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CDC Investigation Update: Multistate Outbreak of Human Salmonella Montevideo Infections
Posted on February 11, 2010 by Bill Marler
CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS), the U.S. Food and Drug Administration (FDA), and the State of Rhode Island to investigate a multistate outbreak of Salmonella serotype Montevideo infections. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

As of 9:00 pm EST on February 10, 2010, a total of 225 individuals infected with the outbreak strain of Salmonella Montevideo, which displays either of two closely related PFGE patterns, have been reported from 44 states and District of Columbia since July 1, 2009. The number of ill persons identified in each state with this strain is as follows: AK (1), AL (2), AZ (6), CA (30), CO (4), CT (5), DC (1), DE (2), FL (3), GA (3), IA (1), ID (2), IL (15), IN (3), KS (3), LA (1), MA (13), MD (1), ME (1), MI (4), MN (5), MO (2), MS (1), NC (10), ND (1), NE (1), NH (2), NJ (8), NM (2), NY (18), OH (9), OK (1), OR (9), PA (6), RI (2), SC (1), SD (3), TN (5), TX (7), UT (9), VA (1), WA (17), WI (1), WV (1), and WY (2). Because the main Salmonella Montevideo outbreak PFGE pattern is commonly occurring in the United States, public health investigators may determine that some of the illnesses are not part of this outbreak.

Salmonella Senftenberg, a different serotype of Salmonella, has been found in food samples from retail and a patient household during this outbreak investigation. PulseNet identified 5 persons who had illness caused by Salmonella Senftenberg with matching PFGE patterns between July 1, 2009 and today. Public health officials have interviewed 4 of the 5 ill persons with this strain of Salmonella Senftenberg and determined that one consumed a recalled salami product during the week before their illness began. These five cases are not included in the overall case count reported above.

Among the persons with reported dates available, illnesses began between July 4, 2009 and January 24, 2010. Infected individuals range in age from < 1 year old to 93 years old and the median age is 39 years. Fifty-three percent of patients are male. Among the 166 patients with available information, 43 (26%) were hospitalized. No deaths have been reported.

During January 16-21, 2010, CDC and public health officials in multiple states conducted an epidemiologic study by comparing foods eaten by 41 ill and 41 well persons. Preliminary analysis of this study has suggested salami as a possible source of illness. Ill persons (58%) were significantly more likely than well persons (16%) to report eating salami. Additionally, 16 ill persons have been identified who purchased the same type of sliced salami variety pack at different grocery store locations before becoming ill; Two additional ill persons have been identified who purchased a similar type of sliced salami deli tray before becoming ill. These data suggest this product is the source of some of these illnesses. This sliced salami variety pack was recently recalled by Daniele International Inc. CDC and public health officials in multiple states continue to interview ill persons to ask them about the foods they ate during the week before they became ill as well as to collect shopper card information.
On January 23, 2010, FSIS issued a news release that Daniele International Inc. is recalling approximately 1,240,000 pounds of ready-to-eat varieties of Italian sausage products (including salame/salami) in commerce and potentially available to customers in retail locations because they may be contaminated with Salmonella. On February 4, 2010, FSIS updated its January 23, 2010 news release to include two additional salame/salami products, adding approximately 23,754 pounds to the initial recall. These products can have an extended shelf life of up to one year. The manufacturer has voluntarily halted production of salami products.
This initial recall followed isolation of Salmonella in a private laboratory from a retail sample of a salami product produced by Daniele International; this product was different than the sliced salami variety pack purchased at different grocery store locations by the 16 ill persons. FSIS reviewed and affirmed these private laboratory results. The Salmonella strain initially found by the private laboratory was different from the strains causing the outbreak. However, the Washington State Department of Health subsequently tested the bacterial culture provided by the private laboratory (the salami was not provided) and identified two different Salmonella serotypes, the strain found by the private lab and Salmonella Montevideo indistinguishable from the outbreak strain and Salmonella Senftenberg. In addition, the Iowa Department of Public Health and public health officials in Plymouth County, Iowa investigated a patient with Salmonella Montevideo infection indistinguishable from the outbreak strain and discovered an open sliced salami variety pack frozen at the patient's home. The patient had eaten this product before becoming ill. This sliced salami variety pack was the same as that purchased by 16 other ill persons. Using DNA analysis, the University of Iowa Hygienic Laboratory (Iowa's public health laboratory) confirmed that the Salmonella isolated from this leftover salami was indistinguishable from the outbreak strain of Salmonella Montevideo.

