy.blogspot.com/</a></div>
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</div>
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<div>
Monday, November 3, 2014</div>
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</div>
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<div>
USA CJD TSE PRION UNIT, TEXAS, SURVEILLANCE UPDATE NOVEMBER 2014 </div>
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</div>
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<div>
National Prion Disease Pathology Surveillance Center Cases Examined1
(October 7, 2014) </div>
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</div>
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<div>
***6 Includes 11 cases in which the diagnosis is pending, and 19
inconclusive cases; </div>
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</div>
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<div>
***7 Includes 12 (11 from 2014) cases with type determination pending in
which the diagnosis of vCJD has been excluded. </div>
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</div>
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<div>
***The sporadic cases include 2660 cases of sporadic Creutzfeldt-Jakob
disease (sCJD), </div>
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</div>
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<div>
***50 cases of Variably Protease-Sensitive Prionopathy (VPSPr) </div>
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</div>
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***and 21 cases of sporadic Fatal Insomnia (sFI). </div>
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<div>
</div>
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<div>
<a href="http://prionunitusaupdate.blogspot.com/2014/11/usa-cjd-tse-prion-unit-texas.html">http://prionunitusaupdate.blogspot.com/2014/11/usa-cjd-tse-prion-unit-texas.html</a>
</div>
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</div>
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<div>
<a href="http://prionunitusaupdate.blogspot.com/">http://prionunitusaupdate.blogspot.com/</a></div>
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</div>
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Sunday, December 14, 2014 </div>
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</div>
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<div>
ALERT new variant Creutzfeldt Jakob Disease nvCJD or vCJD, sporadic CJD
strains, TSE prion aka Mad Cow Disease United States of America Update December
14, 2014 Report</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2014/12/alert-new-variant-creutzfeldt-jakob.html">http://transmissiblespongiformencephalopathy.blogspot.com/2014/12/alert-new-variant-creutzfeldt-jakob.html</a></div>
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</div>
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Friday, January 30, 2015</div>
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</div>
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<div>
Scrapie: a particularly persistent pathogen</div>
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</div>
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<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2015/01/scrapie-particularly-persistent-pathogen.html">http://transmissiblespongiformencephalopathy.blogspot.com/2015/01/scrapie-particularly-persistent-pathogen.html</a>
</div>
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<div>
</div>
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<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/">http://transmissiblespongiformencephalopathy.blogspot.com/</a></div>
<br />
<div>
</div>
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<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/">http://creutzfeldt-jakob-disease.blogspot.com/</a></div>
<br />
<div>
</div>
<br />
<div>
<a href="http://vcjd.blogspot.com/">http://vcjd.blogspot.com/</a></div>
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</div>
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<div>
Diagnosis and Reporting of Creutzfeldt-Jakob Disease </div>
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</div>
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<div>
Singeltary, Sr et al. JAMA.2001; 285: 733-734. Vol. 285 No. 6, February 14,
2001 JAMA</div>
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</div>
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<div>
Diagnosis and Reporting of Creutzfeldt-Jakob Disease</div>
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</div>
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<div>
To the Editor: In their Research Letter, Dr Gibbons and colleagues1
reported that the annual US death rate due to Creutzfeldt-Jakob disease (CJD)
has been stable since 1985. These estimates, however, are based only on reported
cases, and do not include misdiagnosed or preclinical cases. It seems to me that
misdiagnosis alone would drastically change these figures. An unknown number of
persons with a diagnosis of Alzheimer disease in fact may have CJD, although
only a small number of these patients receive the postmortem examination
necessary to make this diagnosis. Furthermore, only a few states have made CJD
reportable. Human and animal transmissible spongiform encephalopathies should be
reportable nationwide and internationally.</div>
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<div>
</div>
<br />
<div>
Terry S. Singeltary, Sr Bacliff, Tex</div>
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<div>
</div>
<br />
<div>
1. Gibbons RV, Holman RC, Belay ED, Schonberger LB. Creutzfeldt-Jakob
disease in the United States: 1979-1998. JAMA. 2000;284:2322-2323.</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://jama.jamanetwork.com/article.aspx?articleid=1031186">http://jama.jamanetwork.com/article.aspx?articleid=1031186</a>
</div>
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</div>
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<div>
26 March 2003</div>
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</div>
<br />
<div>
Terry S. Singeltary, retired (medically) CJD WATCH</div>
<br />
<div>
</div>
<br />
<div>
I lost my mother to hvCJD (Heidenhain Variant CJD). I would like to comment
on the CDC's attempts to monitor the occurrence of emerging forms of CJD.
Asante, Collinge et al [1] have reported that BSE transmission to the
129-methionine genotype can lead to an alternate phenotype that is
indistinguishable from type 2 PrPSc, the commonest sporadic CJD. However, CJD
and all human TSEs are not reportable nationally. CJD and all human TSEs must be
made reportable in every state and internationally. I hope that the CDC does not
continue to expect us to still believe that the 85%+ of all CJD cases which are
sporadic are all spontaneous, without route/source. We have many TSEs in the USA
in both animal and man. CWD in deer/elk is spreading rapidly and CWD does
transmit to mink, ferret, cattle, and squirrel monkey by intracerebral
inoculation. With the known incubation periods in other TSEs, oral transmission
studies of CWD may take much longer. Every victim/family of CJD/TSEs should be
asked about route and source of this agent. To prolong this will only spread the
agent and needlessly expose others. In light of the findings of Asante and
Collinge et al, there should be drastic measures to safeguard the medical and
surgical arena from sporadic CJDs and all human TSEs. I only ponder how many
sporadic CJDs in the USA are type 2 PrPSc? </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.neurology.org/content/60/2/176/reply#neurology_el_535">http://www.neurology.org/content/60/2/176/reply#neurology_el_535</a>
</div>
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</div>
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<div>
2 January 2000</div>
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</div>
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<div>
British Medical Journal</div>
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</div>
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<div>
U.S. Scientist should be concerned with a CJD epidemic in the U.S., as
well</div>
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<div>
</div>
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<div>
<a href="http://www.bmj.com/rapid-response/2011/10/28/us-scientist-should-be-concerned-cjd-epidemic-us-well">http://www.bmj.com/rapid-response/2011/10/28/us-scientist-should-be-concerned-cjd-epidemic-us-well</a></div>
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<div>
</div>
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<div>
15 November 1999</div>
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<div>
</div>
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<div>
British Medical Journal</div>
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</div>
<br />
<div>
vCJD in the USA * BSE in U.S.</div>
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<div>
</div>
<br />
<div>
<a href="http://www.bmj.com/rapid-response/2011/10/28/re-vcjd-usa-bse-us">http://www.bmj.com/rapid-response/2011/10/28/re-vcjd-usa-bse-us</a>
</div>
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<div>
</div>
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<div>
Self-Propagative Replication of Ab Oligomers Suggests Potential
Transmissibility in Alzheimer Disease</div>
<br />
<div>
</div>
<br />
<div>
Received July 24, 2014; Accepted September 16, 2014; Published November 3,
2014</div>
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</div>
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<div>
Singeltary comment ;</div>
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<div>
</div>
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<div>
<a href="http://www.plosone.org/annotation/listThread.action?root=82860">http://www.plosone.org/annotation/listThread.action?root=82860</a>
</div>
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</div>
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<div>
Thursday, July 24, 2014 </div>
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</div>
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<div>
*** Protocol for further laboratory investigations into the distribution of
infectivity of Atypical BSE SCIENTIFIC REPORT OF EFSA New protocol for Atypical
BSE investigations </div>
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<div>
</div>
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<div>
<a href="http://bse-atypical.blogspot.com/2014/07/protocol-for-further-laboratory.html">http://bse-atypical.blogspot.com/2014/07/protocol-for-further-laboratory.html</a>
</div>
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</div>
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<div>
Discussion: The C, L and H type BSE cases in Canada exhibit molecular
characteristics similar to those described for classical and atypical BSE cases
from Europe and Japan. </div>
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<div>
</div>
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<div>
*** This supports the theory that the importation of BSE contaminated
feedstuff is the source of C-type BSE in Canada. </div>
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<div>
</div>
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<div>
*** It also suggests a similar cause or source for atypical BSE in these
countries. *** </div>
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<div>
</div>
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<div>
see page 176 of 201 pages...tss </div>
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<div>
</div>
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<div>
<a href="http://www.neuroprion.org/resources/pdf_docs/conferences/prion2009/prion2009_bookofabstracts.pdf">http://www.neuroprion.org/resources/pdf_docs/conferences/prion2009/prion2009_bookofabstracts.pdf</a>
</div>
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<div>
</div>
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<div>
*** Singeltary reply ; Molecular, Biochemical and Genetic Characteristics
of BSE in Canada Singeltary reply ; </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.plosone.org/annotation/listThread.action;jsessionid=635CE9094E0EA15D5362B7D7B809448C?root=7143">http://www.plosone.org/annotation/listThread.action;jsessionid=635CE9094E0EA15D5362B7D7B809448C?root=7143</a>
</div>
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<div>
</div>
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<div>
ruminant feed ban for cervids in the United States ? </div>
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<div>
</div>
<br />
<div>
31 Jan 2015 at 20:14 GMT </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.plosone.org/annotation/listThread.action?root=85351">http://www.plosone.org/annotation/listThread.action?root=85351</a></div>
<br />
<div>
</div>
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<div>
Saturday, January 24, 2015 </div>
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<div>
</div>
<br />
<div>
Bovine Spongiform Encephalopathy: Atypical Pros and Cons </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://bse-atypical.blogspot.com/2015/01/bovine-spongiform-encephalopathy.html">http://bse-atypical.blogspot.com/2015/01/bovine-spongiform-encephalopathy.html</a>
</div>
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<div>
</div>
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<div>
Saturday, January 31, 2015 </div>
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<div>
</div>
<br />
<div>
RAPID ADVICE 17-2014 : Evaluation of the risk for public health of casings
in countries with a “negligible risk status for BSE” and on the risk of
modification of the list of specified risk materials (SRM) with regard to BSE
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://bse-atypical.blogspot.com/2015/01/rapid-advice-17-2014-evaluation-of-risk.html">http://bse-atypical.blogspot.com/2015/01/rapid-advice-17-2014-evaluation-of-risk.html</a>
</div>
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<div>
</div>
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<div>
</div>
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<div>
Thursday, February 19, 2015 </div>
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<div>
</div>
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<div>
Inspections Circumvented for Condemned Cows STATEMENT OF THE HONORABLE
PHYLLIS K. FONG INSPECTOR GENERAL </div>
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<div>
</div>
<br />
<div>
<a href="http://downercattle.blogspot.com/2015/02/inspections-circumvented-for-condemned.html">http://downercattle.blogspot.com/2015/02/inspections-circumvented-for-condemned.html</a></div>
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<div>
</div>
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<div>
</div>
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<div>
Tuesday, February 17, 2015 </div>
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<div>
</div>
<br />
<div>
Could we spot the next BSE?, asks BVA President </div>
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<div>
</div>
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<div>
<a href="http://bseusa.blogspot.com/2015/02/could-we-spot-next-bse-asks-bva.html">http://bseusa.blogspot.com/2015/02/could-we-spot-next-bse-asks-bva.html</a></div>
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<div>
</div>
<br />
<div>
> Could we spot the next BSE?</div>
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<div>
</div>
<br />
<div>
we have not spotted all the cases the first time around. with Nations like
the United States and Canada, organizations like the USDA, OIE, and WTO et al,
it was never about ‘spotting’ all the BSE TSE prion cases, it was more about how
not to find them. the triple BSE mad cow firewall, was and still is, nothing but
ink on paper. ...please see facts ;</div>
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<div>
</div>
<br />
<div>
Saturday, February 14, 2015 </div>
<br />
<div>
</div>
<br />
<div>
Canadian Food Inspection Agency Confirms Bovine Spongiform Encephalopathy
(BSE) in Alberta</div>
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<div>
</div>
<br />
<div>
<a href="http://madcowusda.blogspot.com/2015/02/canadian-food-inspection-agency.html">http://madcowusda.blogspot.com/2015/02/canadian-food-inspection-agency.html</a></div>
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<div>
</div>
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<div>
</div>
<br />
<div>
Tuesday, February 10, 2015 </div>
<br />
<div>
</div>
<br />
<div>
Alberta Canada First case of chronic wasting disease found in farm elk
since 2002 </div>
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<div>
</div>
<br />
<div>
<a href="http://chronic-wasting-disease.blogspot.com/2015/02/alberta-canada-first-case-of-chronic.html">http://chronic-wasting-disease.blogspot.com/2015/02/alberta-canada-first-case-of-chronic.html</a></div>
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<div>
</div>
<br />
<div>
</div>
<br />
<div>
2014 </div>
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<div>
</div>
<br />
<div>
***Moreover, L-BSE has been transmitted more easily to transgenic mice
overexpressing a human PrP [13,14] or to primates [15,16] than C-BSE. </div>
<br />
<div>
</div>
<br />
<div>
***It has been suggested that some sporadic CJD subtypes in humans may
result from an exposure to the L-BSE agent. </div>
<br />
<div>
</div>
<br />
<div>
*** Lending support to this hypothesis, pathological and biochemical
similarities have been observed between L-BSE and an sCJD subtype (MV genotype
at codon 129 of PRNP) [17], and between L-BSE infected non-human primate and
another sCJD subtype (MM genotype) [15]. </div>
<br />
<div>
</div>
<br />
<div>
snip... </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213560/pdf/viruses-06-03766.pdf">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4213560/pdf/viruses-06-03766.pdf</a>
</div>
<br />
<div>
</div>
<br />
<div>
Monday, October 10, 2011 </div>
<br />
<div>
</div>
<br />
<div>
EFSA Journal 2011 The European Response to BSE: A Success Story </div>
<br />
<div>
</div>
<br />
<div>
snip... </div>
<br />
<div>
</div>
<br />
<div>
EFSA and the European Centre for Disease Prevention and Control (ECDC)
recently delivered a scientific opinion on any possible epidemiological or
molecular association between TSEs in animals and humans (EFSA Panel on
Biological Hazards (BIOHAZ) and ECDC, 2011). This opinion confirmed Classical
BSE prions as the only TSE agents demonstrated to be zoonotic so far </div>
<br />
<div>
</div>
<br />
<div>
*** but the possibility that a small proportion of human cases so far
classified as "sporadic" CJD are of zoonotic origin could not be excluded.
</div>
<br />
<div>
</div>
<br />
<div>
*** Moreover, transmission experiments to non-human primates suggest that
some TSE agents in addition to Classical BSE prions in cattle (namely L-type
Atypical BSE, Classical BSE in sheep, transmissible mink encephalopathy (TME)
and chronic wasting disease (CWD) agents) might have zoonotic potential. </div>
<br />
<div>
</div>
<br />
<div>
snip... </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.efsa.europa.eu/en/efsajournal/pub/e991.htm?emt=1">http://www.efsa.europa.eu/en/efsajournal/pub/e991.htm?emt=1</a>
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.efsa.europa.eu/en/efsajournal/doc/e991.pdf">http://www.efsa.europa.eu/en/efsajournal/doc/e991.pdf</a>
</div>
<br />
<div>
</div>
<br />
<div>
Thursday, August 12, 2010</div>
<br />
<div>
</div>
<br />
<div>
Seven main threats for the future linked to prions</div>
<br />
<div>
</div>
<br />
<div>
First threat</div>
<br />
<div>
</div>
<br />
<div>
The TSE road map defining the evolution of European policy for protection
against prion diseases is based on a certain numbers of hypotheses some of which
may turn out to be erroneous. In particular, a form of BSE (called atypical
Bovine Spongiform Encephalopathy), recently identified by systematic testing in
aged cattle without clinical signs, may be the origin of classical BSE and thus
potentially constitute a reservoir, which may be impossible to eradicate if a
sporadic origin is confirmed. </div>
<br />
<div>
</div>
<br />
<div>
*** Also, a link is suspected between atypical BSE and some apparently
sporadic cases of Creutzfeldt-Jakob disease in humans. </div>
<br />
<div>
</div>
<br />
<div>
*** These atypical BSE cases constitute an unforeseen first threat that
could sharply modify the European approach to prion diseases.</div>
<br />
<div>
</div>
<br />
<div>
Second threat</div>
<br />
<div>
</div>
<br />
<div>
snip... </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://www.neuroprion.org/en/np-neuroprion.html">http://www.neuroprion.org/en/np-neuroprion.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
Thursday, January 15, 2015 </div>
<br />
<div>
</div>
<br />
<div>
41-year-old Navy Commander with sporadic Creutzfeldt–Jakob disease CJD TSE
Prion: Case Report </div>
<br />
<div>
</div>
<br />
<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2015/01/41-year-old-navy-commander-with.html">http://creutzfeldt-jakob-disease.blogspot.com/2015/01/41-year-old-navy-commander-with.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
Saturday, January 17, 2015 </div>
<br />
<div>
</div>
<br />
<div>
*** Becky Lockhart 46, Utah’s first female House speaker, dies diagnosed
with the extremely rare Creutzfeldt-Jakob disease</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2015/01/becky-lockhart-46-utahs-first-female.html">http://creutzfeldt-jakob-disease.blogspot.com/2015/01/becky-lockhart-46-utahs-first-female.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
FDA SCIENCE BOARD TO THE FOOD AND DRUG ADMINISTRATION BOVINE HEPARIN
Wednesday, June 4, 2014 </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
SCIENCE BOARD TO THE FOOD AND DRUG ADMINISTRATION </div>
<br />
<div>
</div>
<br />
<div>
Wednesday, June 4, 2014</div>
<br />
<div>
</div>
<br />
<div>
FDA White Oak Campus</div>
<br />
<div>
</div>
<br />
<div>
Building 31, Room 1503</div>
<br />
<div>
</div>
<br />
<div>
10903 New Hampshire Avenue</div>
<br />
<div>
</div>
<br />
<div>
Silver Spring, Maryland 20993</div>
<br />
<div>
</div>
<br />
<div>
The meeting was convened at 8:32 a.m., Russ ALTMAN, </div>
<br />
<div>
</div>
<br />
<div>
snip... </div>
<br />
<div>
</div>
<br />
<div>
So it has been shown -- so how would you -- there is a risk, though. There
is a theoretical risk of any herd or whatever having contamination. So how can
you mitigate even that very small risk? It has been shown that the existing
manufacturing processes could remove or inactive BSE agents if present. This is
because they're an extremely robust extraction under very harsh
conditions.SCIENCE BOARD TO THE FOOD AND DRUG ADMINISTRATION</div>
<br />
<div>
</div>
<br />
<div>
The FDA has guidelines regarding TSEs that can be applied to heparin, and
these generally were developed by CBER and include control of animal sources,
which obviously is critical, selection of the type of tissue used, incorporation
of risk-reduction steps into the production process. And, of course, this is
typical for any animal source material or even human source material that we use
in other people, and so that's what we'd like to talk about today. </div>
<br />
<div>
</div>
<br />
<div>
UNIDENTIFIED SPEAKER: Janet, what's a TSE? </div>
<br />
<div>
</div>
<br />
<div>
DR. WOODCOCK: Pardon me? </div>
<br />
<div>
</div>
<br />
<div>
UNIDENTIFIED SPEAKER: What is a TSE? </div>
<br />
<div>
</div>
<br />
<div>
===========================================</div>
<br />
<div>
</div>
<br />
<div>
I friggen give up...tss</div>
<br />
<div>
</div>
<br />
<div>
=========================================== </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
snip...see full text ;</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Sunday, February 08, 2015 </div>
<br />
<div>
</div>
<br />
<div>
FDA SCIENCE BOARD TO THE FOOD AND DRUG ADMINISTRATION BOVINE HEPARIN BSE
CJD TSE PRION Wednesday, June 4, 2014</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://creutzfeldt-jakob-disease.blogspot.com/2015/02/fda-science-board-to-food-and-drug.html">http://creutzfeldt-jakob-disease.blogspot.com/2015/02/fda-science-board-to-food-and-drug.html</a></div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Saturday, December 13, 2014 </div>
<br />
<div>
</div>
<br />
<div>
*** Terry S. Singeltary Sr. Publications TSE prion disease Peer Review
***</div>
<br />
<div>
</div>
<br />
<div>
Diagnosis and Reporting of Creutzfeldt-Jakob Disease </div>
<br />
<div>
</div>
<br />
<div>
Singeltary, Sr et al. JAMA.2001; 285: 733-734. Vol. 285 No. 6, February 14,
2001 JAMA</div>
<br />
<div>
</div>
<br />
<div>
snip...</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2014/12/terry-s-singeltary-sr-publications-tse.html">http://transmissiblespongiformencephalopathy.blogspot.com/2014/12/terry-s-singeltary-sr-publications-tse.html</a>
</div>
<br />
<div>
</div>
<br />
<div>
TSS</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-41797062834948943522014-11-04T06:25:00.000-08:002014-11-04T06:25:14.327-08:00Time-Scaled Evolutionary Analysis of the Transmission and Antibiotic Resistance Dynamics of Staphylococcus aureus Clonal Complex 398 <h1 id="article-title-1" itemprop="headline">
<span style="font-family: Times New Roman;">Time-Scaled Evolutionary Analysis of the Transmission and
Antibiotic Resistance Dynamics of <span class="named-content genus-species" id="named-content-1">Staphylococcus aureus</span> Clonal Complex
398 </span></h1>
<br />
<div class="contributors">
<ol class="contributor-list" id="contrib-group-1">
<li class="contributor" id="contrib-1" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=M.+J.+Ward&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">M. J. Ward</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-1-1" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-1";"><sup><span style="font-family: Times New Roman;">a</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-2" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=C.+L.+Gibbons&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">C. L. Gibbons</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-1-2" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-1";"><sup><span style="font-family: Times New Roman;">a</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-3" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=P.+R.+McAdam&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">P. R. McAdam</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-2-1" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-2";"><sup><span style="font-family: Times New Roman;">b</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-4" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=B.+A.+D.+van+Bunnik&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">B. A. D. van Bunnik</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-1-3" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-1";"><sup><span style="font-family: Times New Roman;">a</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-5" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=E.+K.+Girvan&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">E. K. Girvan</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-3-1" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-3";"><sup><span style="font-family: Times New Roman;">c</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-6" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=G.+F.+Edwards&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">G. F. Edwards</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-3-2" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-3";"><sup><span style="font-family: Times New Roman;">c</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-7" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" style="itemprop: "name";"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=J.+R.+Fitzgerald&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">J. R. Fitzgerald</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-2-2" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-2";"><sup><span style="font-family: Times New Roman;">b</span></sup></a><span style="font-family: Times New Roman;"> and
</span></li>
<li class="last" id="contrib-8"><span class="name"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=M.+E.+J.+Woolhouse&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">M. E. J. Woolhouse</span></a></span><a class="xref-aff" href="https://www.blogger.com/null" id="xref-aff-1-4" style="href: "http://aem.asm.org/content/80/23/7275.full#aff-1";"><sup><span style="font-family: Times New Roman;">a</span></sup></a></li>
</ol>
<ol class="affiliation-list hideaffil">
<li class="aff"><a href="https://www.blogger.com/null" id="aff-1" style="name: aff-1;"></a>
<address>
<span style="font-family: Times New Roman;"><sup>a</sup>Centre for Immunity, Infection
and Evolution, School of Biological Sciences, University of Edinburgh,
Edinburgh, United Kingdom </span></address>
</li>
<li class="aff"><a href="https://www.blogger.com/null" id="aff-2" style="name: aff-2;"></a>
<address>
<span style="font-family: Times New Roman;"><sup>b</sup>The Roslin Institute and
Edinburgh Infectious Diseases, Royal (Dick) School of Veterinary Studies,
University of Edinburgh, Midlothian, United Kingdom </span></address>
</li>
<li class="aff"><a href="https://www.blogger.com/null" id="aff-3" style="name: aff-3;"></a>
<address>
<span style="font-family: Times New Roman;"><sup>c</sup>Scottish MRSA Reference
Laboratory, National Health Service Greater Glasgow and Clyde, Glasgow Royal
Infirmary, Glasgow, United Kingdom </span></address>
</li>
</ol>
</div>
<br />
<div class="contributors">
<ol class="contributor-list" id="contrib-group-2">
<li class="last" id="contrib-9"><span class="name"><a class="name-search" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/search?author1=C.+A.+Elkins&sortspec=date&submit=Submit";"><span style="font-family: Times New Roman;">C. A. Elkins</span></a></span><span class="contrib-role"><span style="font-family: Times New Roman;">, Editor</span></span></li>
</ol>
<div class="affiliation-list-reveal">
<a class="view-more" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/content/80/23/7275.full#";"><span style="font-family: Times New Roman;">+</span></a><span style="font-family: Times New Roman;"> Author
Affiliations</span></div>
</div>
<br />
<div class="section abstract" id="abstract-1" itemprop="description">
<div class="section-nav">
<div class="nav-placeholder">
<span style="font-family: Times New Roman;"> </span></div>
<a class="next-section-link" href="https://www.blogger.com/null" style="href: "http://aem.asm.org/content/80/23/7275.full#sec-1";" title="INTRODUCTION"><span><span style="font-family: Times New Roman;">Next Section</span></span></a></div>
<h2>
<span style="font-family: Times New Roman;">ABSTRACT</span></h2>
<div id="p-2">
<span style="font-family: Times New Roman;"><span class="named-content genus-species" id="named-content-2">Staphylococcus aureus</span> clonal complex
398 (CC398) is associated with disease in humans and livestock, and its origins
and transmission have generated considerable interest. We performed a
time-scaled phylogenetic analysis of CC398, including sequenced isolates from
the United Kingdom (Scotland), along with publicly available genomes. Using
state-of-the-art methods for mapping traits onto phylogenies, we quantified
transitions between host species to identify sink and source populations for
CC398 and employed a novel approach to investigate the gain and loss of
antibiotic resistance in CC398 over time. We identified distinct human- and
livestock-associated CC398 clades and observed multiple transmissions of CC398
from livestock to humans and between countries, lending quantitative support to
previous reports. Of note, we identified a subclade within the
livestock-associated clade comprised of isolates from hospital environments and
newborn babies, suggesting that livestock-associated CC398 is capable of onward
transmission in hospitals. In addition, our analysis revealed significant
differences in the dynamics of resistance to methicillin and tetracycline
related to contrasting historical patterns of antibiotic usage between the
livestock industry and human medicine. We also identified significant
differences in patterns of gain and loss of different tetracycline resistance
determinants, which we ascribe to epistatic interactions between the resistance
genes and/or differences in the modes of inheritance of the resistance
determinants. </span></div>
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;">snip...</span><br />
<span style="font-family: Times New Roman;"></span><br />
<div id="p-43">
<span style="font-family: Times New Roman;">In conclusion, we have performed a
time-scaled phylogenetic analysis of CC398 and provided a quantitative
understanding of the circulation of CC398 through separate human- and
livestock-associated lineages, but with livestock also a significant source of
human infection. We have also carried out a quantitative phylogenetic analysis
of the loss and gain of antibiotic resistance determinants. However, human and
livestock populations are linked in many ways, including agriculture, the food
chain, and shared environments (</span><a class="xref-bibr" href="https://www.blogger.com/null" id="xref-ref-39-1" style="href: "http://aem.asm.org/content/80/23/7275.full#ref-39";"><span style="font-family: Times New Roman;">39</span></a><span style="font-family: Times New Roman;">). In the
future, further studies of a range of bacterial species and strains, using a
large number of sequences from numerous potential sources of infection, are
required to develop a more detailed understanding of the spread of bacteria and
antibiotic resistance. </span></div>
<span style="font-family: Times New Roman;"></span><br />
<a href="http://aem.asm.org/content/80/23/7275.full" title="http://aem.asm.org/content/80/23/7275.full">http://aem.asm.org/content/80/23/7275.full</a><br />
<br />
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br />
<br />
<br />
TSS</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-763150328927788302013-09-22T13:48:00.000-07:002013-09-22T13:48:01.613-07:00Livestock Origin for a Human Pandemic Clone of Community-Associated Methicillin-Resistant Staphylococcus aureus<h1 id="article-title-1" itemprop="headline">
<span style="font-family: Times New Roman;">Livestock Origin for a Human Pandemic Clone of
Community-Associated Methicillin-Resistant <em>Staphylococcus
aureus</em></span></h1>
<br />
<div itemprop="headline">
</div>
<br />
<div class="contributors">
</div>
<div class="contributors">
<ol class="contributor-list" id="contrib-group-1">
<li class="contributor" id="contrib-1" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Laura+E.+Spoor&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Laura E. Spoor</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-1" id="xref-aff-1-1"><sup><span style="font-family: Times New Roman;">a</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-2" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Paul+R.+McAdam&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Paul R. McAdam</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-1" id="xref-aff-1-2"><sup><span style="font-family: Times New Roman;">a</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-3" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Lucy+A.+Weinert&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Lucy A. Weinert</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-2" id="xref-aff-2-1"><sup><span style="font-family: Times New Roman;">b</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-4" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Andrew+Rambaut&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Andrew Rambaut</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-3" id="xref-aff-3-1"><sup><span style="font-family: Times New Roman;">c</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-5" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Henrik+Hasman&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Henrik Hasman</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-4" id="xref-aff-4-1"><sup><span style="font-family: Times New Roman;">d</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-6" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Frank+M.+Aarestrup&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Frank M. Aarestrup</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-4" id="xref-aff-4-2"><sup><span style="font-family: Times New Roman;">d</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-7" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Angela+M.+Kearns&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Angela M. Kearns</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-5" id="xref-aff-5-1"><sup><span style="font-family: Times New Roman;">e</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-8" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Anders+R.+Larsen&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Anders R. Larsen</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-6" id="xref-aff-6-1"><sup><span style="font-family: Times New Roman;">f</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="contributor" id="contrib-9" itemprop="author" itemscope="itemscope" itemtype="http://schema.org/Person"><span class="name" itemprop="name"><a class="name-search" href="http://mbio.asm.org/search?author1=Robert+L.+Skov&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">Robert L. Skov</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-6" id="xref-aff-6-2"><sup><span style="font-family: Times New Roman;">f</span></sup></a><span style="font-family: Times New Roman;">,
</span></li>
<li class="last" id="contrib-10"><span class="name"><a class="name-search" href="http://mbio.asm.org/search?author1=J.+Ross+Fitzgerald&sortspec=date&submit=Submit"><span style="font-family: Times New Roman;">J. Ross Fitzgerald</span></a></span><a class="xref-aff" href="http://mbio.asm.org/content/4/4/e00356-13#aff-1" id="xref-aff-1-3"><sup><span style="font-family: Times New Roman;">a</span></sup></a></li>
</ol>
</div>
<div class="last">
</div>
<ol class="affiliation-list">
<li class="aff"><a href="http://www.blogger.com/null" id="aff-1" name="aff-1"></a>
<address>
<span style="font-family: Times New Roman;">The Roslin Institute and Edinburgh
Infectious Diseases, University of Edinburgh, Easter Bush, Midlothian, United
Kingdom<sup>a</sup></span></address>
</li>
<li class="aff"><a href="http://www.blogger.com/null" id="aff-2" name="aff-2"></a>
<address>
<span style="font-family: Times New Roman;">University of Cambridge, Department of
Veterinary Medicine, Cambridge, United Kingdom<sup>b</sup></span></address>
</li>
<li class="aff"><a href="http://www.blogger.com/null" id="aff-3" name="aff-3"></a>
<address>
<span style="font-family: Times New Roman;">Institute of Evolutionary Biology,
Ashworth Laboratories, University of Edinburgh, Edinburgh, United
Kingdom<sup>c</sup></span></address>
</li>
<li class="aff"><a href="http://www.blogger.com/null" id="aff-4" name="aff-4"></a>
<address>
<span style="font-family: Times New Roman;">National Food Institute, Technical
University of Denmark (DTU), Lyngby, Denmark<sup>d</sup></span></address>
</li>
<li class="aff"><a href="http://www.blogger.com/null" id="aff-5" name="aff-5"></a>
<address>
<span style="font-family: Times New Roman;">Microbiology Services, Colindale, Health
Protection Agency, London, United Kingdom<sup>e</sup></span></address>
</li>
<li class="aff"><a href="http://www.blogger.com/null" id="aff-6" name="aff-6"></a>
<address>
<span style="font-family: Times New Roman;">Department of Antimicrobial Surveillance
and Research, Statens Serum Institute, Copenhagen,
Denmark<sup>f</sup></span></address>
</li>
</ol>
<ol class="corresp-list">
<li class="corresp" id="corresp-1"><span style="font-family: Times New Roman;">Address
correspondence to J. Ross Fitzgerald, <span class="em-link"><span class="em-addr">Ross.Fitzgerald{at}ed.ac.uk</span></span>. </span></li>
</ol>
<ol class="fn-track">
<li class="fn-edited-by" id="fn-2">
<div id="p-2">
<span style="font-family: Times New Roman;"><strong>Editor</strong> Fernando Baquero,
Ramón y Cajal University Hospital </span></div>
</li>
</ol>
<br />
<div class="section abstract" id="abstract-1" itemprop="description">
<h2>
<span style="font-family: Times New Roman;"></span> </h2>
<h2>
<span style="font-family: Times New Roman;">ABSTRACT</span></h2>
<div id="p-4">
<span style="font-family: Times New Roman;"></span> </div>
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;"></span><br />
<span style="font-family: Times New Roman;">The importance of livestock as a source
of bacterial pathogens with the potential for epidemic spread in human
populations is unclear. In recent years, there has been a global increase in
community-associated methicillin-resistant <em>Staphylococcus aureus</em>
(CA-MRSA) infections of healthy humans, but an understanding of the different
evolutionary origins of CA-MRSA clones and the basis for their recent expansion
is lacking. Here, using a high-resolution phylogenetic approach, we report the
discovery of two emergent clones of human epidemic CA-MRSA which resulted from
independent livestock-to-human host jumps by the major bovine <em>S. aureus</em>
complex, CC97. Of note, one of the new clones was isolated from human infections
on four continents, demonstrating its global dissemination since the host jump
occurred over 40 years ago. The emergence of both human <em>S. aureus</em>
clones coincided with the independent acquisition of mobile genetic elements
encoding antimicrobial resistance and human-specific mediators of immune
evasion, consistent with an important role for these genetic events in the
capacity to survive and transmit among human populations. In conclusion, we
provide evidence that livestock represent a reservoir for the emergence of new
human-pathogenic <em>S. aureus</em> clones with the capacity for pandemic
spread. These findings have major public health implications highlighting the
importance of surveillance for early identification of emergent clones and
improved transmission control measures at the human-livestock interface.
</span><br />
<div id="p-5">
<span style="font-family: Times New Roman;"><strong></strong></span> </div>
<span style="font-family: Times New Roman;"><strong></strong></span><br />
<span style="font-family: Times New Roman;"><strong></strong></span><br />
<span style="font-family: Times New Roman;"><strong>IMPORTANCE</strong> Animals are
the major source of new pathogens affecting humans. However, the potential for
pathogenic bacteria that originally were found in animals to switch hosts and
become widely established in human populations is not clear. Here, we report the
discovery of emergent clones of methicillin-resistant <em>Staphylococcus
aureus</em> (MRSA) that originated in livestock and switched to humans, followed
by host-adaptive evolution and epidemic spread in global human populations. Our
findings demonstrate that livestock can act as a reservoir for the emergence of
new human bacterial clones with potential for pandemic spread, highlighting the
potential role of surveillance and biosecurity measures in the agricultural
setting for preventing the emergence of new human pathogens. </span></div>
<br />
<div class="section fn-group" id="fn-group-1">
<h2>
<span style="font-family: Times New Roman;"></span> </h2>
<h2>
<span style="font-family: Times New Roman;">Footnotes</span></h2>
<br />
<br />
<ul>
<li class="fn-other" id="fn-1">
<div id="p-1">
<span style="font-family: Times New Roman;"><strong>Citation</strong> Spoor LE,
McAdam PR, Weinert LA, Rambaut A, Hasman H, Aarestrup FM, Kearns AM, Larsen AR,
Skov RL, Fitzgerald JR. 2013. Livestock origin for a human pandemic clone of
community-associated methicillin-resistant <em>Staphylococcus aureus</em>. mBio
4(4):e00356-13. doi:10.1128/mBio.00356-13. </span></div>
</li>
</ul>
</div>
<br />
<ul class="history-list">
<li class="received" xmlns:hwp="http://schema.highwire.org/Journal"><span style="font-family: Times New Roman;"><span class="received-label">Received </span>20 May 2013
</span></li>
<li class="accepted" xmlns:hwp="http://schema.highwire.org/Journal"><span style="font-family: Times New Roman;"><span class="accepted-label">Accepted </span>14 June 2013
</span></li>
<li class="published"><span style="font-family: Times New Roman;"><span class="published-label">Published </span>13 August 2013 </span></li>
</ul>
<br />
<ul class="copyright-statement">
<li class="fn" id="copyright-statement-1"><span style="font-family: Times New Roman;">Copyright ©
2013 Spoor et al.</span></li>
</ul>
<br />
<div class="license" id="license-1">
<div id="p-3">
<span style="font-family: Times New Roman;">This is an open-access article
distributed under the terms of the </span><a href="http://creativecommons.org/licenses/by-nc-sa/3.0/"><span style="font-family: Times New Roman;">Creative Commons Attribution-Noncommercial-ShareAlike 3.0
Unported license</span></a><span style="font-family: Times New Roman;">, which permits
unrestricted noncommercial use, distribution, and reproduction in any medium,
provided the original author and source are credited. </span></div>
</div>
<br />
<div>
<cite><span style="font-family: Times New Roman;"><span><abbr class="slug-jnl-abbrev" title="Veterinary Record"></abbr></span></span></cite> </div>
<br />
<div>
<cite><span style="font-family: Times New Roman;"><span><abbr class="slug-jnl-abbrev" title="Veterinary Record"></abbr></span></span></cite> </div>
<br />
<div>
<a href="http://mbio.asm.org/content/4/4/e00356-13" title="http://mbio.asm.org/content/4/4/e00356-13">http://mbio.asm.org/content/4/4/e00356-13</a></div>
<br />
<div>
<em><span style="font-family: Times New Roman;"></span></em> </div>
<br />
<br />
<div>
<cite><span style="font-family: Times New Roman;"><span><abbr class="slug-jnl-abbrev" title="Veterinary Record"></abbr></span></span></cite> </div>
<br />
<div>
<cite><span style="font-family: Times New Roman;"><span><abbr class="slug-jnl-abbrev" title="Veterinary Record">Veterinary Record</abbr> </span><span class="slug-pub-date" itemprop="datePublished">2013;</span><span class="slug-vol">173<span class="cit-sep cit-sep-after-article-vol">:</span></span><span class="slug-pages">260 </span><span class="slug-doi" title="10.1136/vr.f5488">doi:10.1136/vr.f5488 </span></span></cite></div>
<br />
<ul class="subject-headings last-child">
<li><span style="font-family: Times New Roman;">News and Report</span></li>
</ul>
<br />
<ul class="series-titles">
<li><span style="font-family: Times New Roman;">Research</span></li>
</ul>
<br />
<br />
<div class="generated-extract-div" itemprop="articleBody">
<span class="highwire-journal-article-marker-start"></span>
<div class="article extract-view">
<h1 id="article-title-1" itemprop="headline">
<span style="font-family: Times New Roman;">Study
reveals bovine origin for human MRSA strain</span></h1>
<div itemprop="headline">
</div>
<div itemprop="headline">
</div>
<div itemprop="headline">
</div>
<div class="section" id="sec-1">
<div id="p-1">
<span style="font-family: Times New Roman;">A RECENT study has suggested a type of
meticillin-resistant <em>Staphylococcus aureus</em> found in people originated
in cattle at least 40 years ago. Researchers say that their work provides clear
evidence that livestock were the original source of the MRSA strain, which is
now widespread in the human population. </span></div>
<div id="p-2">
<span style="font-family: Times New Roman;">The researchers, from a number of
different institutions, including the Roslin Institute and Cambridge veterinary
school, … </span></div>
<span style="font-family: Times New Roman;"></span><br />
<br />
<a href="http://veterinaryrecord.bmj.com/content/173/11/260.1.extract.html?etoc" title="http://veterinaryrecord.bmj.com/content/173/11/260.1.extract.html?etoc">http://veterinaryrecord.bmj.com/content/173/11/260.1.extract.html?etoc</a><br />
<br />
<br />
<br />
<br />
<br />
<span style="font-family: Times New Roman;">Tuesday, September 17, 2013
<br /><br /><br />Antibiotic resistance threats in the United States, 2013 THREAT
REPORT <br /><br />“We continue to promote the concept that, if an animal is sick,
using antibiotics to treat that animal is obviously important,” said CDC
Director Dr. Tom Frieden. “We also know that there are specific situations in
which the widespread use of antimicrobials in agriculture has resulted in an
increase in resistant infections in humans.”<br /><br /></span><a href="http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html"><span style="font-family: Times New Roman;">http://staphmrsa.blogspot.com/2013/09/antibiotic-resistance-threats-in-united.html</span></a></div>
<div class="section">
</div>
<div class="section">
</div>
<div class="section">
</div>
<div class="section">
</div>
<div class="section">
kind regards,</div>
<div class="section">
terry</div>
<div class="section">
</div>
</div>
</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-80356933012323071712013-09-17T07:35:00.001-07:002013-09-17T07:35:26.199-07:00Antibiotic resistance threats in the United States, 2013 THREAT REPORT <span style="font-family: Georgia;">About 80 percent of all antibiotics distributed in the
U.S. were for food animals, and CSPI </span><a href="http://cspinet.org/new/pdf/outbreaks_antibiotic_resistance_in_foodborne_pathogens_2013.pdf"><span style="color: #023462; font-family: Georgia;">has documented</span></a><span style="font-family: Georgia;"> 55
foodborne illness outbreaks between 1973 and 2011 where the bacteria identified
were resistant to at least one antibiotic. Thirty-four of those outbreaks
occurred since 2000.</span><br />
<br />
<span style="font-family: Georgia;">“Because of the link between antibiotic use in
food-producing animals and the occurrence of antibiotic-resistant infections in
humans, antibiotics should be used in food-producing animals only under
veterinary oversight and only to manage and treat infectious diseases, not to
promote growth,” reads the report.</span><br />
<br />
<span style="font-family: Georgia;">“We continue to promote the concept that, if an animal is
sick, using antibiotics to treat that animal is obviously important,” said CDC
Director Dr. Tom Frieden. “We also know that there are specific situations in
which the widespread use of antimicrobials in agriculture has resulted in an
increase in resistant infections in humans.”</span><br />
<br />
<span style="font-family: Georgia;"></span><br />
<br />
<a href="http://www.foodsafetynews.com/2013/09/drug-resistant-infections/#.Ujhl1owo4qQ" title="http://www.foodsafetynews.com/2013/09/drug-resistant-infections/#.Ujhl1owo4qQ">http://www.foodsafetynews.com/2013/09/drug-resistant-infections/#.Ujhl1owo4qQ</a><br />
<br />
<span style="font-family: Georgia;"></span><br />
<br />
<span style="font-family: Georgia;"></span><br />
<br />
<a href="http://www.cdc.gov/drugresistance/threat-report-2013/" title="http://www.cdc.gov/drugresistance/threat-report-2013/">http://www.cdc.gov/drugresistance/threat-report-2013/</a><br />
<br />
<span style="font-family: Georgia;"></span><br />
<br />
<span style="font-family: Georgia;"></span><br />
<br />
<h1>
<span style="font-family: Times New Roman;">Threat Report 2013</span></h1>
<br />
<span style="font-family: Times New Roman;">This report, <em>Antibiotic resistance threats
in the United States, 2013</em> gives a first-ever snapshot of the burden and
threats posed by the antibiotic-resistant germs having the most impact on human
health. </span><br />
<br />
<span style="font-family: Times New Roman;">Each year in the United States, at least 2
million people become infected with bacteria that are resistant to antibiotics
and at least 23,000 people die each year as a direct result of these infections.
Many more people die from other conditions that were complicated by an
antibiotic-resistant infection. </span><br />
<br />
<span style="font-family: Times New Roman;">Antibiotic-resistant infections can happen
anywhere. Data show that most happen in the general community; however, most
deaths related to antibiotic resistance happen in healthcare settings such as
hospitals and nursing homes.</span><br />
<br />
<div class="module noBorder blocklist clearRight toc">
<div class="inner">
<h3>
<span style="font-family: Times New Roman;">What's in the Report</span></h3>
<div class="subc">
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=5" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Foreword</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
5]</span></span></a></h5>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=6" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Executive
Summary</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
6]</span></span></a></h5>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=11" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Section 1: The
Threat of Antibiotic Resistance</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
11]</span></span></a></h5>
<ul>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=11" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Introduction</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
11]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=13" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">National Summary
Data</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
13]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=14" target="_blank"><span class="tp-label"><span style="font-family: Times New Roman;">Cycle of
Resistance Infographics</span></span><span class="plugIns"><span style="font-family: Times New Roman;"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page 14]
</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=15" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Minimum
Estimates of Morbidity and Mortality from <br />Antibiotic-Resistant
Infections</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
15]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=18" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Limitations of
Estimating the Burden of Disease Associated <br />with Antibiotic-Resistant
Bacteria</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
18]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=20" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Assessment of
Domestic Antibiotic-Resistant Threats</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
20]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=22" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Running Out of
Drugs to Treat Serious Gram-Negative Infections</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
22]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=24" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">People at
Especially High Risk</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
24]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=25" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Antibiotic
Safety</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
25]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=27" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Gaps in
Knowledge of Antibiotic Resistance</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
27]</span></span></a></li>
<li class="lastChild"><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=28" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Developing
Resistance: Timeline of Key Antibiotic Resistance Events</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
28]</span></span></a></li>
</ul>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=31" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Section 2:
Fighting Back Against Antibiotic Resistance</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
31]</span></span></a></h5>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=31" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Four Core
Actions to Prevent Antibiotic Resistance</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
31]</span></span></a></h5>
<ul>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=32" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">1. Preventing
Infections, Preventing the Spread of Resistance</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
32]</span></span></a>
<div class="module noBorder">
<div class="inner">
<div class="subColumns">
<div class="subc">
<ul>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=32" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">•CDC's Work to
Prevent Infections and Antibiotic Resistance<br />in Healthcare
Settings</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
32]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=34" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">• CDC's Work to
Prevent Antibiotic Resistance in the Community</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
34]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=36" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">• CDC's Work to
Prevent Antibiotic Resistance in Food</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
36]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=39" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">2. Tracking
Resistance Patterns</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
39]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=41" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">3. Antibiotic
Stewardship: Improving Prescribing, Improving Use</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
41]</span></span></a></li>
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=44" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">4. Developing
New Antibiotics and Diagnostic Tests</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
44]</span></span></a></li>
</ul>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=49" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Section 3:
Current Antibiotic Resistance Threats in the United States, <br />by
Microorganism</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
49]</span></span></a></h5>
<blockquote>
<h5>
<span style="font-family: Times New Roman;">Microorganisms with a Threat Level of
Urgent</span></h5>
</blockquote>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Clostridium difficile" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Clostrodium_difficile.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=51" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label"><em>Clostridium
difficile</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
51]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Carbapenem-resistant Enterobacteriacea" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/CRE.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=53" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Carbapenem-resistant Enterobacteriaceae</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
53]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Neisseria gonorrhoeae" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Neisseria_gonorrhoeae-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=55" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
<em>Neisseria gonorrhoeae</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
55]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<br />
<blockquote>
<h5>
<span style="font-family: Times New Roman;">Microorganisms with a Threat Level of Serious
</span></h5>
</blockquote>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Acinetobacter spp" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Acinetobacter_spp.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=59" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Multidrug-resistant <em>Acinetobacter</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
59]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Campylobacter spp" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Campylobacter_spp-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=61" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
<em>Campylobacter</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
61]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Candida spp" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Candida_spp-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=63" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Fluconazole-resistant <em>Candida</em> (a fungus)</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
63]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="ESBL" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/ESBL-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=65" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Extended
spectrum β-lactamase producing <br />Enterobacteriaceae (ESBLs)</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
65]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Vancomycin-resistant Enterococcus (VRE)" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Enterococcus_spp-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=67" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Vancomycin-resistant <em>Enterococcus</em> (VRE).</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
67]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Pseudomonas spp" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Pseudomonas_spp.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=69" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Multidrug-resistant <em>Pseudomonas aeruginosa </em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
69]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="non-typhoidal Salmonella " class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/non_typhoidal_Salmonella.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=71" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
non-typhoidal<em> Salmonella</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
71]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="salmonella typhi" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/salmonella_typhi-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=73" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant<em> Salmonella</em> Typhi</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
73]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="shigella spp" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/shigella_spp-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=75" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
<em>Shigella</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
75]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="MRSA" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/MRSA_crop.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=77" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Methicillin-resistant <em>Staphylococcus aureus</em>
(MRSA)</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
77]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Streptococcus pneumoniae" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/strp_pneu-copy.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=79" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
<em>Streptococcus pneumoniae</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
79]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="tuberculosis " class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/XDR_M_tuberculosis.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=81" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Drug-resistant
tuberculosis</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
81]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<br />
<h5>
<span style="font-family: Times New Roman;">Microorganisms with a Threat Level of
Concerning </span></h5>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Staphylococcus aureus (VRSA)" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/VRSA.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=85" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Vancomycin-resistant <em>Staphylococcus aureus</em>
(VRSA)</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
85]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Group A Streptococcus" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/Strep_pyogenes.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=87" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Erythromycin-resistant Group A <em>Streptococcus</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
87]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<ul>
<li>
<div class="module">
<div class="inner">
<div class="subColumns">
<div class="subc">
<div class="lefty">
<img alt="Group B Streptococcus" class="lefty" src="http://www.cdc.gov/drugresistance/threat-report-2013/images/strep_agalactiae.jpg" /></div>
<span style="font-family: Times New Roman;"> </span><br />
<ul class="bullet-list nolines inliner">
<li><a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=89" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Clindamycin-resistant Group B <em>Streptococcus</em></span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
89]</span></span></a></li>
</ul>
</div>
</div>
</div>
</div>
</li>
</ul>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=93" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Technical
Appendix</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
93]</span></span></a></h5>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=107" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Glossary</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
107]</span></span></a></h5>
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf#page=112" target="_blank"><span style="font-family: Times New Roman;"><span class="tp-label">Acknowledgements</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [page
112]</span></span></a></h5>
<span style="font-family: Times New Roman;"> </span></div>
</div>
</div>
<br />
<div class="module roundem">
<div class="inner">
<div class="subColumns">
<div class="subc">
<h5>
<a class="noDecoration" href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf"><span style="font-family: Times New Roman;"><span class="tp-label">Download the 2013 Report now
»</span><span class="plugIns"> <img alt="Adobe PDF file" border="0" class="plugin" src="http://www.cdc.gov/TemplatePackage/images/icon_pdf.gif" title="Adobe PDF file" /> [PDF - 114 pages
4.18mb]</span></span></a></h5>
<span style="font-family: Times New Roman;"> </span><br />
<a href="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf" title="http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf">http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf</a><br />
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<a href="http://www.cdc.gov/drugresistance/threat-report-2013/" title="http://www.cdc.gov/drugresistance/threat-report-2013/">http://www.cdc.gov/drugresistance/threat-report-2013/</a><br />
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Tuesday, July 16, 2013 </div>
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Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus
aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation
Workers in North Carolina </div>
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Research Article </div>
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<a href="http://staphmrsa.blogspot.com/2013/07/livestock-associated-methicillin-and.html">http://staphmrsa.blogspot.com/2013/07/livestock-associated-methicillin-and.html</a></div>
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Wednesday, January 2, 2013</div>
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New MRSA ST398 superbug strain found in UK milk Occupational risk factor
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Rapid communications </div>
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<a href="http://staphmrsa.blogspot.com/2013/01/new-mrsa-st398-superbug-strain-found-in.html">http://staphmrsa.blogspot.com/2013/01/new-mrsa-st398-superbug-strain-found-in.html</a>
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Thursday, March 1, 2012 </div>
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Staphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin
Resistance in Livestock </div>
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<a href="http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html">http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html</a>
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Thursday, February 9, 2012 </div>
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Occurrence and distribution of Staphylococcus aureuslineages among zoo
animals </div>
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<a href="http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html">http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html</a>
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Tuesday, January 17, 2012 </div>
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In-feed antibiotic effects on the swine intestinal microbiome </div>
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<a href="http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html">http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html</a>
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Thursday, June 9, 2011 </div>
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New Superbug Found in Cows and People </div>
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<a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a>
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Wednesday, May 11, 2011 </div>
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<div>
Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit,
Michigan, USA </div>
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</div>
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<a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a>
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Monday, April 18, 2011 </div>
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</div>
<div>
Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry </div>
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</div>
<div>
<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a>
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</div>
that MRSA is some nasty stuff. damn near killed me in 2001 after one of my
neck surgeries. 8 weeks vancomycin via long PIC line straight to the heart.
nasty, nasty stuff. ...<br />
<br />
<br />
<div>
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a>
</div>
<div>
</div>
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<span class="post-count" dir="ltr">(3)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2013_01_01_archive.html"><span style="color: #473624; font-family: Georgia;">January</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2012-01-01T00:00:00-08:00&updated-max=2013-01-01T00:00:00-08:00&max-results=4"><span style="color: #473624; font-family: Georgia;">2012</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(4)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2012_03_01_archive.html"><span style="color: #473624; font-family: Georgia;">March</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2012_02_01_archive.html"><span style="color: #473624; font-family: Georgia;">February</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2011-01-01T00:00:00-08:00&updated-max=2012-01-01T00:00:00-08:00&max-results=3"><span style="color: #473624; font-family: Georgia;">2011</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(3)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2011_05_01_archive.html"><span style="color: #473624; font-family: Georgia;">May</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2011_04_01_archive.html"><span style="color: #473624; font-family: Georgia;">April</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2010-01-01T00:00:00-08:00&updated-max=2011-01-01T00:00:00-08:00&max-results=3"><span style="color: #473624; font-family: Georgia;">2010</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(3)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2010_04_01_archive.html"><span style="color: #473624; font-family: Georgia;">April</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2010_02_01_archive.html"><span style="color: #473624; font-family: Georgia;">February</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2009-01-01T00:00:00-08:00&updated-max=2010-01-01T00:00:00-08:00&max-results=2"><span style="color: #473624; font-family: Georgia;">2009</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(2)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2009_01_01_archive.html"><span style="color: #473624; font-family: Georgia;">January</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2008-01-01T00:00:00-08:00&updated-max=2009-01-01T00:00:00-08:00&max-results=6"><span style="color: #473624; font-family: Georgia;">2008</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(6)</span> </span></span>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2008_03_01_archive.html"><span style="color: #473624; font-family: Georgia;">March</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(4)</span> </span></span></li>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2008_01_01_archive.html"><span style="color: #473624; font-family: Georgia;">January</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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</li>
</ul>
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/search?updated-min=2007-01-01T00:00:00-08:00&updated-max=2008-01-01T00:00:00-08:00&max-results=2"><span style="color: #473624; font-family: Georgia;">2007</span></a><span style="color: #29303b; font-family: Georgia;">
<span class="post-count" dir="ltr">(2)</span> </span></span>
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<li class="archivedate collapsed" style="list-style-type: none; margin: 0px;"><span style="font-size: 10.3pt;"><a class="toggle" href="javascript:void(0)"><span style="color: #29303b;"><span style="font-family: Georgia;"><span class="zippy">► </span> </span></span></a><a class="post-count-link" href="http://staphmrsa.blogspot.com/2007_11_01_archive.html"><span style="color: #473624; font-family: Georgia;">November</span></a><span style="color: #29303b; font-family: Georgia;"> <span class="post-count" dir="ltr">(1)</span> </span></span>
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<li style="list-style-type: none; margin: 0px;"><a href="http://staphmrsa.blogspot.com/2007/11/emergence-of-methicillin-resistant.html"><span style="font-family: Georgia;"><span style="color: #473624; font-size: 10.3pt;">Emergence of
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</span></span></span></a><span style="font-size: 10.3pt;"><a class="post-count-link" href="http://staphmrsa.blogspot.com/2007_10_01_archive.html"><span style="color: #473624; font-family: Georgia;">October</span></a></span><span style="font-family: Georgia;"><span style="color: #29303b; font-size: 10.3pt;"> <span class="post-count" dir="ltr">(1)</span> </span></span></li>
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TSS<br />
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Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-36559123142338351242013-07-16T13:49:00.001-07:002013-07-16T13:49:05.618-07:00Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in North Carolina <div>
Research Article </div>
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Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus
aureus Is Present among Industrial, Not Antibiotic-Free Livestock Operation
Workers in North Carolina </div>
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Jessica L. Rinsky equal contributor, equal contributor Contributed equally
to this work with: Jessica L. Rinsky, Maya Nadimpalli</div>
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Affiliation: Department of Epidemiology, University of North Carolina,
Chapel Hill, North Carolina, United States of America </div>
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X Maya Nadimpalli equal contributor, equal contributor Contributed equally
to this work with: Jessica L. Rinsky, Maya Nadimpalli</div>
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Affiliation: Department of Environmental Sciences and Engineering,
University of North Carolina, Chapel Hill, North Carolina, United States of
America </div>
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X Steve Wing, Affiliation: Department of Epidemiology, University of North
Carolina, Chapel Hill, North Carolina, United States of America </div>
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X Devon Hall, Affiliation: Rural Empowerment Association for Community Help
(REACH), Warsaw, North Carolina, United States of America </div>
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X Dothula Baron, Affiliation: Rural Empowerment Association for Community
Help (REACH), Warsaw, North Carolina, United States of America </div>
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X Lance B. Price, Affiliation: Department of Environmental and Occupational
Health, George Washington University, Washington, District of Columbia, United
States of America </div>
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X Jesper Larsen, Affiliation: Microbiology and Infection Control, Statens
Serum Institut, Copenhagen, Denmark </div>
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X Marc Stegger, Affiliation: Microbiology and Infection Control, Statens
Serum Institut, Copenhagen, Denmark </div>
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X Jill Stewart, Affiliation: Department of Environmental Sciences and
Engineering, University of North Carolina, Chapel Hill, North Carolina, United
States of America </div>
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X Christopher D. Heaney mail * E-mail: <a href="mailto:cheaney@jhsph.edu">cheaney@jhsph.edu</a></div>
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Affiliations: Department of Environmental Health Sciences, Bloomberg School
of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
of America, Department of Epidemiology, Bloomberg School of Public Health, Johns
Hopkins University, Baltimore, Maryland, United States of America </div>
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Abstract </div>
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Objectives Administration of antibiotics to food animals may select for
drug-resistant pathogens of clinical significance, such as methicillin-resistant
Staphylococcus aureus (MRSA). In the United States, studies have examined
prevalence of MRSA carriage among individuals exposed to livestock, but
prevalence of multidrug-resistant S. aureus (MDRSA) carriage and the association
with livestock raised with versus without antibiotic selective pressure remains
unclear. We aimed to examine prevalence, antibiotic susceptibility, and
molecular characteristics of S. aureus among industrial livestock operation
(ILO) and antibiotic-free livestock operation (AFLO) workers and household
members in North Carolina.</div>
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Methods Participants in this cross-sectional study were interviewed and
provided a nasal swab for S. aureus analysis. Resulting S. aureus isolates were
assessed for antibiotic susceptibility, multi-locus sequence type, and absence
of the scn gene (a marker of livestock association).</div>
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Results Among 99 ILO and 105 AFLO participants, S. aureus nasal carriage
prevalence was 41% and 40%, respectively. Among ILO and AFLO S. aureus carriers,
MRSA was detected in 7% (3/41) and 7% (3/42), respectively. Thirty seven percent
of 41 ILO versus 19% of 42 AFLO S. aureus-positive participants carried MDRSA.
S. aureus clonal complex (CC) 398 was observed only among workers and
predominated among ILO (13/34) compared with AFLO (1/35) S. aureus-positive
workers. Only ILO workers carried scn-negative MRSA CC398 (2/34) and
scn-negative MDRSA CC398 (6/34), and all of these isolates were tetracycline
resistant.</div>
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Conclusions Despite similar S. aureus and MRSA prevalence among ILO and
AFLO-exposed individuals, livestock-associated MRSA and MDRSA
(tetracycline-resistant, CC398, scn-negative) were only present among
ILO-exposed individuals. These findings support growing concern about
antibiotics use and confinement in livestock production, raising questions about
the potential for occupational exposure to an opportunistic and drug-resistant
pathogen, which in other settings including hospitals and the community is of
broad public health importance. </div>
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snip... </div>
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The results reported here show that the proportion of S. aureus identified
as MDRSA and the proportion exhibiting phenotypic and molecular markers of
livestock association was elevated among individuals exposed to the ILO
environment compared to those exposed to the AFLO environment. Carriage of
scn-negative MRSA CC398 and scn-negative MDRSA CC398 was limited to individuals
with direct exposure to ILO production – all of these isolates were also
resistant to tetracycline. Whether or not these livestock-associated S. aureus
strains (including MRSA and MDRSA) pose a health risk to workers and the broader
public requires further investigation. Overall, our findings support growing
concern about antibiotic use and confinement in livestock production, and raise
questions about the potential for occupational exposure to an opportunistic and
drug-resistant pathogen which in other settings including hospitals and the
community is a major cause of morbidity and mortality in the United States [4],
[61] and globally [6], [7]. </div>
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Citation: Rinsky JL, Nadimpalli M, Wing S, Hall D, Baron D, et al. (2013)
Livestock-Associated Methicillin and Multidrug Resistant Staphylococcus aureus
Is Present among Industrial, Not Antibiotic-Free Livestock Operation Workers in
North Carolina. PLoS ONE 8(7): e67641. doi:10.1371/journal.pone.0067641</div>
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Editor: Axel Cloeckaert, Institut National de la Recherche Agronomique,
France </div>
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Received: February 19, 2013; Accepted: May 20, 2013; Published: July 2,
2013</div>
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Copyright: © 2013 Rinsky et al. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.</div>
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Funding: Funding for this study was provided by the North Carolina
Translational and Clinical Sciences Institute, North Carolina Occupational
Safety and Health Education and Research Center, the W.K. Kellogg Health
Scholars Program – Community Track, and a Gillings Innovation Laboratory award
from the UNC Gillings School of Global Public Health. CDH was supported by the
W.K. Kellogg Health Scholars Program – Community Track, JLR by the National
Institute of Environmental Health Sciences (NIEHS; award no. T32ES007018), and
MN by a Royster Society fellowship and an EPA Science to Achieve Results
fellowship. The funders had no role in study design, data collection and
analysis, decision to publish, or preparation of the manuscript.</div>
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Competing interests: SW provided pro bono testimony in legal proceedings
related to landfills and provided pro bono consultation on radiation and health
for two law firms that made gifts to the University of North Carolina and
another law firm that did not make a gift to the University of North Carolina.
He conducted research on epidemiologic investigation of symptoms reported by
neighbors of areas where sewage sludge is applied to land funded by the Water
Environment Research Foundation. This does not alter the authors' adherence to
all the PLOS ONE policies on sharing data and materials. </div>
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<a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0067641">http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0067641</a>
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Wednesday, January 2, 2013</div>
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New MRSA ST398 superbug strain found in UK milk Occupational risk factor
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Rapid communications </div>
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<a href="http://staphmrsa.blogspot.com/2013/01/new-mrsa-st398-superbug-strain-found-in.html">http://staphmrsa.blogspot.com/2013/01/new-mrsa-st398-superbug-strain-found-in.html</a>
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Thursday, March 1, 2012 </div>
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Staphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin
Resistance in Livestock </div>
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<a href="http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html">http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html</a>
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Thursday, February 9, 2012 </div>
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Occurrence and distribution of Staphylococcus aureuslineages among zoo
animals </div>
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<a href="http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html">http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html</a>
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Tuesday, January 17, 2012 </div>
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In-feed antibiotic effects on the swine intestinal microbiome </div>
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Thursday, June 9, 2011 </div>
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New Superbug Found in Cows and People </div>
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<a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a>
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Wednesday, May 11, 2011 </div>
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Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit,
Michigan, USA </div>
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<a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a>
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Monday, April 18, 2011 </div>
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Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry </div>
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<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a>
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that MRSA is some nasty stuff. damn near killed me in 2001 after one of my
neck surgeries. 8 weeks vancomycin via long PIC line. ... </div>
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TSS </div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-88081483213362996642013-04-04T09:51:00.001-07:002013-04-04T09:51:48.922-07:00Whole genome sequencing identifies zoonotic transmission of MRSA isolates with the novel mecA homologue mecC<div>
Whole genome sequencing identifies zoonotic transmission of MRSA isolates
with the novel mecA homologue mecC </div>
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Ewan M. Harrison1, Gavin K. Paterson1, Matthew T.G. Holden2, Jesper
Larsen3, Marc Stegger3, Anders Rhod Larsen3, Andreas Petersen3, Robert L. Skov3,
Judit Marta Christensen4, Anne Bak Zeuthen4, Ole Heltberg4, Simon R. Harris2,
Ruth N. Zadoks5, Julian Parkhill2, Sharon J. Peacock2,6, Mark A. Holmes1* </div>
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Keywords: cattle; mecC; MRSA; sheep; zoonosis </div>
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DOI 10.1002/emmm.201202413 Received December 21, 2012 Revised February 06,
2013 Accepted February 08, 2013 GSee accompanying article <a href="http://dx.doi.org/10.1002/emmm.201302622">http://dx.doi.org/10.1002/emmm.201302622</a>
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Several methicillin-resistant Staphylococcus aureus (MRSA) lineages that
carry a novel mecA homologue (mecC) have recently been described in livestock
and humans. In Denmark, two independent human cases of mecC-MRSA infection have
been linked to a livestock reservoir. We investigated the molecular epidemiology
of the associated MRSA isolates using whole genome sequencing (WGS). Single
nucleotide polymorphisms (SNP) were defined and compared to a reference genome
to place the isolates into a phylogenetic context. Phylogenetic analysis
revealed two distinct farm-specific clusters comprising isolates from the human
case and their own livestock, whereas human and animal isolates from the same
farm only differed by a small number of SNPs, which supports the likelihood of
zoonotic transmission. Further analyses identified a number of genes and
mutations that may be associated with host interaction and virulence. This study
demonstrates that mecC-MRSA ST130 isolates are capable of transmission between
animals and humans, and underscores the potential of WGS in epidemiological
investigations and source tracking of bacterial infections. </div>
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The paper explained </div>
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PROBLEM:</div>
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The emergence of livestock-associated methicillin-resistant Staphylococcus
aureus (LA-MRSA) is a major public health concern. Recently, MRSA strains with a
novel mecA homologue (mecC), which may go undetected by current diagnostic
tests, were described in both livestock and humans suggesting potential zoonotic
transmission. Denmark has reported a significant increase in cases of CC130
mecC-MRSA between 2003 and 2011 and two independent human cases of mecC-MRSA
infection directly linked to a livestock reservoir have been identified.</div>
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RESULTS:</div>
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We investigated the molecular epidemiology of these livestockassociated
mecC-MRSA cases using WGS. Phylogenetic analysis across the entire core genome
revealed that the isolates from these cases form two distinct, farm-specific
clusters comprising near identical isolates from the human case and from
livestock on that farm. Within each cluster, the human and animal isolates only
differed by a small number of SNPs, which supports the premise of zoonotic
transmission. In-depth genome analysis identified a number of candidate genes
and mutations that may be associated with host–pathogen interactions and
virulence of this emerging MRSA clone.</div>
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IMPACT:</div>
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Our findings demonstrate that the CC130 MRSA lineage is capable of
transmission between animals and humans, further highlighting the role of
livestock as a reservoir for MRSA. Our study also underscores the potential of
WGS in epidemiological investigations and source tracking of bacterial
infections. </div>
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<a href="http://onlinelibrary.wiley.com/doi/10.1002/emmm.201202413/pdf">http://onlinelibrary.wiley.com/doi/10.1002/emmm.201202413/pdf</a>
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TSS</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-27557307364614297192013-01-02T10:08:00.002-08:002013-01-02T10:20:49.134-08:00New MRSA ST398 superbug strain found in UK milk Occupational risk factor<div>
Rapid communications</div>
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First detection of livestock-associated meticillinresistant Staphylococcus
aureus CC398 in bulk tank milk in the United Kingdom, January to July 2012</div>
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G K Paterson1, J Larsen2, E M Harrison1, A R Larsen2, F J Morgan1, S J
Peacock3,4, J Parkhill4, R N Zadoks5, M A Holmes (mah1@cam.ac.uk)1</div>
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1. Department of Veterinary Medicine, University of Cambridge, Cambridge,
United Kingdom</div>
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2. Microbiology and Infection Control, Statens Serum Institut, Copenhagen,
Denmark</div>
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3. School of Clinical Medicine, University of Cambridge, Cambridge, United
Kingdom</div>
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4. The Wellcome Trust Sanger Institute, Wellcome Trust, Cambridge, United
Kingdom</div>
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5. Moredun Research Institute, Penicuik, United Kingdom </div>
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Citation style for this article: </div>
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Paterson GK, Larsen J, Harrison EM, Larsen AR, Morgan FJ, Peacock SJ,
Parkhill J, Zadoks RN, Holmes MA. First detection of livestock-associated
meticillin-resistant Staphylococcus aureus CC398 in bulk tank milk in the United
Kingdom, January to July 2012. Euro Surveill. 2012;17(50):pii=20337. Available
online: <a href="http://www/">http://www</a>.
eurosurveillance.org/ViewArticle.aspx?ArticleId=20337 </div>
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Article submitted on 27 November 2012 / published on 13 December 2012
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Livestock-associated meticillin-resistant Staphylococcus aureus belonging
to clonal complex 398 (LA-MRSA CC398) is an important cause of zoonotic
infections in several countries, but there is only a single published report of
this lineage from the United Kingdom (UK). Here, we describe the isolation of
LA-MRSA CC398 from bulk tank milk from five geographically dispersed farms in
the UK. Our findings suggest that LA-MRSA CC398 is established in livestock in
the UK. Awareness of the potential occupational risks and surveillance in other
food-producing animal species should be promoted. </div>
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Isolation of meticillin-resistant Staphylococcus aureus from dairy
cattle</div>
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</div>
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<div>
During a study, performed from January to July 2012, to detect mecC
meticillin-resistant Staphylococcus aureus (MRSA) in dairy cattle in the United
Kingdom (UK), ca. 1,500 bulk tank milk samples were supplied by National Milk
Laboratories Ltd., (Chippenham, UK). These were collected aseptically by trained
technicians for quality assurance purposes and stored at 4 °C for up to five
days prior to testing. Enrichment for S. aureus was performed using a
modification of a published technique [1] omitting the incubation in phenol red
mannitol broth supplemented with 4 mg/L oxacillin (24 h at 37°C). Identification
of potential MRSA colonies (blue colour) was confirmed by subculture on Staph
Brilliance 24 plates (Oxoid, Baskingstoke, UK) and these were subsequently
screened for mecA, mecC and femB by multiplex PCR as described previously [2].
Approximately 300 potential MRSA colonies were identified and subjected to PCR
testing, yielding a total of seven mecA MRSA isolates from five farms, including
three isolates from the same farm. These isolates were found to be mecA,
femB-positive by PCR (Table). All seven isolates were resistant to penicillin,
meticillin and cefoxitin by disk diffusion according to the European Committee
on Antimicrobial Susceptibility Testing (EUCAST) guidelines [3]. </div>
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</div>
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</div>
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Molecular and phenotypic characterisation of LA-MRSA CC398 from dairy
cattle in the United Kingdom</div>
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<div>
Multi-locus sequence typing found all seven isolates belonged to sequence
type ST398, and CC398-specific PCR based on the restriction–modification system
sau1–hsdS1 confirmed that all the isolates belonged to clonal complex CC398 [4].
Isolates from three farms exhibited spa type t011 and carried a composite
staphylococcal cassette chromosome mec (SCCmec) V(5C2&5)c element, whereas
isolates from the remaining two farms had spa types t011 and t2546 and harboured
SCCmec IVa. All isolates lacked the lukS-PV and lukF-PV genes encoding
Panton-Valentine leukocidin and the scn gene (Table). Antimicrobial
susceptibility testing using disk diffusion according to the EUCAST guidelines
revealed that all isolates were resistant to tetracycline, and PCR [10]
demonstrated the presence of the tetracycline resistance gene tet(M) in all
seven, and of tet(K) in three isolates (Table). </div>
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Discussion</div>
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</div>
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<div>
Here we describe the first isolation of LA-MRSA CC398 from dairy cattle in
the UK. This is only the second published instance of LA-MRSA CC398 in this
country following the report of isolates (t011 and SCCmec IVa) from two horses
in south-eastern England [11]. In many countries in continental Europe and
elsewhere, LA-MRSA CC398 poses an occupational risk for those in close contact
with livestock, particularly pigs and veal calves. For instance, significantly
higher rates of MRSA nasal carriage by humans in contact with pigs (farm
workers, abattoir workers, veterinarians) have been noted in several
epidemiological studies, with the isolates typically belonging to CC398 [12-16].
Further studies have shown an association between clinical disease resulting
from LA-MRSA CC398 infection and contact with pigs or pig farms [16-20]. The
impact of this can be significant locally, and this lineage can be imported into
healthcare settings. For example, in a German hospital in an area with a large
number of pigs, 22% of patients colonised with MRSA at admission carried ST398
[21]. Nosocomial transmission has also been reported [22]. LA-MRSA CC398, like
other MRSA, may be responsible for life-threatening infections during long or
frequent hospitalisations, or following wound or surgery site infections, and
also increases healthcare costs resulting from screening, isolation of carriers,
and decolonisation. Although pasteurisation of milk should ensure that CC398
MRSA will not enter the food chain, our finding of LA-MRSA CC398 in dairy cattle
has clear public health implications for the UK. Workers on dairy farms, or
individuals with regular contact with dairy cows, are likely to have a higher
risk of colonisation or infection with LA-MRSA CC398 compared to the general
population in the UK. LA-MRSA CC398 isolates from three of the farms where
isolated were found carried SCCmec type IVa. The isolates from the other two
farms carried SCCmec type V(5C2&5) c. Both of these SCCmec types have
previously been found in LA-MRSA CC398 isolates [23]. </div>
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<div>
</div>
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</div>
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</div>
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<div>
Heterogeneity is seen in S. aureus CC398, with human and
livestock-associated lineages being differentiated by the presence or absence of
specific resistance and virulence-related genes [23-24]. In all of our isolates
the absence of the scn gene, encoding the humanspecific staphylococcal
complement inhibitor, and the presence of tet(M) suggested that they were all
livestock-associated, as opposed to S. aureus CC398 strains which circulate in
the human population independent of a livestock reservoir [23-24]. Likewise, all
seven isolates lacked the lukS-PV and lukF-PV genes encoding Panton-Valentine
leukocidin which is absent in LA-MRSA CC398, but is present in some, but not
all, human-associated CC398 isolates [23]. Three consecutive samples from the
same farm over a seven-month period were positive for LA-MRSA CC398 isolates
with identical spa (t011) and SCCmec types (IVa), suggesting that this strain is
able to persist in dairy herds over prolonged periods. While there are
relatively few reports of LA-MRSA CC398 from dairy cattle compared to pig farms,
it has been found to cause bovine mastitis [25-27]. Our findings therefore have
significance to veterinary medicine, in addition to public health. The relative
absence of CC398 MRSA from the UK prior to this study, when it is widespread in
the rest of Europe suggests that the geographical separation of the UK from
continental Europe may have delayed the spread of this lineage to the UK rather
than there being any fundamental difference in husbandry or biosecurity in the
UK. The authors are aware of unpublished surveys looking for potential LA-MRSA
in UK dairy and pig herds that have been negative before now. These
CC398-positive samples were not part of a formal prevalence study, and it is
therefore unclear how common LA-MRSA CC398 isolates are in UK dairy farms or if
they are present in other livestock. However, the five farms with positive
samples were identified from a sample of ca. 1,500 farms, indicating a low
prevalence currently. </div>
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<div>
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</div>
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<div>
Conclusions </div>
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<div>
</div>
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<div>
</div>
<br />
<div>
This is the first description of LA-MRSA CC398 in foodproducing animals in
the UK. The ability of this lineage to colonise a wide range of host species,
coupled with its zoonotic potential, make this finding of significance to both
veterinary and human health. Future surveillance for this LA-MRSA CC398 strain
in all food-producing animal species in the UK and the evaluation of
occupational risk factors for MRSA carriage and infection should be considered.
</div>
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SNIP.</div>
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<div>
Table Molecular and phenotypic characteristics of meticillin-resistant
Staphylococcus aureus CC398 from bulk tank milk in the United Kingdom, January
to July 2012 (n=7)</div>
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SNIP...</div>
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Acknowledgments </div>
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SNIP... </div>
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<a href="http://www.eurosurveillance.org/images/dynamic/EE/V17N50/art20337.pdf">http://www.eurosurveillance.org/images/dynamic/EE/V17N50/art20337.pdf</a>
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New MRSA superbug strain found in UK milk</div>
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84 21 712B/y Jeremy Laurance Wednesday, 26 December 2012 </div>
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A new strain of MRSA has been found in British milk, indicating that the
superbug is spreading through the livestock population and poses a growing
threat to human health. </div>
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The new strain, MRSA ST398, has been identified in seven samples of bulk
milk from five different farms in England. </div>
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The discovery, from tests on 1,500 samples, indicates that
antibiotic-resistant organisms are gaining an increasing hold in the dairy
industry. </div>
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The disclosure comes amid growing concern over the use of modern
antibiotics on British farms, driven by price pressure imposed by the big
supermarket chains. Intensive farming with thousands of animals raised in
cramped conditions means infections spread faster and the need for antibiotics
is consequently greater. </div>
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</div>
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Three classes of antibiotics rated as “critically important to human
medicine” by the World Health Organisation – cephalosporins, fluoroquinolones
and macrolides – have increased in use in the animal population by eightfold in
the last decade. </div>
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The more antibiotics are used, the greater the likelihood that
antibiotic-resistant bacteria, such as MRSA, will evolve. </div>
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</div>
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</div>
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<div>
Experts say there is no risk of MRSA infection to consumers of milk or
dairy products so long as the milk is pasteurised. The risk comes from
farmworkers, vets and abattoir workers, who may become infected through contact
with livestock and transmit the bug to others. </div>
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The discovery was made by scientists from Cambridge University who first
identified MRSA in milk in 2011. They say the latest finding of a different
strain is worrying. </div>
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</div>
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</div>
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<div>
Mark Holmes, of the department of veterinary medicine, who led the study,
published in Eurosurveillance, said: “This is definitely a worsening situation.
In 2011 when we first found MRSA in farm animals, the Department of Environment,
Food and Rural Affairs [Defra] initially didn’t believe it. They said we don’t
have MRSA in the dairy industry in this country.” </div>
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“Now we definitely have MRSA in livestock. What is curious is that it has
turned up in dairy cows when in other countries on the Continent it is
principally in pigs. Could it be in pigs or poultry in this country? We don’t
know.” </div>
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</div>
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The MRSA superbug can cause serious infections in humans which are
difficult to treat, require stronger antibiotics, and take longer to resolve.
Human cases of infection with the new strain have been found in Scotland and
northern England according to Defra, but no details are available. </div>
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</div>
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</div>
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Dr Holmes said supermarket pressure on farmers to hold down prices was
leading to the overuse of antibiotics to prevent cattle getting mastitis, an
infection of the udder, that might interrupt the milk supply. </div>
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“If farmers were not screwed into the ground by the supermarkets and
allowed to get a fair price for their milk they would be able to use fewer
antibiotics,” he said. </div>
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“Common sense tells us that anything we can do to reduce use of antibiotics
will reduce the growth of resistant bugs. We want to wean our farmers off
antibiotics and the only way we can do that is with better regulation.” </div>
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Vets in Norway and Denmark had much more limited prescribing powers than in
the UK, he added. </div>
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<div>
<a href="http://www.belfasttelegraph.co.uk/news/health/new-mrsa-superbug-strain-found-in-uk-milk-16254417.html">http://www.belfasttelegraph.co.uk/news/health/new-mrsa-superbug-strain-found-in-uk-milk-16254417.html</a>
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MRSA found in our milk: Superbug strain can cause serious infections in
humans and is resistant to antibiotics</div>
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Scientists tested 1,500 samples of bulk milk and found seven cases of MRSA
ST398 from five farms in England, Scotland and Wales</div>
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The superbug can cause serious and occasionally deadly infections in humans
</div>
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<div>
By Sean Poulter PUBLISHED:19:52 EST, 20 December 2012| UPDATED: 02:46 EST,
21 December 2012 Comments (47) Share </div>
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. . A potentially deadly MRSA superbug has been found in British milk for
the first time.</div>
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</div>
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The superbug – already a problem in farm animals on the Continent – can
cause serious and occasionally deadly infections in humans and is becoming a
cause of udder infections in dairy cows.</div>
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The strain of MRSA known as ST398 is resistant to antibiotics, so doctors
find it difficult to treat infected people effectively. </div>
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Superbug: A strain of MRSA has been found in British milk for the first
time In theory the bug should be killed off when milk is heat-treated in the
pasteurisation process before it reaches the high street or doorstep. However,
some people prefer unpasteurised milk and cheese in the belief it is better for
them or tastes nicer. </div>
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</div>
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</div>
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<div>
More... Exterminate! Doctor Who-villain lookalike robot taking on superbugs
could save NHS £200 million per year Scientists halt deadly MRSA outbreak by
cracking genetic code and tracking down carrier in breakthrough that could save
hundreds of lives each year </div>
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</div>
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And farmers, vets and abattoir workers who come into contact with the cows
and their calves can become infected, allowing the bug to spread into the wider
community. That has happened in the Netherlands where the same strain of MRSA
has caused illness among nursing home residents. </div>
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</div>
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MRSA ST398 was first seen in pigs in Holland in 2003. It has since become
epidemic in European and North American pig populations and has spread to
poultry and cattle.</div>
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</div>
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<div>
It is one of a number of superbugs that have emerged in recent years,
apparently as a result of the overuse of antibiotics by farmers treating sick
animals. Over time the farm animal bugs develop a resistance. </div>
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</div>
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Strain: Farmers, vets and abbatoir workers who come into contact with cows
and their calves can become infected The Soil Association, which campaigns for
organic farming, is calling for a government investigation to establish the
spread of the MRSA and a crackdown on the use of antibiotics on UK farms.</div>
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</div>
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</div>
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<div>
Scientists from the department of veterinary medicine at the University of
Cambridge tested 1,500 samples of bulk milk and found seven cases of MRSA ST398
from five farms in England, Scotland and Wales.</div>
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</div>
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</div>
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<div>
They said the high level of antibiotic resistance in the bug means the
findings are ‘of significance to both veterinary and human health’. Dr Mark
Holmes, a senior lecturer in preventive veterinary medicine, said the discovery
was made while looking for a different strain of MRSA found in cows and
people.</div>
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<div>
He said: ‘Until this discovery it was always assumed that this form of
livestock MRSA was a problem on the Continent, but it has now jumped the
Channel. It now seems that it is established in this country – perhaps one in
every 200 farms.</div>
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‘If it ends up becoming more commonplace it will, sooner or later, cause
disease in people here.’</div>
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Dr Holmes said the major question is why MRSA is appearing in farm animals
and whether this is linked to intensive farming and the associated heavy use of
antibiotics.</div>
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He asked: ‘Should we be thinking again about the type and range of
antibiotics we use in farm animals? Is it wise to have a lot of preventive use
of antibiotics, particularly in dairy cows?</div>
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</div>
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</div>
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‘They get a lot of mastitis – udder infection – because they are driven
hard to produce a lot of milk, which is the only way farmers can make
money.</div>
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‘I think you have to look at the pressures the supermarkets create by
screwing the farmers down so tightly on costs.’ </div>
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<div>
<a href="http://www.dailymail.co.uk/health/article-2251417/MRSA-milk-Superbug-strain-cause-infections-humans-resistant-antibiotics.html?ito=feeds-newsxml">http://www.dailymail.co.uk/health/article-2251417/MRSA-milk-Superbug-strain-cause-infections-humans-resistant-antibiotics.html?ito=feeds-newsxml</a>
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Letter </div>
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<div>
Lethal Necrotizing Pneumonia Caused by an ST398 Staphylococcus aureus
Strain</div>
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<span style="color: black;"></span> </div>
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<div>
<a href="http://wwwnc.cdc.gov/eid/article/16/8/10-0317_article.htm" title="http://wwwnc.cdc.gov/eid/article/16/8/10-0317_article.htm">http://wwwnc.cdc.gov/eid/article/16/8/10-0317_article.htm</a></div>
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Letter </div>
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</div>
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<div>
Ventilator-associated Pneumonia and MRSA ST398, Italy</div>
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<a href="http://wwwnc.cdc.gov/eid/article/16/4/09-1584_article.htm" title="http://wwwnc.cdc.gov/eid/article/16/4/09-1584_article.htm">http://wwwnc.cdc.gov/eid/article/16/4/09-1584_article.htm</a></div>
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Letter </div>
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</div>
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<div>
Livestock-associated Methicillin-Susceptible Staphylococcus aureus ST398
Infection in Woman, Colombia</div>
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<a href="http://wwwnc.cdc.gov/eid/article/17/10/11-0638_article.htm" title="http://wwwnc.cdc.gov/eid/article/17/10/11-0638_article.htm">http://wwwnc.cdc.gov/eid/article/17/10/11-0638_article.htm</a></div>
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Letter </div>
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Suspected Horse-to-Human Transmission of MRSA ST398</div>
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<a href="http://wwwnc.cdc.gov/eid/article/17/6/10-1330_article.htm" title="http://wwwnc.cdc.gov/eid/article/17/6/10-1330_article.htm">http://wwwnc.cdc.gov/eid/article/17/6/10-1330_article.htm</a></div>
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</div>
<br />
<div>
Letter </div>
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<div>
</div>
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<div>
</div>
<br />
<div>
Lethal Necrotizing Pneumonia Caused by an ST398 Staphylococcus aureus
Strain</div>
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</div>
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<div>
</div>
<br />
<div>
<a href="http://wwwnc.cdc.gov/eid/article/17/6/10-1394_article.htm" title="http://wwwnc.cdc.gov/eid/article/17/6/10-1394_article.htm">http://wwwnc.cdc.gov/eid/article/17/6/10-1394_article.htm</a></div>
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<div>
Dispatch </div>
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</div>
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<div>
Methicillin-Resistant Staphylococcus aureus ST398 in Swine Farm Personnel,
Belgium</div>
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</div>
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</div>
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<div>
<a href="http://wwwnc.cdc.gov/eid/article/15/7/08-0652_article.htm" title="http://wwwnc.cdc.gov/eid/article/15/7/08-0652_article.htm">http://wwwnc.cdc.gov/eid/article/15/7/08-0652_article.htm</a></div>
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</div>
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<div>
Dispatch </div>
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</div>
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</div>
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<div>
Staphylococcus aureus ST398, New York City and Dominican Republic</div>
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</div>
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Abstract</div>
<br />
<div>
</div>
<br />
<div>
Closely related Staphylococcus aureus strains of ST398, an
animal-associated strain, were identified in samples collected from humans in
northern Manhattan, New York, NY, USA, and in the Dominican Republic. A large
population in northern Manhattan has close ties to the Dominican Republic,
suggesting international transmission. </div>
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</div>
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<a href="http://wwwnc.cdc.gov/eid/article/15/2/08-0609_article.htm" title="http://wwwnc.cdc.gov/eid/article/15/2/08-0609_article.htm">http://wwwnc.cdc.gov/eid/article/15/2/08-0609_article.htm</a></div>
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Letter </div>
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</div>
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</div>
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<div>
Methicillin-Resistant Staphylococcus aureus ST398, Italy</div>
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</div>
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</div>
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</div>
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<div>
<a href="http://wwwnc.cdc.gov/eid/article/16/2/09-1478_article.htm" title="http://wwwnc.cdc.gov/eid/article/16/2/09-1478_article.htm">http://wwwnc.cdc.gov/eid/article/16/2/09-1478_article.htm</a></div>
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Monday, April 18, 2011</div>
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</div>
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<div>
Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry </div>
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<div>
</div>
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</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a>
</div>
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</div>
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Wednesday, May 11, 2011 </div>
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</div>
<br />
<div>
Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit,
Michigan, USA </div>
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</div>
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<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a>
</div>
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</div>
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Thursday, June 9, 2011 </div>
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</div>
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<div>
New Superbug Found in Cows and People </div>
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<div>
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a>
</div>
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<div>
Thursday, August 12, 2010</div>
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<div>
</div>
<br />
<div>
Escherichia coli sequence type ST131 as the major cause of serious
multidrug-resistant E. coli infections in the United States</div>
<br />
<div>
</div>
<br />
<div>
Clin Infect Dis. 2010 Aug 1;51(3):286-94. </div>
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</div>
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<div>
</div>
<br />
<div>
<a href="http://staphmrsa.blogspot.com/2010/08/escherichia-coli-sequence-type-st131-as.html">http://staphmrsa.blogspot.com/2010/08/escherichia-coli-sequence-type-st131-as.html</a>
</div>
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</div>
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</div>
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<div>
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a>
</div>
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<div>
</div>
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<div>
</div>
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<div>
</div>
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</div>
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<div>
MRSA damn near killed me in 2001 after one of my many neck surgeries, and
it’s some nasty stuff. 8 weeks vancomycin straight through top of heart via PIC
long line, twice daily, and the vanco almost stopped working, had to double dose midway
through. ...</div>
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<div>
</div>
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</div>
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</div>
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<div>
NOW, today we have VRSA. no telling where that will take us...</div>
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</div>
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</div>
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</div>
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<div>
</div>
<br />
<div>
Comparative Genomics of Vancomycin-Resistant Staphylococcus aureus Strains
and Their Positions within the Clade Most Commonly Associated with
Methicillin-Resistant S. aureus Hospital-Acquired Infection in the United States
</div>
<br />
<div>
</div>
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<div>
</div>
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<div>
</div>
<br />
<div>
doi: 10.1128/mBio.00112-12 22 May 2012 mBio vol. 3 no. 3 e00112-12 </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Veronica N. Kosa,b, Christopher A. Desjardinsb, Allison Griggsb, Gustavo
Cerqueirab, Andries Van Tonderc, Matthew T. G. Holdenc, Paul Godfreyb, Kelli L.