On January 31, 2010, FSIS issued a second news release that Daniele International Inc. has expanded its recall to include more ready-to-eat (RTE) varieties of Italian sausage products. Specific products include:

* Packages of ¡°DANIELE HOT SOPRESSATA CALABRESE,¡± produced on 11/7/09, 12/16/09 and 12/18/09.
* Packages of ¡°DANIELE SOPRESSATA CALABRESE,¡± produced on 12/16/09 and 12/18/09.
* Packages of ¡°BOAR¡¯S HEAD BRAND HOT SOPRESSATA CALABRESE,¡± produced on 11/28/09, 12/9/09 and 12/14/09.

The recall was being expanded as a result of a confirmed finding of Salmonella in an unopened salami product reported by the Illinois Department of Public Health. The product was sampled during the course of an ongoing investigation of a multistate outbreak of Salmonella serotype Montevideo illnesses. The product tested was not included in the previous recall (FSIS Recall 006-2010) issued January 23, 2010, but is similar to products bought by customers who later became sick and were identified as part of the Montevideo investigation. The company believes that black pepper is a possible source of Salmonella contamination.

On February 4, 2010, FSIS announced that Daniele International Inc. added two more products to its list of recalled products. Specific products include:

* Approximately 6-pound packages of ¡°DANIELE SALAME GRANDE COATED WITH PORK FAT & PEPPER.¡±

Further testing is ongoing at a state health partner laboratory, and might determine if the product tested in Illinois contained the Salmonella Montevideo strain associated with the multistate outbreak.
Daniele International Inc. has recalled ready-to-eat varieties of Italian sausage products, including salami, which are regulated by the USDA. Some of the products contain black pepper, which is regulated by the FDA.

Recent test results provided by the Rhode Island Department of Health revealed that an opened container of black pepper used in the manufacturing of at least some of the recalled products was positive for Salmonella Montevideo and that the DNA fingerprint matched the outbreak strain: *.

The FDA is investigating the supply chain of the black pepper used in the manufacturing of the recalled meat products. The Agency has collected and is currently analyzing black pepper samples. To date, all the samples collected and analyzed by the FDA have tested negative for Salmonella, however, sample collection and analysis continues.

CDC and its public health partners are continuing the epidemiologic investigation to verify that the outbreak is controlled. CDC, USDA-FSIS, and FDA continue to work closely to identify the specific products or ingredients that became contaminated and how the contamination occurred and to identify any other food vehicles that may be involved.

U.S.D.A. Plans to Drop Program to Trace Livestock
Faced with stiff resistance from ranchers and farmers, the Obama administration has decided to scrap a national program intended
to help authorities quickly identify and track livestock in the event of an animal disease outbreak.
In abandoning the program, called the National Animal Identification System, officials said they would start over in trying to devise a livestock tracing program that could win widespread support from the industry.
The agriculture secretary, Tom Vilsack, will announce the changes on Friday, according to officials at the Agriculture Department, who spoke on condition of anonymity because the decision had not yet been made public.
The officials said that it would be left to the states to devise many aspects of a new system, including requirements for identifying livestock.
New federal rules will be developed but the officials said they would apply only to animals being moved in interstate commerce, such as cattle raised in one state being transported to a slaughterhouse in another state.
It could take two years or more to create new federal rules, the officials said, and it was not clear how far the government would go to restrict the movement of livestock between states if the animals did not meet basic traceability standards.
The system was created by the Bush administration in 2004 after the discovery in late 2003 of a cow infected with mad cow disease.
Participation of ranchers and farmers in the identification system was voluntary, but the goal was to give every animal, or in the case of pigs and poultry, groups of animals, a unique identification number that would be entered in a database. The movements of animals would be tracked, and if there was a disease outbreak or a sick animal was found, officials could quickly locate other animals that had been exposed.
But the system quickly drew the ire of many farmers and ranchers, particularly cattle producers. Some objected to the cost of identification equipment and the extra work in having to report their animals¡¯ movements. Others said they believed the voluntary system would become mandatory, that it was intrusive and that the federal government would use it to pry into their lives and finances.
The old system received $142 million in federal financing, but gained the participation of only 40 percent of the nation¡¯s livestock producers, according to a report by the Congressional Research Service.
When Mr. Vilsack took over the Agriculture Department last year, he began a series of public meetings on the identification program and was bombarded by strident opposition.
Agriculture officials said that most details of a new system would be worked out in the coming months through consultation with the livestock industry and the states.
¡°It was just overwhelming in the country that people didn¡¯t like it, and I think they took that feedback to heart,¡± said Mary Kay Thatcher, public policy director of the American Farm Bureau Federation, which had opposed the identification system. ¡°I think it¡¯s good they¡¯ve at least said we¡¯re going to do something different.¡±
Carol Tucker Foreman, a food safety expert of the Consumer Federation of America, agreed that the old system was not working and needed to be changed.