Palmera, Kip Bodid, Emmanuel F. Mongodine, Jennifer Wortmanb, Michael
Feldgardenb, Trevor Lawleyc, Steven R. Gillf, Brian J. Haasb, Bruce Birrenb, and
Michael S. Gilmorea,b </div>
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<div>
</div>
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<div>
</div>
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<div>
</div>
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</div>
<br />
<div>
Address correspondence to Michael S. Gilmore, <a href="mailto:michael_gilmore@meei.harvard.edu">michael_gilmore@meei.harvard.edu</a>.
</div>
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<div>
</div>
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<div>
</div>
<br />
<div>
Editor Paul Keim, Northern Arizona University </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
ABSTRACT</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Methicillin-resistant Staphylococcus aureus (MRSA) strains are leading
causes of hospital-acquired infections in the United States, and clonal cluster
5 (CC5) is the predominant lineage responsible for these infections. Since 2002,
there have been 12 cases of vancomycin-resistant S. aureus (VRSA) infection in
the United States—all CC5 strains. To understand this genetic background and
what distinguishes it from other lineages, we generated and analyzed
high-quality draft genome sequences for all available VRSA strains. Sequence
comparisons show unambiguously that each strain independently acquired Tn1546
and that all VRSA strains last shared a common ancestor over 50 years ago, well
before the occurrence of vancomycin resistance in this species. In contrast to
existing hypotheses on what predisposes this lineage to acquire Tn1546, the
barrier posed by restriction systems appears to be intact in most VRSA strains.
However, VRSA (and other CC5) strains were found to possess a constellation of
traits that appears to be optimized for proliferation in precisely the types of
polymicrobic infection where transfer could occur. They lack a bacteriocin
operon that would be predicted to limit the occurrence of non-CC5 strains in
mixed infection and harbor a cluster of unique superantigens and lipoproteins to
confound host immunity. A frameshift in dprA, which in other microbes influences
uptake of foreign DNA, may also make this lineage conducive to foreign DNA
acquisition. </div>
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<div>
</div>
<br />
<div>
</div>
<br />
<div>
IMPORTANCE </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Invasive methicillin-resistant Staphylococcus aureus (MRSA) infection now
ranks among the leading causes of death in the United States. Vancomycin is a
key last-line bactericidal drug for treating these infections. However, since
2002, vancomycin resistance has entered this species. Of the now 12 cases of
vancomycin-resistant S. aureus (VRSA), each was believed to represent a new
acquisition of the vancomycin-resistant transposon Tn1546 from enterococcal
donors. All acquisitions of Tn1546 so far have occurred in MRSA strains of the
clonal cluster 5 genetic background, the most common hospital lineage causing
hospital-acquired MRSA infection. To understand the nature of these strains, we
determined and examined the nucleotide sequences of the genomes of all available
VRSA. Genome comparison identified candidate features that position strains of
this lineage well for acquiring resistance to antibiotics in mixed infection.
</div>
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<div>
</div>
<br />
<div>
</div>
<br />
<div>
Footnotes</div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Citation Kos VN, et al. 2012. Comparative genomics of vancomycin-resistant
Staphylococcus aureus strains and their positions within the clade most commonly
associated with methicillin-resistant S. aureus hospital-acquired infection in
the United States. mBio 3(3):e00112-12. doi:10.1128/mBio.00112-12. </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
Received 13 April 2012 Accepted 24 April 2012 Published 22 May 2012
Copyright © 2012 Kos et al. </div>
<br />
<div>
</div>
<br />
<div>
</div>
<br />
<div>
This is an open-access article distributed under the terms of the Creative
Commons Attribution-Noncommercial-Share Alike 3.0 Unported License, which
permits unrestricted noncommercial use, distribution, and reproduction in any
medium, provided the original author and source are credited. </div>
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<div>
</div>
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<div>
</div>
<br />
<div>
</div>
<br />
<div>
<a href="http://mbio.asm.org/content/3/3/e00112-12.abstract?ijkey=62c72c08cb3a7e98a5ad4dfb729ea6a7c25480c4&keytype2=tf_ipsecsha" title="http://mbio.asm.org/content/3/3/e00112-12.abstract?ijkey=62c72c08cb3a7e98a5ad4dfb729ea6a7c25480c4&keytype2=tf_ipsecsha">http://mbio.asm.org/content/3/3/e00112-12.abstract?ijkey=62c72c08cb3a7e98a5ad4dfb729ea6a7c25480c4&keytype2=tf_ipsecsha</a></div>
<div>
</div>
<div>
</div>
<div>
</div>
<div>
</div>
<div>
</div>
<div>
TSS</div>
Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-19173440861146690382012-04-08T10:36:00.000-07:002012-04-08T10:36:13.630-07:00US FDA told to stop certain antibiotics being used as growth promotersSubject: US FDA told to stop certain antibiotics being used as growth promoters<br />
<br />
Veterinary Record2012;170:348 doi:10.1136/vr.e2472 <br />
<br />
News & Reports <br />
<br />
Antibiotic Resistance <br />
<br />
US FDA told to stop certain antibiotics being used as growth promoters<br />
<br />
A FEDERAL court in the USA has ruled that the US Food and Drug Administration (FDA) should start proceedings to withdraw the approval of certain uses of antibiotics used in food production. <br />
<br />
The ruling, by United States Magistrate Judge Theodore H. Katz on March 22, relates to what the FDA currently refers to as ‘production uses’ of penicillins and tetracyclines in food-producing … <br />
<br />
<br />
<br />
<br />
<br />
<a href="http://veterinaryrecord.bmj.com/content/170/14/348.2.extract?etoc">http://veterinaryrecord.bmj.com/content/170/14/348.2.extract?etoc</a><br />
<br />
<br />
<br />
<br />
<br />
<br />
Staphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin Resistance in Livestock <br />
<br />
<br />
<br />
Lance B. Pricea, Marc Steggerb, Henrik Hasmanc, Maliha Aziza, Jesper Larsenb, Paal Skytt Andersenb, Talima Pearsond, Andrew E. Watersa, Jeffrey T. Fosterd, James Schuppa, John Gillecea, Elizabeth Driebea, Cindy M. Liua,d, Burkhard Springere, Irena Zdovcf, Antonio Battistig, Alessia Francog, Jacek Żmudzkih, Stefan Schwarzi, Patrick Butayej,k, Eric Jouyl, Constanca Pombam, M. Concepción Porreron, Raymond Ruimyo, Tara C. Smithp, D. Ashley Robinsonq, J. Scott Weeser, Carmen Sofia Arriolas, Fangyou Yut, Frederic Laurentu, Paul Keima,d, Robert Skovb, and Frank M. Aarestrupc <br />
<br />
+ Author Affiliations <br />
<br />
snip...<br />
<br />
<br />
Address correspondence to Lance B. Price, lprice@tgen.org. <br />
<br />
Editor Fernando Baquero, Ramón y Cajal University Hospital <br />
<br />
<br />
<br />
ABSTRACT <br />
<br />
Since its discovery in the early 2000s, methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 (CC398) has become a rapidly emerging cause of human infections, most often associated with livestock exposure. We applied whole-genome sequence typing to characterize a diverse collection of CC398 isolates (n = 89), including MRSA and methicillin-susceptible S. aureus (MSSA) from animals and humans spanning 19 countries and four continents. We identified 4,238 single nucleotide polymorphisms (SNPs) among the 89 core genomes. Minimal homoplasy (consistency index = 0.9591) was detected among parsimony-informative SNPs, allowing for the generation of a highly accurate phylogenetic reconstruction of the CC398 clonal lineage. Phylogenetic analyses revealed that MSSA from humans formed the most ancestral clades. The most derived lineages were composed predominantly of livestock-associated MRSA possessing three different staphylococcal cassette chromosome mec element (SCCmec) types (IV, V, and VII-like) including nine subtypes. The human-associated isolates from the basal clades carried phages encoding human innate immune modulators that were largely missing among the livestock-associated isolates. Our results strongly suggest that livestock-associated MRSA CC398 originated in humans as MSSA. The lineage appears to have undergone a rapid radiation in conjunction with the jump from humans to livestock, where it subsequently acquired tetracycline and methicillin resistance. Further analyses are required to estimate the number of independent genetic events leading to the methicillin-resistant sublineages, but the diversity of SCCmec subtypes is suggestive of strong and diverse antimicrobial selection associated with food animal production. <br />
<br />
<br />
<br />
IMPORTANCE <br />
<br />
Modern food animal production is characterized by densely concentrated animals and routine antibiotic use, which may facilitate the emergence of novel antibiotic-resistant zoonotic pathogens. Our findings strongly support the idea that livestock-associated MRSA CC398 originated as MSSA in humans. The jump of CC398 from humans to livestock was accompanied by the loss of phage-carried human virulence genes, which likely attenuated its zoonotic potential, but it was also accompanied by the acquisition of tetracycline and methicillin resistance. Our findings exemplify a bidirectional zoonotic exchange and underscore the potential public health risks of widespread antibiotic use in food animal production. <br />
<br />
<br />
<br />
Footnotes <br />
<br />
Citation Price LB, et al. 2012. Staphylococcus aureus CC398: host adaptation and emergence of methicillin resistance in livestock. mBio 3(1):e00305-11. doi:10.1128/mBio.00305-11. <br />
<br />
Received 19 December 2011 Accepted 3 January 2012 Published 21 February 2012 Copyright © 2012 Price et al. <br />
<br />
<br />
<br />
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. <br />
<br />
<br />
<br />
<a href="http://mbio.asm.org/content/3/1/e00305-11.abstract?etoc">http://mbio.asm.org/content/3/1/e00305-11.abstract?etoc</a> <br />
<br />
<br />
<br />
<br />
<br />
<a href="http://mbio.asm.org/content/3/1/e00305-11.full.pdf+html">http://mbio.asm.org/content/3/1/e00305-11.full.pdf+html</a> <br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
Thursday, March 1, 2012<br />
<br />
<br />
Staphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin Resistance in Livestock <br />
<br />
<br />
<br />
<a href="http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html">http://staphmrsa.blogspot.com/2012/03/staphylococcus-aureus-cc398-host.html</a><br />
<br />
<br />
<br />
<br />
<br />
<br />
<br />
SEE ALSO ; <br />
<br />
<br />
<br />
Tuesday, January 17, 2012<br />
<br />
In-feed antibiotic effects on the swine intestinal microbiome <br />
<br />
<a href="http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html">http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html</a> <br />
<br />
<br />
<br />
<br />
<br />
Thursday, February 9, 2012<br />
<br />
Occurrence and distribution of Staphylococcus aureuslineages among zoo animals <br />
<br />
<a href="http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html">http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html</a> <br />
<br />
<br />
<br />
<br />
<br />
<br />
Thursday, June 9, 2011<br />
<br />
New Superbug Found in Cows and People <br />
<br />
<a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a> <br />
<br />
<br />
<br />
<br />
<br />
Wednesday, May 11, 2011<br />
<br />
Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USA <br />
<br />
<a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a> <br />
<br />
<br />
<br />
<br />
<br />
Monday, April 18, 2011<br />
<br />
Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry <br />
<br />
<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a> <br />
<br />
<br />
<br />
<br />
<br />
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a> <br />
<br />
<br />
<br />
<br />
TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-80444191940365189532012-03-01T14:33:00.000-08:002012-03-01T14:33:31.589-08:00Staphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin Resistance in LivestockStaphylococcus aureus CC398: Host Adaptation and Emergence of Methicillin Resistance in Livestock <br />
<br />
<br />
<br />
Lance B. Pricea, Marc Steggerb, Henrik Hasmanc, Maliha Aziza, Jesper Larsenb, Paal Skytt Andersenb, Talima Pearsond, Andrew E. Watersa, Jeffrey T. Fosterd, James Schuppa, John Gillecea, Elizabeth Driebea, Cindy M. Liua,d, Burkhard Springere, Irena Zdovcf, Antonio Battistig, Alessia Francog, Jacek Żmudzkih, Stefan Schwarzi, Patrick Butayej,k, Eric Jouyl, Constanca Pombam, M. Concepción Porreron, Raymond Ruimyo, Tara C. Smithp, D. Ashley Robinsonq, J. Scott Weeser, Carmen Sofia Arriolas, Fangyou Yut, Frederic Laurentu, Paul Keima,d, Robert Skovb, and Frank M. Aarestrupc <br />
<br />
+ Author Affiliations <br />
<br />
snip...<br />
<br />
<br />
Address correspondence to Lance B. Price, lprice@tgen.org. <br />
<br />
Editor Fernando Baquero, Ramón y Cajal University Hospital <br />
<br />
<br />
<br />
ABSTRACT <br />
<br />
Since its discovery in the early 2000s, methicillin-resistant Staphylococcus aureus (MRSA) clonal complex 398 (CC398) has become a rapidly emerging cause of human infections, most often associated with livestock exposure. We applied whole-genome sequence typing to characterize a diverse collection of CC398 isolates (n = 89), including MRSA and methicillin-susceptible S. aureus (MSSA) from animals and humans spanning 19 countries and four continents. We identified 4,238 single nucleotide polymorphisms (SNPs) among the 89 core genomes. Minimal homoplasy (consistency index = 0.9591) was detected among parsimony-informative SNPs, allowing for the generation of a highly accurate phylogenetic reconstruction of the CC398 clonal lineage. Phylogenetic analyses revealed that MSSA from humans formed the most ancestral clades. The most derived lineages were composed predominantly of livestock-associated MRSA possessing three different staphylococcal cassette chromosome mec element (SCCmec) types (IV, V, and VII-like) including nine subtypes. The human-associated isolates from the basal clades carried phages encoding human innate immune modulators that were largely missing among the livestock-associated isolates. Our results strongly suggest that livestock-associated MRSA CC398 originated in humans as MSSA. The lineage appears to have undergone a rapid radiation in conjunction with the jump from humans to livestock, where it subsequently acquired tetracycline and methicillin resistance. Further analyses are required to estimate the number of independent genetic events leading to the methicillin-resistant sublineages, but the diversity of SCCmec subtypes is suggestive of strong and diverse antimicrobial selection associated with food animal production. <br />
<br />
<br />
<br />
IMPORTANCE <br />
<br />
Modern food animal production is characterized by densely concentrated animals and routine antibiotic use, which may facilitate the emergence of novel antibiotic-resistant zoonotic pathogens. Our findings strongly support the idea that livestock-associated MRSA CC398 originated as MSSA in humans. The jump of CC398 from humans to livestock was accompanied by the loss of phage-carried human virulence genes, which likely attenuated its zoonotic potential, but it was also accompanied by the acquisition of tetracycline and methicillin resistance. Our findings exemplify a bidirectional zoonotic exchange and underscore the potential public health risks of widespread antibiotic use in food animal production. <br />
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Footnotes <br />
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Citation Price LB, et al. 2012. Staphylococcus aureus CC398: host adaptation and emergence of methicillin resistance in livestock. mBio 3(1):e00305-11. doi:10.1128/mBio.00305-11. <br />
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Received 19 December 2011 Accepted 3 January 2012 Published 21 February 2012 Copyright © 2012 Price et al. <br />
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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported License, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author and source are credited. <br />
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<a href="http://mbio.asm.org/content/3/1/e00305-11.abstract?etoc">http://mbio.asm.org/content/3/1/e00305-11.abstract?etoc</a> <br />
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<a href="http://mbio.asm.org/content/3/1/e00305-11.full.pdf+html">http://mbio.asm.org/content/3/1/e00305-11.full.pdf+html</a> <br />
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SEE ALSO ; <br />
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Tuesday, January 17, 2012<br />
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In-feed antibiotic effects on the swine intestinal microbiome <br />
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<a href="http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html">http://staphmrsa.blogspot.com/2012/01/in-feed-antibiotic-effects-on-swine.html</a> <br />
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Thursday, February 9, 2012<br />
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Occurrence and distribution of Staphylococcus aureuslineages among zoo animals <br />
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<a href="http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html">http://staphmrsa.blogspot.com/2012/02/occurrence-and-distribution-of.html</a> <br />
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Thursday, June 9, 2011<br />
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New Superbug Found in Cows and People <br />
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<a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a> <br />
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Wednesday, May 11, 2011<br />
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Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USA <br />
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<a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a> <br />
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Monday, April 18, 2011<br />
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Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry <br />
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<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a> <br />
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<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a> <br />
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TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-6595367259821621102012-02-09T13:47:00.000-08:002012-02-09T13:47:28.714-08:00Occurrence and distribution of Staphylococcus aureuslineages among zoo animals<div><a class="cLink" href="http://www.sciencedirect.com/science/article/pii/S0378113512000855?v=s5" querystr="?&_rdoc=7&_fmt=high&_origin=browse&_srch=cid(271229)%20AND%20(itemstage(S5)%20OR%20itemstage(S100)%20OR%20itemstage(S200))&_docanchor=&_ct=188&_zone=rslt_list_item&md5=f1e0ac254226cf66c11ec6f373b7e27c"><span><span style="font-family: Times New Roman;">Occurrence and distribution of <span><em>Staphylococcus aureus</em></span> lineages among zoo animals</span></span></a></div><br />
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<div><span style="font-family: Times New Roman;"><span style="white-space: nowrap;"><span style="color: #7e7e7e; font-size: 11.1pt;">Original Research Article</span></span></span></div><br />
<div><span style="color: #7e7e7e; font-family: Times New Roman;"><span style="white-space: nowrap;"></span></span> </div><span style="font-family: Times New Roman;"><span style="white-space: nowrap;"><span style="color: #7e7e7e;"></span></span> </span><br />
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<i><b><span style="color: red;">In Press, Accepted Manuscript</span></b></i>, <i>Available online 2 February 2012</i></div><br />
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Carmen Espinosa-Gongora, Dorota Chrobak, Arshnee Moodley, Mads Frost Bertelsen, Luca Guardabassi</div></span><div><br />
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<div class="articleText_indent" style="line-height: 14pt;"> <h3 class="h3" style="clear: both; margin: 0px 0px 8px;"><span style="font-family: Arial;"><span style="font-size: 9.9pt;">Abstract</span></span></h3><div class="h3" style="clear: both; margin: 0px 0px 8px;"> </div><div class="h3" style="clear: both; margin: 0px 0px 8px;"> </div><span style="font-family: Arial;"><span style="font-size: 9pt;">The current knowledge of the occurrence and diversity of <em>Staphylococcus aureus</em> in animals is largely biased in favour MRSA and domestic animals. In order to generate novel information on the ecology and population structure of this bacterial species in the animal kingdom, we investigated the occurrence and genotypic diversity of <em>S. aureus</em> in a range of animal species kept at the Copenhagen Zoo. We sampled 146 animals belonging to 25 mammalian species and 21 reptiles belonging to six species. A total of 59 <em>S. aureus</em> isolates were found in 10 of the 25 mammalian species tested. All isolates were MSSA belonging to fourteen <em>spa</em> types, including three novel <em>spa</em> types. MLST revealed the occurrence of seven STs. The study of the ecology of commensal <em>S. aureus</em> in captive wild animals revealed that ST133 has a broader host range than previously thought.</span></span></div><br />
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<div><a href="http://www.sciencedirect.com/science/journal/aip/03781135" title="http://www.sciencedirect.com/science/journal/aip/03781135">http://www.sciencedirect.com/science/journal/aip/03781135</a></div><br />
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<div>Thursday, June 9, 2011</div><br />
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<div>New Superbug Found in Cows and People </div><br />
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<div><a href="wlmailhtml:{DF7DDD7C-C70A-41E4-A8B1-D5D27F4F623C}mid://00000681/!x-usc:http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a> </div><br />
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<div>Wednesday, May 11, 2011</div><br />
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<div>Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USA </div><br />
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<div><a href="wlmailhtml:{DF7DDD7C-C70A-41E4-A8B1-D5D27F4F623C}mid://00000681/!x-usc:http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a> </div><br />
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<div>Monday, April 18, 2011</div><br />
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<div>Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry </div><br />
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<div><a href="wlmailhtml:{DF7DDD7C-C70A-41E4-A8B1-D5D27F4F623C}mid://00000681/!x-usc:http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a> </div><br />
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<div><a href="wlmailhtml:{DF7DDD7C-C70A-41E4-A8B1-D5D27F4F623C}mid://00000681/!x-usc:http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a></div><br />
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<div> </div><div> </div><div>TSS</div><br />
<div> </div>Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-82371601626203568572012-01-17T19:40:00.001-08:002012-01-17T19:40:50.183-08:00In-feed antibiotic effects on the swine intestinal microbiome<div>In-feed antibiotic effects on the swine intestinal microbiome </div><br />
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<div> Torey Loofta,1, Timothy A. Johnsonb,c,1, Heather K. Allena,1, Darrell O. Baylesa, David P. Alta, Robert D. Stedtfeldb,d, Woo Jun Sulb,c, Tiffany M. Stedtfeldb, Benli Chaib, James R. Coleb, Syed A. Hashshamb,d, James M. Tiedjeb,c,2, and Thad B. Stantona,2 aAgricultural Research Service, National Animal Disease Center, US Department of Agriculture, Ames, IA 50010; and bCenter for Microbial Ecology, cDepartment of Crop and Soil Science, and dDepartment of Civil and Environmental Engineering, Michigan State University, East Lansing, MI 48823 </div><br />
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<div> Contributed by James M. Tiedje, December 19, 2011 (sent for review July 12, 2011) </div><br />
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<div> Antibiotics have been administered to agricultural animals for disease treatment, disease prevention, and growth promotion for over 50 y. The impact of such antibiotic use on the treatment of human diseases is hotly debated. We raised pigs in a highly controlled environment, with one portion of the littermates receiving a diet containing performance-enhancing antibiotics [chlortetracycline, sulfamethazine, and penicillin (known as ASP250)] and the other portion receiving the same diet but without the antibiotics. We used phylogenetic, metagenomic, and quantitative PCR-based approaches to address the impact of antibiotics on the swine gut microbiota. Bacterial phylotypes shifted after 14 d of antibiotic treatment, with the medicated pigs showing an increase in Proteobacteria (1–11%) compared with nonmedicated pigs at the same time point. This shift was driven by an increase in Escherichia coli populations. Analysis of the metagenomes showed that microbial functional genes relating to energy production and conversion were increased in the antibiotic-fed pigs. The results also indicate that antibiotic resistance genes increased in abundance and diversity in the medicated swine microbiome despite a high background of resistance genes in nonmedicated swine. Some enriched genes, such as aminoglycoside O-phosphotransferases, confer resistance to antibiotics that were not administered in this study, demonstrating the potential for indirect selection of resistance to classes of antibiotics not fed. The collateral effects of feeding subtherapeutic doses of antibiotics to agricultural animals are apparent and must be considered in cost-benefit analyses. </div><br />
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<div> intestinal microbiota | microbiome shifts | swine bacteria | BioTrove microarray | metagenomics </div><br />
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<div>Conclusions </div><br />
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<div> The results show that even a low, short-term dose of in-feed antibiotics increases the abundance and diversity of antibiotic resistance genes, including resistance to antibiotics not administered, and increases the abundance of E. coli, a potential human pathogen. Additionally, analysis of the metagenomes implicated functions potentially involved with improved feed efficiency. The study design featured environmental control in a single uniform inoculum source (the mother), control of the host genetics, no exposure of the sow or piglets to antibiotics except for the treatment, and identical diet except for the inclusion of ASP250 in one group. Future studies should include other in-feed antibiotics, multiple litters of swine with robust replication, and the identification of the antibiotic-induced mechanisms that lead to increased feed efficiency. Implications of antibiotic resistance on human and animal health need to be taken into account when discussing agricultural management policies and evaluating alternatives to traditional antibiotics. With the use of antibiotics in animal agriculture at a crossroads, studies like this and others that highlight the collateral effects of antibiotic use are needed. </div><br />
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<div><a href="http://news.msu.edu/media/documents/2012/01/23219e73-d86c-49b3-a4d0-ae4effc5d55c.pdf">http://news.msu.edu/media/documents/2012/01/23219e73-d86c-49b3-a4d0-ae4effc5d55c.pdf</a> </div><br />
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<div>Study provides new insights into antibiotics and pig feeds Contact: Layne Cameron, University Relations, Office: (517) 353-8819, Cell: (765) 748-4827, layne.cameron@ur.msu.edu; Thad Stanton, USDA-ARS National Animal Disease Center, Office: (515) 337-7244, thad.stanton@ars.usda.gov; James Tiedje, Crop and Soil Sciences, Office: (517) 355-0271, ext. 1287, tiedjej@msu.edu</div><br />
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<div>Published: Jan. 16, 2012 E-mail Editor ShareThis</div><br />
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<div> Jim Tiedje, University Distinguished professor of microbiology and molecular genetics, is the co-author of a comprehensive study on antibiotics use in pig feed. Photo by Kurt Stepnitz.</div><br />
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<div> Antibiotics in pig feed are increasing antibiotic resistance genes in gastronintestinal microbes in pigs. Photo courtesy of MSU.</div><br />
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<div>Click on an image to view a larger or high-resolution version.</div><br />
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<div>Related Links PNAS paper (opens in new window) EAST LANSING, Mich. — Antibiotics in pig feed increased the number of antibiotic resistant genes in gastrointestinal microbes in pigs, according to a study conducted by Michigan State University and the U.S. Department of Agriculture’s Agricultural Research Service.</div><br />
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<div>Published in the current edition of the Proceedings of the National Academy of Sciences, the comprehensive study focused on understanding the effects of conventional, in-feed antibiotics in U.S. farms.</div><br />
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<div>For decades, many producers of pigs, chickens and other farm animals have used antibiotics not only to protect their livestock from disease, but also to boost growth rates and enhance feed efficiency, a measure of how well animals convert feed into weight gains.</div><br />
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<div>Scientists don’t know precisely how antibiotics enhance growth rates and feed efficiency, but they are concerned that on-farm use of these medications may contribute to the development of strains of microbes resistant to conventional antibiotics, which are potentially harmful to humans and animals, said James Tiedje, MSU University Distinguished Professor of microbiology and molecular genetics and of crop and soil sciences.</div><br />
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<div>“The growth of antibiotic resistance in pathogens is a huge challenge for society around the world,” said Tiedje, an MSU AgBioResearch scientist. “Studies to understand what contributes to the spread and what interventions can help control the problem are vital.”</div><br />
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<div>Additional findings include:</div><br />
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<div>Both diversity and abundance of antibiotic resistance genes increased in the intestinal microbial communities of the pigs treated with antibiotics. Longer term studies are needed. Some of the genes found in the treated pigs were unexpected and usually linked to antibiotics not used in the study. Microbial genes associated with production and use of energy by microbes increased in abundance in the antibiotic-fed pigs, which may shed light on how antibiotics increase livestock growth and feed efficiency. E. coli populations increased in the intestines of the treated pigs. Further study is needed to clarify this observation. “To our knowledge, this study is the first of its kind to look at the collateral impacts of in-feed antibiotic use in farm animals, using a comprehensive approach to detect shifts in the function and the makeup or membership of the microbial community in the model animal’s gastrointestinal tract,” said Torey Looft, USDA researcher.</div><br />
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<div>Additional MSU researchers included Tim Johnson, doctoral student; Robert Stedtfeld, civil and environmental engineering research associate; Woo Jun Sul, doctoral student; Tiffany Stedtfeld, civil and environmental engineering technical aide; Benli Chai, information technologist, Center for Microbial Ecology; James Cole, assistant professor at the Center for Microbial Ecology; and Syed Hashsham, civil and environmental engineering professor.</div><br />
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<div>Funding was provided by MSU’s Environmental Science and Policy Program initiative on Pharmaceuticals in the Environment, ARS and the National Institutes of Health and through the Alliance for the Prudent Use of Antibiotics program on Reservoirs of Antibiotic Resistance.</div><br />
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<div>Michigan State University has been working to advance the common good in uncommon ways for more than 150 years. One of the top research universities in the world, MSU focuses its vast resources on creating solutions to some of the world’s most pressing challenges, while providing life-changing opportunities to a diverse and inclusive academic community through more than 200 programs of study in 17 degree-granting colleges.</div><br />
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<div>As the USDA’s chief scientific research agency, ARS is leading America toward a better future through agricultural research and information. ARS conducts research to develop and transfer solutions to help answer agricultural questions that impact Americans every day. </div><br />
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<div><a href="http://news.msu.edu/story/10214/">http://news.msu.edu/story/10214/</a> </div><br />
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<div>Thursday, June 9, 2011</div><br />
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<div>New Superbug Found in Cows and People </div><br />
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<div><a href="http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html">http://staphmrsa.blogspot.com/2011/06/new-superbug-found-in-cows-and-people.html</a> </div><br />
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<div>Wednesday, May 11, 2011</div><br />
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<div>Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USA </div><br />
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<div><a href="http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/05/methicillin-resistant-staphylococcus.html</a> </div><br />
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<div>Monday, April 18, 2011</div><br />
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<div>Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry </div><br />
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<div><a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a> </div><br />
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<div><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a></div><br />
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<div>TSS</div>Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-57025819979115548782011-06-09T14:22:00.000-07:002011-06-09T14:22:39.011-07:00New Superbug Found in Cows and PeopleNew Superbug Found in Cows and People<br />
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by Jocelyn Kaiser on 2 June 2011, 6:30 PM| <br />
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A novel form of deadly drug-resistant bacteria that hides from a standard test has turned up in Europe. Researchers found the so-called MRSA strain in both dairy cows and humans in the United Kingdom, suggesting that it might be passed from dairies to the general population. But before you toss your milk, don't panic: The superbug isn't a concern in pasteurized dairy products.<br />
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MRSA, short for methicillin-resistant Staphylococcus aureus, is a drug-resistant form of the widespread and normally harmless S. aureus bacteria. Many people walk around with MRSA in their noses or on their skin yet don't get sick. But in some hospital patients and people with weakened immune systems, MRSA thrives, and it is blamed for about 19,000 hospital deaths a year in the United States.<br />
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Mark Holmes of the University of Cambridge in the United Kingdom and colleagues stumbled upon the new strain while studying mastitis, or infected udders, in U.K. dairy cows. Some milk samples from sick cows contained S. aureus bacteria that grew in the presence of antibiotics, which is one test for MRSAs. Yet the same samples turned up negative for the drug-defying bacterium when the team used PCR, a DNA amplification technique, to detect a gene called mecA, which is found in all MRSA strains.<br />
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The PCR test doesn't always pick up variants of the gene it's meant to detect, however. To check this, the researchers sent a cow S. aureus sample to the Wellcome Trust Sanger Institute in Cambridge, which sequenced the bacterium's entire genome. "Lo and behold, there was a mecA gene there," one whose sequence overlapped with the better-known mecA by a surprisingly low 60%, Holmes said today in a press conference.<br />
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The researchers then looked for this mecA gene in people. They tested 74 samples of S. aureus isolated from people from the United Kingdom and Denmark that were drug resistant in the antibiotic growth test but not in the PCR test—most from carriers but some from patients who were sickened by MRSA. They found the new mecA in about two-thirds of the samples, they report today in The Lancet Infectious Diseases. A nearly identical mecA gene has also now been reported in human samples from Germany and Ireland.<br />
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The strain is still relatively rare—it probably makes up less than 1% of all detected MRSA cases, the U.K. team says. But its prevalence appears to have risen in the past decade. "More likely it's been around in the environment for a long time, and it's just getting into the human population," says University College Dublin microbiologist David Coleman, whose team reports on the Irish samples today in Antimicrobial Agents and Chemotherapy.<br />
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The new superbug probably isn't leading to missed infections, at least in the United Kingdom, because hospitals that suspect a patient is infected with an MRSA nearly always use the antibiotic growth test in addition to PCR, Holmes says. (Patients with a confirmed infection then receive antibiotics that work on MRSAs.) However, many hospitals in continental Europe are moving toward using only PCR tests; this is a warning that those tests need to be modified to test for the new mecA gene, Holmes says.<br />
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The study also points to dairy cows as a possible reservoir for the bug, just as pigs seem to pass MRSA to humans in the Netherlands. The bug probably doesn't get to humans through the milk supply, because almost all milk in the United Kingdom and Denmark is pasteurized, a process that kills bacteria. But workers who come into contact with infected dairy cows could be carriers. Holmes's team reports "circumstantial evidence" for this, such as the fact that genetic subtypes of the human and cow samples from the same geographical areas were nearly identical. "The main worry would be that these cows represent a pool of the bacteria" that farm workers spread into the human population, Holmes says.<br />
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The big mystery, says Patrick Schlievert of the University of Minnesota, Twin Cities, is where the unusual mecA gene came from. One possibility is that it originated long ago in a patient treated with multiple antibiotics and later somehow got into cows. "This should trigger an awful lot of research to figure out what is going on here," he says.<br />
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<a href="http://news.sciencemag.org/sciencenow/2011/06/new-superbug-found-in-cows-and-p.html?ref=hp">http://news.sciencemag.org/sciencenow/2011/06/new-superbug-found-in-cows-and-p.html?ref=hp</a><br />
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The Lancet Infectious Diseases, Early Online Publication, 3 June 2011<br />
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doi:10.1016/S1473-3099(11)70126-8Cite or Link Using DOI<br />
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Meticillin-resistant Staphylococcus aureus with a novel mecA homologue in human and bovine populations in the UK and Denmark: a descriptive study<br />
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Laura García-Álvarez PhD a, Matthew TG Holden PhD b, Heather Lindsay BSc a, Cerian R Webb PhD a, Derek FJ Brown PhD c, Martin D Curran PhD c, Enid Walpole FIMLS c, Karen Brooks BSc b, Derek J Pickard PhD b, Christopher Teale MRCVS d, Prof Julian Parkhill PhD b, Stephen D Bentley PhD b, Giles F Edwards FRCPath e, E Kirsty Girvan MSc e, Angela M Kearns PhD f, Bruno Pichon PhD f, Robert LR Hill PhD f, Anders Rhod Larsen PhD g, Robert L Skov MD g, Prof Sharon J Peacock PhD h, Prof Duncan J Maskell PhD a, Dr Mark A Holmes VetMB a<br />
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Summary<br />
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Background<br />
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Animals can act as a reservoir and source for the emergence of novel meticillin-resistant Staphylococcus aureus (MRSA) clones in human beings. Here, we report the discovery of a strain of S aureus (LGA251) isolated from bulk milk that was phenotypically resistant to meticillin but tested negative for the mecA gene and a preliminary investigation of the extent to which such strains are present in bovine and human populations.<br />
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Methods<br />
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Isolates of bovine MRSA were obtained from the Veterinary Laboratories Agency in the UK, and isolates of human MRSA were obtained from diagnostic or reference laboratories (two in the UK and one in Denmark). From these collections, we searched for mecA PCR-negative bovine and human S aureus isolates showing phenotypic meticillin resistance. We used whole-genome sequencing to establish the genetic basis for the observed antibiotic resistance.<br />
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Findings<br />
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A divergent mecA homologue (mecALGA251) was discovered in the LGA251 genome located in a novel staphylococcal cassette chromosome mec element, designated type-XI SCCmec. The mecALGA251 was 70% identical to S aureus mecA homologues and was initially detected in 15 S aureus isolates from dairy cattle in England. These isolates were from three different multilocus sequence type lineages (CC130, CC705, and ST425); spa type t843 (associated with CC130) was identified in 60% of bovine isolates. When human mecA-negative MRSA isolates were tested, the mecALGA251 homologue was identified in 12 of 16 isolates from Scotland, 15 of 26 from England, and 24 of 32 from Denmark. As in cows, t843 was the most common spa type detected in human beings.<br />
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Interpretation<br />
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Although routine culture and antimicrobial susceptibility testing will identify S aureus isolates with this novel mecA homologue as meticillin resistant, present confirmatory methods will not identify them as MRSA. New diagnostic guidelines for the detection of MRSA should consider the inclusion of tests for mecALGA251.<br />
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Funding<br />
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Department for Environment, Food and Rural Affairs, Higher Education Funding Council for England, Isaac Newton Trust (University of Cambridge), and the Wellcome Trust.<br />
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a Department of Veterinary Medicine, University of Cambridge, UK<br />
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b The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Cambridge, UK<br />
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c Health Protection Agency, Addenbrooke's Hospital, Cambridge, UK<br />
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d Veterinary Laboratories Agency, Shrewsbury, UK<br />
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e Scottish MRSA Reference Laboratory, NHS Greater Glasgow and Clyde, Stobhill Hospital, Glasgow, UK<br />
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f Microbiology Services Division, Health Protection Agency, London, UK<br />
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g Department of Antimicrobial Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark<br />
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h Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK<br />
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Correspondence to: Dr Mark A Holmes, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, UK<br />
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<a href="http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70126-8/abstract">http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70126-8/abstract</a><br />
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<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br />
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TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-58666602627693360732011-05-11T20:53:00.000-07:002011-05-13T13:40:41.631-07:00Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USADOI: 10.3201/eid1706.101095<br />
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Suggested citation for this article: Bhargava K, Wang X, Donabedian S, Zervos M, da Rocha L, Zhang Y. Methicillin-resistant Staphylococcus aureus in retail meat, Detroit, Michigan, USA [letter]. Emerg Infect Dis. 2011 Jun; [Epub ahead of print]<br />
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Methicillin-resistant Staphylococcus aureus in Retail Meat, Detroit, Michigan, USA<br />
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To the Editor: Because methicillin-resistant Staphylococcus aureus (MRSA) has been identified in retail meat worldwide (1–4), the potential exists for its transmission to humans. Of the various meat products surveyed, pork had the highest contamination rate in the United States and Canada (1,2), as did beef in Korea (3) and poultry in the Netherlands (4). The study in Korea also observed MRSA from chicken, which demonstrated sequence type (ST) 692 by multilocus sequence typing (MLST), a type distinct from that isolated in beef and pork. Despite sample size variations, these studies suggested that MRSA contamination in different meat categories can vary by location and that molecular distinction may exist among MRSA isolates in meat of different origin.<br />
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We collected 289 raw meat samples (156 beef, 76 chicken, and 57 turkey) from 30 grocery stores in Detroit, Michigan, USA, during August 2009–January 2010. Up to 3 presumptive S. aureus colonies per sample were identified by coagulase test and species-specific PCR (1). Antimicrobial drug MICs were determined and interpreted according to Clinical and Laboratory Standards Institute guidelines (5). S. aureus were characterized by pulsed-field gel electrophoresis (PFGE), mecA identification, SCCmec typing, Panton-Valentine leukocidin identification, agr typing, MLST, and spa typing as described (1,6).<br />
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Sixty-five (22.5%) samples yielded S. aureus: 32 beef (20.5%), 19 chicken (25.0%), and 14 turkey (24.6%) samples. Six samples, consisting of 2 beef (1.3%), 3 chickens (3.9%), and 1 turkey (1.7%), were positive for MRSA as evidenced by the presence of mecA. The overall lower prevalence of S. aureus and MRSA than found in a previous study in the United States (40% and 5%, respectively) (1) might be explained by our exclusion of pork because pork and swine production have been major reservoirs of MRSA (4,7). However, different geographic location Page 2 of 4<br />
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and cold sampling seasons in this study also might have caused the variations. The only multidrug-resistant MRSA isolate in this study (MRSA1) was from beef and was resistant to ß-lactams, macrolides, and fluoroquinolones (Figure).<br />
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Although an extra band was generated in MRSA2a, 2b, 3, 5, and 6 by PFGE, all 9 MRSA isolates belonged to USA300 (Figure). Multiple isolates from the same samples (MRSA2a and 2b; MRSA4a, 4b, and 4c) demonstrated indistinguishable PFGE patterns and other characteristics, which suggested identical MRSA clones. Moreover, MLST, SCCmec typing, agr typing, and pvl detection showed all strains to be positive for ST8, SCCmec IVa, agr I, and Panton-Valentine leukocidin, which are typical characteristics of USA300 clones. However, spa typing identified 2 distinct spa types, t008 (11–19–12-21–17-34–24–34–22–25) and t2031 (11–19–12-12–34-34–24–34–22–25) (repeat variants in boldface), which differed by 5 nucleotides. t008, the most common spa type of USA300, was identified in 6 isolates of beef, chicken, and turkey origin, whereas t2031 was recovered from MRSA4a, 4b, and 4c from a chicken sample. The nucleotide variation in t2031 caused amino acid changes from glycine-asparagine in t008 to asparagine-lysine. The single nucleotide difference between repeats 12 (GGT) and 21 (GGC) and repeats 34 (AAA) and 17 (AAG) resulted in no amino acid change, with glycine and lysine encoded, respectively.<br />
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Unlike studies in Europe, where researchers have reported the animal MRSA clone ST398 from various meat products (4), all MRSA isolates in our study were USA300, which suggests a possible human source of contamination during meat processing (1). The failure to identify ST398 in the US retail meat also indicates that the human MRSA clones might be better adapted in meat processing than ST398 in this country. Since ST398 is widespread in animals and meat in Europe and has been isolated from other parts of the world (8), it is not too bold to predict that ST398 might appear in US meat in the future, especially after the recent report of ST398 from US swine (7).<br />
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The 5-nt difference between t2031 and t008 implicates multiple MRSA clones in poultry. Previous studies have shown spa variants of USA300 from clinical cases associated with distinctive symptoms (9,10). A single repeat variant, t024, showed substantial genetic, epidemiologic, and clinical differences from t008 in Denmark (10). Researchers in Japan also recovered 2 spa variants of USA300: t024, which causes blood infections, and t711, which is Page 3 of 4<br />
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associated with subcutaneous abscesses (9). In both studies, t024 behaved as hospital-associated MRSA, suggesting that spa variants of USA300 could lead to different clinical outcomes. Therefore, we can reasonably assume that variants with a meat origin also might have different public health implications; further research on their virulence potential would be helpful to elucidate this possibility.<br />
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Despite the recovery of MRSA from retail chicken and t2031 that has an antibiogram distinct from t008, except for ß-lactam resistance, several questions remain about whether more spa variants are present in poultry (or meat). These include whether t2031 is more adaptable to chicken production because of the 2 amino acid difference from t008, or whether t2031 is linked with specific antimicrobial drug resistance phenotypes other than ß-lactam resistance.<br />
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Kanika Bhargava, Xiaogang Wang, Susan Donabedian, Marcus Zervos, Liziane da Rocha, and Yifan Zhang<br />
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Author affiliations: Wayne State University, Detroit, Michigan, USA (K. Bhargava, X. Wang, L. da Rocha, Y. Zhang) and Henry Ford Health Systems, Detroit (S. Donabedian, M. Zervos)<br />
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References<br />
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1. Pu S, Han F, Ge B. Isolation and characterization of methicillin-resistant Staphylococcus aureus strains from Louisiana retail meats. Appl Environ Microbiol. 2009;75:265–7. PubMed doi:10.1128/AEM.01110-08<br />
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2. Weese JS, Avery BP, Reid-Smith RJ. Detection and quantification of methicillin-resistant Staphylococcus aureus (MRSA) clones in retail meat products. Lett Appl Microbiol. 2010;51:338–42. PubMed doi:10.1111/j.1472-765X.2010.02901.x<br />
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3. Lim SK, Nam HM, Park HJ, Lee HS, Choi MJ, Jung SC, et al. Prevalence and characterization of methicillin-resistant Staphylococcus aureus in raw meat in Korea. J Microbiol Biotechnol. 2010;20:775–8. PubMed<br />
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4. de Boer E, Zwartkruis-Nahuis JT, Wit B, Huijsdens XW, de Neeling AJ, Bosch T, et al. Prevalence of methicillin-resistant Staphylococcus aureus in meat. Int J Food Microbiol. 2009;134:52–6. PubMed doi:10.1016/j.ijfoodmicro.2008.12.007<br />
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5. Clinical and Laboratory Standards Institute. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically, 7th ed. Wayne (PA): The Institute; 2006. Page 4 of 4<br />
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6. Strommenger B, Cuny C, Werner G, Witte W. Obvious lack of association between dynamics of epidemic methicillin-resistant Staphylococcus aureus in central Europe and agr specificity groups. Eur J Clin Microbiol Infect Dis. 2004;23:15–9. PubMed doi:10.1007/s10096-003-1046-8<br />
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7. Smith TC, Male MJ, Harper AL, Kroeger JS, Tinkler GP, Moritz ED, et al. Methicillin-resistant Staphylococcus aureus (MRSA) strain ST398 is present in midwestern U.S. swine and swine workers. PLoS ONE. 2009;4:e4258. PubMed doi:10.1371/journal.pone.0004258<br />
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8. Weese JS, Reid-Smith R, Rousseau J, Avery B. Methicillin-resistant Staphylococcus aureus (MRSA) contamination of retail pork. Can Vet J. 2010;51:749–52. PubMed<br />
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9. Higuchi W, Mimura S, Kurosawa Y, Takano T, Iwao Y, Yabe S, et al. Emergence of the community-acquired methicillin-resistant Staphylococcus aureus USA300 clone in a Japanese child, demonstrating multiple divergent strains in Japan. J Infect Chemother. 2010;16:292–7. PubMed doi:10.1007/s10156-010-0051-y<br />
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10. Larsen AR, Goering R, Stegger M, Lindsay JA, Gould KA, Hinds J, et al. Two distinct clones of methicillin-resistant Staphylococcus aureus (MRSA) with the same USA300 pulsed-field gel electrophoresis profile: a potential pitfall for identification of USA300 community-associated MRSA. J Clin Microbiol. 2009;47:3765–8. PubMed doi:10.1128/JCM.00934-09<br />
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Address for correspondence: Yifan Zhang, Department of Nutrition and Food Science, Wayne State University, 3009 Science Hall, 5045 Cass Ave, Detroit, MI 48202, USA; email: yifanzhang@wayne.edu<br />
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Figure. Dendrogram showing comparison of SmaI pulsed-field gel electrophoresis patterns, SCCmec type, PVL content, and agr type of methicillin-resistant Staphylococcus aureus (MRSA) isolated from meat samples. All MRSA isolates were resistant to ß-lactam antimicrobial drugs (ampicillin, penicillin, and oxacillin) and grew on the 6 µg/mL of cefoxitin for screening methicillin resistance. *Isolates with the same arabic numbers were from the same sample; †only resistance to non–ß-lactam antimicrobial drugs was listed. ID, identification; MLST, multilocus sequence typing; PVL, Panton-Valentine leukocidin; CIP, ciprofloxacin; ERY, erythromycin; LEVO, levofloxacin; TET, tetracycline.<br />
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<a href="http://www.cdc.gov/eid/content/17/6/pdfs/10-1905.pdf">http://www.cdc.gov/eid/content/17/6/pdfs/10-1905.pdf</a><br />
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May 11, 2011<br />
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Human-type MRSA found in Detroit raw meat<br />
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Researchers testing retail meat samples in Detroit found that almost a fourth contained Staphylococcus aureus and 2% contained methicillin-resistant S aureus (MRSA). In a letter to Emerging Infectious Diseases today, the scientists report that they collected 289 raw meat samples (156 beef, 76 chicken, and 57 turkey) from 30 grocery stores from August 2009 through January 2010. Of those samples, 65 (22.5%) yielded S aureus via coagulase test and polymerase chain reaction (PCR): 32 beef (20.5%), 19 chicken (25.0%), and 14 turkey (24.6%) samples. Six samples (2 beef [1.3%], 3 chicken [3.9%], and 1 turkey [1.7%]), were positive for MRSA, while only one sample, a beef one, contained multidrug-resistant MRSA. Furthermore, the MRSA was the human type, USA300, which the authors said could indicate a human rather than animal source of meat contamination. They said similar studies in European meat typically show ST398, an animal MRSA clone. They noted that the percentage of positive MRSA samples is lower than in an earlier study in Louisiana meat, perhaps because the Michigan researchers didn't test pork, noting that swine production has been identified as a reservoir of MRSA. They wrote that although USA300 might be better adapted to meat processing in the United States, ST398 might someday appear as a contaminant in US meat, given its recent identification in US swine.<br />
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<a href="http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/may1111newsscan.html">http://www.cidrap.umn.edu/cidrap/content/fs/food-disease/news/may1111newsscan.html</a><br />
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Monday, April 18, 2011<br />
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Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry<br />
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<a href="http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html">http://staphmrsa.blogspot.com/2011/04/multidrug-resistant-staphylococcus.html</a><br />
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Tuesday, May 10, 2011<br />
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Food safety for whom? Corporate wealth versus people's health<br />
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<a href="http://fdafailedus.blogspot.com/2011/05/food-safety-for-whom-corporate-wealth.html">http://fdafailedus.blogspot.com/2011/05/food-safety-for-whom-corporate-wealth.html</a><br />
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Horizon Acres 3/18/11<br />
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Department of Health and Human Services Public Health Service Food and Drug Administration Cincinnati District Office Central Region 6751 Steger Drive Cincinnati, OH 45237-30977 Telephone: (513) 679-2700 FAX: (513) 679-2761<br />
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WARNING LETTER CIN-11-65585-06<br />
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March 18, 2011<br />
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United Parcel Service<br />
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Mr. Kenneth D. Weaver, General Manager Horizon Acres 6728 Zuercher Road <br />
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Dalton, Ohio 44618<br />
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Dear Mr. Weaver:<br />
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On November 10, 12, 19,24, 2010, and December 20, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your veal calf operation located at 6728 Zuercher Road, Dalton, Ohio 44618. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov1.<br />
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We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
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Specifically, our investigation revealed that on or about June 22, 2010, you sold an unidentified, untagged veal calf for slaughter as food. On or about June 22, 2010, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence 0.28 parts per million (ppm) of flunixin in the liver tissue. FDA has established a tolerance of 0.125 ppm for residues of flunixin in the liver of cattle as codified in 21 C.F.R. 556.286(b)(1)(i). However, this tolerance does not apply to use of Suppressor (flunixin meglumine) Injectable Solution, ANADA 200-308, in veal calves (pre-ruminating calves), and there is no acceptable level of residue associated with use of flunixin meglumine in veal calves (pre-ruminating calves). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
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Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records and segregate treated animals. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
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We also found that you adulterated the new animal drugs Suppressor (flunixin meglumine) ANADA 200-308, Dexamethasone ANADA 200-312, Ceftiflex sterile powder (ceftiofur sodium) ANADA 200-420, PennOne Pro (penicillin G procaine) NADA 65-010, Amoxicillin capsules NDC 65862-017-05, Sulfamethoxazole and Trimethoprim Double Strength tablets NDC 53746-272-05 (SMZ-TMP tablets), and Pennchlor 64 (chlortetracycline HCI) ANADA 200-295. Specifically, our investigation revealed that you did not use these drugs as directed by their approved labeling. Use of these drugs in this manner is an extralabel use. 21 C.F.R. § 530.3(a).<br />
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The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
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Our investigation found that you administered flunixin meglumine to veal calves without following the withdrawal period as stated in the approved labeling. Your extralabel use of flunixin meglumine was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a) and your extralabel use of flunixin meglumine resulted in an illegal drug residue, in violation of 21 C.F.R. § 530.11(c).<br />
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Our investigation found that you administered dexamethasone to veal calves without following the route of administration and the withdrawal period as stated in the approved labeling. Your extralabel use of Dexamethasone was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11 (a).<br />
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Our investigation found that you administered ceftiofur sodium to veal calves without following the withdrawal period as stated in the approved labeling. Your extralabel use of ceftiofur sodium was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a).<br />
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Our investigation found that you administered penicillin G procaine to veal calves without following the route of administration and the withdrawal period as stated in the approved labeling. Your extralabel use of penicillin G procaine was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a).<br />
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Our investigation found that you administered amoxicillin and sulfamethoxazole and trimethoprim (SMZ-TMP) to veal calves without following the route of administration and duration of the treatment as stated in their approved labeling. Your extralabel use of Amoxicillin and SMZ-TMP were not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11 (a) and your use of amoxicillin and SMZ-TMP in or on feed, is in violation of 21 C.F.R. § 530.11(b).<br />
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Our investigation found that you administered chlortetracycline HCI to veal calves without following the duration of treatment. Your use of chlortetracycline HCI was not under the supervision of a licensed veterinarian, and is in violation of 21 C.F.R. § 530.11<br />
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(a) and your use of pennchlor 64 in or on feed, is in violation of 21 C.F.R. § 530.11<br />
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(b). Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug(s) to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5).<br />
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In addition, you adulterated the liquid animal feed within the meaning of section 501(a)(6) of the FD&C Act, 21 U.S.C. § 351(a)(6), when you added sulfamethoxazole and trimethoprim, Amoxicillin, and chlortetracycline HCI, and you failed to use the medicated feed in conformance with its approved labeling. Your use of this medicated feed without following the animal class as directed by the approved labeling caused this medicated feed to be unsafe under section 512(a)(2) of the FD&C Act, 21 U.S.C. § 360b(a)(2), and adulterated under section 501(a)(6) of the FD&C Act, 21 U.S.C. § 351(a)(6). Section 512 of the FD&C Act, 21 U.S.C. § 360b, and 21 C.F.R. 530.11(b) do not permit the extralabel use of medicated feed.<br />
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The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
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You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
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You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. <br />
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Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
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Your written response should be sent to Allison C. Hunter, Compliance Officer, U.S. Food and Drug Administration, 6751 Steger Drive, Cincinnati, Ohio 45237. If you have any questions about this letter, please contact Compliance Officer Hunter at 513-679-2700 ext. 134.<br />
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Sincerely yours, /S/<br />
<br />
Teresa Thompson District Director Cincinnati District<br />
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<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2011/ucm248212.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/2011/ucm248212.htm</a><br />
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p.s. update prion disease ;<br />
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Sunday, May 01, 2011<br />
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STUDY OF ATYPICAL BSE 2010 Annual Report May 2011<br />
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<a href="http://bse-atypical.blogspot.com/2011/05/study-of-atypical-bse-2010-annual.html">http://bse-atypical.blogspot.com/2011/05/study-of-atypical-bse-2010-annual.html</a><br />
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Saturday, March 5, 2011<br />
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MAD COW ATYPICAL CJD PRION TSE CASES WITH CLASSIFICATIONS PENDING ON THE RISE IN NORTH AMERICA<br />
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<a href="http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html">http://transmissiblespongiformencephalopathy.blogspot.com/2011/03/mad-cow-atypical-cjd-prion-tse-cases.html</a><br />
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TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-19948631780051939402011-04-18T15:03:00.000-07:002011-04-29T18:34:42.713-07:00Multidrug-Resistant Staphylococcus aureus in US Meat and PoultryMultidrug-Resistant Staphylococcus aureus in US Meat and Poultry<br />
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Andrew E. Waters,1 Tania Contente-Cuomo,1 Jordan Buchhagen,1 Cindy<br />
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M. Liu,1,2 Lindsey Watson,1 Kimberly Pearce,1 Jeffrey T. Foster,2<br />
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Jolene Bowers,1 Elizabeth M. Driebe,1 David M. Engelthaler,1 Paul<br />
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S. Keim,1,2 and Lance B. Price1<br />
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1Division of Pathogen Genomics, Translational Genomics Research Institute, and<br />
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2Center for Microbial Genetics and Genomics, Northern Arizona University,<br />
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Flagstaff, Arizona<br />
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We characterized the prevalence, antibiotic susceptibility profiles, and genotypes of Staphylococcus aureus among US meat and poultry samples (n 5 136). S. aureus contaminated 47% of samples, and multidrug resistance was common among isolates (52%). S. aureus genotypes and resistance profiles differed significantly among sample types, suggesting food animal–specific contamination.<br />
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Antimicrobials are used extensively in food animal production, where they are often applied subtherapeutically for growth promotion and routine disease prevention [1]. Surveys conducted by the National Antimicrobial Resistance Monitoring System (NARMS) indicate that retail meat and poultry products are frequently contaminated with multidrug-resistant Campylobacter species, Salmonella species, Enterococcus species, and Escherichia coli [2]; but little is known about the prevalence of other antibiotic-resistant pathogens in the US food supply. Staphylococcus aureus is among the most prevalent causes of clinical infections globally and has garnered substantial public attention due to increasing mortality associated with multidrug resistance. A new multidrug-resistant S. aureus strain, ST398, has emerged that predominantly colonizes people working in food animal production. First discovered in 2003, ST398 now makes up a substantial proportion of the community-acquired methicillin-resistant S. aureus (MRSA) cases in the Netherlands [3]. Multiple studies have demonstrated the high prevalence of multidrug-resistant S. aureus, including ST398, among intensively raised swine in the European Union, Canada, and the United States [4, 5], but few studies have been conducted to measure its prevalence in US food products [6]. In the current study, we evaluated the prevalence and antibiotic susceptibility profiles of S. aureus in retail meat and poultry samples from 5 US cities. We found that S. aureus contamination was common among the samples and that distinct S. aureus populations were associated with each meat and poultry type. We further demonstrated the prevalence of multidrug resistance, including resistance to clinically important antibiotics such as ciprofloxacin, quinupristin/dalfopristin, clindamycin, erythromycin, oxacillin, and daptomycin.<br />
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snip...<br />
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Our data demonstrate that retail meat and poultry are frequently contaminated with multidrug-resistant S. aureus, but the public health relevance of this finding is unclear. European and North American studies indicate that ST398 can successfully colonize and infect humans [4, 10], but few studies have investigated the risk of human colonization and infection with S. aureus from meat and poultry products [11, 12]. The European Food Safety Authority (EFSA) concluded that the risk for MRSA infection from food handling and consumption was low; however, this was based on a small number of studies [11]. Furthermore, EFSA did not evaluate the risk from methicillinsusceptible multidrug-resistant S. aureus, which is more common than MRSA among food samples.<br />
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Conventional concentrated animal feeding operations (CAFOs) provide all the necessary components for the emergence and proliferation of multidrug-resistant zoonotic pathogens. In the United States, billions of food animals are raised in densely stocked CAFOs, where antibiotics are routinely administered in feed and water for extended periods to healthy animals [1]. NARMS has shown that multidrug-resistant E. coli and Enterococcus species are prevalent among US meat and poultry products [2]. Our findings indicate that multidrug-resistant S. aureus should be added to the list of antimicrobial-resistant pathogens that routinely contaminate our food supply.<br />
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<a href="http://cid.oxfordjournals.org/content/early/2011/04/14/cid.cir181.full.pdf+html">http://cid.oxfordjournals.org/content/early/2011/04/14/cid.cir181.full.pdf+html</a><br />
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Study Title: Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry Study<br />
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Abstract: We characterized the prevalence, antibiotic susceptibility profiles, and genotypes of Staphylococcus aureus among US meat and poultry samples (n = 136). S. aureus contaminated 47% of samples, and multidrug resistance was common among isolates (52%). S. aureus genotypes and resistance profiles differed significantly among sample types, suggesting food animal–specific contamination.<br />
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From press release:<br />
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Drug-resistant strains of Staphylococcus aureus, a bacteria linked to a wide range of human diseases, are present in meat and poultry from U.S. grocery stores at unexpectedly high rates, according to a nationwide study by the Translational Genomics Research Institute (TGen).<br />
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Nearly half of the meat and poultry samples—47 percent—were contaminated with S. aureus, and more than half of those bacteria—52 percent—were resistant to at least three classes of antibiotics, according to the study published April 15 in the journal Clinical Infectious Diseases.<br />
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This is the first national assessment of antibiotic resistant S. aureus in the U.S. food supply. And, DNA testing suggests that the food animals themselves were the major source of contamination.<br />
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Although Staph should be killed with proper cooking, it may still pose a risk to consumers through improper food handling and cross-contamination in the kitchen.<br />
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Researchers collected and analyzed 136 samples—covering 80 brands—of beef, chicken, pork and turkey from 26 retail grocery stores in five U.S. cities: Los Angeles, Chicago, Fort Lauderdale, Flagstaff and Washington, D.C.<br />
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“For the first time, we know how much of our meat and poultry is contaminated with antibiotic-resistant Staph, and it is substantial,” said Lance B. Price, Ph.D., senior author of the study and Director of TGen’s Center for Food Microbiology and Environmental Health.<br />
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“The fact that drug-resistant S. aureus was so prevalent, and likely came from the food animals themselves, is troubling, and demands attention to how antibiotics are used in food-animal production today,” Dr. Price said.<br />
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Densely-stocked industrial farms, where food animals are steadily fed low doses of antibiotics, are ideal breeding grounds for drug-resistant bacteria that move from animals to humans, the report says.<br />
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“Antibiotics are the most important drugs that we have to treat Staph infections; but when Staph are resistant to three, four, five or even nine different antibiotics—like we saw in this study—that leaves physicians few options,” Dr. Price said.<br />
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“The emergence of antibiotic-resistant bacteria—including Staph—remains a major challenge in clinical medicine,” said Paul S. Keim, Ph.D., Director of TGen’s Pathogen Genomics Division and Director of the Center for Microbial Genetics and Genomics at Northern Arizona University (NAU).<br />
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“This study shows that much of our meat and poultry is contaminated with multidrug-resistant Staph. Now we need to determine what this means in terms of risk to the consumer,” said Dr. Keim, a co-author of the paper.<br />
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The U.S. government routinely surveys retail meat and poultry for four types of drug-resistant bacteria, but S. aureus is not among them. The paper suggests that a more comprehensive inspection program is needed.<br />
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S. aureus can cause a range of illnesses from minor skin infections to life-threatening diseases, such as pneumonia, endocarditis and sepsis.<br />
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The study was supported through a grant from The Pew Charitable Trusts as part of The Pew Campaign on Human Health and Industrial Farming.<br />
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Study Information: Andrew E. Waters, Tania Contente-Cuomo, Jordan Buchhagen, Cindy M. Liu, Lindsey Watson, Kimberly Pearce, Jeffrey T. Foster, Jolene Bowers, Elizabeth M. Driebe, David M. Engelthaler, Paul S. Keim, and Lance B. Price. Multidrug-Resistant Staphylococcus aureus in US Meat and Poultry Clinical Infectious Diseases 2011 April Center for Microbial Genetics and Genomics, Northern Arizona University, Flagstaff, Arizona.<br />
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Full Study: <a href="http://cid.oxfordjournals.org/content/early/2011/04/14/cid.cir181.full.pdf+html">http://cid.oxfordjournals.org/content/early/2011/04/14/cid.cir181.full.pdf+html</a><br />
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ALSO, see ;<br />
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Thursday, August 12, 2010<br />
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Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United States<br />
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Clin Infect Dis. 2010 Aug 1;51(3):286-94.<br />
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<a href="http://staphmrsa.blogspot.com/2010/08/escherichia-coli-sequence-type-st131-as.html">http://staphmrsa.blogspot.com/2010/08/escherichia-coli-sequence-type-st131-as.html</a><br />
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Staphylococcus toxin is not markedly affected by heating or freezing as it is heat stable. Even if the food is heated before eating, the poison in the food will cause illness although the heat has killed the bacterial cells.<br />
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<a href="http://www.foodscience.caes.uga.edu/extension/documents/FoodPoisoning-FoodInfection.pdf">http://www.foodscience.caes.uga.edu/extension/documents/FoodPoisoning-FoodInfection.pdf</a><br />
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Do all toxins in food survive the cooking process?<br />
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No, all toxins in food do not survive the cooking process. In fact, the botulism toxin caused by Clostridium botulinum can be inactivated by cooking. Boiling food for 10 minutes eliminates this toxin. However, many other toxins are heat stable. For example, Staphylococcus can produce toxins that are not destroyed by high cooking temperatures. To prevent toxins from developing in food, don"t leave food sitting out at room temperature for more than 2 hours. On a hot day (90° F or higher), food should not sit out for more than 1 hour.<br />
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<a href="http://www.gchd.org/NFSEM/a2z-t.html">http://www.gchd.org/NFSEM/a2z-t.html</a><br />
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The toxin produced by staph bacteria is very heat-stable – so it is not easily destroyed by heat at normal cooking temperatures. The bacteria may be killed, but the toxin remains. Careful handling of food that is prepared ahead of serving is important. This is especially important with foods left over after one meal and planned to be used again at a later meal. Quick cooling and refrigeration, or holding at or above 140ºF, can help ensure that toxin has no chance to be formed.<br />
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<a href="http://www.summitcountyhealth.org/food-service/foodborne-illness/staph-infection/">http://www.summitcountyhealth.org/food-service/foodborne-illness/staph-infection/</a><br />
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The toxin produced by staph bacteria is very heat-stable - it is not easily destroyed by heat at normal cooking temperatures. The bacteria themselves may be killed, but the toxin remains. Careful handling of food that is prepared ahead is important. This is especially important of foods left over after one meal and planned to be used again at a later meal. Quick cooling and refrigeration, or holding at or above 140 degrees F, can help ensure that toxin has no chance to be formed.<br />
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<a href="http://ohioline.osu.edu/hyg-fact/5000/5564.html">http://ohioline.osu.edu/hyg-fact/5000/5564.html</a><br />
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Wednesday, April 14, 2010<br />
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FSIS National Residue Program for Cattle Audit Report 24601-08-KC March 2010 U.S. Department of Agriculture Office of Inspector General<br />
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<a href="http://staphmrsa.blogspot.com/2010/04/fsis-national-residue-program-for.html">http://staphmrsa.blogspot.com/2010/04/fsis-national-residue-program-for.html</a><br />
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Thursday, February 11, 2010<br />
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Denmark's Case for Antibiotic-Free Animals NEW YORK, Feb. 10, 2010<br />
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<a href="http://staphmrsa.blogspot.com/2010/02/denmarks-case-for-antibiotic-free.html">http://staphmrsa.blogspot.com/2010/02/denmarks-case-for-antibiotic-free.html</a><br />
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also see ;<br />
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<a href="http://staphmrsa.blogspot.com/2008/03/iceid-2008-methicillin-resistant.html">http://staphmrsa.blogspot.com/2008/03/iceid-2008-methicillin-resistant.html</a><br />
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<br />
<a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br />
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<br />
update 4/28/11<br />
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<br />
10 PATHOGEN-FOOD COMBINATIONS RANKING THE HEALTH RISK (TITLE TO RANCHERS)<br />
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<br />
Ranking the Risks: The 10 Pathogen-Food Combinations With The Greatest Burden on Public Health<br />
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Michael B. Batz, Sandra Hoffmann and J. Glenn Morris, Jr.<br />
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<a href="http://www.epi.ufl.edu/sites/www.epi.ufl.edu/files/RankingTheRisksREPORT.pdf">http://www.epi.ufl.edu/sites/www.epi.ufl.edu/files/RankingTheRisksREPORT.pdf</a><br />
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<br />
if this is what feeding the masses has come to, count me out ;<br />
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<a href="http://www.bloggernews.net/126457">http://www.bloggernews.net/126457</a><br />
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update 4/21/11<br />
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Cache Creek Dairy 4/6/11<br />
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Department of Health and Human Services Public Health Service Food and Drug Administration San Francisco District Pacific Region 1431 Harbor Bay Parkway Alameda, CA 94502-7070 Telephone: 510-337-6700 FAX: 510-337-6701<br />
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UNITED PARCEL SERVICE DELIVERY SIGNATURE REQUESTED<br />
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Our Reference: 3006172673<br />
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WARNING LETTER<br />
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April 6, 2011<br />
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Mr. Jack Kasbergen, Co-Owner Mrs. Ellie M. Kasbergen, Co-Owner Cache Creek Dairy 31503 County Road 26 Woodland, California 95695<br />
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Dear Mr. & Mrs. Kasbergen:<br />
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On February 1, 2, and 10, 2011, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 31503 County Road 26, Woodland, California. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
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We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
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Specifically, our investigation revealed that on or about May 27, 2010, you sold a dairy cow, identified with ear tag (b)(4) , for slaughter as food. On or about May 28, 2010, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of sulfadimethoxine at 0.431 parts per million (ppm) in the liver tissue. FDA has established a tolerance of 0.1 ppm for residues of sulfadimethoxine in the edible tissues of cattle as codified in Title 21, Code of Federal Regulations (C.F.R.), Section 556.640 (21 C.F.R. 556.640). The presence of this drug in edible tissue from this animal causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
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Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.<br />
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For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
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We also found that you adulterated the new animal drugs sulfadimethoxine (b)(4) and flunixin meglumine (b)(4). Specifically, our investigation revealed that you did not use sulfadimethoxine and flunixin meglumine as directed by their approved labeling. Use of these drugs in this manner is an extralabel use. See 21 C.F.R. 530.3(a).<br />
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The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
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Our investigation found that you administered sulfadimethoxine to one of your dairy cows identified with ear tag (b)(4) without following the dose and route of administration as stated in the approved labeling. Sulfadimethoxine is prohibited for extralabel use in lactating dairy cattle by 21 C.F.R. 530.41(a)(9) and your extralabel use of sulfadimethoxine resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d). Our investigation also found that you administered flunixin to one of your dairy cows identified with ear tag [b4] without following the route of administration as stated in its approved labeling. Your extralabel use of flunixin was not under the supervision of a licensed veterinarian in violation of 21 C.F.R. 530.11(a). Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drugs to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5).<br />
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The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
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You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
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You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
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Your written response should be sent to Karen L. Robles, Compliance Officer, Food and Drug Administration, at 650 Capitol Mall Room 8-400, Sacramento, California 95814. If you have any questions about this letter, please contact Compliance Officer Karen L. Robles at (916) 930-3674 extension 114 or via e-mail at Karen.Robles@fda.hhs.gov.<br />
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Sincerely,<br />
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<br />
/s/<br />
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<br />
Barbara J. Cassens District Director San Francisco District U. S. Food and Drug Administration<br />
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<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm250770.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm250770.htm</a><br />
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<br />
March 28, 2011<br />
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WARNING LETTER<br />
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CERTIFIED MAIL RETURN RECEIPT REQUESTED Refer to MIN 11 - 18<br />
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James B. Drake President and Co-owner Drake Dairy, Inc. N8870 Drake Court Elkhart Lake, Wisconsin 53020<br />
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Dear Mr. Drake:<br />
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On January 25 and February 14, 2011, the Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at N8870 Drake Court, Elkhart Lake, Wisconsin. This letter notifies you of violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov.<br />
<br />
<br />
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We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
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Specifically, our investigation revealed that on or about September 17, 2010, you consigned (b)(4) to haul your dairy cow (ear tag# (b)(4) indentified with back tag # (b)(4) for slaughter as food. On or about September 17, 2010, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of ampicillin at 0.33 parts per million (ppm) in kidney. The FDA has established a tolerance of 0.01 ppm for ampicillin in the uncooked edible tissues of cattle as codified in Title 21, Code of Federal Regulations, section 556.40, 21 CFR 556.40. The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
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Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to have an effective system to control administration of drug treatments to your animals. Herdsmen have been authorized to administer drugs; but they failed to relay treatment information to the herd manager. You also failed to maintain complete treatment records that include the drug, dosage, route of administration, and withholding period to ensure that treated cattle are not culled before labeled meat and milk withhold times are met. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br />
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In addition to the above violation, we are concerned that USDA/FSIS identified another recent tissue residue associated with your dairy operation. Illegal levels of ampicillin and flunixin were found on October 20, 2009, in your dairy cow with ear tag #(b)(4) (back tag (b)(4).<br />
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<br />
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The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute are in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
We received an unsigned letter dated October 26, 2010, from Drake Dairy. The letter was post-marked February 17, 2011, and received in our office on February 22, 2011. The letter states that you have taken steps to help ensure that drug residue violations will not happen in the future. You made changes in your treatment protocols and record keeping, established a new communication system between the Herdsman and the Herd Manager, and are now entering all treatments into the (b)(4) computer system. We consider these to be necessary and appropriate corrective actions. However, your letter did not provide documentation that corrections have been implemented. Within 15 working days of receiving this letter, please provide our office with further documentation to substantiate your corrections. For example, provide copies of a representative sample of treatment records and any other records demonstrating that corrections have been made.<br />
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Your written response should be sent to Timothy G. Philips, Compliance Officer, Food and Drug Administration, at the address located on the letterhead. If you have any questions about this letter, please contact Mr. Philips at (612) 758-7133.<br />
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Sincerely, /S/ Gerald J. Berg Director Minneapolis District<br />
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<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm249410.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm249410.htm</a><br />
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<br />
Van Es Dairy 3/25/11<br />
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Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District Pacific Region 22201 23rd Drive SE Bothell, WA 98021-4421 Telephone: 425-486-8788 FAX: 425-483-4996<br />
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<br />
March 25, 2011<br />
<br />
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CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
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In reply refer to Warning Letter SEA 11-08<br />
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<br />
Dale Van Es, Owner Van Es Dairy 8222 Desert Drive Marsing, Idaho 83639-8264<br />
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<br />
WARNING LETTER<br />
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<br />
Dear Mr. Van Es:<br />
<br />
<br />
<br />
On December 8 and 9, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 8222 Desert Drive, Marsing, Idaho. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about June 16, 2010, you sold a dairy cow, identified with back tag (b)(4) and ear tag (b)(4), for slaughter as food. On or about June 18, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of flunixin in the liver tissue at 0.662 parts per million (ppm). FDA has established a tolerance of 0.125 ppm for residues of flunixin in the liver of cattle as codified in Title 21, Code of Federal Regulations, Section 556.286 (21 C.F.R. 556.286). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated sulfadimethoxine and flunixin meglumine. Specifically, our investigation revealed that you did not use Albon (sulfadimethoxine) Boluses, NADA 031-715, and Prevail (flunixin meglumine) Injectable, ANADA 200-308, as directed by their approved labeling. Use of these drugs in this manner is an extralabel use, 21 C.F.R. 530.3(a).<br />
<br />
<br />
<br />
The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered Albon (sulfadimethoxine) Boluses, NADA 031-715, to your dairy cows without following the dose as indicated in its approved labeling. Albon (sulfadimethoxine) Boluses, NADA 031-715, is prohibited from extralabel use in lactating dairy cattle by 21 C.F.R. 530.41(a)(9). Because your extralabel use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5).<br />
<br />
<br />
<br />
In addition, our investigation found that you administered Prevail (flunixin meglumine) Injectable, ANADA 200-308, to your dairy cows without following the dose and duration of treatment as indicated in its approved labeling. Your extralabel use of Prevail (flunixin meglumine) Injectable, ANADA 200-308, was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a). Because your extralabel use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Lisa M. Althar, Compliance Officer, U.S. Food and Drug Administration, 22201 23rd Drive SE, Bothell, Washington 98021-4421. If you have any questions about this letter, please contact Compliance Officer Lisa M. Althar at (425) 483-4940.<br />
<br />
<br />
<br />
Sincerely,<br />
<br />
<br />
<br />
/s/<br />
<br />
<br />
<br />
Charles M. Breen District Director<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm249856.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm249856.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Zimmerman, Mark S. 3/22/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration PHILADELPHIA DISTRICT 900 U.S. Customhouse 2nd and Chestnut Streets Philadelphia, PA 19106 Telephone: 215-597-4390<br />
<br />
<br />
<br />
WARNING LETTER 11-PHI-08<br />
<br />
<br />
<br />
CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
<br />
<br />
<br />
March 22, 2011<br />
<br />
<br />
<br />
Mark S. Zimmerman, Owner Mark S. Zimmerman Farm 641 Cranberry Road Martinsburg, Pennsylvania 16662<br />
<br />
<br />
<br />
Dear Mr. Zimmerman:<br />
<br />
<br />
<br />
On January 25, 2011, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy farm operation located at 641 Cranberry Road, Martinsburg, Pennsylvania. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about March 1, 2010, you sold a bob veal calf, identified with back tag (b)(4), for slaughter as food. On or about March 2, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of flunixin in the liver at 0.121 parts per million (ppm). FDA has not established a tolerance for residues of flunixin in the edible tissues of veal calves. The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drug Flunazine (flunixin meglumine). Specifically, our investigation revealed that you did not use Flunazine (flunixin meglumine) as directed by its approved labeling. Use of this drug in this manner is an extralabel use. 21 C.F.R. 530.3(a).<br />
<br />
<br />
<br />
The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered the new animal drug Flunazine (flunixin meglumine) to a bob veal calf, with back tag (b)(4), without following the animal class as stated in the approved labeling. Your extralabel use of the new animal drug Flunazine (flunixin meglumine) was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a) and resulted in an illegal residue, in violation of 21 C.F.R. 530.11(c). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
We acknowledge that you have started keeping medical treatment records for your animals. However, we do not have enough information to allow FDA to evaluate whether the referenced corrective actions are adequate.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Robin Rivers, Compliance Officer, U.S. Food and Drug Administration, 900 U.S. Customhouse, 200 Chestnut Street, Philadelphia, Pennsylvania 19106. If you have any questions about this letter, please contact Ms. Rivers at (215) 717-3076 or E-mail at robin.rivers@fda.hhs.gov.<br />
<br />
<br />
<br />
Sincerely,<br />
<br />
<br />
<br />
/s/<br />
<br />
<br />
<br />
Kirk D. Sooter District Director Philadelphia District<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm248149.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm248149.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Horizon Acres 3/18/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration Cincinnati District Office Central Region 6751 Steger Drive Cincinnati, OH 45237-30977 Telephone: (513) 679-2700 FAX: (513) 679-2761<br />
<br />
<br />
<br />
WARNING LETTER CIN-11-65585-06<br />
<br />
<br />
<br />
March 18, 2011<br />
<br />
<br />
<br />
United Parcel Service<br />
<br />
<br />
<br />
Mr. Kenneth D. Weaver, General Manager Horizon Acres 6728 Zuercher Road Dalton, Ohio 44618<br />
<br />
<br />
<br />
Dear Mr. Weaver:<br />
<br />
<br />
<br />
On November 10, 12, 19,24, 2010, and December 20, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your veal calf operation located at 6728 Zuercher Road, Dalton, Ohio 44618. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about June 22, 2010, you sold an unidentified, untagged veal calf for slaughter as food. On or about June 22, 2010, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence 0.28 parts per million (ppm) of flunixin in the liver tissue. FDA has established a tolerance of 0.125 ppm for residues of flunixin in the liver of cattle as codified in 21 C.F.R. 556.286(b)(1)(i). However, this tolerance does not apply to use of Suppressor (flunixin meglumine) Injectable Solution, ANADA 200-308, in veal calves (pre-ruminating calves), and there is no acceptable level of residue associated with use of flunixin meglumine in veal calves (pre-ruminating calves). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records and segregate treated animals. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drugs Suppressor (flunixin meglumine) ANADA 200-308, Dexamethasone ANADA 200-312, Ceftiflex sterile powder (ceftiofur sodium) ANADA 200-420, PennOne Pro (penicillin G procaine) NADA 65-010, Amoxicillin capsules NDC 65862-017-05, Sulfamethoxazole and Trimethoprim Double Strength tablets NDC 53746-272-05 (SMZ-TMP tablets), and Pennchlor 64 (chlortetracycline HCI) ANADA 200-295. Specifically, our investigation revealed that you did not use these drugs as directed by their approved labeling. Use of these drugs in this manner is an extralabel use. 21 C.F.R. § 530.3(a).<br />
<br />
<br />
<br />
The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered flunixin meglumine to veal calves without following the withdrawal period as stated in the approved labeling. Your extralabel use of flunixin meglumine was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a) and your extralabel use of flunixin meglumine resulted in an illegal drug residue, in violation of 21 C.F.R. § 530.11(c).<br />
<br />
<br />
<br />
Our investigation found that you administered dexamethasone to veal calves without following the route of administration and the withdrawal period as stated in the approved labeling. Your extralabel use of Dexamethasone was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11 (a).<br />
<br />
<br />
<br />
Our investigation found that you administered ceftiofur sodium to veal calves without following the withdrawal period as stated in the approved labeling. Your extralabel use of ceftiofur sodium was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a).<br />
<br />
<br />
<br />
Our investigation found that you administered penicillin G procaine to veal calves without following the route of administration and the withdrawal period as stated in the approved labeling. Your extralabel use of penicillin G procaine was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11(a).<br />
<br />
<br />
<br />
Our investigation found that you administered amoxicillin and sulfamethoxazole and trimethoprim (SMZ-TMP) to veal calves without following the route of administration and duration of the treatment as stated in their approved labeling. Your extralabel use of Amoxicillin and SMZ-TMP were not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. § 530.11 (a) and your use of amoxicillin and SMZ-TMP in or on feed, is in violation of 21 C.F.R. § 530.11(b).<br />
<br />
<br />
<br />
Our investigation found that you administered chlortetracycline HCI to veal calves without following the duration of treatment. Your use of chlortetracycline HCI was not under the supervision of a licensed veterinarian, and is in violation of 21 C.F.R. § 530.11(a) and your use of pennchlor 64 in or on feed, is in violation of 21 C.F.R. § 530.11(b). Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug(s) to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5).<br />
<br />
<br />
<br />
In addition, you adulterated the liquid animal feed within the meaning of section 501(a)(6) of the FD&C Act, 21 U.S.C. § 351(a)(6), when you added sulfamethoxazole and trimethoprim, Amoxicillin, and chlortetracycline HCI, and you failed to use the medicated feed in conformance with its approved labeling. Your use of this medicated feed without following the animal class as directed by the approved labeling caused this medicated feed to be unsafe under section 512(a)(2) of the FD&C Act, 21 U.S.C. § 360b(a)(2), and adulterated under section 501(a)(6) of the FD&C Act, 21 U.S.C. § 351(a)(6). Section 512 of the FD&C Act, 21 U.S.C. § 360b, and 21 C.F.R. 530.11(b) do not permit the extralabel use of medicated feed.<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Allison C. Hunter, Compliance Officer, U.S. Food and Drug Administration, 6751 Steger Drive, Cincinnati, Ohio 45237. If you have any questions about this letter, please contact Compliance Officer Hunter at 513-679-2700 ext. 134.<br />
<br />
<br />
<br />
Sincerely yours, /S/<br />
<br />
<br />
<br />
Teresa Thompson District Director Cincinnati District<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm248212.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm248212.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Azevedo and Sons Dairy, Inc. 3/4/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District<br />
<br />
<br />
<br />
Pacific Region<br />
<br />
<br />
<br />
22201 23rd Drive SE<br />
<br />
<br />
<br />
Bothell, WA 98021-4421<br />
<br />
<br />
<br />
Telephone: 425-486-8788<br />
<br />