But she worried that a new system that could have different rules in every state might not be effective.
¡°It¡¯s very, very hard to have an effective state-by-state program,¡± she said.

Tainted milk shows China's food safety challenges
The Associated Press
Thursday, February 4, 2010; 4:49 AM
BEIJING -- The resurfacing of tainted milk products in China highlights the challenges of policing the food supply in a country where close ties between local authorities and companies hamper regulation while producers are undertrained, experts said Thursday.
The problems have dealt another blow to China's efforts to restore confidence in its dairy supply after a massive contaminated milk scandal in 2008 left at least six babies dead and sickened 300,000 other children. At the time, China promised sweeping changes and punished dozens of officials, dairy executives and farmers. In November, it executed a dairy farmer and a milk salesman.
But the penalties failed to deter others, and local governments with close ties to dairy companies often shield them from being punished, leading to the new misdemeanors, said a food safety expert at Renmin University in Beijing.
"When companies violate the law, the government raises its stick high, but lets it fall down softly," said Zheng Fengtian, an agricultural economics and rural development professor. "The government coddles those companies too much and considers more the economic and employment impact that would occur if such companies suffer."
The 2008 scandal exposed the widespread practice of adding melamine, a chemical normally used in making plastics and fertilizer, to watered-down milk to increase profits and fool inspectors testing for protein. When ingested in large amounts, melamine can cause kidney stones and kidney failure.
At least five companies are believed to have resold milk products tainted with melamine that were supposed to have been destroyed in the earlier sweep, the Health Ministry said this week as it launched a new 10-day crackdown on the dairy industry. The ministry has not said if anyone was sickened by the latest contamination.
"Some companies and individuals are still ignoring the safety and health of the mass of the population. Their hearts are full of greed, and they committed crimes," the ministry said in a statement.
Three dairy plant managers and one milk powder dealer in central China suspected of selling melamine-tainted milk products were the first known arrests, announced Wednesday, in the crackdown after contaminated products were recently found in several provinces.
The scandal, China's worst food safety crisis in years, prompted the government to tighten regulations and vow to step up checks. But enforcement is weakened when local governments place the interests of their local dairies above regulation, allowing milk producers to be more daring, another food expert said.
"Recently there are a lot of melamine problems happening because people thought the crackdown on melamine is over and the milk powder produced two years ago will soon be expired and there are people who want to take the risk" of selling it, Chen Yu, a professor at the Beijing Agro-Business Management University, told the Southern Weekend newspaper.
The China Dairy Industry Association's chairman could not be reached for comment Thursday.
The recent spate of tainted milk reports also underscores China's struggle to effectively regulate a massive food industry full of small, scattered operations.
China adopted a food safety law last summer that places more responsibility on food producers to ensure their products are safe, but it will take more time for the law to be fully implemented, said Dr. Peter Ben Embarek, a WHO senior scientist on food safety based in Beijing.
"You have millions of food producers who all also need to be trained and educated, in some cases in some very basic food hygiene and food safety principles," Ben Embarek said.
"What is a little bit discouraging is to see that there are still producers out there who have not understood the seriousness of tampering with food safety and are continuing to put profits before safety in their products," he said.
Concerns about tainted milk products peaked again early this year after authorities in Shanghai said they secretly investigated a dairy for nearly a year before announcing it had been producing tainted products.
The case was especially troubling because Shanghai Panda Dairy Co. was one of the 22 dairies named by China's product safety authority in the 2008 scandal, with its products having among the highest levels of melamine.

In other recent cases, officials in late January said tainted dairy products from three companies were pulled from more than a dozen convenience stores around the southern province of Guizhou. Officials said products recalled during the previous scandal somehow made it back to the market.