<br />
<br />
FAX: 425-483-4996<br />
<br />
<br />
<br />
March 4, 2011<br />
<br />
<br />
<br />
CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
<br />
<br />
<br />
In reply refer to Warning Letter SEA 11-06<br />
<br />
<br />
<br />
Lisuarte M. Azevedo, President Azevedo and Sons Dairy, Inc. 10034 Hendricks Road Othello, Washington 99344<br />
<br />
<br />
<br />
WARNING LETTER<br />
<br />
<br />
<br />
Dear Mr. Azevedo:<br />
<br />
<br />
<br />
On January 5 and 13, 2011, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 10034 Hendricks Road, Othello, Washington. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov. 1<br />
<br />
<br />
<br />
We found that you offered for sale animals for slaughter as food that were adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about July 23, 2010, you sold a cow, identified with ear tag number (b)(4) for slaughter as food. On or about July 23, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 0.801 parts per million (ppm) flunixin in the liver tissue. FDA has established a tolerance of 0.125 ppm for residues of flunixin in the edible tissues of cows as codified in Title 21, Code of Federal Regulations, Section 556.286 (21 C.F.R. § 556.286). In addition, our investigation revealed that on or before May 6, 2010, you delivered a cow identified with ear tag number (b)(4) to (b)(4). On or about May 6, 2010, (b)(4), slaughtered this animal. USDA/FSIS analysis of tissue samples collected from this animal identified the presence of 0.755 ppm sulfadimethoxine in liver tissue. FDA has established a tolerance of 0.1 ppm for residues of sulfadimethoxine in the edible tissues of cows as codified in 21 C.F.R. § 556.640. The presence of these drugs in edible tissue from these animal in these amounts causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drugs Banamine NADA # 101-479 (flunixin meglumine) and Albon NADA # 031-715 (sulfadimethoxine). Specifically, our investigation revealed that you did not use flunixin meglumine and sulfadimethoxine as directed by their approved labeling. Use of these drugs in this manner is an extralabel use as indicated in 21 C.F.R. § 530.3(a).<br />
<br />
<br />
<br />
The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered flunixin meglumine to the cow identified with ear tag number (b)(4) without following the dose, route of administration, and withdrawal period as stated in the approved labeling. Your extralabel use of flunixin meglumine was not under the supervision of a license veterinarian, in violation of 21 C.F.R. § 530.11(a) and your extralabel use of flunixin meglumine resulted in illegal drug residues, in violation of 21 C.F.R. § 530.11(d). Our investigation also found that you administered sulfadimethoxine (Albon) to the cow identified with ear tag number (b)(4) without following the dose and withdrawal period as stated in the approved labeling. Sulfadimethoxine is prohibited for extralabel use in lactating dairy cattle by 21 C.F.R. § 530.41(a)(9) and your extralabel use of sulfadimethoxine resulted in an illegal drug residue, in violation of 21 C.F.R. § 530.11(d). Because your use of these drugs were not in conformance with their approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drugs to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
Our investigation also revealed that on or about May 4, 2010, and on or about August 17, 2010, you provided to (b)(4), a signed certification, that states that all animals brought to (b)(4), for sale or processing, have been handled in a manner to prevent pharmaceutical or biological residue violation. On or about July 23, 2010, you delivered a cow containing violative flunixin residue to (b)(4). Providing such a false guaranty is prohibited by section 301(h) of the FD&C Act, 21 U.S.C. 331(h). You should take appropriate actions to ensure that this violation does not recur. You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Patricia A. Pinkerton, Compliance Officer, U.S. Food and Drug Administration, 22201 23rd Drive SE, Bothell, Washington 98021-4426. If you have any questions about this letter, please contact Compliance Officer Patricia Pinkerton at 425-483-4926.<br />
<br />
<br />
<br />
Sincerely yours,<br />
<br />
<br />
<br />
S/<br />
<br />
<br />
<br />
Charles M. Breen District Director<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm247175.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm247175.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Amting Dairy Farm 3/4/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration Detroit District 300 River Place Suite 5900 Detroit, MI 48207 Telephone: 313-393-8100 FAX: 313-393-8139<br />
<br />
<br />
<br />
WARNING LETTER 2011-DET-07<br />
<br />
<br />
<br />
March 4, 2011<br />
<br />
<br />
<br />
VIA UNITED PARCEL SERVICE<br />
<br />
<br />
<br />
Mr. Bernardus H. Amting, Owner Amting Dairy Farm 17451 N Drive N Marshall, Michigan 49068<br />
<br />
<br />
<br />
Dear Mr. Amting:<br />
<br />
<br />
<br />
On December 16 and 29, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 17451 N Drive N, Marshall, Michigan. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about August 31, 2010, you sold a dairy cow, identified with back tag (b)(4) and ear tag (b)(4), for slaughter as food. On or about September 1, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of sulfamethazine in the liver tissue at 0.268 parts per million (ppm). FDA has established a tolerance of 0.1 ppm for residues of sulfamethazine in the uncooked edible tissues of cattle as codified in Title 21, Code of Federal Regulations, Section 556.670 (21 C.F.R. 556.670). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drugs flunixin and oxytetracycline. Specifically, our investigation revealed that you did not use Suppressor (flunixin meglumine), ANADA 200-308, and Oxytet 100 (oxytetracycline hydrochloride), ANADA 200-452, as directed by their approved labeling. Use of these drugs in this manner is an extra label use, 21 C.F.R. 530.3(a).<br />
<br />
<br />
<br />
The extra label use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extra label use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered flunixin to a dairy cow, identified with back tag (b)(4) and ear tag (b)(4), without following the route of administration and the withdrawal period as indicated in its approved labeling. Your extra label use of flunixin was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a). Because your extra label use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
<br />
<br />
<br />
In addition, our investigation found that you administered oxytetracycline to a dairy cow, identified with back tag (b)(4) and ear tag (b)(4), without following the withdrawal period as indicated in its approved labeling. Your extra label use of oxytetracycline was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a). Because your extra label use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
We remind you that FDA has issued you a prior Warning Letter on August 29, 2003. A copy of this Warning Letter is provided for your review and information.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Mr. Michael V. Owens, Compliance Officer, U.S. Food and Drug Administration at 300 River Place, Suite 5900 Detroit, Michigan 48207. If you have any questions about this letter, please contact Compliance Officer Michael Owens at 313-393-8167 or E-mail at michael.owens@fda.hhs.gov.<br />
<br />
<br />
<br />
Sincerely yours,<br />
<br />
<br />
<br />
/s/<br />
<br />
<br />
<br />
Joann M. Givens District Director Detroit District Office<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm246193.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm246193.htm</a><br />
<br />
<br />
<br />
<br />
<br />
InSight Dairy, LLC. 2/24/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration New York District<br />
<br />
<br />
<br />
158-15 Liberty Avenue Jamaica, NY 11433<br />
<br />
<br />
<br />
February 24, 2011<br />
<br />
<br />
<br />
WARNING LETTER NYK-2011-18<br />
<br />
<br />
<br />
VIA United Parcel Services<br />
<br />
<br />
<br />
Christopher A. and Jessica A. Fredericks, Owners InSight Dairy, LLC. 682 Newville Road Little Falls, New York 13365-4614<br />
<br />
<br />
<br />
Dear Mr. and Ms. Fredericks,<br />
<br />
<br />
<br />
On January 4 and 6, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 682 Newville Road, Little Falls, New York 13365-4614. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale animals for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about July 19, 2010, you sold a bob veal calf, identified with back tag (b)(4), for slaughter as food. On or about July 20, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 12.95 parts per million (ppm) of neomycin residue in the kidney. In addition, our investigation revealed that on or about August 2, 2010, you sold a bob veal calf, identified with back tag (b)(4), for slaughter as food. On or about August 3, 2010, (b)(4), slaughtered this animal. USDA/FSIS analysis of tissue samples collected from this animal identified the presence of 10.53 parts per million (ppm) of neomycin residue in the kidney. FDA has established a tolerance of 7.2 ppm for residues of neomycin in the kidney tissue of cattle as codified in Title 21, Code of Federal Regulations (C.F.R.), 556.430 (21 C.F.R. 556.430). However, this tolerance does not apply to the use of (b)(4) in bob veal calves, and there is no acceptable level of residue associated with the use of this medicated milk replacer in veal calves. The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drug neomycin sulfate. Specifically, our investigation revealed that you did not use neomycin sulfate as directed by its approved labeling. Use of this drug in this manner is an extralabel use. See 21 C.F.R. 530.3(a).<br />
<br />
<br />
<br />
Our investigation found that you fed (b)(4) containing neomycin sulfate to both bob veal calves with back tags #(b)(4) without following the approved labeling. The extralabel use of (b)(4)containing neomycin sulfate was in or on feed, in violation of 21 C.F.R. 530.11(b), and the extralabel use resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(c). Because this use of (b)(4) containing neomycin sulfate was not in conformance with the approved labeling, you caused the drug in the feed to be unsafe under section 512(a)(1) of the FD&C Act, 21 U.S.C. § 360b(a)(1), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. § 351(a)(5). In addition, you caused the animal feed containing the neomycin sulfate to be unsafe under section 512(a)(2) of the FD&C Act, 21 U.S.C. § 360b(a)(2), and adulterated within the meaning of section 501(a)(6) of the FD&C Act, 21 U.S.C. § 351(a)(6).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Dean R. Rugnetta, Compliance Officer, U.S. Food and Drug Administration, 300 Pearl Street, Suite 100, Buffalo, New York 14202. If you have any questions about this letter, please contact Compliance Officer Dean R. Rugnetta at (716) 541-0324 or Email at Dean.Rugnetta@fda.hhs.gov.<br />
<br />
<br />
<br />
Sincerely yours,<br />
<br />
<br />
<br />
/S/ Ronald M. Pace District Director New York District<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm245257.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm245257.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Jesse R. Petre Farm 2/15/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration PHILADELPHIA DISTRICT 900 U.S. Customhouse 2nd and Chestnut Street Philadelphia, PA 19106 Telephone: 215-597-4390<br />
<br />
<br />
<br />
WARNING LETTER 11-PHI-06<br />
<br />
<br />
<br />
CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
<br />
<br />
<br />
February 15, 2011<br />
<br />
<br />
<br />
Mr. Jesse R. Petre Farm, Owner 1215 Mason Dixon Road Greencastle, PA 17225<br />
<br />
<br />
<br />
Dear Mr. Petre:<br />
<br />
<br />
<br />
On January 12, 2011, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy farm operation located at 1215 Mason Dixon Road, Greencastle, PA. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale, an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about January 14, 2010, you sold a veal calf, identified with back tag (b)(4) for slaughter as food. On or about January 15, 2010, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 7.37 parts per million (ppm) of neomycin in the kidney tissue, and 0.11 ppm of flunixin in the liver tissue. FDA has established a tolerance of 7.2 ppm for neomycin, and 0.125 parts per billion (ppb) for flunixin in the uncooked edible tissues of cattle as codified in Title 21, Code of Federal Regulations (C.F.R.), (21 C.F.R. 556.430(b)(1); 556.286(b)(1)). The presence of these drugs in edible tissues from this animal in these amounts cause the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(II).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Robin M. Rivers, Compliance Officer, United States Food and Drug Administration, United States Customs House, Room 900, 200 Chestnut Street, Philadelphia, PA 19106. If you have any questions about this letter, please contact Ms. Rivers at 215-717-3076.<br />
<br />
<br />
<br />
Sincerely,<br />
<br />
<br />
<br />
/s/<br />
<br />
<br />
<br />
Kirk D. Sooter District Director Philadelphia District Office<br />
<br />
<br />
<br />
<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm244595.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm244595.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Lloyd B. Zimmerman and Sons 2/15/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration PHILADELPHIA DISTRICT 900 U.S. Customhouse 2nd and Chestnut Street Philadelphia, PA 19106 Telephone: 215-597-4390<br />
<br />
<br />
<br />
WARNING LETTER 11-PHI-07<br />
<br />
<br />
<br />
CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
<br />
<br />
<br />
February 15, 2011<br />
<br />
<br />
<br />
Mr. Lloyd B. Zimmerman, Owner Lloyd B. Zimmerman and Sons 2413 Snydertown Road Danville, Pennsylvania 17821-7429<br />
<br />
<br />
<br />
Dear Mr. Zimmerman:<br />
<br />
<br />
<br />
On October 28, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy farm operation located at 2413 Snydertown Road, Danville, PA. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
<br />
<br />
<br />
We found that you offered for sale animals for slaughter as food that were adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
<br />
<br />
<br />
Specifically, our investigation revealed that on or about May 5, 2010, you sold a bob veal calf, identified with back tag (b)(4), for slaughter as food. On or about May 5, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of neomycin in the kidney at 15.14 parts per million (ppm). FDA has established a tolerance of 7.2 ppm for residues of neomycin in the uncooked edible kidney tissue of cattle as codified in Title 21, Code of Federal Regulations, Section 556.430(b)(1) (21 C.F.R. 556.430(b)(1)). However, this tolerance does not apply to the use of (b)(4) Vigormilk 22BNT Medicated Milk Replacer containing oxytetracycline, and neomycin in veal calves (pre-ruminating calves), and there is no acceptable level of residue associated with the use of (b)(4) Vigormilk 22BNT Medicated Milk Replacer containing oxytetracycline, and neomycin in veal calves (pre-ruminating calves). Therefore, the presence of this drug in kidney tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
In addition, our investigation revealed that on or about July 14, 2010, you sold a bob veal calf, identified with back tag (b)(4), for slaughter as food. On or about July 14, 2010, (b)(4), slaughtered this animal. USDA/FSIS analysis of tissue samples collected from this animal identified the presence of neomycin in the kidney at 11.51 ppm. FDA has established a tolerance of 7.2 ppm for residues of neomycin in the uncooked edible kidney tissue of cattle as codified in 21 C.F.R. 556.430(b)(1). However, this tolerance does not apply to the use of (b)(4) Vigormilk 22BNT Medicated Milk Replacer containing oxytetracycline, and neomycin in veal calves (pre-ruminating calves), and there is no acceptable level of residue associated with the use of (b)(4) Vigormilk 22BNT Medicated Milk Replacer containing Oxytetracycline, and neomycin in veal calves (pre-ruminating calves). Therefore, the presence of this drug in kidney tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii).<br />
<br />
<br />
<br />
Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4).<br />
<br />
<br />
<br />
We also found that you adulterated the new animal drugs oxytetracycline, and neomycin that were contained in the (b)(4) Vigormilk 22BNT Medicated Milk Replacer. Specifically, our investigation revealed that you did not use (b)(4) Vigormilk 22BNT Medicated Milk Replacer as directed by its approved labeling. Use of these drugs in this manner is an extralabel use, 21 C.F.R. 530.3(a).<br />
<br />
<br />
<br />
The extralabel use of approved animal or human drugs in animals is allowed under the FD&C Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
<br />
<br />
<br />
Our investigation found that you administered the new animal drugs Oxytetracycline, and neomycin that were contained in the (b)(4) Vigormilk 22BNT Medicated Milk Replacer to your bob veal calves without following the animal class as stated in the approved labeling. Your extralabel use of the new animal drugs oxytetracycline, and neomycin that were contained in the (b)(4) Vigormilk 22BNT Medicated Milk Replacer was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a) and resulted in an illegal residue, in violation of 21 C.F.R. 530.11(c). Because your use of these drugs in the (b)(4) Vigormilk 22BNT Medicated Milk Replacer was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drugs to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
<br />
<br />
<br />
The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
<br />
<br />
<br />
You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
<br />
<br />
<br />
We are aware that you sold two bob veal calves on or about October 6, 2010, that contained 10.2 ppm of neomycin in the kidney tissue of one bob veal calf, identified with back tag (b)(4), and the presence of gentamicin in the kidney tissue of one bob veal calf, identified with back tag (b)(4). FDA has established a tolerance of 7.2 ppm for residues of neomycin in the uncooked edible kidney tissue of cattle as codified in 21 C.F.R. 556.430(b)(1). FDA has not established a tolerance for gentamicin in the edible tissues of cattle.<br />
<br />
<br />
<br />
You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
<br />
<br />
<br />
Your written response should be sent to Robin Rivers, Compliance Officer, U.S. Food and Drug Administration, 900 U.S. Customhouse, 200 Chestnut Street, Philadelphia, Pennsylvania 19106. If you have any questions about this letter, please contact Ms. Rivers at (215) 717-3076 or E-mail at robin.rivers@fda.hhs.gov.<br />
<br />
<br />
<br />
Sincerely,<br />
<br />
<br />
<br />
/s/<br />
<br />
<br />
<br />
Kirk D. Sooter District Director Philadelphia District<br />
<br />
<br />
<br />
- <a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm244555.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm244555.htm</a><br />
<br />
<br />
<br />
<br />
<br />
Hite's Livestock, Inc. 2/1/11<br />
<br />
<br />
<br />
Department of Health and Human Services Public Health Service Food and Drug Administration Baltimore District Office 6000 Metro Drive, Suite 101 Baltimore, MD 21215 Telephone: (410) 779-5455 FAX: (410) 779-5707<br />
<br />
<br />
<br />
WARNING LETTER CMS #151635<br />
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February 1, 2011<br />
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CERTIFIED MAIL RETURN RECEIPT REQUESTED<br />
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Mr. David A. Hite, Owner Hite’s Livestock, Inc. HC 34 Box 8 Bloomery, West Virginia 26817-9703<br />
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Dear Mr. Hite:<br />
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On November 29 and December 3, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your livestock operation located at HC 34 Box 8, Bloomery, West Virginia 26817-9703. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
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We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
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Specifically, our investigation revealed that on or about August 22, 2010, you sold an unidentified goat for slaughter as food. On or about August 24, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of moxidectin at 0.0383 parts per million (ppm) in the liver tissue and 0.0543 ppm in the muscle tissue. FDA has not established a tolerance for residues of moxidectin in the edible tissues of goats. The presence of this drug in edible tissue from this animal causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii).<br />
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Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you lack a system to ensure that animals you buy and then sell for slaughter as food have not been medicated or, if they have been medicated, to allow you to withhold the animals from slaughter for an appropriate period of time to deplete potentially hazardous residues of drugs from edible tissues. In addition, you fail to keep accurate records of animals you buy and sell to ensure that the animals can be traced back to the producer or other dealer. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4).<br />
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The violations listed above are not intended to be an all-inclusive list. It is your responsibility to assure that your operations are in compliance with the law. As a dealer of animals, you are frequently the individual who introduces or offers for introduction into interstate commerce, the adulterated animals. As such, you share responsibility for violating the Federal Food, Drug and Cosmetic Act. To avoid future illegal residue violations you should take precautions such as:<br />
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1. Implementing a system to identify the animals you purchase with records to establish traceability to the source of the animal; and<br />
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2. Implementing a system to determine from the source of the animal whether the animal has been medicated and with what drug(s); and<br />
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3. If the animal has been medicated, implementing a system to withhold the animal from slaughter for an appropriate period of time to deplete potentially hazardous residues of drugs from edible tissue. If you do not want to hold the medicated animal then it should not be offered for human food, and it should be clearly identified and sold as a medicated animal.<br />
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You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
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You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
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Your written response should be sent to Ms. Cherlita Honeycutt, Compliance Officer, U.S. Food and Drug Administration, 6000 Metro Drive, Suite 101, Baltimore, Maryland 21215. If you have any questions about this letter, please contact Compliance Officer Cherlita Honeycutt at (410) 779-5412 or via e-mail at Cherlita.Honeycut@fda.hhs.gov.<br />
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Sincerely yours,<br />
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/s/<br />
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Evelyn Bonnin District Director Baltimore District<br />
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<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm242828.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm242828.htm</a><br />
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Vander Schaaf Dairy #2 1/10/11<br />
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Department of Health and Human Services Public Health Service Food and Drug Administration San Francisco District Pacific Region 1431 Harbor Bay Parkway Alameda, CA 94502-7070 Telephone: 510-337-6700 FAX: 510-337-6701<br />
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UNITED PARCEL SERVICE DELIVERY SIGNATURE REQUESTED<br />
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Our Reference: 1000307183<br />
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WARNING LETTER<br />
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January 10, 2011<br />
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Mr. Earl John Vander Schaaf, Owner Vander Schaaf Dairy #2 15355 Van Allen Road Escalon, California 95320<br />
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Dear Mr. Vander Schaaf:<br />
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On September 22 and 27, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 15355 Van Allen Road, Escalon, California 95320. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the FD&C Act) that we found during our investigation of your operation. You can find the FD&C Act and its associated regulations on the Internet through links on FDA’s web page at www.fda.gov1.<br />
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We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the FD&C Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br />
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Specifically, our investigation revealed that on or about April 9, 2010, you sold a dairy cow, identified with ear tag (b)(4), for slaughter as food. On or about April 10, 2010, (b)(4), slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of sulfadimethoxine at 7.068 parts per million (ppm) in the liver tissue. FDA has established a tolerance of 0.1 ppm for residues of sulfadimethoxine in the edible tissues of cattle as codified in Title 21, Code of Federal Regulations (C.F.R.), Section 556.640 (21 C.F.R. 556.640). The presence of this drug in edible tissue from this animal causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the FD&C Act, 21 U.S.C. 342(a)(2)(C)(ii).<br />
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Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.<br />
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For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the FD&C Act, 21 U.S.C. 342(a)(4).<br />
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We also found that you adulterated the new animal drugs sulfadimethoxine (b)(4) , sulfadimethoxine (b)(4), Penicillin G Procaine (b)(4) , and Ceftiofur (b)(4). Specifically, our investigation revealed that you did not use sulfadimethoxine, penicillin G procaine, and ceftiofur as directed by its approved labeling. Use of these drugs in this manner is an extralabel use. See 21 C.F.R. 530.3(a). In addition, the extralabel use of sulfadimethoxine is prohibited in lactating dairy cows under 21 C.F.R. 530.41(a)(9).<br />
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The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the FD&C Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br />
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Our investigation found that you administered sulfadimethoxine (b)(4) to one of your dairy cows identified with ear tag (b)(4) without following the dose and withdrawal period as stated in the approved labeling. Sulfadimethoxine is prohibited for extralabel use in lactating dairy cows by 21 C.F.R. 530.41(a)(9). Furthermore, your extralabel use of sulfadimethoxine resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
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Our investigation also found that you administer sulfadimethoxine (b)(4) to your dairy cows intravenously or subcutaneously whereas the label directions indicate the drug is to be administered intravenously only. Your extralabel use of sulfadimethoxine (b)(4) was not under the supervision of a licensed veterinarian in violation of 21 C.F.R. 530.11(a). Sulfadimethoxine is prohibited for extra label use in lactating dairy cattle within 21 C.F.R. 530.41(a)(9). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
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Our investigation also found that you administer penicillin G procaine injectable suspension (b)(4) to your dairy cows without following the dose as stated in the approved labeling. Your extralabel use of penicillin was not under the supervision of a licensed veterinarian which is in violation of 21 C.F.R. 530.11(a). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
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Our investigation also found that you administer ceftiofur (b)(4) to your dairy cows without following the meat withdrawal period and conditions for treatment as stated in the approved labeling. Your extralabel use of ceftiofur was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the FD&C Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the FD&C Act, 21 U.S.C. 351(a)(5).<br />
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The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br />
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You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br />
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You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br />
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Your written response should be sent to Karen L. Robles, Compliance Officer, Food and Drug Administration, at 650 Capitol Mall Room 8-400, Sacramento, California 95814. If you have any questions about this letter, please contact Compliance Officer Karen L. Robles at (916) 930-3674 extension 114 or via e-mail at Karen.Robles@fda.hhs.gov.<br />
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Sincerely,<br />
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Barbara J. Cassens District Director San Francisco District U. S. Food and Drug Administration<br />
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<a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm239912.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm239912.htm</a><br />
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see more here ;<br />
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<a href="http://google2.fda.gov/search?q=Animals+for+Sale+for+Slaughter+as+Food%2FAdulterated&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*&x=11&y=14">http://google2.fda.gov/search?q=Animals+for+Sale+for+Slaughter+as+Food%2FAdulterated&client=FDAgov&site=FDAgov&lr=&proxystylesheet=FDAgov&output=xml_no_dtd&getfields=*&x=11&y=14</a><br />
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TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-4855864222095364882010-08-12T18:51:00.000-07:002010-08-12T18:53:52.295-07:00Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United StatesClin Infect Dis. 2010 Aug 1;51(3):286-94.<br /><br />Escherichia coli sequence type ST131 as the major cause of serious multidrug-resistant E. coli infections in the United States.<br /><br />Johnson JR, Johnston B, Clabots C, Kuskowski MA, Castanheira M.<br /><br />Infectious Diseases,VA Medical Center, Minneapolis, MN 55417, USA. johns007@umn.edu<br /><br />Comment on:<br /><br />Clin Infect Dis. 2010 Aug 1;51(3):280-5.<br /><br />Abstract<br /><br />BACKGROUND: Escherichia coli sequence type ST131 (O25:H4), associated with the CTX-M-15 extended-spectrum beta-lactamase, has emerged internationally as a multidrug-resistant pathogen but has received little attention in the United States.<br /><br />METHODS: From the SENTRY and Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) surveillance programs, 127 E. coli clinical isolates from hospitalized patients across the United States in 2007, stratified by extended-spectrum cephalosporin and fluoroquinolone phenotype and bla(CTX-M-15) genotype, were assessed for phylogenetic group, ST131 status, susceptibility profile, virulence genotype, gyrA and parC sequence, and pulsed-field gel electrophoresis profile.<br /><br />RESULTS: The 54 identified ST131 isolates (all fluoroquinolone resistant) accounted for an estimated 17% of the source populations, including 67%-69% of isolates resistant to extended-spectrum cephalosporins or fluoroquinolones, 55% of those resistant to both fluoroquinolones and trimethoprim-sulfamethoxazole, and 52% of multidrug-resistant isolates. Their distinctive virulence profiles were more extensive compared with other antimicrobial-resistant isolates but similarly extensive compared with antimicrobial-susceptible isolates. Pulsed-field profiling suggested ongoing dissemination among locales, with concentration of bla(CTX-M-15) within specific ST131 lineages. A historical ST131 isolate lacked the 2007 ST131 isolates' conserved fluoroquinolone resistance-associated single-nucleotide polymorphisms in gyrA and parC.<br /><br />CONCLUSIONS: A single E. coli clonal group, ST131, probably caused the most significantly antimicrobial-resistant E. coli infections in the United States in 2007, thereby constituting an important new public health threat. Enhanced virulence and/or antimicrobial resistance compared with other E. coli, plus ongoing dissemination among locales, may underlie ST131's success. Urgent investigation of the sources and transmission pathways of ST131 is needed to inform mitigation efforts.<br /><br />PMID: 20572763 [PubMed - in process]<br /><br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/20572763">http://www.ncbi.nlm.nih.gov/pubmed/20572763</a><br /><br /><br />NEWS RELEASE<br /><br />For Release: Friday, July 30, 2010<br /><br />Contact Information Contact Name: John Heys Contact E-mail: jheys@idsociety.org Contact Phone: 703-299-0412<br /><br />Emerging E. coli Strain Causes Many Antimicrobial-Resistant Infections in U.S.<br /><br />A new, drug-resistant strain of E. coli is causing serious disease, according to a new study, now available online, in the August 1, 2010 issue of Clinical Infectious Diseases.<br /><br />The new strain, ST131, was a major cause of serious antimicrobial-resistant E. coli infections in the United States in 2007, researchers found. This strain has been reported in multiple countries and encountered all over the United States. In the study, researchers analyzed resistant E. coli isolates collected during 2007 from hospitalized patients across the country. They identified 54 ST131 isolates, which accounted for 67 percent to 69 percent of E. coli isolates exhibiting fluoroquinolone or extended-spectrum cephalosporin resistance.<br /><br />“If we could discover the sources of this strain, the transmission pathways that allow it to spread so effectively, and the factors that have led to its rapid emergence, we could find ways to intervene and possibly slow or halt this strain’s emergence,” said study author James Johnson, MD, of the VA Medical Center in Minneapolis.<br /><br />In the past, highly virulent E. coli strains usually have been susceptible to antibiotics, while highly resistant strains have been fairly weak in terms of their ability to cause disease. The susceptible strains were easily treated even though they caused serious infections, while the resistant ones tended mostly to affect only weakened or vulnerable individuals. Now, the study’s findings suggest, the ST131 strain has appeared with a high level of virulence and antimicrobial resistance.<br /><br />“If this strain gains one additional resistance gene,” Dr. Johnson added, “it will become almost untreatable and will be a true superbug, which is a very concerning scenario.”<br /><br />###<br /><br />Founded in 1979, Clinical Infectious Diseases publishes clinical articles twice monthly in a variety of areas of infectious disease, and is one of the most highly regarded journals in this specialty. It is published under the auspices of the Infectious Diseases Society of America (IDSA). Based in Arlington, Va., IDSA is a professional society representing more than 9,000 physicians and scientists who specialize in infectious diseases. For more information, visit www.idsociety.org.<br /><br /><a href="http://www.idsociety.org/Content.aspx?id=16864">http://www.idsociety.org/Content.aspx?id=16864</a><br /><br /><br /><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br /><br /><br />Terry S. Singeltary Sr. P.O. Box 42 Bacliff, Texas USA 77518Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-65483398572495714332010-04-14T19:15:00.000-07:002010-04-14T19:20:22.398-07:00FSIS National Residue Program for Cattle Audit Report 24601-08-KC March 2010U.S. Department of Agriculture Office of Inspector General<br /><br />Audit Report 24601-08-KC March 2010<br /><br />FSIS National Residue Program for Cattle<br /><br />U.S. Department of Agriculture Office of Inspector General Washington, D.C. 20250<br /><br />DATE: March 25, 2010<br /><br />REPLY TO ATTN OF: 24601-08-KC<br /><br />TO: Alfred V. Almanza Administrator Food Safety and Inspection Service<br /><br />ATTN: William C. Smith Assistant Administrator Office of Program Evaluation, Enforcement and Review FROM: Gil H. Harden /s/ Acting Assistant Inspector General for Audit<br /><br />SUBJECT: FSIS National Residue Program for Cattle<br /><br />This report presents the results of our audit concerning FSIS management of the national residue program, especially as it relates to cattle. Your response to the official draft report, dated March 2, 2010, is included at the end of the report. Excerpts of the response, along with Office of Inspector General’s position, are incorporated into the Findings and Recommendations section of the report. Based on your responses, we were able to reach management decision on all of the report’s 14 recommendations. Please follow your agency’s internal procedures in forwarding documentation for final action to the Office of the Chief Financial Officer.<br /><br />We appreciate the courtesies and cooperation extended to us by members of your staff during this audit.<br /><br />snip...<br /><br />FSIS National Residue Program for Cattle<br /><br />Executive Summary<br /><br />One of the public food safety issues facing the United States is the contamination of meat with residual veterinary drugs, pesticides, and heavy metals. “Residue” of this sort finds its way into the food supply when producers bring animals to slaughter plants while they have these residual contaminants in their system. When the animals are slaughtered, traces of the drugs or pesticides contained in these animals’ meat is shipped to meat processors and retail supermarkets, and eventually purchased by consumers. In order to safeguard the Nation’s food supply from harmful residue, the U.S. Department of Agriculture’s (USDA) Food Safety and Inspection Service (FSIS) administers the national residue program. FSIS inspectors sample meat processed through slaughter plants for residue testing and compare the results with tolerances established by the Food and Drug Administration (FDA) and the Environmental Protection Agency (EPA) to prevent adulterated meat from entering into commerce.2 The Office of Inspector General (OIG) initiated this audit to evaluate the effectiveness of the national residue program and to assess how well FSIS, FDA, and EPA were coordinating to accomplish the program’s objectives.<br /><br />Based on our review, we found that the national residue program is not accomplishing its mission of monitoring the food supply for harmful residues. Together, FSIS, FDA, and EPA have not established thresholds for many dangerous substances (e.g., copper or dioxin3), which has resulted in meat with these substances being distributed in commerce. Additionally, FSIS does not attempt to recall meat, even when its tests have confirmed the excessive presence of veterinary drugs.<br /><br />To address these serious shortcomings in the national residue program, FSIS, EPA, and FDA need to take steps to improve how they coordinate with one another to accomplish the program’s mission. Recognizing that they needed to work together to prevent residue from entering the food supply, the three agencies established the Surveillance Advisory Team (SAT) and the Interagency Residue Control Group (IRCG) as a way of coming together to communicate and coordinate.4 We found, however, that there were a wide range of problems with relying on this process: not all agencies were equally committed to the SAT and IRCG; essential participants were not required to attend; and no one agency had authority to ensure that necessary actions were taken to deal with disagreements. Due to problems with how the SAT and IRCG were established and were functioning, we identified four issues relating to coordination between FSIS, EPA, and FDA. The three agencies involved need to: 1) expand the substances they test<br /><br />1 Pesticides are any substance intended for preventing, destroying, repelling, or mitigating any pest (e.g., insects or mice) or any substance intended for use as a plant regulator, defoliant, or desiccant. 2 When violative levels of residues are detected in food-producing animals submitted for slaughter, the product found to be contaminated with violative residues is considered “adulterated” and is subject to condemnation and disposal. If the product has already been released into commerce, then FSIS evaluates the hazard the product poses to the public and, based on this analysis, determines whether to request a product recall by the firm that manufactured the adulterated product. 3 Dioxins are formed as a result of combustion processes, such as waste incineration and the burning of fuels (e.g., wood, coal, or oil). Exposure to large amounts of dioxins may cause skin diseases, mild liver damage, cancer, reproductive problems, or developmental effects. 4 The SAT meets annually with the primary function of establishing the sampling plan for the national residue program’s scheduled sampling for the next year. The IRCG meets monthly to address ongoing issues concerning the national residue program.<br /><br />Audit Report 24601-08-KC<br /><br />for, 2) improve their methodology for sampling hazardous residues, 3) determine more efficient ways of approving newer methods of testing for drug residues, and 4) collaborate to set tolerances for additional residues.<br /><br />FSIS, EPA, and FDA Need to Expand the Substances They Test For<br /><br />Each year, the SAT brings together representatives from FSIS, EPA, and FDA to decide which residues they will include in the approximately 120 substances they test for annually. Although EPA routinely asks FSIS to test for pesticides that the three agencies have together determined to be high health risks, FSIS has, for many years, continued to test for only one type of pesticide, citing its limited resources and the fact that EPA has not established tolerances for<br /><br />Audit Report 24601-08-KC<br /><br />2<br /><br />many varieties of pesticides.<br /><br />We acknowledge that FSIS’ laboratory testing resources are not unlimited and that the agency must make decisions about what it will and will not test for. However, if EPA, FDA, and FSIS determine that there are additional high risk substances that should be tested, the SAT needs a mechanism for resolving differences and, if necessary, obtaining necessary testing resources. One such mechanism would be to elevate such disagreements to executive-level officials capable of arriving at an appropriate compromise. A 1984 memorandum of understanding to coordinate Federal residue monitoring activities was signed by the FSIS Administrator and other officials at FDA and EPA below the Administrator’s level. We believe that residue monitoring is of such importance that the framework of the program should be re-established and approved at the highest levels within the respective Departments.<br /><br />FSIS, FDA, and EPA Need to Improve Their Methodology for Sampling Hazardous Residues<br /><br />Once the three agencies involved have determined which substances they will test for, they then decide how they will sample for those substances. We found, however, that different groups have questioned FSIS’ sampling methodology, both its sample size and design. For example, FSIS laboratory personnel believe that they should be testing more than 300 samples for some residues, while an outside contractor performing a quality control review recommended that FSIS could test fewer samples “without a significant loss in precision.” Members of the SAT and IRCG have also proposed that sampling for some veterinary drugs quarterly instead of monthly would provide equally useful information and could also save laboratory resources.<br /><br />The SAT is the appropriate forum for discussing issues concerning FSIS’ sample design, but at present, the appropriate agency managers and personnel with the relevant qualifications do not always attend SAT meetings, and the agencies have not conducted a thorough review of how they design the sample for these substances. The three agencies should work together to strike a balance between sampling demands, resource limitations, and the relative importance of any given compound. Following appropriate risk analysis principles would provide FSIS with a scientific and structured approach that would also allow the agency to optimize its limited laboratory resources. FSIS and FDA Need to Determine More Efficient Ways of Approving Newer Methods of Testing for Drug Residues<br /><br />When testing for the various types of drug residue that the agencies have determined to be high risk, FSIS relies on FDA to approve the testing methods it uses. However, the approved methods are often antiquated and ineffective because they were approved when FDA first approved the drug. “Bridging” testing methods—confirming that a newer and more efficient method will yield acceptable results when compared to the FDA-approved method—is a slow and difficult process, and FDA is not always willing, or able, to undertake the work.<br /><br />Although FDA and FSIS disagree on how to solve this problem, they agree that until the problem is resolved, FSIS will not be able to test for residues as efficiently as possible. FSIS and FDA should cooperate to improve their efficiency in approving newer methods for FSIS to use in testing for residues, as doing so will enable FSIS to take advantage of advanced technologies, lower its costs, and improve the quality of its analyses.<br /><br />FSIS, EPA, and FDA Need to Collaborate to Set Tolerances for Additional Residues<br /><br />If FSIS confirms the presence of residue in a sample of meat, it needs a “tolerance” or a threshold for determining if the concentration of that residue is dangerous for human consumption. For example, FDA has set a tolerance of .05 parts per million for penicillin in beef, so FSIS knows that beef with 10.62 parts per million should be excluded from the food supply. FSIS relies on FDA or EPA to set tolerances for drugs, pesticides, and heavy metals.<br /><br />We found, however, that tolerances have not been set for many potentially harmful substances, which can impair FSIS’ enforcement activities. For example, in 2008, when Mexican authorities rejected a shipment of U.S. beef because it contained copper in excess of Mexico’s tolerances, FSIS had no basis to stop distribution of this meat in the United States since FDA has set no tolerance for copper. Though we acknowledge that setting tolerances is an expensive and time-consuming process, FSIS needs a systematic and formal process to request FDA and EPA to set tolerances for residues that are deemed potentially hazardous. FSIS also needs procedures that specify what actions agency personnel are to take regarding the disposition of carcasses that contain potentially hazardous substances when there are no formal tolerances established by EPA or FDA.<br /><br />Along with the issues of coordination among the three agencies involved in the national residue program, we found that FSIS itself can take action to strengthen the program by requiring slaughter plants to increase their controls when processing dairy cows and bob veal.<br /><br />Audit Report 24601-08-KC 3<br /><br />5 Plants handling dairy cows and bob veal were, in 2008, responsible for over 90 percent of residue violations found. FSIS allowed such plants to continue treating residue problems as “not reasonably likely to occur”—the determination that would allow plants to justify not implementing additional procedures to control residues. Although FSIS had reviewed these plants’ control plans multiple times, agency officials explained that they had not done the analysis to determine that violations were so concentrated among dairy cows and bob veal. As a result, in 2008, individual plants amassed as many as 211 violations—with 21 producers having<br /><br />5<br /><br />Bob veal are calves, usually unwanted male calves born at dairy operations, that are slaughtered within a few days of birth.<br /><br />multiple violations—and still were able to treat residue as a problem “not reasonably likely to occur.” FSIS has had a longstanding problem of not being able to identify the producers of cattle that have tested positive for residue, as dairy cows often pass through several buyers and sellers before they are presented for slaughter by suppliers. Without this information, FSIS will always be limited in its ability to respond to repeat violators and to prevent such cattle from entering the slaughter plants. In order to resolve this problem, it would be in FSIS’ interest to require that plants with a history of residue violations identify the producers of any animals presented for slaughter, so that plants can take proactive measures to prevent or control shipments of cattle at high risk for residues and FSIS can subject the animals to additional testing.<br /><br />Audit Report 24601-08-KC 4<br /><br />6 However, FSIS officials explained that the Agency does not have the authority to require plants to obtain producer identification for animals arriving for slaughter.7 As an alternative to obtaining the authority to request producer identification, FSIS should establish procedures that provide incentives for the plants with a history of residue violations to voluntarily request producer’s identification for any animal presented for slaughter, such as subjecting every shipment of cattle from unknown producers to additional on-site screening for potential residue testing. Additionally, since FSIS already maintains repeat violator information, it should establish performance measures, such as tracking reductions in the occurrence of repeat residue violations over time.<br /><br />We also found that FSIS does not recall meat adulterated with harmful residue, even when it is aware that the meat has failed its laboratory tests. Between July 12, 2007, and March 11, 2008, FSIS found that four carcasses were adulterated with violative levels of veterinary drugs8 and that the plants involved had released the meat into the food supply. Although the drugs involved could result in stomach, nerve, or skin problems for consumers, FSIS requested no recall. Officials explained that when meat enters commerce, the agency must prove that consuming a single serving of the contaminated meat is likely to cause harm. In these cases, FSIS determined that consumers would not likely be “acutely harmed” by consuming a single serving of this meat so it could be difficult to force a plant to implement a voluntary recall. In addition, FSIS faces the task of convincing a U.S. Attorney to file for the product seizure in federal district court if the plant refuses the voluntary recall. According to FSIS officials, seizure of the product is not likely for non-acute health risks, e.g., a small amount of residue adulterated product from a single carcass. However, in the past, FSIS has requested plants initiate voluntary Class II recalls for “low” risk health situations for non-acute causes, such as distribution of product that was produced from animals that had not received a proper ante-mortem inspection.<br /><br />Finally, we found that FSIS needs to modernize its process for sampling carcasses at slaughter plants and then testing those samples at its laboratories so that the agency can make use of readily available technologies, including barcode scanning, electronic forms for retaining information, and an electronic reservation system for scheduling tests. At present, the agency<br /><br />6<br /><br />This additional testing was recently required by FSIS publication of Notice 04-09, in January, 2009.<br /><br />7<br /><br />FSIS does have the authority to require producer identification for producers bringing bob veal into slaughter under 9 Code of Federal Regulations 309.16(d)(2), which states that “[t]he identity of the producer of each calf presented for ante-mortem inspection shall be made available by the official establishment to the inspection [inspector] prior to the animal being presented for ante-mortem inspection.”<br /><br />8<br /><br />These drugs were Ivermectin, Sulfadimethoxine, Florfenicol, and Sulfamethazine, which are anti-parasitic or anti-bacterial agents.<br /><br />relies on a system that requires employees to make pen and paper notes on tags that are affixed to carcasses—a system that is slow, cumbersome, and not always very legible. FSIS officials stated that they did not realize their technology was out-of-date and did not know that some plants were already using newer and more innovative techniques for tracking carcasses. Due to this problem, FSIS’ public health veterinarians had less time to devote to their primary mission of inspecting and testing animal carcasses for harmful adulterants, and FSIS was testing meat samples for residue less efficiently and reliably than was necessary. We concluded that FSIS—both alone and in collaboration with FDA and EPA—needs to take a number of important steps to strengthen the national residue program. Those steps should ensure that the program is effectively accomplishing its objectives of ensuring that adulterated meat is not entering the U.S. food supply.<br /><br />snip...<br /><br />Background & Objectives<br /><br />Background<br /><br />As the public health agency of USDA, FSIS administers the national residue program to ensure that the Nation’s food supply is safe from the residues of veterinary drugs, pesticides, and heavy metals that might find their way into meat destined for human consumption.<br /><br />The effects of these residues on human beings who consume such meat are a growing concern. Not only does overuse of antibiotics help create antibiotic-resistant strains of diseases, but the residues of certain drugs and heavy metals can have potentially adverse health consequences if they are consumed in meat. The following table shows five drugs or substances and the potential side effects or health consequences:<br /><br />DRUG OR SUBSTANCE POTENTIAL SIDE EFFECTS<br /><br />Flunixin Fecal blood, gastrointestinal erosions and ulcers, and renal necrosis.<br /><br />Penicillin Life-threatening allergic reaction (i.e., difficulty breathing, closing of the throat); serious nerve damage; severe inflammation of the colon; swelling of the lips, tongue, or face; bleeding; and diarrhea.<br /><br />Arsenic Nonmalignant skin lesions, skin malignancy, internal malignancies, vascular diseases, and hypertension.<br /><br />Copper Hemolysis, jaundice, changes in lipid profile, oxidative stress, renal dysfunction, and even death.<br /><br />Ivermectin Neurotoxicity (e.g., altering normal activity of the nervous system which can eventually disrupt or even kill neurons, key cells that transmit and process signals from the brain).<br /><br />Residues of drugs, pesticides, and heavy metals differ from microbiological pathogens like E. coli,11 Salmonella, and Listeria Monocytogenes, which the public more readily associates with food safety. While cooking meat properly can destroy these pathogens before they are consumed, no amount of cooking will destroy residues. In some cases, heat may actually break residues down into components that are more harmful to consumers. Since consumers have no easy way of protecting themselves against the residues of harmful substances in their food, it is important that the national residue program’s controls be as robust as possible to prevent meat contaminated with harmful substances from reaching the kitchen table.<br /><br />11<br /><br />For purposes of this report, we refer to Escherichia coli O157:H7 simply as E. coli.<br /><br />Audit Report 24601-08-KC 8<br /><br />snip...<br /><br />Section 2: FSIS Needs to Strengthen Oversight at Plants and Upgrade the National Residue Program’s Technology<br /><br />Finding 2: FSIS Needs to Strengthen Oversight of the National Residue Program, Especially at Plants Slaughtering Dairy Cows and Bob Veal<br /><br />FSIS has not required that slaughter plants processing dairy cows and bob veal implement adequate controls to ensure that residue is not entering the food supply, even though these plants are at much higher risk than plants processing beef cattle. This has occurred because Hazard Analysis and Critical Control Point (HACCP) principles allow slaughter plants themselves to make the determination as to whether residue problems were “reasonably likely to occur”—the threshold for implementing additional controls—and the primary function of the FSIS plant-level personnel is not to challenge the hazardous risk assessment but to verify or monitor the plant’s application of the existing controls. FSIS did not exercise additional oversight despite the fact that plants handling dairy cows and bob veal were responsible for over 90 percent of residue violations in 2008.<br /><br />Audit Report 24601-08-KC 24<br /><br />33 Agency officials had not performed the analysis necessary to determine that violations were concentrated within dairy cows and bob veal, and they regard residue as a lower priority than other sorts of adulterants, such as E. coli and Salmonella. As a result, in 2008, one plant amassed as many as 211 violations—another had 21 producers with multiple violations—and other plants treated residue as a problem “not reasonably likely to occur” (see Table 1, below). Furthermore, we verified that at least four beef carcasses were adulterated with violative levels of residue, entered commerce, and were not recalled by the slaughter plant or FSIS.34<br /><br />The following table summarizes the number of residue violations at 7 selected cattle slaughter establishments during the 2008 calendar year. The violation data was taken from the Residue Violation Information System (RVIS).35 This information includes OIG’s assigned plant identification number (1 – 7), the number of residue violations at each plant, the number of repeat offenders that delivered cattle to the plant, the number of residue violations that occurred at the plant from repeat offenders, and the overall percentage of residue violations at the plant that came from repeat offenders.<br /><br />33<br /><br />The 2008 data from the RVIS database was the most recent full calendar year information available at the time of our field work.<br /><br />34<br /><br />Since FSIS did not request a voluntary recall by the establishments, the plants did not collect the production data necessary for FSIS to determine the number of pounds of product from the four carcasses with the violative amounts of Ivermectin, Sulfadimethoxine, Florfenicol, and Sulfamethazine.<br /><br />35<br /><br />During the course of our audit, we did not verify information in the RVIS, and make no representation of the adequacy of the system or the information generated from it.<br /><br />PLANT VIOLATIONS REPEAT OFFENDERS VIOLATIONS FROM REPEAT OFFENDERS PERCENT OF VIOLATIONS FROM REPEAT OFFENDERS<br /><br />1 211 12 24 11 percent<br /><br />2 196 21 57 29 percent<br /><br />3 102 6 14 14 percent<br /><br />4 90 9 22 24 percent<br /><br />5 58 1 2 3 percent<br /><br />6 50 3 6 12 percent<br /><br />7 42 7 17 40 percent<br /><br />see full text ;<br /><br /><a href="http://www.usda.gov/oig/webdocs/24601-08-KC.pdf">http://www.usda.gov/oig/webdocs/24601-08-KC.pdf</a><br /><br /><br />EXAMPLE ;<br /><br />1008 Grinstead Mill Road Dairy<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration<br /><br />March 15, 2010<br /><br />VIA FEDERAL EXPRESS<br /><br />WARNING LETTER 10-89924-08<br /><br />Mr. Kelly Poynter, Sr., Owner 1008 Grinstead Mill Road Cave City, Kentucky 42127-9601<br /><br />Dear Mr. Poynter:<br /><br />On October 6, 7, 8, 13, and 14, 2009, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 1008 Grinstead Mill Road, Cave City, Kentucky 42127-9601. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about July 6, 2009, you sold a culled dairy cow, identified with back tag (b)(4) for slaughter as food. On or about July 7, 2009, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 35.936 parts per million (ppm) of sulfamethazine residue in the muscle tissue and the presence of 32.294 ppm of sulfamethazine residue in the liver tissue. FDA has established a tolerance of 0.1 ppm for residues of sulfamethazine in the uncooked edible tissues of cattle as codified in Title 21, Code of Federal Regulations (C.F.R.), 556.670 (21 C.F.R. 556.670). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4).<br /><br />We also found that you adulterated the new animal drug sulfamethazine. Specifically, our investigation revealed that you did not use sulfamethazine as directed by its approved labeling. Use of this drug in this manner is an extra-label use. See 21 C.F.R. 530.3(a). In addition, the extra-label use of sulfamethazine is prohibited in lactating dairy cows under 21 C.F.R. 530.41(a)(9).<br /><br />The extra-label use of approved new animal or human drugs in animals is allowed under the Act only if the extra-label use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Our investigation found that you administered sulfamethazine to the culled dairy cow identified with back tag (b)(4) without following the dose and withdrawal period as stated in the approved labeling. Sulfamethazine is prohibited for extra-label use in lactating dairy cows by 21 C.F.R. 530.41(a)(9). Furthermore, your extra-label use of sulfamethazine resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the Act, 21 U.S.C. 351(a)(5).<br /><br />The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute is in compliance with the law.<br /><br />You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br /><br />You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within fifteen (15) working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br /><br />Your written response should be sent to Stephen J. Rabe, Compliance Officer, U.S. Food and Drug Administration, 6751 Steger Drive, Cincinnati, Ohio 45237. If you have any questions about this letter, please contact Mr. Rabe at 513-679-2700 ext. 163.<br /><br />Sincerely, /S/<br /><br />Karen Gale Sego Acting District Director Cincinnati District<br /><br />Cc: Dr. William Thorn University of Kentucky Division of Regulatory Service 103 Regulatory Service Building Lexington, KY 40546-0275<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm206359.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm206359.htm</a><br /><br /><br />Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers<br /><br />Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).<br /><br />We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.<br /><br />In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.<br /><br />These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.<br /><br />snip...<br /><br />Discussion<br /><br />This study is the first to document MRSA in U.S. swine and swine workers, and to our knowledge, the first to report the presence of ST398 (also reported as non-typeable MRSA, NT-MRSA) [15] in the U.S. Like previous studies in Canada, Denmark, and the Netherlands [11], [12], [24], ST398 was found in both animals and humans, suggesting transmission between the two. The prevalence of MRSA colonization among swine and swine workers was high at one farm system that we examined in the Midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. Strain ST398 was the only MRSA identified among the swine and swine workers. This strain has been the predominant strain among swine in the Netherlands and Canada. However, Khanna et al. in Canada recently found both ST398 and ST5/USA100 colonizing the nares of swine and swine workers [12]. This difference may indicate that the epidemiology of MRSA on Canadian swine farms is different than on the affected farm system in Iowa and Illinois. On the other hand, the difference may have resulted from differing sampling methodologies. Khanna et al. sampled a small number of humans and swine on 20 farms whereas we took a larger number of samples from a smaller number of farms in two corporate systems. Furthermore, because we did not type all isolates in this pilot study, additional strain types may be present that we did not detect.<br /><br />snip...<br /><br />In summary, we report the first isolation of MRSA from swine and swine workers in the U.S. Although the extent of this problem in the U.S. is currently unknown, our findings may have important implications for the epidemiology of MRSA disease. For example, Van Loo et al. identified MRSA in meat products in the Netherlands [32], suggesting that persons who handle raw pork products might be at risk for acquiring MRSA. Future studies should assess the risk of MRSA disease among swine workers and their contacts, survey retail meat products for MRSA contamination, study larger populations of swine and humans to define the epidemiology of MRSA within swine operations, and assess MRSA carriage rates in other livestock.<br /><br />full text ;<br /><br /><a href="http://www.plosone.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004258&representation=PDF">http://www.plosone.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004258&representation=PDF</a><br /><br /><br />also see, and please note ;<br /><br />"none of the colonized participants reported recent travel to the Dominican Republic. No contact among the different households was reported."<br /><br />From Emerging Infectious Diseases<br /><br />Staphylococcus aureus ST398, New York City and Dominican Republic<br /><br />Meera Bhat; Caroline Dumortier; Barbara S. Taylor; Maureen Miller; Glenny Vasquez; Jose Yunen; Karen Brudney; Jacqueline Sánchez E.; Carlos Rodriguez-Taveras; Rita Rojas; Patricia Leon; Franklin D. Lowy<br /><br />Authors and Disclosures<br /><br />Posted: 05/11/2009; Emerging Infectious Diseases © 2008 Centers for Disease Control and Prevention (CDC)<br /><br />Abstract Closely related Staphylococcus aureus strains of ST398, an animal-associated strain, were identified in samples collected from humans in northern Manhattan, New York, NY, USA, and in the Dominican Republic. A large population in northern Manhattan has close ties to the Dominican Republic, suggesting international transmission.<br /><br />Introduction<br /><br />In the past 5 years, as methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a community pathogen, awareness of the role of animal exposure from pets or farming as sources of MRSA has increased.[1-3] We identified a clone of S. aureus previously associated with outbreaks of infections in animals and in humans who work with animals in 2 unique collections of S. aureus isolates. The first was from a population-based study of S. aureus colonization among residents of northern Manhattan in New York, NY, USA; the second was from isolates obtained from the Dominican Republic. This clone does not digest with the restriction enzyme SmaI, which is generally used for pulsed-field gel electrophoresis (PFGE). Consequently, the clone is identified by multilocus sequence typing as sequence type 398 (ST398). Both methicillin-resistant and methicillin-susceptible isolates of S. aureus have been reported.[4] ST398 has been found primarily in Europe, where it has been isolated from pigs and pig farmers in the Netherlands and France and from dogs, pigs, horses, and humans in Germany and Austria.[5-8] Colonization with MRSA ST398 has recently been reported in pigs and pig farmers in Canada.[9]<br /><br />snip...<br /><br />The Study<br /><br />The community-based study was conducted from 2004 through 2007 in the northern section of Manhattan, a borough of New York City. Northern Manhattan contains a large, medically underserved population that has close ties to the Dominican Republic. Participants were recruited by using random-digit dialing. Consenting persons and household members were subsequently interviewed and screened for S. aureus colonization. A total of 321 eligible households containing 914 household members participated. In 9 households, 13 participants were found to be colonized with S. aureus isolates that were SmaI resistant. Digestion with the Cfr9I, an isoschizomer of SmaI, yielded identical PFGE profiles (Figure). Subsequent multilocus sequence typing confirmed the ST398 identification (allelic profile 3-35-19-2-20-26-39). All strains were methicillin susceptible. A representative strain was spa-typed as type t571 (allelic profile 8-16-2-25-2-25-34-25, eGenomics type 109); it was Panton-Valentine leukocidin negative.<br /><br />Characteristics of persons colonized with ST398 were similar to those of persons in the community-based study and with northern Manhattan census characteristics (Table). The 13 isolates were from 9 different families; 1 family had 4 members colonized with ST398 at either nasal or axillary sites. The mean age of those colonized was 33.4 years; only 1 child (7 years of age) was colonized. Two persons from different families were colonized with ST398 at multiple sites, none of which were confirmed as infections.<br /><br />No household reported owning pets, although 2 reported animal contact. Of the 12 adults, 5 (41.7%) reported possible job exposure to S. aureus, including 1 who worked in a healthcare-associated field. No household reported patronizing viveros, or live poultry markets, which are common in the Latino communities of northern Manhattan and the Bronx. Two households reported having children who attended day care, although none of these children were colonized with S. aureus. Although 15% of the Dominican population in the study reported travel to the<br /><br />Page 2 of 7<br /><br />Dominican Republic within 6 months of their interview, none of the colonized participants reported recent travel to the Dominican Republic. No contact among the different households was reported.<br /><br />snip...<br /><br /><a href="http://www.cdc.gov/eid/content/15/2/pdfs/08-0609.pdf">http://www.cdc.gov/eid/content/15/2/pdfs/08-0609.pdf</a><br /><br /><br />Vancomycin-Resistant Staphylococcus aureus Isolates Associated with Inc18-Like vanA Plasmids in Michigan Wenming Zhu, Nancye C. Clark, Linda K. McDougal, Jeffery Hageman, L. Clifford McDonald, and Jean B. Patel* Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia<br /><br />Received 11 July 2007/ Returned for modification 11 September 2007/ Accepted 13 November 2007<br /><br />Vancomycin-Resistant Staphylococcus aureus Isolates Associated with Inc18-Like vanA Plasmids in Michigan<br /><br />Wenming Zhu, Nancye C. Clark, Linda K. McDougal, Jeffery Hageman, L. Clifford McDonald, and Jean B. Patel* Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia<br /><br />Received 11 July 2007/ Returned for modification 11 September 2007/ Accepted 13 November 2007<br /><br />ABSTRACT<br /><br />Five of the seven cases of vancomycin-resistant Staphylococcus aureus (VRSA) infection identified to date have occurred in southeastern Michigan. VRSA isolates from the four most recent cases (all from Michigan) were characterized. The vanA gene was localized to a single plasmid in each VRSA isolate. The pulsed-field gel electrophoresis patterns of chromosomal DNA and the restriction profile of the plasmid demonstrated that the four isolates were unique and differed from the first three VRSA isolates. Vancomycin-resistant Enterococcus (VRE) isolates, all of which were Enterococcus faecalis, were recovered from case patients 4 to 6. Each VRE isolate transferred vancomycin resistance to E. faecalis JH2-2 by conjugation. PCRs for vanA and the Inc18-like plasmid genes traA and repR confirmed the presence of an Inc18-like vanA plasmid in all VRE isolates and transconjugants. An Inc18-like vanA plasmid was identified in the VRSA isolate from case patient 7. These findings suggest a role of Inc18-like plasmids as vanA donors.<br /><br />snip...<br /><br />The occurrence of VRSA appears to be either a one- or a two-step genetic event. The plasmid from the first VRSA isolate was sequenced and was found to be a previously recognized S. aureus plasmid containing a Tn1546 insertion (35). The proposed model of resistance transfer was a two-step genetic event in which the S. aureus isolate acquired the Enterococcus vanA plasmid, Tn1546 transferred from the Enterococcus plasmid to the S. aureus plasmid by transposition, and the Enterococcus plasmid was not maintained in the S. aureus recipient. In the third VRSA case, the entire Enterococcus vanA plasmid was maintained in the S. aureus recipient (36). This suggests a single genetic event in which the vanA plasmid is transferred from one isolate to the next, most likely by conjugation. In our analysis of the Michigan VRSA isolates, both outcomes were observed.<br /><br />It is not clear how common VRSA will be in the future, but this is certainly a concerning antimicrobial resistance that should be prevented, if possible. An important aspect of VRSA prevention will be the control of VRE and methicillin-resistant S. aureus transmission. This is a challenging prospect, since both VRE and methicillin-resistant S. aureus are endemic in most health care settings in the United States (4). It may be prudent to implement the most rigorous control measures for patient populations and at locations where VRE isolates with Inc18-like plasmids occur.<br /><br /><a href="http://aac.asm.org/cgi/content/full/52/2/452?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=isolates&searchid=1&FIRSTINDEX=2780&sortspec=date&resourcetype=HWFIG">http://aac.asm.org/cgi/content/full/52/2/452?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=isolates&searchid=1&FIRSTINDEX=2780&sortspec=date&resourcetype=HWFIG</a><br /><br /><br /><br />High-Level Vancomycin-Resistant Staphylococcus aureus (VRSA) Associated with a Polymicrobial Biofilm<br /><br /><a href="http://aac.asm.org/cgi/reprint/AAC.00576-06v1.pdf">http://aac.asm.org/cgi/reprint/AAC.00576-06v1.pdf</a><br /><br /><br />REVIEW The emergence of vancomycin-intermediate and vancomycin-resistant Staphylococcus aureus P. C. Appelbaum Hershey Medical Center, Hershey, Pennsylvania, USA Corresponding author and reprint requests: P. C. Appelbaum, Department of Pathology, Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA E-mail: pappelbaum@psu.edu Copyright 2006 European Society of Clinical Microbiology and Infectious Diseases KEYWORDS Antibiotic . methicillin-resistant Staphylococcus aureus . review . vancomycin-non-susceptible Staphylococcus aureus . vancomycin-resistant enterococci Abstract<br /><br />Methicillin-resistant Staphylococcus aureus (MRSA) is well-recognised as a major cause of infection in the healthcare setting but, even more worryingly, is now emerging in the community. The glycopeptides-notably vancomycin-have traditionally been the mainstay of treatment of MRSA but overuse has led to the emergence of vancomycin-intermediate and vancomycin-resistant MRSA (VISA and VRSA, respectively). Although the mechanisms underlying vancomycin resistance are not yet fully understood, changes to the bacterial cell wall-the site of action of the glycopeptides-are believed to be key. Recent evidence also supports the transfer of genetic material among bacteria as contributing to the development of VRSA. Based on the cases identified to date, risk factors for the development of VRSA may include older age, compromised blood flow to the lower limbs, and the presence of chronic ulcers. The true extent of the problem, however, remains to be determined-it is likely that many cases of VISA and VRSA infection go undetected because of suboptimal screening programmes and possible limitations of automated and non-automated detection methods. Effective screening directed at those patients considered to be most at risk should therefore be a priority. Not surprisingly, the spread of MRSA from the hospital to the community setting, coupled with the emergence of VISA and VRSA, has become a major cause of concern among clinicians and microbiologists. The treatment options available for these infections are now severely compromised and thus new classes of antimicrobial agents effective against MRSA, VISA and VRSA are urgently required.<br /><br />--------------------------------------------------------------------------------<br /><br />DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1469-0691.2006.01344.x About DOI<br /><br /><a href="http://www3.interscience.wiley.com/journal/118633206/abstract?CRETRY=1&SRETRY=0">http://www3.interscience.wiley.com/journal/118633206/abstract?CRETRY=1&SRETRY=0</a><br /><br /><br />DOI: 10.3201/eid1604.091435<br /><br />Suggested citation for this article: Golding GR, Bryden L, Levett PN, McDonald RR, Wong A, Wylie J, et al.<br /><br />Livestock-associated methicillin-resistant Staphylococcus aureus sequence type 398 in humans, Canada.<br /><br />Emerg Infect Dis; [Epub ahead of print]<br /><br />Livestock-associated Methicillin-Resistant Staphylococcus aureus Sequence Type 398 in Humans, Canada<br /><br />George R. Golding, Louis Bryden, Paul N. Levett, Ryan R. McDonald, Alice Wong, John Wylie, Morag R. Graham, Shaun Tyler, Gary Van Domselaar, Andrew E. Simor, Denise Gravel, and Michael R. Mulvey Author affiliations: National Microbiology Laboratory, Winnipeg, Manitoba, Canada (G.R. Golding, L. Bryden, M.R. Graham, S. Tyler, G. Van Domselaar, M.R. Mulvey); Saskatchewan Disease Control Laboratory, Regina, Saskatchewan, Canada (P.N. Levett, R.R. McDonald); Royal University Hospital, Saskatoon, Saskatchewan, Canada (A. Wong); Cadham Provincial Laboratories, Winnipeg (J. Wylie); Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada (A.E. Simor); and Public Health Agency of Canada, Ottawa, Ontario, Canada (D. Gravel)<br /><br />Rates of colonization with livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 have been high for pigs and pig farmers in Canada, but prevalence rates for the general human population are unknown. In this study, 5 LA-MRSA isolates, 4 of which were obtained from skin and soft tissue infections, were identified from 3,687 tested MRSA isolates from persons in Manitoba and Saskatchewan, Canada. Further molecular characterization determined that these isolates all contained staphylococcal cassette chromosome (SCC) mecV, were negative for Panton-Valentine leukocidin, and were closely related by macrorestriction analysis with the restriction enzyme Cfr91. The complete DNA sequence of the SCCmec region from the isolate showed a novel subtype of SCCmecV harboring clustered regularly interspaced short palindromic repeats and associated genes. Although prevalence of livestock-associated MRSA seems to be low for the general population in Canada, recent emergence of infections resulting from this strain is of public health concern.<br /><br />High prevalence of colonization with livestock-associated (LA) methicillin-resistant Staphylococcus aureus (MRSA) sequence type (ST) 398 among pigs and pig farmers was first<br /><br />Page 1 of 16<br /><br />reported in the Netherlands (1) and has since been identified in Canada (2) and the United States (3). In Canada, this LA-MRSA strain was identified in pigs and pig farmers in southwestern Ontario, where prevalence of MRSA colonization was 24.9% (71/285) and 20% (5/25), respectively (2). In the United States, nasal samples from 20 production system workers and 299 swine from 2 farms in Illinois and Iowa showed that 45% (9/20) and 49% (147/299), respectively, were colonized with LA-MRSA (3). Despite such high prevalence of MRSA colonization on these tested farms, to our knowledge, no human or animal infections resulting from LA-MRSA strains have been reported in North America. To determine whether LA-MRSA has recently emerged in the general population of Canada, we identified human infections and colonizations associated with the LA-MRSA strain in Canada and molecularly characterized the isolates. We also identified a novel staphylococcal cassette chromosome (SCC) mecV subtype harboring clustered regularly interspaced short palindromic repeats (CRISPR) and CRISPR-associated genes (cas).<br /><br />SNIP...<br /><br />Discussion<br /><br />The high prevalence of LA-MRSA colonization of pigs and pig farmers in Canada (2) and the United States (3) and this report of human infections suggest that this LA-MRSA strain from Canada poses potential public and occupational health concern in North America. This strain has been associated with various types of infections in pigs (17,18) and humans (19,20) and is transmissible from animal patients to veterinary workers (21), healthcare workers (22), and family members (1). Evidence also suggests that this strain might be spreading from animals to the environment, which may facilitate the colonization or infection of persons who are not involved in animal husbandry (23). Whereas in 2006 in the Netherlands LA-MRSA accounted for >20% of all MRSA isolated (24), carriage of this strain in the general population of 2 provinces in Canada (Manitoba and Saskatchewan) appears rare (0.14%). This difference could be attributed to the substantially higher density of pigs in the Netherlands (1,244 pigs/km2) than in Manitoba (55 pigs/km2), Saskatchewan (6 pigs/km2), and Ontario (91 pigs/km2) (www.agriculture.gov.sk.ca/Pig_Densities). It is also plausible that the much lower proportions of LA-MRSA in Canada, relative to a country with low MRSA endemicity such as the Netherlands, is attributable to competition with other highly successful human epidemic MRSA clones circulating in Canada, including CMRSA2 (USA200/800), CMRSA7 (USA400), and CMRSA10 (USA300) (25,26). The tested LA-MRSA isolates were highly susceptible to most classes of antimicrobial drugs, except ß-lactams and tetracyclines, the latter of which has been attributed to its high usage in animal husbandry (27). The complete sequence of the SCCmec region showed a novel SCCmecV subtype sharing sequence identity in its J1 and J3 regions with chromosomal genes in the S. epidermidis RP62A chromosome (GenBank accession no. CP000029), including a<br /><br />Page 6 of 16<br /><br />CRISPR system. CRISPRs and associated cas genes are present in many other bacterial (˜40%) and archaeal (˜90%) genomes (28,29) and have been shown to be involved in sequence-directed immunity against phages (30,31) and plasmids (32). The resistance to plasmids and phages encoded by this system could explain why many of these ST398-MRSA-V strains contain fewer antimicrobial drug resistance genes and phage-encoded virulence factors than do other epidemic MRSA strains (33,34). The origin of this CRISPR system is unknown, but the propagation of CRISPR loci throughout prokaryote genomes has been proposed to occur through horizontal gene transfer by conjugation of megaplasmids >40 kb (35). Because the CRISPR system identified in this study is encoded within a putative mobile genetic element, we propose that an additional mechanism of mobilization to other methicillin-susceptible Staphylococcus spp. is plausible.<br /><br />This novel subtype of SCCmecV was found in only 4 of the 6 LA-MRSA isolates identified in this study. One isolate not containing this novel SCCmec subtype (08 BA 08100) could also be distinguished by a different but closely related spa type (t1250) (Table 1) and variant PFGE fingerprint (Figure 2) when compared with the other LA-MRSA isolates, which suggests that at least 2 epidemiologically different strains of LA-MRSA circulate in Saskatchewan. The other LA-MRSA isolate that did not contain this novel SCCmec element was obtained in Ontario. However, this isolate was the same spa type (t034) and was closely related, according to PFGE, to the LA-MRSA isolates identified in Saskatchewan. Therefore, in addition to PFGE and spa typing, SCCmec subtyping could provide a useful epidemiologic tool for surveillance, outbreak investigations, or traceability studies of this emerging strain. For detection of this SCCmecV subtype (tentatively designated V.2.1.2; Vb), we propose using primer set 1 (spanning orfX into Sk02 in the J3 region) and primer set 7 (spanning Sk20 into cas1 in the J1 region) (Table 4).<br /><br />Visual comparison of PFGE fingerprints from this study with those reported from patients from the Dominican Republic and the United States (northern Manhattan, New York, NY) (36), showed substantial variations in fingerprint patterns, as well as related but different spa types. These variations suggest further molecular and geographic diversity of these LA-MRSA strains on a global scale.<br /><br />Page 7 of 16<br /><br />Because cases of LA-MRSA infections have only recently been identified in Canada, additional surveillance efforts are required to monitor the emergence and clinical relevance of this MRSA strain in Canada, including communities, the environment, livestock, farmers, and production facility workers. Whether these strains pose a major threat to human health in light of the low livestock density and continued spread of epidemic hospital and community strains of MRSA in Canada remains unknown.<br /><br /><a href="http://www.cdc.gov/eid/content/16/4/pdfs/09-1435.pdf">http://www.cdc.gov/eid/content/16/4/pdfs/09-1435.pdf</a><br /><br /><br />Volume 16, Number 4–April 2010 Dispatch Porcine-Origin Gentamicin-Resistant Enterococcus faecalis in Humans, Denmark Jesper Larsen, Henrik C. Schønheyder, Camilla H. Lester, Stefan S. Olsen, Lone J. Porsbo, Lourdes Garcia-Migura, Lars B. Jensen, Magne Bisgaard, and Anette M. Hammerum Author affiliations: University of Copenhagen, Frederiksberg, Denmark (J. Larsen, M. Bisgaard); Aarhus University Hospital, Aalborg, Denmark (H.C. Schønheyder); Statens Serum Institut, Copenhagen, Denmark (C.H. Lester, S.S. Olsen, A.M. Hammerum); Technical University of Denmark, Søborg, Denmark (L.J. Porsbo); and Technical University of Denmark, Copenhagen (L. Garcia-Migura, L.B. Jensen)<br /><br />Suggested citation for this article<br /><br />Abstract During 2001–2002, high-level gentamicin-resistant (HLGR) Enterococcus faecalis isolates were detected in 2 patients in Denmark who had infective endocarditis and in pigs and pork. Our results demonstrate that these isolates belong to the same clonal group, which suggests that pigs are a source of HLGR E. faecalis infection in humans.<br /><br />snip...<br /><br />Conclusions Our study provides evidence of the existence of a widespread community reservoir of HLGR ST16 in pigs in Denmark during 2001–2002, which coincided with emergence of HLGR ST16 isolates among IE patients in North Denmark Region. One isolate was present in pork, which supports foodborne transmission, although direct transmission from animals to humans is also possible.<br /><br />Our study has potential limitations. First, the method used by DANMAP (susceptibility testing of 1 colony per sample, rather than resistance prevalence per sample) may underestimate the extent of the HLGR reservoir in food-producing animals, meat products, and community-dwelling persons. Second, HLGR isolates from patients with infective endocarditis emanated from 2001 and 2002 and therefore do not represent recent trends.<br /><br />Our findings support the results of a recent study in the United States that identified HLGR E. faecalis isolates with similar PFGE patterns (<3-band>22 million slaughter pigs (4–6), Denmark has a large potential reservoir of HLGR ST16. Although HLGR ST16 was not detected in other food-producing animals and meat products, this type may not be exclusive to pigs. We found HLGR ST16 isolates in 2 community-dwelling persons during 2003–2005. Preference for eating pork, close contact with the healthcare setting, underlying disease, or a combination thereof may have predisposed these persons to become colonized by this potential pathogen.<br /><br />HLGR ST16 appears to be transmitted from pigs to humans, although other routes of transmission also may exist. Further studies are needed to better understand the human and veterinary epidemiology of this zoonosis. Areas of study should include recent trends of HLGR among invasive E. faecalis; size of the reservoir in pigs; its association with antimicrobial drug use in pigs; and whether other animals, immunocompromised persons, or healthy persons constitute a community reservoir of HLGR ST16.<br /><br />snip...<br /><br />see full text ;<br /><br /><a href="http://www.cdc.gov/eid/content/16/4/682.htm">http://www.cdc.gov/eid/content/16/4/682.htm</a><br /><br /><br />Animal Sale for Slaughter as Food/Adulterated A few examples ;<br /><br />Double B Dairy, LLC 3/8/10<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District Pacific Region 22201 23rd Drive SE Bothell, WA 98021-4421 Telephone: 425-486-8788 FAX: 425-483-4996<br /><br />March 8, 2010<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />In reply refer to Warning Letter SEA 10-17<br /><br />Joseph F. Brasil, President and Partner Double B Dairy, LLC 2930 South 2300 East Wendell, Idaho 83355<br /><br />WARNING LETTER<br /><br />Dear Mr. Brasil:<br /><br />On January 14, and 20, 2010, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 280 West 110 South, Murtaugh, Idaho. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on the FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to, be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about September 17, 2009, you sold a dairy cow, identified with Back Tag number (b)(4), for slaughter as food to (b)(4) where it was subsequently slaughtered on that same day. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from that animal identified the presence of Flunixin at 1.494 parts per million (ppm) in the liver. FDA has established a tolerance of 0.125 ppm for residues of Flunixin in the edible tissues of cattle, as codified in Title 21, Code of Federal Regulations, Section 556.286 (21 C.F.R. 556.286).<br /><br />The presence of Flunixin in edible tissues from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. You lack an adequate system to ensure that animals medicated by you have been withheld from slaughter for appropriate periods of time to permit depletion of potentially hazardous residues of drugs from edible tissues.<br /><br />For example, you failed to maintain records regarding the identity of animal(s) that you delivered for sale to (b)(4). Specifically, your treatment records are correlated to the numbered ear tags that you apply to the individual cows. On or about September 17, 2009, you sold seven cows for slaughter and removed the ear tags prior to them leaving your premises. You failed to correlate the ear tag numbers with back tag numbers, (b)(4) applied by (b)(4) when they picked up the cows and thereby lost the true identity of the cows and the ability to provide treatment records for those individual cows.<br /><br />Additionally, you failed to have a system to control the administration of drug treatments to your animals. Specifically, it appears that the cow identified by back tag number (b)(4) was administered Banamine (Flunixin meglumine) and the treatment was never recorded. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm204888.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm204888.htm</a><br /><br /><br />Quesnel Livestock 11/23/09<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration New England District One Montvale Avenue Stoneham, Massachusetts 02180 (781) 596-7700 FAX: (781) 596-7896<br /><br />WARNING LETTER<br /><br />NWE-07-10W<br /><br />VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />November 23, 2009<br /><br />Mr. Bernard Quesnel, Co-Owner Quesnel Livestock 1442 Route 7 North Middlebury, VT 05753-8780<br /><br />Dear Mr. Quesnel:<br /><br />An inspection of your operation located in Middlebury, VT, by a Food and Drug Administration investigator on September 22, 2009, September 24, 2009, October 7, 2009 and November 4, 2009, confirmed a dairy cow identified with back tag (b)(4), ear tag # (b)(4), and farm tag (b)(4) purchased and sold by you on or about April 7, 2009, for slaughter for human food to (b)(4), was in violation of Section 402 (a)(2)(C)(ii) of the Federal Food, Drug, and Cosmetic Act (the Act). USDA/FSIS analyses of tissues collected from that animal disclosed the presence of the following drugs:<br /><br />Date Animal Form Number USDA Case Number Tissue Drug Residue Level Found (ppm) Tolerance 21 CFR Reference Cite 04/08/09 Dairy Cow 343018 09-0371-VT Kidney Liver Penicillin Flunixin 0.60<br /><br />0.3355 0.05<br /><br />0.125 556.510<br /><br />556.286<br /><br />* Tolerances have been established for residues in the edible tissues of dairy cows which are codified in Title 21 Code of Federal Regulations Section 556.<br /><br />In addition, USDA has reported the finding of illegal residues in other livestock sold by you and offered for slaughter for human drugs. Copies of letters from USDA/FSIS notifying you of these residues are attached.<br /><br />Date Animal Form Number USDA Case Number Tissue Drug Residue Level Found (ppm) Tolerance 21 CFR Reference Cite 12/14/06 Dairy Cow 468604 06-0603-VT<br /><br />07-0066-VT Kidney Penicillin 0.14 0.05 556.510 10/11/06 Bob Veal Calf 109370 06-0906-VT Kidney<br /><br />Muscle Oxytetracycline 33.52<br /><br />4.19 12.0<br /><br />2.00 556.500 08/04/05 Dairy Cow 460745 05-0446-VT Kidney<br /><br />Liver Penicillin 0.23<br /><br />0.16 0.05<br /><br />0.05 556.510 05/06/05 Dairy Cow 460348 05-0446-VT Liver<br /><br />Muscle Sulfadimethoxine 0.859<br /><br />1.19 0.10<br /><br />0.10 556.640 10/08/02 Dairy Cow 446075 02-1302-VT Kidney<br /><br />Penicillin 0.22 0.05 556.510 03/27/01 Dairy Cow 429987 01-0649-VT Liver<br /><br />Muscle Sulfadimethoxine 3.40<br /><br />2.10 0.10<br /><br />0.10 556.640 06/07/00 Dairy<br /><br />Cow 406327 00-0052-VT Kidney Penicillin 0.09 0.05 556.510<br /><br />* Tolerances have been established for residues in the edible tissues of dairy cows which are codified in Title 21 Code of Federal Regulations<br /><br />In addition, your firm has employed poor husbandry practices by failing to take reasonable precautions to prevent the marketing and sale of animals containing illegal residues in interstate commerce. Your significant violations are as follows:<br /><br />1. You have failed to implement and maintain a system to identify the animals you purchase with records to establish traceability to the source of the animal. Specifically on or about April 7, 2009 you purchased and sold a cow in interstate commerce, identified with back tag # (b)(4), ear tag # (b)(4), and farm tag # (b)(4), however you maintained no documentation as to the origin of the cow.<br /><br />2. You have failed to determine from the source of the animal whether the animal has been medicated and with what drug(s). Specifically, since 2000 you have purchased and sold at least (b)(4) livestock animals for slaughter that have been found to contain violative tissue residues. You answered in the negative when asked if you inquire about the medication status of the animal from the source.<br /><br />Pursuant to section 301(a) {U.S.C. § 331(a)} of the Act the introduction or delivery for introduction into interstate commerce of any food that is adulterated is prohibited.<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm192802.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm192802.htm</a><br /><br /><br />Crestview Calves, Inc.<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District Pacific Region 22201 23rd Drive SE Bothell, WA 98021-4421 Telephone: 425-486-8788 FAX: 425-483-4996<br /><br />February 16, 2010<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED /or/ Federal Express<br /><br />In reply refer to Warning Letter SEA 10-13<br /><br />Cody G. Morgan; Owner / President Crestview Calves, Inc. 756 South 2800 East Hazelton, Idaho 83335-5280<br /><br />WARNING LETTER<br /><br />Dear Mr. Morgan:<br /><br />On November 3 and 5, 2009, the U.S. Food and Drug Administration (FDA) conducted an investigation of your calf raising operation located at 756 South 2800 East, Hazelton, Idaho 83335-5280. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the. Internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale animals for slaughter as food that were adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about August 14, 2009, you sold a calf, identified with back tag (b)(4), for slaughter as food. On or about August 14, 2009, (b)(4) slaughtered this animal. In addition, our investigation revealed that on or about August 26, 2009, you sold a calf, identified with back tag (b)(4) for slaughter as food. On or about August 26, 2009, this animal was also slaughtered at (b)(4). United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from these animals identified the presence of gentamicin sulfate in the kidney tissues. FDA has not established a tolerance for residues of gentamicin sulfate in the edible tissues of cattle. The presence of this drug in edible tissue from these animals causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain treatment records for the animals identified with back tags (b)(4) and (b)(4) Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4).<br /><br />We also found that you adulterated the new animal drug gentamicin sulfate. Specifically, our investigation revealed that you did not use gentamicin sulfate as directed by the veterinarian's prescription labeling nor as directed by its approved labeling. Use of this drug in this manner is an extralabel use. See Title 21, Code of Federal Regulations, Section 530.3(a) (21 C.F.R. 530.3(a)).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Our investigation found that you administered gentamicin sulfate to two calves, back tags (b)(4) and (b)(4) without following the dose and withdrawal period as stated in the veterinarian's prescription labeling nor as directed by its approved labeling. Your extralabel use of gentamicin sulfate resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11 (c). Because your use of this drug was not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501(a)(5) of the Act, 21 U.S.C. 351(a)(5).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm201740.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm201740.htm</a><br /><br /><br />Double V Dairy<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District Pacific Region 22201 23rd Drive SE Bothell, WA 98021-4421 Telephone: 425-486-8788 FAX: 425-483-4996<br /><br />October 28, 2009<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />In reply refer to Warning Letter SEA 10-05<br /><br />Ray Vander Vegt, President Double V, LLC 1587 East 3100 South Wendell, Idaho, 83355<br /><br />WARNING LETTER<br /><br />Dear Mr. Vander Vegt:<br /><br />On June 30 and July 2, 2009, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 1587 East 3100 South, Wendell, Idaho. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on the FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii) a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about February 17, 2009, you sold 12 cows for slaughter to (b)(4) one of which was identified by (b)(4) with back tag (b)(4) On or about February 18, 2009 (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 3.55 parts per million (ppm) of penicillin residue in the liver, 10.62 ppm in the muscle, and 2.29 ppm in the kidney tissue. FDA has established a tolerance for residues of penicillin in the uncooked edible tissues of cattle at 0.05 ppm as codified in Title 21, Code of Federal Regulations, Section 556.510(a) (21 C.F.R. 556.510(a)). The presence of this drug in edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4).<br /><br />We also found that you adulterated the new animal drug Penicillin G Procaine Injectable Solution. Specifically, our investigation revealed that you did not use this drug as directed by its approved labeling. Use of this drug in this manner is an extralabel use. 21 C.F.R. 530.3(a).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/c1ienUpatient relationship.<br /><br />Our investigation found that in February 2009 you administered Penicillin G Procaine to the cow identified by back tag (b)(4) without following the indications or dosing instructions as stated in the drug's approved labeling. Your extralabel use of Penicillin G Procaine was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11 (a). Furthermore, your extralabel. use of Penicillin G Procaine in the cow identified by back tag (b)(4) resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11 (d). Because your extralabel uses of this drug were not in conformance with its approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the Act, 21 U.S.C. 360b(a), and adulterated within the meaning of section 501 (a)(5) of the Act, 21 U.S.C. 351 (a)(5).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189222.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189222.htm</a><br /><br /><br />Schlegel Dairy Farms Inc 9/11/09<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Cincinnati District Office Central Region 6751 Steger Drive Cincinnati, OH 45237-3097 Telephone: (513) 679-2700 FAX: (513) 679-2761<br /><br />September 11, 2009<br /><br />WARNING LETTER CIN-09-68103-17<br /><br />VIA FEDERAL EXPRESS<br /><br />Kurt A. Schlegel, Owner Schlegel Dairy Farms, Inc. 10720 Township Road 526 Shreve, Ohio 44676-9415<br /><br />Dear Mr. Schlegel:<br /><br />On May 7, 2009, and June 3, 2009, the U.S Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 10720 Township Road 526, Shreve, Ohio. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b.<br /><br />Specifically, our investigation revealed that on or about October 15, 2008, you sold a Holstein bull veal calf for slaughter as food through (b)(4), where the Holstein bull veal calf was identified with back tag # (b)(4). On or about October 16, 2008, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected on October 16,2008 from this bull veal calf with back tag (b)(4) identified the presence of 0.66 parts per million (ppm) sulfamethoxazole in the liver and 0.70 ppm sulfamethoxazole in the muscle of this animal. The FDA has not established a tolerance for residue associated with use of sulfamethoxazole in the edible tissue of veal calves as codified in Title 21, Code of Federal Regulations (C.F.R.), Part 556 (21 C.F.R. Part 556). The presence of this drug in the edible tissue of this bull veal calf in these amounts causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii).<br /><br />We also found that you violated section 501(a)(5) of the Act, 21 U.S.C. 351(a)(5), when your employees administered Sulfamethoxazole and Trimethoprim Tablets, 800 milligrams (mg)/160 mg, Double Strength (NDC 61971-120-05) to the bull veal calf. Specifically, our investigation revealed that sulfamethoxazole and trimethoprim tablets were used in an extralabel manner by a layperson on your farm outside the orders, instructions, or supervision of a licensed veterinarian in violation of 21 C.F.R. 530.1 I (a), and the use of these tablets resulted in sulfamethoxazole residue which may present a risk to public health, in violation of 21 C.F.R. 530.11(c).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512 (a)(4) and (5) of the Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Because the use of the sulfamethoxazole and trimethoprim tablets did not comply with 21 C.F.R. Part 530, you caused the drug to be unsafe under section 512(a) of the Act, 21 U.S.C. 360b(a), and thus adulterated within the meaning of section 501 (a)(5) of the Act, 21 U.S.C. 351(a)(5).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm183614.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm183614.htm</a><br /><br /><br />Adon Farms 8/5/09<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration New York District 158-15 Liberty Avenue Jamaica, NY 11433<br /><br />August 5 2009<br /><br />WARNING LETTER NYK 2009-15<br /><br />Via Federal Express Andrew J. Gilbert Adon Farms 403 State Highway 72 Potsdam, New York 13676<br /><br />Dear Mr. Gilbert:<br /><br />On April 2 and 9, 2009, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy farm located at 403 State Highway 72, Potsdam, New York 13676. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about October 15, 2008, you sold a dairy cow, identified with farm tag#(b)(4) for slaughter. On or about October 16, 2008, (b)(4) slaughtered this animal. The United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of 0.82 parts per million (ppm) of penicillin residue in the kidney tissue. FDA has established a tolerance for residues of penicillin in the uncooked edible tissues of cattle at 0.05 ppm as codified in Title 21, Code of Federal Regulations, Section 556.510(a) [21 C.F.R. 556.510(a)]. The presence of this drug in edible tissue from this animal causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain accurate treatment records and you lack an adequate system to ensure that animals medicated by you have been withheld from slaughter for appropriate periods of time to permit depletion of potentially hazardous residues of drugs from edible tissues. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. 342(a)(4).<br /><br />We also found that you adulterated the new animal drugs (b)(4) (Penicillin G Procaine Injectable Suspension), (b)(4) (ceftiofur hydrochloride), and (b)(4) (hetacillin potassium). Specifically, our investigation revealed that you did not use (b)(4) and (b)(4) as directed by their approved labeling. Use of these drugs in this manner is an extralabel use. See 21 C.F.R. 530.3(a).