USDA tightens requirements to assure school lunch safety
By Blake Morrison and Peter Eisler, USA TODAY

The U.S. Department of Agriculture announced sweeping steps Thursday to "assure the safety and quality of food" purchased for the National School Lunch Program.
The measures include tightening requirements on companies that supply ground beef to schools, testing the beef more often and more thoroughly, and improving communications within the USDA to "identify potential food safety issues" before children get sick.
The initiatives come in the wake of a USA TODAY investigation that revealed failures in government programs intended to protect students from food-borne illnesses. More than 31 million children participate in the school lunch program.
The newspaper found that McDonald's and other fast-food chains are far more rigorous than the government in checking for bacteria and dangerous pathogens in beef. USA TODAY also found that the government lacks ways to quickly alert schools when products have been recalled or implicated in safety investigations.
The measures outlined Thursday are intended to address each of those points, bringing the standards and testing protocols in line with those used by the most selective restaurants and retailers. "It's a big deal," food safety consultant David Theno said of the USDA measures. He said the moves will push companies to "play to a higher standard" if they want to continue to supply food to schools.
The USDA also pledged to review the safety records of its school lunch suppliers more carefully and bar companies that have had repeated problems with their commercial products.
Such a move could affect companies such as Beef Packers, a Fresno company that recalled 826,000 pounds of ground beef last summer because it contained a drug-resistant strain of salmonella. Public health officials warned consumers to discard products from the company, which had a history of salmonella problems, but USA TODAY found that the USDA paid Beef Packers hundreds of thousands of dollars for 450,000 pounds of ground beef made during the period covered by the commercial recall.
Rep. George Miller, D-Calif., praised the announcement. Miller, who chairs the House Committee on Education and Labor, asked the USDA last month to enlist the National Academy of Sciences in a food-safety review ? a move the USDA also announced Thursday.
Miller called the USDA announcement "a meaningful step" in improving the school lunch program.

source: Multi-Agency Announcements Part of Ongoing Effort to Ensure Safety of School Lunches
WASHINGTON, Feb. 4, 2010 - Agriculture Secretary Tom Vilsack today announced several new initiatives to assure the safety and quality of food purchased by USDA for the National School Lunch Program and other food and nutrition assistance programs.
"Nothing is more important than the health and well-being of our Nation's school children," said Vilsack. "We must do everything we can to ensure that our kids are being served safe, high quality foods at school. Today's announcement demonstrates our commitment to constantly improving the safety and quality of foods purchased by USDA."
The initiatives announced today are a combined effort of five USDA agencies - the Agricultural Marketing Service (AMS), the Agricultural Research Service (ARS), the Food Safety and Inspection Service (FSIS), the Farm Service Agency (FSA) and the Food and Nutrition Service (FNS).
Secretary Vilsack announced the following initiatives by these agencies:

AMS will implement new food safety purchasing requirements for its beef suppliers as a result of a review of the beef purchase program conducted by FSIS and ARS. AMS will continue its zero tolerance for Salmonella and E. coli O157:H7 for its products and will continue to use onsite meat acceptance specialists and other control measures.
ARS and FSIS will provide technical assistance to AMS for School Lunch and other Federal nutrition assistance programs.
In addition to the reviews by FSIS and ARS, AMS has asked the National Academy of Sciences (NAS) to review the ground beef purchasing program. By the summer, NAS will conduct a thorough evaluation of the scientific validity of the current AMS technical requirements. This review will include benchmarking AMS vendor requirements against recognized industry leading programs that supply product directly to consumers.
AMS will increase information sharing with other agencies in order to better monitor vendor performance and identify potential food safety issues in the process. Information on in-plant enforcement actions, positive pathogen test results, contract suspensions, recall notifications, and more will be better shared between USDA agencies.
FSIS will work with AMS to review and evaluate meat, poultry, and processed egg vendors as part of the AMS vendor eligibility process.
FNS will review and evaluate methods currently being used by state agencies to communicate with schools and school districts regarding product recalls. FNS will develop performance criteria for states that allows them to provide rapid communication to schools and school districts. FNS will provide financial assistance to states to allow them to upgrade the speed and accuracy of their food safety messages.
FNS will also establish a Center of Excellence devoted to research on school food safety issues in FNS child nutrition programs. Research is needed in areas such as produce safety, proper cooling practices, evaluation of in-school food safety programs, and the containment of norovirus, which is the leading cause of foodborne illness in schools.
FSA is evaluating and strengthening current requirements and will amend those requirements to better reflect compliance with Good Manufacturing Practices and use of a verified Hazard Analysis and Critical Control Points program. FSA will ensure that commercial suppliers are able to provide a qualified level of food safety assurance for USDA programs.
These changes and continuous reviews will ensure that the food USDA distributes to school children and others meets the highest quality and safety standards.

USDA is an equal opportunity provider, employer and lender. To file a complaint of discrimination, write: USDA, Director, Office of Civil Rights, 1400 Independence Ave., S.W., Washington, D.C. 20250-9410 or call (800) 795-3272 (voice), or (202) 720-6382 (TDD).