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Our investigation found that you administered the drugs (b)(4) and (b)(4) without following the dosage levels as stated in the approved labeling. Your extralabel use of these drugs was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a). Furthermore, your extralabel use of (b)(4) resulted in an illegal residue, in violation of 21 C.F.R. 530.11(d). In addition, you administered the drug (b)(4) without following the withdrawl period for slaughter set forth in the approved labeling. Specifically, you administered the drug (b)(4) on October 9, 2008, and then sold the dairy cow identified with farm tag # (b)(4) for slaughter on October 15, 2008. The approved labeling of (b)(4) states treated animals must not be slaughtered for food until ten days after the latest treatment. Because your extralabel use of these drugs was not in compliance with 21 C.F.R. Part 530, these drugs were unsafe under section 512(a) of the Act, 21 U.S.C. 360b(a), and your use caused them to be adulterated within the meaning of section 501(a)(5) of the Act, 21 U.S.C. 351(a)(5).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189754.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189754.htm</a><br /><br /><br />G & H Dairy #1, LLC<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Seattle District Pacific Region 22201 23rd Drive SE Bothell, WA 98021-4421 Telephone: 425-486-8788 FAX: 425-483-4996<br /><br />July 31, 2009<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />In reply refer to Warning Letter SEA 09-24<br /><br />Gilbert Hurtado, Partner G & H Dairy #1, LLC 1330 Addison Avenue W Twin Falls, Idaho 83301<br /><br />WARNING LETTER<br /><br />Dear Mr. Hurtado:<br /><br />On April 24 and 30, 2009, the U.S. Food and Drug Administration (FDA) conducted an inspection of your dairy operation located at 3209 S 1800 E, Wendell, Idaho. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on the FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our inspection revealed that on or about December 1, 2008, you sold a dairy cow, identified with back tag (b)(4) for slaughter as food. On or about December 1, 2008, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of flunixin at 2.5735 parts per million (ppm) in the liver. FDA has established a tolerance of 125 parts per billion (0.125 ppm) for residues of flunixin in the liver tissues of cattle, as codified in Title 21, Code of Federal Regulations, Section 556.286 (21 C.F.R. 556.286). The presence of flunixin in the liver tissues from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br /><br />We also found that you adulterated the new animal drug flunixin. Specifically, our investigation revealed that you did not use flunixin as directed by its approved labeling. Use of this drug in this manner is an extralabel use, 21 C.F.R. 530.3(a).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. § 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Our investigation found that you routinely administer flunixin to your animals without following the route of administration or withhold time as stated in the approved labeling. Your extralabel use of flunixin is not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11 (a). Because your use of this drug is not in conformance with its approved labeling and does not comply with 21 C.F.R. Part 530, you cause the drug to be unsafe under section 512(a) of the Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501 (a)(5) of the Act, 21 U.S.C. § 351 (a)(5).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm176800.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm176800.htm</a><br /><br /><br />Lucky Acres 7/27/09<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration PHILADELPHIA DISTRICT 900 U.S. Customhouse 2nd and Chestnut Streets Philadelphia, PA 19106 Telephone: 215-597-4390<br /><br />WARNING LETTER 09-PHI-07<br /><br />July 27, 2009<br /><br />Amos S. King, Owner Lucky Acres 3167 Kissel Hill Road Lititz, Pennsylvania 17543-9232<br /><br />Dear Mr. King:<br /><br />On December 12 and 18, 2008, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 3167 Kissel Hill Road, Lititz, Pennsylvania. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during Our investigation of your operation: You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act 21 U.S.C. § 342 (a)(2)(C)(ii) a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. 21 U.S.C. § 360b. Further, Under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about July 7, 2008, you sold a dairy cow, identified with back tag (b)(4), and ear tag (b)(4) for slaughter as food. On or about July 8, 2008, (b)(4) located in (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of sulfadimethoxine in the liver at 0.95 parts per million (ppm) and in the muscle at 1.03 ppm and penicillin in the liver at 0.13 ppm FDA has established a tolerance for residues of sulfadimethoxine in the uncooked edible tissues of cattle at 0.1 ppm as codified in Title 21, Code of Federal Regulations, Section 556.640 (21 C.F.R. 556.640,and a tolerance for residues of penicillin in the uncooked edible tissues of cattle at 0.05 ppm as codified in 21 C.F.R. 556.510 The presence of these drugs in edible tissue from this animal in these amounts causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. You lack an adequate system to ensure that animals medicated by you have been withheld from slaughter for appropriate periods of time to permit depletion of potentially hazardous residues of drugs from edible tissues. For example, you failed to maintain treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br /><br />We also found that you adulterated the new animal drugs sulfadimethoxine and penicillin. Specifically, our investigation revealed that you did not use sulfadimethoxine and penicillin as directed by their approved labeling. Use of these drugs in this manner is an extralabel use. 21 C.F.R. 530.3(a).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. §§ 360b(a)(4) and (5), and 21 C.F.R. Part 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/client/patient relationship.<br /><br />Our investigation found that you administered sulfadimethoxine to a dairy cow identified with back tag (b)(4) and eartag (b)(4), without following the indications for use contained in the approved labeling. Sulfadimethoxine is prohibited for extralabel use in lactating dairy cows by 21 C.F.R. 530.41(a)(9). Further, your extralabel use of this drug resulted in illegal drug residues in this animal, in violation of 21 C.F.R. 530.11(d). In addition, our investigation found that you administered penicillin to a dairy cow, identified with back tag (b)(4) and ear tag (b)(4) without following the indications for use or dose contained in the approved labeling. Your extralabel use of penicillin was not under the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a) and your extralabel use resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d). Because your extralabel uses of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. Part 530, you caused the drugs to be unsafe under section 512(a) of the Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 501(a)(5) of the Act, 21 U.S.C. § 351(a)(5).<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm186911.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm186911.htm</a><br /><br /><br />Van Raay Dairy Farm 7/14/09<br /><br />Department of Health and Human Services Public Health Service Food and Drug Administration Cincinnati District Office Central Region 6751 Steger Drive Cincinnati, OH 45237-3097 Telephone: (513) 679-2700 FAX: (513) 679-2771<br /><br />July 14, 2009<br /><br />WARNING LETTER CIN-09-67403-12<br /><br />VIA FEDERAL EXPRESS<br /><br />Sybrand T.C. Van Raaj, Owner and Manager Van Raay Dairy Farm 12471 Thomas Road South Charleston, OH 45368<br /><br />Dear Mr. Van Raaj:<br /><br />On April 23, 24, and 27, May 7 and 19, and June 18,2009, the U.S. Food and Drug Administration (FDA) conducted an investigation of your dairy operation located at 12471 Thomas Road, South Charleston, Ohio 45368. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that we found during our investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.<br /><br />We found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, our investigation revealed that on or about June 30, 2008, you sold ten calves, one of which was a bull calf that was given back tag (b)(4) by the hauler and sold for slaughter as food. On or about July 1, 2008, (b)(4) of (b)(4) slaughtered this animal. The United States Department of Agriculture, Food Safety and Inspection Service (USDAJFSIS) analysis of tissue samples collected from this animal identified the presence of 10.95 ppm neomycin in the kidney. FDA has established a tolerance of 7.2 ppm of neomycin in the kidney of cattle as codified in Title 21, Code of Federal Regulations, Section 556.430 (21 C.F.R. 556.430). The presence of this drug in the edible tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records and failed to identify treated animals. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br /><br />snip...<br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm183498.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm183498.htm</a><br /><br /><br />please see ;<br /><br /><br /><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br /><br /><br /><br />Terry S. Singeltary Sr. P.O. Box 42 Bacliff, Texas USA 77518Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-10283425881621581972010-02-11T10:19:00.000-08:002010-02-23T15:56:05.295-08:00Denmark's Case for Antibiotic-Free AnimalsNEW YORK, Feb. 10, 2010<br /><br />Denmark's Case for Antibiotic-Free Animals<br /><br />Katie Couric Reports on Denmark's Ban on Antibiotics in Livestock<br /><br />CBS) They call it the "Danish Experiment" - a source of pride for the country's 17,000 farmers. CBS Evening News Anchor Katie Couric reports how unlike industrial farms in the U.S., which use antibiotics to promote growth and prevent disease, farmers in Denmark use antibiotics sparingly, only when animals are sick.<br /><br />The experiment to stop widespread use of antibiotics was launched 12 years ago, when European studies showed a link between animals who were consuming antibiotic feed everyday and people developing antibiotic resistant infections from handling or eating that meat.<br /><br />"We don't want to use more medicine than needed, and a lot of the medicine that is given is not needed," said Soren Helmer. Helmer is a second-generation pig farmer whose sows produce more than 30,000 pigs a year. When the ban started, he and his father thought the industry would suffer.<br /><br />"We thought we could not produce pigs as efficient as we did before," Helmer said. "But that was proven wrong."<br /><br />Since the ban, the Danish pork industry has grown by 43 percent - making it one of the top exporters of pork in the world. All of Europe followed suit in 2006. But the American Pork Industry doesn't want to.<br /><br />"What we've seen in Denmark and other countries is that they actually have had some increases in cost of what it takes to produce a pig," said Liz Wagstrom, a veterinarian with the National Pork Board.<br /><br />"So it's not that unqualified a success. If we did the same thing in the United States, we would likely see small producers pushed out of business, we'd have more sick and dying pigs, and none of that would result in a benefit to the U.S. consumer."<br /><br />Without growth-promoting antibiotics, it only costs $5 more for every 100 pounds of pork brought to market in this country.<br /><br />Animal Antibiotics a Threat?<br /><br />That's a small price for public health, says Dr. Ellen Silbergeld, who has been studying the antibiotic resistance link between livestock and people for the past decade.<br /><br />"I think the Danish and European experience indicate that there will be real and measurable public health benefits," she said. "There'll be improvements in food safety and actually in the prevalence of drug resistant infections in people."<br /><br />Pew Campaign on Human Health and Industrial Farming<br /><br />According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.<br /><br />After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.<br /><br />Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.<br /><br />"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.<br /><br />Rep. Slaughter's "Preservation of Antibiotics for Medical Treatment Act"<br /><br />Some American food producers agree.<br /><br />"It's just gone too far," said Stephen McDonnell, CEO Applegate Farms.<br /><br />"What most bothers you about the way industrial farmers in this country currently operate," Couric asked.<br /><br />"We use too many antibiotics, we use too many growth promotants," McDonnell replied. "The singular focus is to create cheap meat. That's not always the best thing for the health of the Americans who buy it."<br /><br />"We think with some subtle changes - giving them more space, feeding them a good diet, and not stressing them out by growing them too quickly - you don't even need to use antibiotics," McDonnell added.<br /><br />McDonnell helps farmers like Duane Koch kick the habit.<br /><br />"How long have you been raising turkeys, Duane, without using antibiotics," Couric asked.<br /><br />"We started running without antibiotics roughly 14 years ago," Koch replied.<br /><br />"Does it make you feel better doing it this way," Couric asked.<br /><br />"Yeah," Koch said. "Because really, from using the antibiotics so long, a lot of them didn't work well any way anymore."<br /><br />Today his 18 poultry farms scattered throughout Pennsylvania are more profitable than when he used antibiotics.<br /><br />Koch says it costs very little to convert a farm to antibiotic-free. And it doesn't cost consumers much more either. People buying antibiotic free turkey thigh meat will spend around $1.40 versus $1.20 for conventionally raised birds.<br /><br />Koch says higher-quality feed and improving living conditions, his birds are naturally healthier.<br /><br />Couric asked, "What's the importance of giving them more space?"<br /><br />"That's just our natural growth promotants," he said. "By giving them more space, we can get weights that are really close to what they're getting, you know, with the growth promotants."<br /><br />Because farmers are raising livestock successfully without growth-promoting antibiotics - from Lebanon, Pennsylvania to outside Copenhagen - public health officials in this country say this is an idea whose time has come.<br /><br />"We have identified here that we're talking about a public health issue, that the overuse of antibiotics on farms does pose a risk to human health," said Joshua Sharfstein of the FDA.<br /><br />The FDA has for the first time come out against using certain antibiotics to promote growth in livestock.<br /><br />And pending legislation in Congress would ban some types of antibiotics used to treat humans from being administered to healthy farm animals.<br /><br /><br /><a href="http://www.cbsnews.com/stories/2010/02/10/eveningnews/main6195054.shtml">http://www.cbsnews.com/stories/2010/02/10/eveningnews/main6195054.shtml</a><br /><br /><br /><br />Hello Ms. Couric Ma'am !<br /><br />Thank you very much on that show of yours about antibiotics in meat, the over-use-of, and resistance there from, to humans and animals. Nice Job! The public is just oblivious to what is going on with the meat they eat. I thought the Danish study was remarkable, and proves what can be done, if an industry wants to do something. sadly, here in the USA, all the industry cares about is their bottom dollar. I have been most concerned about hormones, antibiotics, TSE aka mad cow disease, and other pathogens in meat for some time. I lost my mother to the Heidenhain Variant of Creutzfeldt Jakob Disease, considering North America is home to c-BSE, h-BSE, and the l-BSE in cattle, who is it to say that it should look exactly like the UK c-BSE ??? THEN, my last neck surgery, I believe my neurosurgeon did use a special bone grinder and a few extra precaustion, due to my Mother having died from hvCJD, and they damn near kill me with MRSA. Looking into to that, I was amazed at the amount of antibiotics and hormones that go into cattle due to the fact they are to sick to slaughter. 8 weeks vancomycin straight to the heart via long pic line made a believer in me. now I know some how I was infected probably via the operating arena, there were 7 other's the same week from the same surgcial unit, I was told later (this was in 2002), but we have become immune to these medicines due to over use, not only in humans but animals for human consumption as well. at any given tuesday you can find something like this ;<br /><br /><br />October 9,2009<br /><br />WARNING LETTER<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />Keith L. Schaeffer Owner Evergreen Acres Dairy, LLC 26162 240th Street Paynesville, Minnesota 56362<br /><br />Dear Mr. Schaeffer:<br /><br />Refer to MIN 10 - 01<br /><br />On April 23 and May 4,2009, the Minnesota Department of Agriculture conducted an investigation of your dairy operation located at 26162 240th Street, Paynesville, Minnesota. This letter notifies you of the violations of the Federal Food, Drug, and Cosmetic Act (the Act) that were found during the investigation of your operation. You can find the Act and its associated regulations on the Internet through links on FDA's web page at www.fda.gov.<br /><br />The investigation found that you offered for sale an animal for slaughter as food that was adulterated. Under section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii), a food is deemed to be adulterated if it bears or contains a new animal drug that is unsafe under section 512 of the Act, 21 U.S.C. § 360b. Further, under section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4), a food is deemed to be adulterated if it has been held under insanitary conditions whereby it may have been rendered injurious to health.<br /><br />Specifically, the investigation revealed that on or about September 16, 2008, you sold a dairy cow identified with your farm ear tag #(b)(4)for slaughter as food. On or about September 17, 2008, (b)(4) slaughtered this animal. United States Department of Agriculture, Food Safety and Inspection Service (USDA/FSIS) analysis of tissue samples collected from this animal identified the presence of neomycin at 31.05 parts per million (ppm) in kidney tissue. FDA has established a tolerance of 7.2 ppm neomycin residue in kidney tissue as codified in Title 21, Code of Federal Regulations, Section 556.430(b)(1), 21 C.F.R. 556.430(b)(1). The presence of this drug in kidney tissue from this animal in this amount causes the food to be adulterated within the meaning of section 402(a)(2)(C)(ii) of the Act, 21 U.S.C. § 342(a)(2)(C)(ii).<br /><br />The investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply. For example, you failed to maintain complete treatment records. Food from animals held under such conditions is adulterated within the meaning of section 402(a)(4) of the Act, 21 U.S.C. § 342(a)(4).<br /><br />The investigation also found that you adulterated the new animal drugs neomycin sulfate, sulfadimethoxine oral solution, oxytetracycline injection, oxytetracycline hydrochloride injection, ceftiofur hydrochloride, ceftiofur crystalline free acid, ceftiofur sodium, penicillin G procaine aqueous suspension, florfenicol, tetracycline hydrochloride soluble powder, and tylosin. Specifically, the investigation revealed that you did not use these drugs as directed by their approved labeling. Use of these drugs contrary to their approved labeling is an extralabel use. See 21 C.F.R. 530.3(a).<br /><br />The extralabel use of approved animal or human drugs in animals is allowed under the Act only if the extralabel use complies with sections 512(a)(4) and (5) of the Act, 21 U.S.C. §§ 360b(a)(4) and (5), and 21 C.F.R. 530, including that the use must be by or on the lawful order of a licensed veterinarian within the context of a valid veterinarian/ client/patient relationship.<br /><br />The investigation found that you administered neomycin sulfate to lactating dairy cows contrary to the approved indication of use. Neomycin sulfate is not approved for the treatment and control of Salmonella infections. Your extralabel use of neomycin sulfate was not in compliance with 21 C.F.R. 530, and your extralabel use of neomycin sulfate resulted in an illegal drug residue, in violation of 21 C.F.R. 530.11(d).<br /><br />The investigation also found that you administered the following new animal drugs contrary to the conditions of use set forth in their approved labeling, and you did so without the supervision of a licensed veterinarian, in violation of 21 C.F.R. 530.11(a):<br /><br />1. Neomycin sulfate (b)(4) - You administered neomycin sulfate to a lactating dairy cow without following the approved indication of use. Neomycin Sulfate (Neomycin Liquid) is not approved for the treatment and control of Salmonella infections.<br /><br />2. Sulfadhnethoxine oral solution (b)(4) - You administered sulfadimethoxine oral solution to lactating dairy cows without following the approved route of administration, indications for use, and animal class. Sulfadimethoxine oral solution is not approved for intravenous injection, not approved to treat peritonitis, and not approved for use in lactating dairy cows. Furthermore, sulfonamide drugs, which include sulfadimethoxine, are prohibited for extralabel use in lactating dairy cows by 21 C.F.R. 530.41(a)(9).<br /><br />3. Oxytetracycline injection (b)(4) - You administered oxytetracycline injection to lactating dairy cows without following the approved dose per injection site. Oxytetracycline injection is not approved for use at more than 10 mL per injection site.<br /><br />4. Oxytetracycline hydrochloride injection (b)(4) - You administered oxytetracycline hydrochloride injection to lactating dairy cows without following the approved animal class and indications for use. Oxytetracycline hydrochloride injection is not approved for use in lactating dairy cattle, or to treat peritonitis.<br /><br />5. Ceftiofur hydrochloride (b)(4) - You administered ceftiofur hydrochloride to lactating dairy cows without following the approved indications for use. Ceftiofur hydrochloride is not indicated for treating watery mastitis in cattle, or for post-surgical use.<br /><br />6. Ceftiofur crystalline free acid (b)(4) - You administered ceftiofur crystalline free acid to lactating dairy cows without following the approved indications of use. Ceftiofur crystalline free acid is not indicated for treating watery mastitis, foot rot, or metritis in cattle, nor is it approved for postsurgical use.<br /><br />7. Ceftiofur sodium (b)(4) - You administered ceftiofur sodium to lactating dairy cows without following the approved indications for use. Ceftiofur sodium is not indicated for treating watery mastitis or metritis in cattle, nor is it approved for post-surgical use.<br /><br />8. Penicillin G procaine (b)(4) - You administered penicillin G procaine aqueous suspension to lactating dairy cows without following the approved indications for use, dosage amount, or dosage amount per injection site. Penicillin G procaine aqueous suspension is not indicated for treating mastitis in cattle, not approved at a dose more than 1 mLI100 pounds of body weight, and not approved for use at the rate of more than 10 mL per injection site.<br /><br />9. Florfenicol (b)(4) - You administered florfenicol to lactating dairy cows without following the approved animal class. Florfenicol is not approved for use in female dairy cattle 20 months of age or older.<br /><br />10.Tetracycline hydrochloride soluble powder (b)(4) - You administered tetracycline hydrochloride soluble powder to lactating dairy cows without following the approved animal class and indications for use. Tetracycline hydrochloride soluble powder is not approved for treating dairy cows or for treatment of uterine infections.<br /><br />11. Tylosin (b)(4) - You administered tylosin to dairy calves without following the approved route of administration and indications for use.Tylosin is not approved for oral administration, nor is the drug approved for preventing scours (bacterial enteritis) in dairy calves. Furthermore, the extralabel use of approved new animal or human drugs in or on an animal feed (milk) is prohibited by 21 C.F.R. 530.11(b).<br /><br />Because your use of these drugs was not in conformance with their approved labeling and did not comply with 21 C.F.R. 530, you caused the drugs to be unsafe under section 512(a) of the Act, 21 U.S.C. § 360b(a), and adulterated within the meaning of section 50 1(a)(5) of the Act, 21 U.S.C. § 351(a)(5).<br /><br />In addition, you adulterated animal feed (milk) within the meaning of section 501 (a)(6) of the Act, 21 U.S.C. § 351 (a)(6). You administered tylosin to dairy calves to prevent Escherichia coli (E. colI) scours by mixing the drug in milk. This caused the animal feed (milk) to which the drug was added to be unsafe within the meaning of section 512(a)(2) of the Act, 21 U.S.C. § 360b(a)(2), and adulterated under section 501(a)(6) of the Act, 21 U.S.C. § 351(a)(6).<br /><br />The above is not intended to be an all-inclusive list of violations. As a producer of animals offered for use as food, you are responsible for ensuring that your overall operation and the food you distribute are in compliance with the law.<br /><br />You should take prompt action to correct the violations described in this letter and to establish procedures to ensure that these violations do not recur. Failure to do so may result in regulatory action without further notice such as seizure and/or injunction.<br /><br />You should notify this office in writing of the steps you have taken to bring your firm into compliance with the law within 15 working days of receiving this letter. Your response should include each step that has been taken or will be taken to correct the violations and to prevent their recurrence. If corrective action cannot be completed within 15 working days of receiving this letter, state the reason for the delay and the time frame within which the corrections will be completed. Please include copies of any available documentation demonstrating that corrections have been made.<br /><br />Your written response should be sent to Dr. Brian D. Garthwaite, Compliance Officer, U.S. Food and Drug Administration, at the address located on the letterhead. If you have any questions about this letter, please contact Dr. Garthwaite at (612) 758-7132.<br /><br />Sincerely,<br /><br />/s/<br /><br />W. Charles Becoat Director Minneapolis District<br /><br />BDG/ccl<br /><br />(b)(4)<br /><br />Doug Leuders Minnesota Department of Agriculture 625 North Robert Street St. Paul, Minnesota 55155<br /><br />District Manager, USDA-FSIS Butler Square West, Suite 989-C 100 North Sixth Street Minneapolis, Minnesota 55403<br /><br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm186791.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm186791.htm</a><br /><br /><br /><br />“October 2009<br /><br />It should be noted that humans can become more susceptible to infection with antimicrobial-resistant zoonotic bacteria to which they are exposed. This can happen, when there has been prior use of antimicrobials, resulting in decrease in colonization resistance (dysregulation of intestinal microbiota) and an increased vulnerability to gastrointestinal illness with antimicrobial-resistant food-borne pathogens. This applies to all infections with all micro-organisms listed in this document.<br /><br />snip...<br /><br /><br /><br /><a href="http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/1372.pdf?ssbinary=true">http://www.efsa.europa.eu/cs/BlobServer/Scientific_Opinion/1372.pdf?ssbinary=true</a><br /><br /><br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189754.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189754.htm</a><br /><br /><br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.<br /><br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189720.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189720.htm</a><br /><br /><br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.<br /><br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189789.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/ucm189789.htm</a><br /><br /><br /><br />Our investigation also found that you hold animals under conditions that are so inadequate that medicated animals bearing potentially harmful drug residues are likely to enter the food supply.<br /><br />Recently Posted Warning Letters Posted on November 17, 2009<br /><br /><br /><a href="http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/default.htm">http://www.fda.gov/ICECI/EnforcementActions/WarningLetters/default.htm</a><br /><br /><br /><br />see also my blog on MRSA here ;<br /><br /><br /><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br /><br /><br /><br /><br />IN regards to the Industry hype about that mean old Katie Couric and CBS on the Danish Study on antibiotics and the overuse there of, or not, I wish to submit the following ;<br /><br /><br /><br /><br />Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers<br /><br />Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).<br /><br />We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.<br /><br />In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.<br /><br />These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.<br /><br />snip...<br /><br />Discussion<br /><br />This study is the first to document MRSA in U.S. swine and swine workers, and to our knowledge, the first to report the presence of ST398 (also reported as non-typeable MRSA, NT-MRSA) [15] in the U.S. Like previous studies in Canada, Denmark, and the Netherlands [11], [12], [24], ST398 was found in both animals and humans, suggesting transmission between the two. The prevalence of MRSA colonization among swine and swine workers was high at one farm system that we examined in the Midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. Strain ST398 was the only MRSA identified among the swine and swine workers. This strain has been the predominant strain among swine in the Netherlands and Canada. However, Khanna et al. in Canada recently found both ST398 and ST5/USA100 colonizing the nares of swine and swine workers [12]. This difference may indicate that the epidemiology of MRSA on Canadian swine farms is different than on the affected farm system in Iowa and Illinois. On the other hand, the difference may have resulted from differing sampling methodologies. Khanna et al. sampled a small number of humans and swine on 20 farms whereas we took a larger number of samples from a smaller number of farms in two corporate systems. Furthermore, because we did not type all isolates in this pilot study, additional strain types may be present that we did not detect.<br /><br />snip...<br /><br />In summary, we report the first isolation of MRSA from swine and swine workers in the U.S. Although the extent of this problem in the U.S. is currently unknown, our findings may have important implications for the epidemiology of MRSA disease. For example, Van Loo et al. identified MRSA in meat products in the Netherlands [32], suggesting that persons who handle raw pork products might be at risk for acquiring MRSA. Future studies should assess the risk of MRSA disease among swine workers and their contacts, survey retail meat products for MRSA contamination, study larger populations of swine and humans to define the epidemiology of MRSA within swine operations, and assess MRSA carriage rates in other livestock.<br /><br />full text ;<br /><br /><br /><br /><br /><a href="http://www.plosone.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004258&representation=PDF">http://www.plosone.org/article/fetchObjectAttachment.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0004258&representation=PDF</a><br /><br /><br /><br /><br />From Emerging Infectious Diseases<br /><br />Staphylococcus aureus ST398, New York City and Dominican Republic<br /><br />Meera Bhat; Caroline Dumortier; Barbara S. Taylor; Maureen Miller; Glenny Vasquez; Jose Yunen; Karen Brudney; Jacqueline Sánchez E.; Carlos Rodriguez-Taveras; Rita Rojas; Patricia Leon; Franklin D. Lowy<br /><br />Authors and Disclosures<br /><br />Posted: 05/11/2009; Emerging Infectious Diseases © 2008 Centers for Disease Control and Prevention (CDC)<br /><br />Abstract Closely related Staphylococcus aureus strains of ST398, an animal-associated strain, were identified in samples collected from humans in northern Manhattan, New York, NY, USA, and in the Dominican Republic. A large population in northern Manhattan has close ties to the Dominican Republic, suggesting international transmission.<br /><br /><br /><br /><br />We identified a clone of S. aureus previously associated with outbreaks of infections in animals and in humans who work with animals in 2 unique collections of S. aureus isolates. The first was from a population-based study of S. aureus colonization among residents of northern Manhattan in New York, NY, USA;<br /><br /><br />Consequently, the clone is identified by multilocus sequence typing as sequence type 398 (ST398).<br /><br /><br /><br />Page 2 of 7<br /><br />Dominican Republic within 6 months of their interview, none of the colonized participants reported recent travel to the Dominican Republic. No contact among the different households was reported.<br /><br /><br /><br /><br /><a href="http://www.cdc.gov/eid/content/15/2/pdfs/08-0609.pdf">http://www.cdc.gov/eid/content/15/2/pdfs/08-0609.pdf</a><br /><br /><br /><br /><br /><br /><br /><br />First human isolates of methicillin-resistant Staphylococcus aureus sequence type 398 in Spain<br /><br /><br />C. Potel & M. Álvarez-Fernández & L. Constenla & P. Álvarez & S. Perez<br /><br /><br />Received: 31 July 2009 / Accepted: 13 December 2009 # Springer-Verlag 2010<br /><br /><br />To the Editor,<br /><br /><br />An emerging sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) clone producing infections in humans has been detected across Europe [1]. Recent studies indicate that it is widely distributed in farm animals, particularly in pigs, suggesting transmission between animals and humans [2].<br /><br /><br />The frequency of MRSA ST398 in the Spanish population is unknown. In this study, we present the first three human cases of MRSA ST398 infections admitted to two hospitals in the north-west of Spain.<br /><br /><br />Forty-four MRSA strains were isolated in 2006 in both hospitals. They were studied by the analysis of restriction fragment length polymorphism (RFLP) of the coagulase gene patterns and pulsed-field gel electrophoresis (PFGE) [3, 4]. Three non-Sma I typeable MRSA strains were identified; the three strains were EagI PFGE typeable. Next, they were analyzed by multilocus sequence typing (MLST) and spa typing [5, 6]. The staphylococcal chromosome cassette (SCC) mec, the accessory gene regulator (agr) types, and the Panton–Valentine leukocidin (PVL)-encoding genes were polymerase chain reaction (PCR)-identified [7–9].<br /><br /><br />The three strains were resistant to tetracycline. Besides, one isolate was resistant to levofloxacin, tobramycin, and erythromycin, and another isolate was resistant to levofloxacin and clindamycin, and susceptible to erythromycin; this rare phenotype has already been described [2]. The three MRSA isolates were identical by RFLP. By EagI PFGE, they were closely related following Tenover’s criteria (Fig. 1) [10]. All isolates were ST398, SCCmec-V, agr-1, and PVL genes-negative. They belonged to three spa types; t108, t011, and t1255.<br /><br /><br />The age of the three patients was 59, 82, and 83 years, respectively. Two patients owned pigs and the other a calf. Two patients were diabetic and were hospitalized because they developed skin and soft-tissue infections by MRSA ST398. The third patient had bronchitis and the strain was isolated from a respiratory secretion submitted to the laboratory from an outpatient clinic. The three patients had had multiple hospital admissions in the last 12 months.<br /><br /><br />As it has been described previously, the ST398 isolates were resistant to tetracycline [2]. Only another strain from the 44 MRSA strains studied was also resistant to tetracycline. This one belonged to the ST239 clone that was epidemic in north-west Spain until 2002, and since then, it has scarcely been isolated [3]. The ST239 clone is easily identified because of the homogeneity in the resistance profile (it is also resistant to levofloxacin, gentamicin, tobramycin, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, and chloramphenicol) [3]. Therefore, it can be stated that the resistance to tetracycline could be a local marker for a presumptive identification of the ST398 clone.<br /><br /><br /><br /><a href="http://www.springerlink.com/content/p8866u775tvm51w5/fulltext.pdf?page=1">http://www.springerlink.com/content/p8866u775tvm51w5/fulltext.pdf?page=1</a><br /><br /><br /><br />Volume 16, Number 1–January 2010<br /><br /><br />Letter Skin Lesion Caused by ST398 and ST1 MRSA, Spain1<br /><br /><br />Carmen Aspiroz, Carmen Lozano, Ana Vindel, Juan J. Lasarte, Myriam Zarazaga, and Carmen Torres Author affiliations: Hospital Royo Villanova, Zaragoza, Spain (C. Aspiroz); Universidad de La Rioja, Logroño, Spain (C. Lozano, M. Zarazaga, C. Torres); Centro Nacional Microbiología, Madrid, Spain (A. Vindel); and Centro Salud San Mateo de Gállego, Zaragoza (J.J. Lasarte) Suggested citation for this article<br /><br /><br />To the Editor:<br /><br /><br />Human infections caused by methicillin-resistant Staphylococcus aureus (MRSA) sequence type 398 (ST398) have been emerging in recent years in Europe (1,2). Pigs represent a common reservoir of MRSA ST398, and working with these animals may constitute a risk factor for MRSA carriage and possible infection (2–4). We report a case of human infection caused by MRSA ST398 in Spain.<br /><br /><br />SEE FULL TEXT ;<br /><br /><br /><br /><a href="http://www.cdc.gov/eid/content/16/1/157.htm">http://www.cdc.gov/eid/content/16/1/157.htm</a><br /><br /><br /><br />Eurosurveillance, Volume 13, Issue 9, 28 February 2008<br /><br />Rapid communications<br /><br /><br />First outbreak of methicillin-resistant Staphylococcus aureus ST398 in a Dutch hospital, June 2007<br /><br /><br />M WH Wulf (mireille.wulf@gmail.com)1, A Markestein2, F T van der Linden3, A Voss4, C Klaassen4, C M Verduin1,2<br /><br /><br />1. Laboratory for Pathology and Medical Microbiology, Veldhoven, the Netherlands 2. Department of Hospital Infection Control, St Anna Hospital, Geldrop, the Netherlands 3. Department of Surgery, St Anna Hospital, Geldrop, the Netherlands 4. Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, the Netherlands<br /><br /><br />We describe the first outbreak of non-typable methicillin-resistant Staphylococcus aureus on a surgical ward in the Netherlands in June 2007. Nine cases of infection and/or colonisation were found among patients and healthcare workers.<br /><br /><br />Background<br /><br /><br />In the Netherlands, the proportion of methicillin-resistant S. aureus (MRSA) among clinical isolates of S. aureus is still low [1], but community-acquired MRSA occurs more frequently [2]. This increase is mainly caused by so called ‘non-typable’ MRSA (NTMRSA, i.e. not typable by pulsed-field gel electrophoresis (PFGE) with Sma1 restriction digest [3]) belonging to multilocus sequence typing (MLST) type ST398 [4].<br /><br /><br />These strains are widely disseminated among pigs, veal calves and people in contact with pigs [5-8]. An association between the use of antibiotics in pig farming and the dissemination of these strains has been suggested [6,8], since the majority of ST398 MRSA are tetracycline-resistant and oxytetracyclins are the most frequently used antibiotics in pig farming.<br /><br /><br />Transmission within families, as well as single cases of colonised healthcare workers, have been described [5]. One report indicates possible healthcare-acquired infections with a Panton-Valentine leukocidin (PVL)- positive ST398 strain in China [9], but no nosocomial transmission to multiple patients or healthcare workers has occurred in the Netherlands to date.<br /><br /><br />Outbreak description<br /><br /><br />In June 2007, MRSA was cultured from a diabetic foot ulcer of a patient on a surgical ward. Subsequent screening of contacts among patients and healthcare workers revealed four additional patients with MRSA infection and/or colonisation and five healthcare workers who carried MRSA.<br /><br /><br />Two of the five affected patients (one with prostate carcinoma and one with a diabetic foot) were successfully decolonised with mupirocin nasal ointment, chlorhexidine wash, and treatment with trimetoprim/rifampicin.<br /><br /><br />A further colonised patient with a gastro-intestinal malignancy and two patients with infected diabetic foot ulcers remained colonised, despite several decolonisation regimens.<br /><br /><br />Of 238 healthcare workers who were screened, five were colonised in the nose and/or throat and had no skin conditions. All five have been treated with mupirocin nasal ointment and chlorhexidine wash and successfully decolonised.<br /><br /><br />All strains were resistant to tetracycline and non-typable by PFGE. Spa-typing showed that all strains were spa-type t567. This spa-type corresponds to MLST type 398, a type previously found in pigs.<br /><br /><br />None of the patients had had contact with pigs or veal calves. One healthcare worker lived on the grounds of a pig farm but neither she nor her partner came into contact with pigs themselves. While we presume that this health care worker was the source of the infection, this could not be proven. Permission to sample the pigs on this farm was not granted.<br /><br /><br />Conclusions<br /><br /><br />The NT-MRSA strain responsible for this outbreak was spa-type t567, which corresponds to MLST type ST398, the clonal complex to which most of NT-MRSA strains belong. This outbreak shows that transmission on a larger scale than a one-on-one transmission between caretaker and patient can occur with NT-MRSA in a hospital setting.<br /><br /><br />References<br /><br /><br /><a href="http://www.eurosurveillance.org/images/dynamic/EE/V13N09/art8051.pdf">http://www.eurosurveillance.org/images/dynamic/EE/V13N09/art8051.pdf</a><br /><br /><br />EDITORIAL<br /><br /><br />MRSA in livestock animals—an epidemic waiting to happen?<br /><br /><br />M. Wulf 1 and A. Voss 2,3 1 PAMM Laboratory for Medical Microbiology, Veldhoven , 2 Department of Medical Microbiology, Nijmegen University Centre for Infectious Diseases, Radboud University Nijmegen Medical Centre and 3 Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands Corresponding author and reprint requests: A. Voss, Department of Medical Microbiology, Nijmegen University Centre for Infectious Diseases, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands E-mail: vossandreas@gmail.com Copyright © 2008 European Society of Clinical Microbiology and Infectious Diseases<br /><br /><br />KEYWORDS Community-acquired MRSA • epidemiology • livestock • methicillin-resistant Staphylococcus aureus • pig farming • ST398<br /><br /><br />ABSTRACT<br /><br /><br />Screening of pig farmers and pigs in The Netherlands has revealed that >20% of pig farmers and 39% of slaughterhouse pigs are positive for an unusual strain of methicillin-resistant Staphylococcus aureus (MRSA) belonging to sequence type (ST) 398. It is now clear that the emergence of ST398 is not just a Dutch problem, with human infections being described in several European countries, Canada and Singapore. Furthermore, some human isolates have now acquired the genes encoding Panton–Valentine leukocidin. Livestock may become an important source of community-acquired MRSA. A concerted effort on the part of clinicians, infection control practitioners and veterinarians will be required to prevent further spread of this novel strain of MRSA.<br /><br /><br />--------------------------------------------------------------------------------<br /><br /><br />DIGITAL OBJECT IDENTIFIER (DOI) 10.1111/j.1469-0691.2008.01970.x About DOI<br /><br /><br /><a href="http://www3.interscience.wiley.com/journal/119414762/abstract?CRETRY=1&SRETRY=0">http://www3.interscience.wiley.com/journal/119414762/abstract?CRETRY=1&SRETRY=0</a><br /><br /><br /><br /><br />Emerg Infect Dis. 2009 May; 15(5): 845–847. doi: 10.3201/eid1505.081417. PMCID: PMC2687035<br /><br /><br />Copyright notice<br /><br />Community-acquired Methicillin-Resistant Staphylococcus aureus ST398 Infection, Italy<br /><br />Angelo Pan, Antonio Battisti, Alessia Zoncada, Francesco Bernieri, Massimo Boldini, Alessia Franco, Maurilio Giorgi, Manuela Iurescia, Silvia Lorenzotti, Mario Martinotti, Monica Monaci, and Annalisa Pantosti Istituti Ospitalieri di Cremona, Cremona, Italy (A. Pan, A. Zoncada, F. Bernieri, S. Lorenzotti, M. Martinotti) Istituto Zooprofilattico Sperimentale delle Regioni Lazio e Toscana, Rome, Italy (A. Battisti, A. Franco, M. Iurescia) Istituto Zooprofilattico Sperimentale delle Regioni Lombardia ed Emilia-Romagna, Cremona (M. Boldini) Azienda Sanitaria Locale di Cremona, Cremona (M. Giorgi) Istituto Superiore di Sanità, Rome (M. Monaci, A. Pantosti)<br /><br />Corresponding author. Address for correspondence: Angelo Pan, Divisione di Malattie Infettive, Istituti Ospitalieri di Cremona, Largo Priori 1, 26100 Cremona, Italy; email: a.pan@ospedale.cremona.it<br /><br />Keywords: Antimicrobial resistance, staphylococci, Staphylococcus aureus, community acquired, MRSA, ST398, pig strain, bloodstream infection, letter<br /><br />To the Editor: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has been identified in livestock animals (particularly pigs), veterinarians, and animal farm workers (1,2). CA-MRSA strains from pigs have been classified most frequently within the multilocus sequence type (ST) 398 (1) and have been rarely identified as a cause of invasive infection in humans (1,3,4). We report a case of invasive infection in a pig-farm worker in Cremona, Italy, an intensive animal farming area; the infection was caused by MRSA of swine origin, ST398.<br /><br />full text ;<br /><br /><br /><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687035/">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2687035/</a><br /><br /><br /><br /><br />EID Journal Home > Volume 16, Number 2–February 2010<br /><br />Volume 16, Number 2–February 2010 Letter Methicillin-Resistant Staphylococcus aureus ST398, Italy Laura Soavi, Roberto Stellini, Liana Signorini, Benvenuto Antonini, Palmino Pedroni, Livio Zanetti, Bruno Milanesi, Annalisa Pantosti, Alberto Matteelli, Angelo Pan, and Giampiero Carosi Author affiliations: University of Brescia, Brescia, Italy (L. Soavi, R. Stellini, L. Signorini, A. Matteelli, G. Carosi); Presidio Ospedaliero di Manerbio, Manerbio, Italy (B. Antonini, P. Pedroni, L. Zanetti, B. Milanesi); Istituto Superiore di Sanità, Rome, Italy (A. Pantosti); and Istituti Ospitalieri di Cremona, Cremona, Italy (A. Pan)<br /><br />Suggested citation for this article<br /><br />To the Editor: It has recently become apparent that livestock can constitute a new methicillin-resistant Staphylococcus aureus (MRSA) reservoir and be a source of a novel and rapidly emerging type of MRSA. These livestock-associated MRSA clones are nontypeable by use of pulsed-field gel electrophoresis with SmaI and belong to sequence type (ST) 398 (1). MRSA ST398 clones account for 20% of all MRSA in the Netherlands (2), but the emergence of such clones has been described worldwide (3). Although ST398 transmission has been reported primarily between animals, persons with occupational exposure to livestock are at higher risk for MRSA carriage than the general population. Even though MRSA ST398 usually causes colonization, several cases of infections of variable clinical relevance, varying from skin and soft tissue infections (4) to endocarditis (5) and pneumonia (6), have been described over the past few years. Most instances of ST398 human carriers have been identified among persons who work at pig farms (7). Data regarding MRSA colonization of dairy farmers are less exhaustive and, to our knowledge, only 1 instance of direct transmission between cattle and humans has been proven. MRSA isolates from cows with subclinical mastitis in 2007 in Hungary were indistinguishable from MRSA isolates from the tonsil swab of a farmer who worked with these animals (. We report a case of MRSA ST398 invasive disease in a cattle farmer, as well as a case of MRSA ST398 necrotizing fasciitis<br /><br /><br /><a href="http://www.cdc.gov/eid/content/16/2/346.htm">http://www.cdc.gov/eid/content/16/2/346.htm</a><br /><br /><br /><br /><br />Volume 15, Number 7–July 2009<br /><br /><br />Dispatch Methicillin-Resistant Staphylococcus aureus ST398 in Swine Farm Personnel, Belgium<br /><br /><br />Olivier Denis, Carl Suetens,1 Marie Hallin, Boudewijn Catry, Ilse Ramboer, Marc Dispas, Glenda Willems, Bart Gordts, Patrick Butaye, and Marc J. Struelens Author affiliations: Université Libre de Bruxelles Hôpital Erasme, Brussels, Belgium (O. Denis, M. Hallin, M.J. Struelens); Scientific Institute of Public Health, Brussels (C. Suetens, B. Catry, I. Ramboer); Veterinary and Agrochemical Research Centre, Brussels (M. Dispas, G. Willems, P. Butaye); and AZ Sint-Jan, Brugge, Belgium (B. Gordts)<br /><br />Abstract We assessed methicillin-resistant Staphylococcus aureus (MRSA) in persons on 49 swine farms in Belgium. Surveys showed that 48 (37.8%) persons carried MRSA ST398 and 1 (0.8%) had concurrent skin infection. Risk factors for carriage were MRSA carriage by pigs, regular contact with pigs and companion animals, and use of protective clothing.<br /><br />snip...<br /><br />Conclusions Human carriage of MRSA was associated with swine colonization with MRSA. Prevalence rate (38%) was higher than that for hospitalized patients or nursing home residents in Belgium (www.nsih.be/surv_mrsa/download_fr.asp). MRSA isolates from farmers belonged to closely related spa types corresponding to ST398, which are unrelated to hospital- and community-acquired strains but identical to strains from humans in contact with pigs in other European countries (1,2,10).<br /><br />Despite the high prevalence of nasal MRSA, active MRSA skin infection was detected infrequently (<1%),<br /><br /><br /><a href="http://www.cdc.gov/EID/content/15/7/1098.htm%22%3Ehttp://www.cdc.gov/EID/content/15/7/1098.htm">http://www.cdc.gov/EID/content/15/7/1098.htm%22%3Ehttp://www.cdc.gov/EID/content/15/7/1098.htm</a><br /><br /><br /><br /><br />doi:10.1016/j.vetmic.2009.12.044 How to Cite or Link Using DOI Copyright © 2010 Elsevier B.V. All rights reserved. Permissions & Reprints<br /><br /><br />Methicillin-resistant Staphylococcus aureus (MRSA) ST398 associated with clinical and subclinical mastitis in Belgian cows<br /><br /><br />Wannes Vanderhaeghena, b, , , , Tineke Cerpentierc, Connie Adriaensena, Jo Viccac, Katleen Hermansb and Patrick Butayea, b<br /><br /><br />a Veterinary and Agrochemical Research Center, CODA-CERVA-VAR, Groeselenberg 99, B-1180 Ukkel, Belgium<br /><br /><br />b Ghent University, Faculty of Veterinary Medicine, Department of Pathology, Bacteriology and Poultry Diseases, Salisburylaan 133, 9820 Merelbeke, Belgium<br /><br /><br />c University College KaHo Sint-Lieven, Association Catholic University Leuven, Department of Agro- and Biotechnology, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium<br /><br /><br />Received 28 October 2009; revised 24 December 2009; accepted 28 December 2009. Available online 11 January 2010.<br /><br />Abstract<br /><br /><br />Methicillin-resistant Staphylococcus aureus (MRSA) is infrequently reported in mastitis. Yet, as in many other countries, the prevalence of methicillin resistance among S. aureus from mastitis is currently unknown in Belgium.<br /><br /><br />To elucidate this, the presence of mecA was investigated in 118 S. aureus strains originating from diagnostic mastitis milk samples from 118 different farms experiencing S. aureus mastitis. MRSA strains were characterized by disk diffusion susceptibility testing, spa-typing, MLST and SCCmec-typing. In an additional study, four MRSA-positive farms were selected to assess the in-herd prevalence of MRSA, by sampling all cows in lactation. Isolated MRSA strains were similarly characterized.