China Finds 170 More Tons of Tainted Milk Powder
China finds 170 more tons of tainted milk powder that should have been destroyed by was reused

By CARA ANNA Associated Press Writer
BEIJING February 8, 2010 (AP)
The discovery has punched a 170-ton hole in China's promises to overhaul its food safety system. Officials say they've found yet another case where large amounts of tainted milk powder from the country's 2008 scandal that should have been destroyed were instead repackaged.
China ordered tens of thousands of milk products laced with an industrial chemical burned or buried after more than 300,000 children were sickened and at least six died from the contamination. But, crucially, the government did not carry out the eradication itself, and this month an emergency crackdown has made it clear that tons of compromised products are still on the market.
Tainted dairy has recently been found in China's largest city, Shanghai, and in the provinces of Shaanxi, Shandong, Liaoning, Guizhou, Jilin and Hebei. At least five companies are suspected of reselling tainted products that should have been destroyed, the Health Ministry said last week. The problem products uncovered in the 10-day emergency crackdown have so far been limited to the domestic market.

The campaign is set to end Wednesday, and it's not clear whether it will be extended. The country's biggest holiday, the Lunar New Year, starts this weekend, and already some offices are closing and millions of people are going on vacation.
The Health Ministry has not commented since the crackdown began, and the China Dairy Association has remained quiet as well.
"The problem is, this is a product with a shelf life of several years. It's very important that the product is not left unattended," said Dr. Peter Ben Embarek, a WHO senior scientist on food safety based in Beijing. "There's always a risk it will find a way back into the system."
The latest discovery underscores the difficulties of policing China's smaller food producers, despite a sweeping new food safety law that took effect last summer and promised stricter quality controls after the 2008 scandal, which was China's worst food safety crisis in years.
In the wake of that crisis, China punished dozens of officials, dairy executives and farmers, even executing a dairy farmer and a milk salesman. But the government didn't destroy seized products itself. Instead, it issued guidelines on how to destroy them, suggesting they be burned in large-capacity incinerators or that small amounts be buried in landfills.
In the southern city of Guangzhou, however, the local government did take over disposal after one garbage company poured tainted milk into a city river.
China's new food safety law places even more responsibility on food producers to ensure their products are safe, including introducing tough new penalties for makers of unsafe products.
On Monday, with the announcement that more products contaminated by the industrial chemical melmine had been found, it appeared the new regulations had failed again. Officials issued a recall for more than 170 tons of milk powder tainted by the industrial chemical melamine and closed two dairy companies in the northern region of Ningxia, the China Daily newspaper reported.
The report said officials have already seized 72 tons of the powder but were still looking for the rest, which had been sold by the Ningxia Tiantian Dairy Co. Ltd. to five factories in the neighboring region of Inner Mongolia and the bustling southern provinces of Guangdong and Fujian.
The report said the tainted powder should have been destroyed in the 2008 scandal, but that an unnamed company gave it to Ningxia Tiantian as a debt payment.
Zhao Shuming, secretary-general of the Ningxia Dairy Industry Association, told the China Daily that said Ningxia Tiantian appears to have been unaware the product contained melamine but should have known that the repackaging itself, which usually involves changing production and sell-by dates, was illegal.
Zhao told the paper that many small dairies, including Ningxia Tiantian, don't have the technology to even test for melamine. When watered-down milk is laced with the chemical, it appears to still be rich in protein in quality tests that measure nitrogen, found in both the melamine and protein.
"Flaws in the previous system led to the current chaos. What if companies with tainted milk also hold back their stocks for this round of checkups and reuse them later, just like what's happening now?" the newspaper quoted him as saying.
Zhao spoke more carefully Monday, telling the AP, "We have strict checks, and our client companies have strict checks, too."
Ningxia Tiantian has been shut down, and a second company, Ningxia Panda Dairy Co. Ltd., was also ordered closed because of ties to a Shanghai dairy found with tainted goods last year, the report said.
Online Chinese chat rooms were buzzing Monday over the latest tainted milk finding, with many asking "Why are these things happening again?"
But a large-scale drop in consumer confidence that happened in the 2008 scandal isn't likely this time, said Cindy Yang, a dairy analyst for the Netherlands-based Rabobank Group in Shanghai.
"These companies are quite small ones," she said Monday, adding that China's largest dairies put stricter safety measures in place after feeling the bite of bad publicity ? and raised prices 20 to 30 percent to pay for the better quality.
"You can't say that because of these cases, there's no trust in the whole market," she said.

China threatens world health by unleashing waves of superbugs
China's reckless use of antibiotics in the health system and agricultural production is unleashing an explosion of drug resistant superbugs that endanger global health, according to leading scientists.
By Peter Foster in Beijing
Published: 6:25PM GMT 05 Feb 2010
Chinese doctors routinely hand out multiple doses of antibiotics for simple maladies like the sore throats and the country's farmers excessive dependence on the drugs has tainted the food chain.
Studies in China show a "frightening" increase in antibiotic-resistant bacteria such as staphylococcus aureus bacteria, also know as MRSA . There are warnings that new strains of antibiotic-resistant bugs will spread quickly through international air travel and internation food sourcing.
"We have a lot of data from Chinese hospitals and it shows a very frightening picture of high-level antibiotic resistance," said Dr Andreas Heddini of the Swedish Institute for Infectious Disease Control.
"Doctors are daily finding there is nothing they can do, even third and fourth-line antibiotics are not working.
"There is a real risk that globally we will return to a pre-antibiotic era of medicine, where we face a situation where a number of medical treatment options would no longer be there. What happens in China matters for the rest of the world."
Particular alarm has been raised by resistance rates of MRSA in Chinese hospitals, which has more than doubled from 30 per cent to 70 per cent, according to Professor Xiao Yonghong of the Institute of Clinical Pharmacology at Beijing University.
Last year researchers found a new strain of MRSA in Chinese pigs imported into Hong Kong and called for urgent new studies into its potential to infect humans after an infection of the new strain was confirmed in Guangzhou, where many of the pigs were farmed.
A Beijing-based health expert with access to unpublished surveys showed that the situation in China was actually worse earlier studies had indicated.
"The Chinese Ministry of Health has all the data," the expert warned, "but they seem unable or unwilling to believe it. The situation has global implications and is highly disturbing."
The Chinese Ministry of Health failed to respond to requests for an interview or information by phone, email and fax over a three-day period.
New prescription guidelines to restrict antibiotic use being issued by the Chinese Ministry of Health in 2004.
"The guidelines are not being followed effectively," added Professor Xiao, "over just the last five years, for example, our studies show the rate antibiotic-resistant E.coli has quadrupled from 10 per cent to 40 per cent."
Public health experts say the rampant over-use of antibiotics in China is primarily caused by China's under-funded healthcare system where hospitals derive up to half of their operating income from selling drugs. In some cities, such as Chongqing, almost half of all drugs sold are antibiotics.
"In Chinese hospitals our data shows that 60 per cent of in-patients are being prescribed antibiotics compared with the WHO guideline of 30 per cent," added Professor Xiao who also heads China's National Antibiotic Resistance Investigation Network.
China's State Food and Drug Administration bans the sale of antibiotics without prescription but a survey by the The Daily Telegraph found the drugs were still easily obtainable over-the-counter.
Three out of five chemists agreed to sell antibiotics after a cursory consultation with the 'patient' who complained of a sore throat.
At one outlet a pharmacist handed over a course of the second-generation antibiotic, Cefuroxime Axetil, with minimal hesitation.
Asked if the sale could "get her into trouble" she said that the pharmacy would get a doctor to write the prescription later to cover their sales records. She added that even doctors from the nearby Capital Institute of Pediatrics came to buy antibiotics without prescription.
"When the surveillance is strict, we won't risk selling antibiotics," Ms Zhang added. Asked to elaborate, she explained, "For example during the 2008 Olympic Games period, we didn't sell them".

If I¡¯d only known then what I know now
Food (Safety) Fight
By: Richard Raymond
John Munsell often criticizes FSIS for not tracing back to the source when a positive is found in ground beef product, and I often responded to John that the Agency is doing its best under the difficult circumstances of multiple sources going into the product. Turns out we are both a little bit right and a little bit wrong.
I have only recently learned that it is Agency policy to attempt to trace back to the source ONLY if there are illnesses involved in an outbreak and that as the result of an extensive epidemiological investigation, a product has been identified. It is Agency policy to not attempt to trace back to the source if no illnesses are involved, and the only evidence of contamination is a positive, routine FSIS sample. We can debate the STEPS database, etc, but today I am talking about where the rest of the contaminated lot went, and trace back activities as outlined in Directive 10,010.1 Rev.2, Chapter 3.
By the time an outbreak has been investigated and the source food identified, that trail is pretty cold and a lot of product has been sold and consumed. On the contrary, if a routine FSIS product sample tests positive, it seems there is a good chance part of the source materials would still be intact at the processing plant and could easily be sampled. Then, and only if this policy were changed could this happen, other plants that had bought meat from the same lot from the source plant could be notified and production halted and a possible recall initiated based on focused sampling in other plants. But under the current policy, these plants are not notified that they may have contaminated meat going into their product, which is then being sold and consumed. The first key to improving the public's health is prevention, and this seems like a very good place to increase our efforts at preventing food borne illnesses. Most grinders do not purchase a full lot from the slaughter facility, so multiple grinders are often involved for each lot, 75% of tested product is from a single source, and the average number of positive tests per year by FSIS is around 50-60. Each one of those positives is an opportunity to identify the source and prevent food borne tragedies. I have not written about this before as I was trying to find the rationale behind this policy. Besides the long standing aversion to "rolling recalls", the only lead I could come up with was a rumor that trace backs were a part of the large packers testimony and debate at the public HACCP hearings back in the mid-90s, and that a compromise was reached to "prevent double jeopardy" for the packers. Can anyone help me out with the history here, and the science behind these confusing facts?