<br /><br /><br />The mecA gene was detected in 11 (9.3%) of the 118 S. aureus isolates, indicating that nearly 10% of the Belgian farms suffering from S. aureus mastitis have an MRSA problem. The in-herd prevalence varied between 0% and 7.4%. Characterization of the MRSA strains showed that they were all resistant to tetracycline. Additional resistances to macrolides, lincosamides and aminoglycosides were frequently detected. The strains were ST398, spa-types t011 or t567 and had SCCmec-type IVa or V, proving that they belong to the emerging livestock-associated MRSA (LA-MRSA) strains of CC398.<br /><br /><br />Our study shows that after detection in Belgian pigs, horses and poultry, LA-MRSA has also attained Belgian cattle. It is the first report on frequent isolation of LA-MRSA from bovine infections. As the in-herd isolation rate resembles that of regular S. aureus in farms experiencing S. aureus mastitis, the multi-resistance of LA-MRSA strains may cause future treatment problems.<br /><br /><br />Keywords: Methicillin-resistant Staphylococcus aureus; MRSA; Mastitis; Belgium; ST398; Multidrug resistance<br /><br /><br /><a href="http://www.sciencedirect.com/">http://www.sciencedirect.com/</a><br /><br /><br />High occurrence of methicillin-resistant Staphylococcus aureus ST398 in equine nasal samples<br /><br /><br />A. Van den Eedea, , , A. Martensa, U. Lipinskab, M. Struelensc, A. Deplanoc, O. Denisc, F. Haesebrouckb, F. Gasthuysa and K. Hermansb<br /><br />aDepartment of Surgery and Anaesthesiology of Domestic Animals, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820 Merelbeke, Belgium<br /><br /><br />bDepartment of Pathology, Bacteriology and Poultry Diseases, Ghent University, Faculty of Veterinary Medicine, Salisburylaan 133, B-9820 Merelbeke, Belgium<br /><br /><br />cLaboratoire de Référence MRSA-Staphylocoques, Department of Microbiology, Université Libre de Bruxelles, Hôpital Erasme, Route de Lennik 808, B-1070 Brussels, Belgium<br /><br /><br />Received 30 March 2008; revised 23 June 2008; accepted 26 June 2008. Available online 5 July 2008.<br /><br /><br />Abstract<br /><br /><br />Methicillin-resistant Staphylococcus aureus (MRSA) infections do occur in equine patients. Little is known, however, about their origin and the general equine MRSA colonization status. In West European horses in particular, neither the colonization rate nor the present strains or their antimicrobial susceptibility patterns are known.<br /><br /><br />In the present study, a sample of 110 (Belgian, French, Dutch and Luxemburg) horses presented at a Belgian equine clinic was screened for nasal MRSA carriage. An indirect culturing protocol using a 0.001% colistin and nalidixic acid containing broth was compared to a direct agar method. Phenotypic identification following growth on a chromogenic MRSA screening agar (ChromID™ MRSA) was combined with genotypic analysis (PCR, PFGE, SCCmec, spa, and MLST typing). Antimicrobial susceptibility was tested through disk diffusion.<br /><br /><br />Twelve (10.9%) horses carried MRSA, with the enrichment protocol resulting in a significantly higher isolation rate. None of the isolated strains were typeable through SmaI PFGE. They all harboured SCCmec type IVa or V and belonged to spa type t011 or t1451 of the ST398 lineage. All isolates were tetracycline resistant and sulfonamide and enrofloxacin susceptible. Macrolide, lincosamide, trimethoprim and aminoglycoside susceptibility varied and in total five different antimicrobial resistance patterns were distinguished.<br /><br /><br />These results show that ST398 is certainly present in West European horses. Due to its known interspecies transmission and the structure of the equine industry, the presence of this clone in horses poses a substantial health hazard for both animals and humans.<br /><br /><br />Keywords: Staphylococcus aureus; MRSA; Horse; Nasal colonization, ST398<br /><br /><br /><a href="http://www.sciencedirect.com/">http://www.sciencedirect.com/</a><br /><br /><br />Veterinary Microbiology Volume 141, Issues 1-2, 24 February 2010, Pages 96-102<br /><br /><br />Methicillin-resistant Staphylococcus aureus in horses and horse personnel: An investigation of several outbreaks<br /><br /><br />E. van Duijkerena, , , M. Molemanb, M.M. Sloet van Oldruitenborgh-Oosterbaanb, J. Multema, A. Troelstrac, A.C. Fluitc, W.J.B. van Wameld, D.J. Houwersa, A.J. de Neelinge and J.A. Wagenaara, f<br /><br /><br />a Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, PO Box 80165, 3508 TD Utrecht, Utrecht University, The Netherlands<br /><br /><br />b Department of Equine Medicine, Faculty of Veterinary Medicine, Utrecht University, The Netherlands<br /><br /><br />c Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, The Netherlands<br /><br /><br />d Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands<br /><br /><br />e National Institute of Public Health and the Environment, Laboratory for Infectious Diseases and Screening, Bilthoven, The Netherlands<br /><br /><br />f Central Veterinary Institute of Wageningen UR, Lelystad, The Netherlands<br /><br /><br />Received 29 May 2009; revised 9 July 2009; accepted 3 August 2009. Available online 8 August 2009.<br /><br /><br />Abstract<br /><br /><br />At the Veterinary Microbiological Diagnostic Center, the Netherlands, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) isolates found in equine clinical samples increased from 0% in 2002 to 37% in 2008. MRSA of spa-type t064, belonging to MLST ST8 and spa-types t011 and t2123, both belonging to the livestock-associated MLST ST398, predominated.<br /><br /><br />During an outbreak of post-surgical MRSA infections in horses at a veterinary teaching hospital in 2006/2007, MRSA isolates of spa-type t2123 were cultured from 7 horses and 4/61 personnel which indicated zoonotic transmission. After intervention the outbreak stopped. However, another outbreak occurred in 2008, where 17 equine MRSA isolates of spa-type t011 (n = 12), t2123 (n = 4), and t064 (n = 1) were found. This time, 16/170 personnel were positive for MRSA with spa-type t011 (n = 11) and t2123 (n = 5). Personnel in close contact with horses were more often MRSA-positive (15/106) than those without (1/64).<br /><br /><br />Screening of horses upon admission showed that 9.3% were MRSA-positive predominantly with spa-type t011. Weekly cross-sectional sampling of all hospitalized horses for 5 weeks showed that 42% of the horses were MRSA-positive at least once, again predominantly with spa-type t011, which suggests that nosocomial transmission took place. Fifty-three percent of the environmental samples were MRSA-positive, including samples from students’ and staff members’ rooms, and all were spa-type t011. This indicates that humans contribute to spreading the organism. Culturing of samples employing high-salt pre-enrichment performed better than a comparable method without pre-enrichment.<br /><br /><br />Our results show that nosocomial transmission occurs in equine clinics and suggests that personnel play a role in the transmission.<br /><br /><br />Keywords: Horse; MRSA; Staphylococcus aureus; Transmission; Environment<br /><br /><br /><a href="http://www.sciencedirect.com/">http://www.sciencedirect.com/</a><br /><br /><br />Preventive Veterinary Medicine Volume 91, Issues 2-4, 1 October 2009, Pages 270-273<br /><br /><br />Short communication<br /><br /><br />Occurrence of methicillin-resistant Staphylococcus aureus in rats living on pig farms<br /><br /><br />A.W. van de Giessen, a, , M.G. van Santen-Verheuvela, P.D. Hengevelda, T. Boscha, E.M. Broensa and C.B.E.M. Reuskena<br /><br /><br />aCentre for Infectious Disease Control Nertherlands, National Institute for Public Health and the Environment, Bilthoven, The Netherlands<br /><br /><br />Received 20 March 2009; revised 8 May 2009; accepted 8 May 2009. Available online 11 June 2009.<br /><br /><br />Abstract<br /><br /><br />In The Netherlands, MRSA ST398 has emerged in hospitals and human carriers have been associated with exposure to pigs and cattle. High prevalences of MRSA ST398 in pigs and pig farmers have been determined and the transmission routes of MRSA on pig farms need to be elucidated. In the south of the Netherlands, in recent years, the black rat (Rattus rattus) has emerged as a prominent rodent on livestock farms. From March till May 2008, a survey on MRSA in rats living on livestock farms in the south of The Netherlands and the north of Belgium was conducted. In total, 40 black rats (R. rattus) and 3 brown rats (Rattus norvegicus) were collected on 12 farms including five pig farms, five poultry farms, one mixed pig and veal farm and one goat farm. MRSA ST398 was detected in black rats captured at two of the five pig farms as well as in a black rat living on the mixed pig and veal farm. From one black rat captured at another pig farm MRSA ST 97 was isolated. Considering the behaviour of rats on livestock farms, it is concluded that rats might play a role in the spread and persistence of MRSA on pig farms.<br /><br /><br />Keywords: Staphylococcus aureus; Methicillin resistance; Swine; Transmission; Rats; Rodents<br /><br /><br />Article Outline<br /><br /><br /><a href="http://www.sciencedirect.com/">http://www.sciencedirect.com/</a><br /><br /><br />JAC Advance Access originally published online on October 21, 2009 Journal of Antimicrobial Chemotherapy 2009 64(6):1325-1326; doi:10.1093/jac/dkp378 © The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: <a href="mailto:journals.permissions@oxfordjournals.org">journals.permissions@oxfordjournals.org</a><br /><br /><br />--------------------------------------------------------------------------------<br /><br /><br />Research letters<br /><br /><br />Detection of methicillin-resistant Staphylococcus aureus ST398 in food samples of animal origin in Spain<br /><br /><br /><br />Carmen Lozano, María López, Elena Gómez-Sanz, Fernanda Ruiz-Larrea, Carmen Torres and Myriam Zarazaga* Departamento de Agricultura y Alimentación, Universidad de La Rioja, Madre de Dios 51, 26006 Logroño, Spain<br /><br /><br /><br />--------------------------------------------------------------------------------<br /><br /><br /><br />* Corresponding author. Tel: +34-941-299751; Fax: +34-941-299721; E-mail: <a href="mailto:myriam.zarazaga@unirioja.es">myriam.zarazaga@unirioja.es</a><br /><br /><br />Keywords: MRSA , food microbiology , ST398 , ST125 , ST217<br /><br /><br /><br />Sir, Methicillin-resistant Staphylococcus aureus (MRSA) strains belonging to clonal lineage sequence type (ST) 398 are being reported at an increasing frequency in Europe.1 This new MRSA type has been isolated from colonized and infected animals and humans, and also from meat in some countries,1,2 representing a risk to human health; nevertheless, so far, no data about detection of MRSA ST398 in food in Spain have been published.<br /><br /><br /><br /><a href="http://jac.oxfordjournals.org/cgi/content/extract/64/6/1325">http://jac.oxfordjournals.org/cgi/content/extract/64/6/1325</a><br /><br /><br /><br />doi:10.1016/j.ijfoodmicro.2008.12.007 How to Cite or Link Using DOI Copyright © 2008 Elsevier B.V. All rights reserved.<br /><br /><br /><br />Prevalence of methicillin-resistant Staphylococcus aureus in meat<br /><br /><br /><br />E. de Boera, , , J.T.M. Zwartkruis-Nahuisa, B. Wita, X.W. Huijsdensc, A.J. de Neelingc, T. Boschc, R.A.A. van Oosteromb, A. Vilaa and A.E. Heuvelinka<br /><br /><br />aFood and Consumer Product Safety Authority (VWA), PO Box 202, 7200 AE Zutphen, The Netherlands<br /><br /><br />bFood and Consumer Product Safety Authority (VWA), PO Box 19506, 2500 CM Den Haag, The Netherlands<br /><br /><br />cNational Institute for Public Health and the Environment (RIVM), PO Box 1, 3720 BA Bilthoven, The Netherlands<br /><br /><br />Received 13 August 2008; revised 18 November 2008; accepted 7 December 2008. Available online 13 December 2008.<br /><br /><br />Abstract<br /><br /><br />Recently the isolation of methicillin-resistant Staphylococcus aureus (MRSA) strains from several food-producing animals has been reported. During slaughtering of MRSA-positive animals, contamination of carcasses with MRSA may occur and consequently the meat of these animals may get contaminated. The aim of this study was to estimate the prevalence of MRSA in raw meat samples from the retail trade.<br /><br /><br />Samples of raw beef, pork, veal, lamb/mutton, chicken, turkey, fowl and game were collected from the retail trade. A detection method including a two-step enrichment in Mueller–Hinton broth + 6.5% NaCl and phenol red mannitol broth containing ceftizoxime and aztreonam, followed by isolation on MRSA ID agar (bioMérieux) was evaluated and subsequently applied for the detection of MRSA in samples of raw meats.<br /><br /><br />MRSA strains were isolated from 264 (11.9%) of 2217 samples analyzed. Isolation percentages for the meat species were: beef (10.6%), veal (15.2%), lamb and mutton (6.2%), pork (10.7%), chicken (16.0%), turkey (35.3%), fowl (3.4%) and game (2.2%). The majority (85%) of the isolated strains belonged to spa-types of pulsed-field gel electrophoresis (PFGE) non-typeable (NT)-MRSA, corresponding to the multilocus sequence type ST398, a type also recently isolated in the Netherlands from pigs. However, a smaller part of these strains were found to be of other ST's, possibly of human origin.<br /><br /><br /><br />Further studies are needed to elucidate transmission routes of MRSA in relation to meat and other foods and to provide the tools for preventing the spread of MRSA. At present the high prevalence of MRSA in meat has not been shown to contribute significantly to the dissemination of MRSA to humans and the possible health hazard for consumers of the presence of MRSA in foods should be further elucidated.<br /><br /><br />Keywords: MRSA; Meat; MLST; spa-Typing<br /><br /><br /><a href="http://www.sciencedirect.com/">http://www.sciencedirect.com/</a><br /><br /><br /><br />Thursday, February 11, 2010<br /><br /><br /><br />Denmark's Case for Antibiotic-Free Animals NEW YORK, Feb. 10, 2010<br /><br /><br />snip...<br /><br /><br /><br />According to one study, when different countries introduced certain antibiotics on farms, a surge occurred in people contracting antibiotic resistant intestinal infections one to two years later. One infection, Campylobacter, increased 20 percent in Denmark and 70 percent in Spain.<br /><br /><br />After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.<br /><br /><br />Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.<br /><br /><br />"It's not going to be a time bomb that goes off like this," said Dr. Frank Aarestrup, of the Danish Food Institute at the University of Denmark. "It's something that's slowly getting more and more complicated, more difficult for us to actually treat infections.<br /><br /><br />Rep. Slaughter's "Preservation of Antibiotics for Medical Treatment Act" Some American food producers agree. "It's just gone too far," said Stephen McDonnell, CEO Applegate Farms.<br /><br /><br />snip...<br /><br /><br />see full text ;<br /><br /><br /><a href="http://staphmrsa.blogspot.com/2010_02_01_archive.html">http://staphmrsa.blogspot.com/2010_02_01_archive.html</a><br /><br /><br /><br />Friday, January 29, 2010 14th International Congress on Infectious Diseases H-type and L-type Atypical BSE January 2010 (special pre-congress edition)<br /><br /><br /><br /><a href="http://bse-atypical.blogspot.com/2010/01/14th-international-congress-on.html">http://bse-atypical.blogspot.com/2010/01/14th-international-congress-on.html</a><br /><br /><br /><br />*** CJD USA RISING, with UNKNOWN PHENOTYPE ;<br /><br /><br />5 Includes 41 cases in which the diagnosis is pending, and 17 inconclusive cases; 6 Includes 46 cases with type determination pending in which the diagnosis of vCJD has been excluded.<br /><br /><br /><a href="http://www.cjdsurveillance.com/pdf/case-table.pdf">http://www.cjdsurveillance.com/pdf/case-table.pdf</a><br /><br /><br /><br />Saturday, January 2, 2010<br /><br />Human Prion Diseases in the United States January 1, 2010 ***FINAL***<br /><br /><br /><a href="http://prionunitusaupdate2008.blogspot.com/2010/01/human-prion-diseases-in-united-states.html">http://prionunitusaupdate2008.blogspot.com/2010/01/human-prion-diseases-in-united-states.html</a><br /><br /><br /><br />my comments to PLosone here ;<br /><br /><br /><a href="http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd&root=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd">http://www.plosone.org/annotation/listThread.action?inReplyTo=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd&root=info%3Adoi%2F10.1371%2Fannotation%2F04ce2b24-613d-46e6-9802-4131e2bfa6fd</a><br /><br /><br /><br />Thursday, February 4, 2010<br /><br />SPONGIFORM ENCEPHALOPATHY ADVISORY COMMITTEE Draft Minutes of the 103rd Meeting held on 24th November 2009<br /><br /><br /><a href="http://seac992007.blogspot.com/2010/02/spongiform-encephalopathy-advisory.html">http://seac992007.blogspot.com/2010/02/spongiform-encephalopathy-advisory.html</a><br /><br /><br /><br />Friday, February 05, 2010<br /><br />New Variant Creutzfelt Jakob Disease case reports United States 2010 A Review<br /><br /><br /><a href="http://vcjd.blogspot.com/2010/02/new-variant-creutzfelt-jakob-disease.html">http://vcjd.blogspot.com/2010/02/new-variant-creutzfelt-jakob-disease.html</a><br /><br /><br /><br />Wednesday, February 10, 2010<br /><br />NAIS MAD COW TRACEABILITY DUMPED BY USDA APHIS 2010<br /><br /><br /><a href="http://naiscoolyes.blogspot.com/2010/02/nais-mad-cow-traceability-dumped-by.html">http://naiscoolyes.blogspot.com/2010/02/nais-mad-cow-traceability-dumped-by.html</a><br /><br /><br /><br /><br /><br />Terry S. Singeltary Sr.<br />P.O. Box 42<br />Bacliff, Texas USA 77518Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-73602162823276466942009-12-01T07:57:00.000-08:002009-12-01T08:01:40.147-08:00EFSA publishes results of the first survey on MRSA in pigs in the EUPress Release 24 November 2009 EFSA publishes results of the first survey on MRSA in pigs in the EU<br /><br />The European Food Safety Authority (EFSA) has published the first EU-wide survey on MRSA (Methicillin-resistant Staphylococcus aureus) in breeding pigs. The results indicate that MRSA, a bacterium resistant to many antibiotics, is commonly detected in holdings with breeding pigs in some EU Member States. The survey provides estimates of its occurrence and makes recommendations for further monitoring and investigation of the causes and implications of MRSA findings in pig holdings in the EU. The survey was carried out in 24 Member States[1], 17 of which found some type of MRSA in their holdings with breeding pigs and 7 none at all. On average, different types of MRSA were found in 1 out of 4 holdings with breeding pigs across the EU, but the survey also says that figures vary greatly between Member States. MRSA ST398 was the most reported type of MRSA among the holdings with breeding pigs in the EU; some Member States also reported other types, but their prevalence was much lower[2].<br /><br />MRSA is a major concern for public health and its various types are recognised as an important cause of hospital-acquired (or nosocomial) infections in humans. The specific type MRSA ST398 has been identified in some domestic animals and is considered an occupational health risk for farmers, veterinarians and their families, who may become exposed to it through direct or indirect contact with these animals. In an opinion published earlier this year, EFSA’s Biological Hazards (BIOHAZ) Panel assessed the public health significance of MRSA in animals and food[3] and concluded that the MRSA ST398[4] strain is less likely to contribute to the spread of MRSA in hospitals than other types carried by humans. The Panel also said that there is currently no evidence that MRSA ST398 can be transmitted to humans by eating or handling contaminated food.<br /><br />In the survey published today, EFSA recommends monitoring of pigs and other food producing animals for MRSA. It also says further research should be carried out, so that the reasons for differences in the prevalence of MRSA in the various Member States can be identified and used to propose options on possible control measures.<br /><br />_________________________________________ Note to editors:<br /><br />The Staphylococcus aureus is a bacterium that can be persistently or intermittently carried by healthy humans and is a very common cause of minor skin infections that usually do not require treatment. In patients in hospitals, Staphylococcus aureus is a common cause of hospital-acquired infections. Its variant Methicillin-Resistant Staphylococcus aureus (MRSA) emerged in the 1970s and is now often found in hospitals in many European Member States. MRSA is resistant to many commonly used antibiotics. In recent years, clones of MRSA have evolved outside the hospitals, causing infections among people who have no connection with hospitals. Most recently MRSA has also been detected in several farm animal species.<br /><br />EFSA’s Zoonoses Unit monitors and analyses the situation on zoonoses, zoonotic agents, antimicrobial resistance, microbiological contaminants and food-borne outbreaks across Europe. The Unit is supported by a Task Force on Zoonoses Data Collection consisting of a pan-European network of national representatives of Member States, other reporting countries, as well as World Health Organisation (WHO) and World organisation for animal health (OIE). They gather each year data in their respective countries.<br /><br />EFSA’s BIOHAZ Panel provides scientific advice on biological hazards in relation to food safety and food-borne diseases. This covers food-borne zoonoses (animal diseases transmissible to humans), Transmissible spongiform Encephalopathies (BSE/TSEs), food microbiology, food hygiene and associated waste management issues. The Panel’s risk assessment work helps to provide a sound foundation for European policies and legislation and supports risk managers in taking effective and timely decisions.<br /><br />Analysis of the baseline survey on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in holdings with breeding pigs, in the EU, 2008 [1] - Part A: MRSA prevalence estimates<br /><br />EFSA’s previous work on MRSA:<br /><br />EFSA’s BIOHAZ Panel “Assessment of the Public Health significance of Methicillin-resistant Staphylococcus aureus (MRSA) in animals and foods” Joint scientific report of ECDC, EFSA and EMEA on Methicillin-resistant Staphylococcus aureus (MRSA) in livestock, companion animals and food<br /><br />Joint Opinion of ECDC, EFSA, EMEA and SCENIHR on antimicrobial resistance (AMR) focused on zoonotic infections<br /><br />--------------------------------------------------------------------------------<br /><br />[1] The sampling took place during 2008. Dust samples were taken in the environment of pigs in a total of 5,073 holdings from 24 EU Member States and two non-Member States. The pooled sample of each holding was tested for the presence of the various MRSA strains. [2] Only six Member States and one non-Member State reported MRSA non-ST398 in the holdings with breeding pigs. The prevalence of MRSA non-ST398 in holdings with breeding pigs across the participating Member States was substantially lower than the prevalence of MRSA and MRSA ST398. [3] EFSA’s BIOHAZ Panel opinion on the “Assessment of the Public Health significance of Methicillin-resistant Staphylococcus aureus (MRSA) in animals and foods” of March 2009 [4] In its opinion the BIOHAZ Panel refers to CC398 which corresponds to MRSA ST398.<br /><br /><br /><br /><a href="http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1211903070258.htm">http://www.efsa.europa.eu/EFSA/efsa_locale-1178620753812_1211903070258.htm</a><br /><br /><br /><br /><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br /><br /><br /><br /><br />TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-47943521292211842202009-01-23T07:16:00.000-08:002009-01-23T07:17:20.287-08:00Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine WorkersMethicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers<br /><br />Tara C. Smith1,2*, Michael J. Male1,2, Abby L. Harper1,2, Jennifer S. Kroeger3, Gregory P. Tinkler2, Erin D. Moritz1,2, Ana W. Capuano1,2, Loreen A. Herwaldt1,3,4, Daniel J. Diekema3,4,5<br /><br />1 Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa, United States of America, 2 Center for Emerging Infectious Diseases, University of Iowa College of Public Health, Iowa City, Iowa, United States of America, 3 Department of Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America, 4 Program of Hospital Epidemiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, United States of America, 5 Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa, United States of America<br /><br />Abstract Background Recent research has demonstrated that many swine and swine farmers in the Netherlands and Canada are colonized with MRSA. However, no studies to date have investigated carriage of MRSA among swine and swine farmers in the United States (U.S.).<br /><br />Methods We sampled the nares of 299 swine and 20 workers from two different production systems in Iowa and Illinois, comprising approximately 87,000 live animals. MRSA isolates were typed by pulsed field gel electrophoresis (PFGE) using SmaI and EagI restriction enzymes, and by multi locus sequence typing (MLST). PCR was used to determine SCCmec type and presence of the pvl gene.<br /><br />Results In this pilot study, overall MRSA prevalence in swine was 49% (147/299) and 45% (9/20) in workers. The prevalence of MRSA carriage among production system A's swine varied by age, ranging from 36% (11/30) in adult swine to 100% (60/60) of animals aged 9 and 12 weeks. The prevalence among production system A's workers was 64% (9/14). MRSA was not isolated from production system B's swine or workers. Isolates examined were not typeable by PFGE when SmaI was used, but digestion with EagI revealed that the isolates were clonal and were not related to common human types in Iowa (USA100, USA300, and USA400). MLST documented that the isolates were ST398.<br /><br />Conclusions These results show that colonization of swine by MRSA was very common on one swine production system in the midwestern U.S., suggesting that agricultural animals could become an important reservoir for this bacterium. MRSA strain ST398 was the only strain documented on this farm. Further studies are examining carriage rates on additional farms.<br /><br />Citation: Smith TC, Male MJ, Harper AL, Kroeger JS, Tinkler GP, et al. (2008) Methicillin-Resistant Staphylococcus aureus (MRSA) Strain ST398 Is Present in Midwestern U.S. Swine and Swine Workers. PLoS ONE 4(1): e4258. doi:10.1371/journal.pone.0004258<br /><br />Editor: Ulrich Dobrindt, University of Würzburg, Germany<br /><br />Received: October 9, 2008; Accepted: December 19, 2008; Published: January 23, 2008<br /><br />Copyright: © 2009 Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.<br /><br />Funding: This study was funded with departmental startup funds (TCS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.<br /><br />Competing interests: The authors have declared that no competing interests exist.<br /><br />* E-mail: <a href="mhtml:%7B33B38F65-8D2E-434D-8F9B-8BDCD77D3066%7Dmid://00000112/!x-usc:mailto:tara-smith@uiowa.edu">tara-smith@uiowa.edu</a><br /><br />Introduction ...snip...end<br /><br />see full text ;<br /><br /><br /><a href="mhtml:%7B33B38F65-8D2E-434D-8F9B-8BDCD77D3066%7Dmid://00000112/!x-usc:http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004258">http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0004258</a><br /><br /><br />MRSA<br /><br /><a href="mhtml:%7B33B38F65-8D2E-434D-8F9B-8BDCD77D3066%7Dmid://00000112/!x-usc:http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a>Terry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-53747434087300539602008-07-23T10:04:00.000-07:002008-07-23T10:06:55.733-07:00WARNING LETTER An inspection of your licensed medicated feed mill, Cargill, Inc. 1000% higher than the levels indicated on the product's label. ...Public Health Service Food and Drug Administration<br /><br />Seattle District Pacific Region 2201 23rd Drive SE Bothell, WA 98021-4421<br /><br />Telephone: 425-486-8788 FAX: 425-483-4996<br /><br />June 25, 2008<br /><br />CERTIFIED MAIL RETURN RECEIPT REQUESTED<br /><br />Gregory R. Page, President and CEO Cargill, Inc. 15407 McGinty Road West Wayzata, Minnesota 55391<br /><br />In reply refer to Warning Letter SEA 08-22<br /><br />WARNING LETTER<br /><br />Dear Mr. Page:<br /><br />An inspection of your licensed medicated feed mill, Cargill, Inc., located at 1406 Industrial Avenue, Billings, Montana, conducted by the U.S. Food and Drug Administration (FDA) on February 25, 26, and 27, 2008, found significant deviations from current Good Manufacturing Practice (cGMP) regulations for Medicated Feeds (Title 21, Code of Federal Regulations, Part 225 (21 C.F.R. 225)). These deviations cause feeds being manufactured at this facility to be adulterated within the meaning of section 501 (a)(2)(B) of the Federal Food, Drug, and Cosmetic Act (the Act) [21 U.S.C. § 351(a)(2)(B)]. In addition, your llama feed, Llama Mineral, was found to contain the new animal drug [redacted] (chlortetracycline), which is not approved for use in llama feed. The use of the new animal drug, Type A, medicated article [redacted] (chlortetracycline), contrary to its approved labeling causes the drug to be deemed unsafe within the meaning of section 512(a)(1) of the Act [21 U.S.C. § 360b(a)(1)] and adulterated with in the meaning of section 501 (a)(5) of the Act [21 U.S.C. § 351(a)(5)]. In addition, the llama feed containing [redacted] (chlortetracycline) is deemed to be unsafe within the meaning of section 512(a)(2) of the Act [21 U.S.C. § 360b(a)(2)] and adulterated within the meaning of section 501 (a)(6) of the Act [21 U.S.C. § 351(a)(6)].<br /><br />We reviewed your firm's response, dated March 13, 2008, to the FDA-483. We found that the response lacks sufficient detail, explanation, documentation, or substantive corrective action plans to adequately address the deviations noted during the February 2008 inspection of your licensed medicated feed mill in Billings, Montana.<br /><br />We acknowledge your firm has made some changes and corrections in response to Agency findings and requests. However, we have found that, while some individual cGMP deficiencies may have been corrected, your firm has failed to institute sufficient corrections for your firm's manufacturing processes to conform to the following cGMP requirements in 21 C.F.R. 225:<br /><br />1. When results of laboratory assays of drug components indicated that medicated feeds were not within permissible assay limits, your facility did not implement investigations and corrective actions, as required by 21 C.F.R. 225.58(d). For example:<br /><br />a. An assay of the cattle feed "NB TRANS PL 5LB [redacted]" manufactured on March 29, 2007, and submitted for sulfamethazine analysis on or about April 12, 2007, determined a sulfamethazine level 26% above the claimed potency. No investigation or corrective action was undertaken at that time.<br /><br />b. An assay of the cattle feed "NB TRANS PL 10LB [redacted] manufactured on May 15, 2007, and submitted for sulfamethazine analysis on or about June 12, 2007, determined a sulfamethazine level 24.4% above the claimed potency. No investigation or corrective action was undertaken at that time.<br /><br />We acknowledge your firm's response that the importance of performing an immediate investigation into the reason for an out-of-tolerance assay result and implementing corrective action has been reviewed with appropriate personnel to ensure compliance with regard to any future out-of-tolerance assays. We further acknowledge your firm's action of completing investigations into these two assays at the time of the February 2008 inspection. However, the results. of the assays were reported to your Billings, Montana feed mill seven to ten months prior to the February 2008 inspection. FDA does not consider an investigation occurring after a seven to ten month delay to be sufficient. Further, your response states that with respect to the February 2008 investigation, "no manufacturing errors were noted." However, FDA was informed by your firm at the time of inspection that the assay of the feed manufactured on March 29, 2007, failed because [redacted] mixer was not functioning properly. The malfunction of [redacted] mixer constitutes a manufacturing error.<br /><br />2. When results of laboratory assays indicated that medicated feeds failed to meet the labeled drug potency, your facility did not take corrective actions that included discontinuing distribution of the feeds, as required by 21 C.F.R. 225.58(e). For example:<br /><br />a. An assay of the cattle feed "NB TRANS PL 5LB [redacted]" manufactured on March 29, 2007, and submitted for sulfamethazine analysis on or about April 12, 2007, determined a sulfamethazine level 26% above the claimed potency. No investigation or corrective action was undertaken at that time, including discontinuing distribution of the affected feed products.<br /><br />b. An assay of the cattle feed "NB TRANS PL 10LB [redacted]" manufactured on May 15, 2007, and submitted for sulfamethazine analysis on or about June 12, 2007, determined a sulfamethazine level 24.4% above the claimed potency. No corrective action was undertaken at that time, including discontinuing distribution of the affected feed products.<br /><br />We acknowledge your firm's response that the importance of withholding such feed from distribution has been reviewed with appropriate personnel to ensure compliance with regard to any future out-of-tolerance assays. Your response also notes that there was no product available for recovery. This is understandable as the investigation into the assays that showed the feeds not to be in accord with permissible limits did not occur for seven to ten months after the assay results were reported. However, as discussed above, FDA does not consider corrective action taken seven to ten months after the reported assay results to be sufficient.<br /><br />3. Laboratory analysis results demonstrate that the cleanout procedures established and used in the production of your facility's medicated feeds are not adequate to prevent unsafe contamination of feed, as required by 21 C.F.R. 225.65(b). For example:<br /><br />a. Laboratory analysis by the Montana State Department of Agriculture found chlorotetracycline in Nutrena Naturewise Lamb and Sheep Feed, manufactured on February 4, 2008, at 550 grams per ton, which is 10 times higher than the level of 50 grams per ton indicated on the product's label. FDA analysis of a sample collected from a different portion of the same lot of lamb and sheep feed found levels of chlorotetracycline at 160 grams per ton (320 % of formula).<br /><br />b. FDA analysis of a retain sample collected from a lot of medicated cattle feed manufactured at your facility, identified as "Nutrabeef Cattle Grower Feed," found levels of chlortetracycline at 4.8 parts per million (ppm). This product is formulated to contain no chlortetracycline.<br /><br />c. FDA analysis of a retain sample collected from a lot of medicated cattle feed manufactured at your facility, identified as "Miller FDLT 45/27," found levels of chlortetracycline at 88.0 ppm. This product is formulated to contain no chlortetracycline.<br /><br />d. FDA analysis of a retain sample collected from a lot of non-medicated llama feed manufactured at your facility, identified as "Llama Mineral," found levels of chlortetracycline at 96.0 ppm. This product is formulated to contain no chlortetracycline.<br /><br />We acknowledge your firm's response that the incident described above regarding Nutrena Naturewise Lamb and Sheep Feed represents an isolated incident.<br /><br />However, this response is inadequate in light of analytical sample results confirming cross contamination in several additional products (i.e., "Nutrabeef Cattle Grower Feed," "Miller FDLT 45/27," and "Llama Mineral"). As these analytical results indicate that this is not an isolated incident, FDA continues to have concerns regarding the adequacy of the cleanout procedures at your Billings, Montana facility.<br /><br />4. Your facility does hot utilize proper sequential production of medicated feeds on a predetermined basis designed to prevent unsafe contamination of feeds with residual drugs in the manufacture of medicated and non-medicated feeds, as required by 21 C.F.R. 225.65(b)(3). For example:<br /><br />a. On February 4, 2008, your facility produced a medicated feed, identified as "Nutrena Naturewise Lamb and Sheep Feed," which is formulated to contain relatively low levels (0.55 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline), following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted]. This resulted in levels of chlortetracycline in the lamb and sheep feed up to 1000% higher than the levels indicated on the product's label.<br /><br />b. On January 8, 2008, your facility produced a lot of non-medicated feed, identified as "Llama Mineral," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Llam a Mineral" with levels of chlortetracycline at 96.0 ppm.<br /><br />c. On November 19, 2007, your facility produced a lot of, medicated feed, identified as "Miller FDLT 45/27," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Miller FDLT 45/27" with levels of chlortetracycline at 88.0 ppm.<br /><br />d. On November 5, 2007, your facility produced a lot of medicated feed, identified as "Nutrabeef Cattle Grower Feed," which is formulated to contain no chlortetracycline, following the production of a medicated feed, identified as "Nutrena CTC 10 Gram," which is formulated to contain relatively high levels (222 lbs per ton) of the Type A, medicated article [redacted] (chlortetracycline). This resulted in cross contamination of the "Nutrabeef Cattle Grower Feed" with levels of chlortetracycline at 4.8 ppm.<br /><br />We acknowledge your firm's response that: (1) the incident described above regarding Nutrena Naturewise Lamb and Sheep Feed represents an isolated incident; (2) the Billings, Montana facility has reviewed its sequencing and flushing procedures and has determined that the procedures for sequencing feeds are adequate and substantiated with appropriate residue testing analysis; and (3) the importance of proper sequencing and flushing has been reviewed with appropriate personnel. We further acknowledge your firm's decision to no longer manufacture the medicated feed identified as "Nutrena CTC 10 Gram" at the Billings, Montana facility. Though the firm has suspended its production of the Nutrena CTC 10 Gram, this response fails to detail any changes in the firm's sequencing procedures to prevent future cross-contamination of products.<br /><br />As a manufacturer of medicated feeds you are required to use all Type A, medicated articles and Type B medicated feeds in accordance with their labeled mixing directions. However, you did not use the Type A, medicated article [redacted] in accordance with its labeled mixing directions when you added it directly into feed ration mixes rather than following the product's labeled mixing direction, which indicates to [redacted] and then [redacted] therefore, the use of the new animal drug, Type A, medicated article [redacted] (chlortetracycline), contrary to its approved labeling causes the drug to be deemed unsafe within the meaning of section 512(a)(1) of the Act [21 U.S.C. § 360b(a)(1)] and adulterated within the meaning of section 501(a)(5) of the Act [21 U.S.C. § 351(a)(5)].<br /><br />We acknowledge your firm's response stating that adding this drug directly from the bag to the mixer "is a long-time standard industry practice" and that "[d]rug reconciliation records, mixer efficiency tests and laboratory assays have all substantiated this practice...." However, this response is inadequate as it fails to indicate what efforts the firm will undertake to bring its manufacturing processes into compliance with the [redacted](chlortetracycline) labeled mixing directions.<br /><br />The above is not intended to be an all-inclusive list of violations. As a manufacturer of medicated and non-medicated feeds, you are responsible for assuring that your overall operation and the products you manufacture and distribute are in compliance with the law.<br /><br />You should take prompt action to correct these violations and you should establish procedures whereby such violations do not recur. Failure to promptly correct these violations may result in regulatory and/or administrative sanctions. These sanctions include, but are not limited to, seizure, injunction, and/or notice of opportunity for a hearing on a proposal to withdraw approval of your Medicated Feed Mill License under section 512(m)(4)(B)(ii) of the Act [21 U.S.C. § 360b(m)(4)(B)(ii)] and 21 C.F.R. 515.22(c)(2).<br /><br />Based on the results of the February 2008 inspection, evaluated together with the evidence before FDA when the Medicated Feed License was approved, the methods used in, or the facilities and controls used for, the manufacture, processing, and packing of medicated feeds are inadequate to assure and preserve the identity, strength, quality, and purity of the new animal drug therein. This letter notifies you of our findings and provides you an opportunity to correct the above deficiencies in your operations.<br /><br />You should notify this office in writing, within fifteen (15) working days of receipt of this letter, of the specific steps you have taken to correct the noted violations. Your, response should include an explanation of each step being taken to correct the cGMP violations and prevent their recurrence. If corrective action cannot be completed within fifteen (15) working days, state the reason for the delay and the date by which the corrections will be completed. Include copies of any available documentation demonstrating that corrections have been made.<br /><br />Please send your written response to the Food and Drug Administration, Attention: Michael J. Donovan, Compliance Officer, 22201 23rd Drive SE, Bothell, Washington 98021. If you have questions regarding any issue in this letter, please contact Mr. Donovan at (425) 483-4906.<br /><br />Sincerely,<br /><br />/S/<br /><br />Charles M. Breen District Director<br /><br />Enclosure:<br /><br />Form FDA 483<br /><br />cc: Terry Wright, Plant Manager Cargill, Inc., 1406 Industrial Avenue, Billings, Montana 59101-3127<br /><br />Sue Carson, Quality Assurance and Regulatory Manager Cargill Animal Nutrition, P.O. Box 5614, Minneapolis, Minnesota 55440-5614<br /><br />Bob Church, Agricultural Specialist Montana Department of Agriculture, Feed and Fertilizer Division 303 North Roberts, Helena, Montana 59620-0201<br /><br /><br /><a href="http://www.fda.gov/foi/warning_letters/s6856c.htm">http://www.fda.gov/foi/warning_letters/s6856c.htm</a><br /><br /><br />> This resulted in levels of chlortetracycline in the lamb and sheep feed up to 1000% higher than the levels indicated on the product's label. ...<br /><br /><br />holy smokes! no wonder many of us are becoming resistant to antibiotics. ...<br /><br /><br /><a href="http://staphmrsa.blogspot.com/">http://staphmrsa.blogspot.com/</a><br /><br /><br />Chlortetracycline plus lasalocid sodium<br /><br /><a href="http://www.fda.gov/cvm/FOI/141-250033106.pdf">http://www.fda.gov/cvm/FOI/141-250033106.pdf</a><br /><br /><br />Chlortetracycline review history and regulatory outcomes<br /><br /><br />snip...<br /><br />Final review and outcomes<br /><br />The APVMA completed the Chlortetracycline Review Final Report* in May 1999 but did not publish a final report because only a small number of registrants were involved. The APVMA found that the registration and approvals of the products containing chlortetracycline could be varied to meet the current requirements for continued registration.<br /><br />In the final review the APVMA recommended:<br /><br />cancelling approval for the use of chlortetracycline in sheep, lambs and lactating animals<br />ancelling approval for the use of chlortetracycline in animals producing milk for human consumption. Product labels must carry the statement, ‘Do not use in lactating cows where milk or milk products may be used for human consumption.’<br />increasing withholding periods for pigs, poultry, and cattle for some use patterns<br />withdrawing MRLs for milk, sheep, lambs and lactating animals<br />establishing new MRLs for pig offal (liver and kidney)<br />establishing MRLs for cattle, eggs and poultry.<br /><br />Chlortetracycline as a topical application is currently listed in Table 5 of the MRL Standard; Table 5 applies to ‘Uses of substances where maximum residue limits are not necessary‘.<br /><br />For more information please contact the Chemical Review Program on (02) 6210 4749 or by email to chemrev@apvma.gov.au<br /><br />* Contact the APVMA for copies of this document<br /><br /><a href="http://www.apvma.gov.au/chemrev/chlortetracyclineHistory.shtml">http://www.apvma.gov.au/chemrev/chlortetracyclineHistory.shtml</a><br /><br /><br /><br />TSSTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0tag:blogger.com,1999:blog-902325709430250180.post-79640256028459135052008-03-27T18:22:00.000-07:002008-03-27T18:28:16.784-07:00Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008Euro Surveill 2008;13(13) Published online March 2008<br /><br />Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008<br /><br /><br /><br /><br />W Witte (wittew@rki.de), C Braulke, B Strommenger<br /><br />Robert Koch Institut, Wernigerode, Germany<br /><br /><br /><br />--------------------------------------------------------------------------------<br /><br />The first cases of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) were reported in 1996 in Minnesota, United States (US) and were deep-seated skin and soft tissue infections and a few cases of necrotising pneumonia, mainly in children and among the Native American population [1]. A few years later, a large outbreak of CA-MRSA infections was reported in the men who have sex with men (MSM) community in California, predominantly among human immunodeficiency virus (HIV)-positive patients; data on sexual transmission was not available [2]. A recent report on the spread of CA-MRSA, mainly due to the widely disseminated strain "USA300", in numerous MSM in San Francisco and in one patient in Boston suggested sexual transmission [3], but initiated critical reviews concerning the transmission route and the corresponding public health message [4,5].<br />CA-MRSA "USA300", the most widely spread CA-MRSA strain in the US [6], has been detected in Germany since 2005 [7]. This clonal lineage is characterised by multilocus sequence type (MLST) ST8, spa-sequence type t008, SCCmec IVa, the presence of an additional arginine decomposition pathway (arginine catabolic mobile element (ACME) on a staphylococcal cassette chromosome (SCC)-element) with arcA as marker gene, and macrolide-resistance coded by the msrA (efflux pump) and mphB (phosphorylation) genes [7,8]. The contribution of ACME to virulence has been shown in a rabbit model [9]. The capacity of CA-MRSA "USA300" to cause invasive infections seems not to be due to production of the Panton-Valentine leukocidin cytotoxin, but rather to the synthesis of a large number of small phenol-soluble peptides, which are able to recruit and lyse neutrophilic granulocytes [10].<br /><br />Here we report a case of infection with CA-MRSA ST8 ("USA300") in an HIV-positive 35-year-old MSM patient in Cologne, Germany. The isolate originated from an infected cyst in the upper abdominal area, which opened spontaneously. The patient suffered from acquired immunodeficiency syndrome (AIDS). His CD4+ T-cell count was 200/microlitre with a fully suppressed virus load due to HIV treatment. A specimen from the cyst was taken for microbiological diagnostics. Primary topical treatment was performed by instillation of Leukase beads containing trypsin, framycetin sulphate and lidocaine hydrochloride (Merck, Vienna). After obtaining the microbiology results, oral doxycyclin (200 mg per day) was included in the treatment. The infection had healed completely after 14 days. Nasal swabs were negative for MRSA.<br /><br />The isolate exhibited the typical characteristics of CA-MRSA ST8 ("USA300", see above). It was resistant to oxacillin, erythromycin, ciprofloxacin, moxifloxacin and susceptible to gentamicin, oxytetracycline, clindamycin, rifampicin, cotrimoxazole, fusidic acid, linezolid, fosfomycin, tigecycline and daptomycin.<br /><br />As shown in the US, CA-MRSA ST8 ("USA300") may spread rapidly in MSM communities [3]. European doctors caring for HIV-positive patients and MSM with skin and soft tissue infections should be aware of the possibility of CA-MRSA in order to provide proper care and prevent further spread.<br /><br />Targeted measures include proper bacteriological diagnosis of skin and soft tissue infections in patients attending dermatological and surgical practises, as well as in HIV-positive patients. When MRSA is detected, it is likely that the infection is caused by a CA-MRSA strain. Early recognition of CA-MRSA ST8 ("USA300") is possible by PCR detection of the lukS-lukF and arcA genes [11]. Confirmation is obtained by additional typing such as spa-typing, MLST, and SCCmec [7]. Further spread can be prevented by personal, environmental and health care hygienic measures [12,13].<br /><br /><br /><br /><br />--------------------------------------------------------------------------------<br /><br />References<br /><br />Naimi TS, LeDell KH, Boxrud DJ, Groom AV, Steward CD, Johnson SK, et al. Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota. Clin Infect Dis. 2001 Oct 1;33(7):990-6.<br />Centers for Disease Control and Prevention (CDC). Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infection - Los Angeles County California, 2002-2003. MMWR Morb Mortal Wkly Rep. 2003;52(5):88. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5205a4.htm<br />Diep BA, Chambers HF, Graber CJ, Szumowski JD, Miller LG, Han LL, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008;148(4):249-57.<br />Skiest D, Brown K, Cooper TW, Hoffman-Roberts H, Mussa HR, Elliott AC. Prospective comparison of methicillin-susceptible and methicillin-resistant community associated Staphylococcus aureus infections in hospitalized patients. J Infect. 2007;54(5):427-34.<br />Centers for Disease Control and Prevention (CDC). CDC statement on MRSA in men who have sex with men. 2008 Jan 16. Available from: http://www.cdc.gov/od/oc/media/pressrel/2008/t080116.htm<br />Van de Laar MJW, Monnet DL, Herida M. Multidrug-resistant methicillin-resistant Staphylococcus aureus (MRSA) strain in a men-who-have-sex-with-men (MSM) community in the United States: comment. Euro Surveill. 2008;13(3). Available from: http://www.eurosurveillance.org/edition/v13n03/080117_1.asp<br />Witte W, Strommenger B, Cuny C, Heuck D, Nuebel U. Methicillin-resistant Staphylococcus aureus containing the Panton-Valentine leucocidin gene in Germany in 2005 and 2006. J Antimicrob Chemother. 2007;60(6):1258-63.<br />Tenover F, McDougal L, Goering RV, Killgore G, Projan SJ, Patel JB, et al. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol. 2006;44(1):108-18.<br />Chambers HF. Deconstructing virulence of the community MRSA clone USA300. in NARSA 8th Annual Meeting. 2007. Reston, VA, USA, March 5-6. Available from: http://www3.niaid.nih.gov/topics/antimicrobialResistance/PDF/futureMedicineMRSAeditorial.pdf<br />Wang R, Braughton KR, Kretschmer D, Bach TH, Queck SY, Li M, et al. Identification of novel cytolytic peptides as key virulence determinants. Nature Med. 2007;13(12):1510-4.<br />Strommenger B, Braulke C, Pasemann B, Schmidt C, Witte W. Multiplex PCR for rapid detection of Staphylococcus aureus isolates suspected to represent community-acquired strains. J Clin Microbiol. 2008;46(2):582-7.<br />Cohen PR. Community-acquired methicillin-resistant Staphylococcus aureus skin infections: implications for patients and practitioners. Am J Clin Dermatol. 2007;8(5):259-70.<br />Wiese-Posselt M, Heuck D, Draeger A, Mielke M, Witte W, Ammon A et al. Successful termination of a furunculosis outbreak due to lukS-lukF-positive, methicillin-susceptible Staphylococcus aureus in a German village by stringent decolonization, 2002 - 2005. Clin Infect Dis. 2007;44(11):88-95.<br /><br /><br /><br /><br /><br />Citation style for this article: . Community-associated methicillin-resistant Staphylococcus aureus ST8 ("USA300") in an HIV-positive patient in Cologne, Germany, February 2008. Euro Surveill 2008;13(13). Available online: http://www.eurosurveillance.org/edition/v13n13/080327_3.asp<br /><br /><br /><a href="http://www.eurosurveillance.org/edition/v13n13/080327_3.asp">http://www.eurosurveillance.org/edition/v13n13/080327_3.asp</a><br /><br /><br /><br />tssTerry S. Singeltary Sr.http://www.blogger.com/profile/06986622967539963260noreply@blogger.com0