The great food allergy myth: Many are just fantasies that can wreck the way you eat and end up giving you a REAL illness
By Matthew Barbour
Last updated at 8:24 AM on 09th February 2010
A generation of Britons could be putting their health at risk by wrongly self-diagnosing a food allergy or intolerance, one of the UK¡¯s leading experts warns.
¡®Instead of having their condition medically diagnosed and treating the root cause of their symptoms, millions of people are needlessly cutting whole food groups out of their diet,¡¯ says Dr Carina Venter, allergy specialist at the University of Portsmouth.
Up to 20 per cent of us now believe we have a food intolerance, she says, with the real figure lying somewhere between 1 and 2 per cent. ¡®The health implications of limiting the diet in this way can be far worse than food allergies or intolerances themselves - and it only takes a few years of cutting food groups out to have a much longer-term impact.¡¯
Downfall: A woman stares at a single pea on her dinner plate. Many people are wrongly diagnosing themselves with a food intolerance and cutting whole food groups out of their diet
Doing this can have significant social implications as well - ¡®leaving you unable to eat food at restaurants or other people¡¯s houses where you¡¯re not 100 per cent sure of what¡¯s on your plate¡¯, she says. ¡®Food isn¡¯t just fuel; meals and eating are a vital social element in our lives.¡¯
She highlights the example of one woman who, 25 years ago, suffered a severe tightening of her throat after eating a lemon, orange, melon and lettuce salad. ¡®She cut them all out of her diet without seeking proper medical advice.
¡®Yet when we tested her, we found she had no adverse reaction to any of those foods. We gave her a glass of orange juice, the first she¡¯d had in more than a quarter of a century, and she was absolutely delighted she could safely have oranges.
¡®But as a result of her self-diagnosis she¡¯d spent years avoiding certain meals and even going hungry to make sure she didn¡¯t encounter that same reaction again, which is at best a waste and at worst a health issue from missing out on all the fantastic nutrients in those foods.¡¯
It is likely that this patient had actually suffered an ¡®idiopathic anaphylaxis¡¯, a random reaction to an allergen or stimulus that causes blood pressure to drop and the airways to close suddenly. These one-off reactions are far from rare, explains Dr Venter.
¡®The point is, we never doubted that she did suffer an anaphylactic shock and although we haven¡¯t determined the cause, we¡¯ve enabled her to get on with enjoying a fuller and more varied diet and getting the nutritional benefit from this.¡¯
The problem of self-misdiagnosis is not helped by celebrity food fads, such as the wheat-free and dairy-free diets followed by the likes of Carol Vorderman and Victoria Beckham.
One recent U.S. study of girls aged between ten and 13 found more than half who claimed to have milk intolerance had no problem whatsoever digesting it - yet those who cut it from their diet were then getting a quarter less of For their recommended daily calcium intake. This has long-term health implications, says nutritionist Dr Judith Bryans, of The Dairy Council.
The problem of self-misdiagnosis is not helped by celebrity food fads, such as diets followed by Carol Vorderman and Victoria Beckham
¡®Adolescence is a critical period for laying the foundation for future bone health, as at least 90 per cent of peak bone mass in girls is achieved by 18 years of age,¡¯ she says.
¡®Milk and dairy foods are some of the best dietary sources of bone-building nutrients such as calcium, phosphorous and protein.¡¯
Worryingly, the girls who thought they had a milk intolerance had significantly lower spinal bone mineral content, a measure of bone strength.
¡®Food allergies and intolerances have become almost fashionable in recent years due to increasing popularity of fad diets and poor examples set by ill-informed role models in the public eye,¡¯ says Dr Bryans. ¡®This study demonstrates the importance of clarifying misconceptions about food and health from an early age.¡¯
For those who have a genuine intolerance, there is no denying it can often be as debilitating as an allergy, although not as dangerous.
True allergies can occur after coming into contact with even trace amounts of the culprit food, causing symptoms that are usually immediate and severe.
¡®In an allergic reaction, the immune system produces IgE antibodies, our defence against foreign substances perceived as harmful,¡¯ Dr Venter explains.
In an allergic reaction, so many antibodies are produced that it causes rashes, swelling or breathing difficulties and, in extreme cases, life-threatening anaphylactic shock.
An intolerance, on the other hand, tends to be a more delayed adverse reaction. It doesn¡¯t involve the immune system, but is often related to the absence of specific chemicals or enzymes needed to digest a particular food, or from reactions to naturally occurring chemicals in foods.
¡®Reactions can take up to a few hours or days to occur,¡¯ says Dr Venter. In most cases, a significant amount of the trigger food must be ingested.
¡®However, food intolerances can often be equally distressing and have an equally significant impact on quality of life, even though they may not be life threatening. An adult with chronic diarrhoea, for instance, might feel he or she can¡¯t safely leave the house.¡¯
¡®And because the reaction often isn¡¯t instant, it¡¯s harder to pinpoint the root cause - which means there¡¯s even more need for professional inquiry before rashly eliminating foods from the diet.¡¯
The plethora of self-tests available on the internet has exacerbated the problem of people misdiagnosing themselves and then unnecessarily changing their diets, says Dr Venter.
The only food intolerance test on the UK market that has passed clinical trials and is approved by the charity Allergy UK is the York Test.
This measures Immunoglobulin E (IgG E) antibodies, which are produced, it's said, when you're intolerant to a food.
But at ¡Ì265, it's far from cheap. And some doubt the science of such tests.
¡®I am not convinced about the usefulness of these tests in diagnosing food intolerances, because there is no evidence that the presence of IgE antibodies in the blood indicates an intolerance and many tests have not been fully validated in clinical trials,¡¯ says Dr Venter.
She¡¯s also concerned by the degree - in many cases, the lack - of support for patients who want to ensure they have a nutritionally balanced diet.
If you think you have a food intolerance, she says to see your GP for a referral to a dietitian. ¡®They will ask you to keep a food and symptoms diary and, from that, to try to establish a pattern,¡¯ she says.
¡®Often you¡¯ll be asked to do a home trial of an elimination diet, followed by reintroduction of the avoided foods one by one to see if any cause a reaction. This is the only reliable way of diagnosing food intolerances at present.¡¯
So if it's not an allergy, what's wrong with you?
Real symptoms: An allergy to dairy can cause hives, chronic itching and projectile vomiting
ALLERGY SYMPTOMS: Hives, a red rash, lip/facial swelling, wheezing, chronic itching, projectile vomiting, diarrhoea and stomach cramps.
INTOLERANCE SYMPTOMS: diarrhoea, bloating.
COULD THE SYMPTOMS BE SOMETHING ELSE? The intolerance symptoms are similar to irritable bowel syndrome (IBS), a common gut disorder. Canadian researchers found IBS was the real problem in up to half of all diagnoses of dairy intolerance.
IBS has no known cause or cure, but symptoms can be eased in most cases by increasing the intake of soluble fibre (fruit, vegetables and wholegrains) and fluids.
Another possible cause is ¡® resistance¡¯ starches, which are formed when you reheat carbohydrates such as potatoes or pasta, says Dr Venter. ¡®The reheating process changes their composition, so they literally resist digestion in the small intestine.¡¯
WHY YOU NEED A PROPER DIAGNOSIS: ¡®Cutting out dairy makes it harder for children to get adequate amounts of protein and calcium,¡¯ says Dr Venter. ¡®You can get these nutrients from other foods, such as tinned salmon or sardines containing bones, or green leafy vegetables, but they¡¯re often not child-friendly.¡¯
Adults may increase their risk of osteoporosis, while low levels of calcium in the blood can result in muscle spasms.
ALLERGY SYMPTOMS: Hives, facial swelling, wheezing, chronic itching, vomiting, diarrhoea and stomach cramps.
INTOLERANCE SYMPTOMS: Aching joints, stomach ache, bloating, depression.
COULD THE SYMPTOMS BE SOMETHING ELSE? Much factory-baked bread contains additives such as soya, cakes are full of sugar and most bread contains yeast ? any of these can upset the digestive system, says Dr Venter. Opt for good-quality wholegrain breads from a local baker who can tell you exactly what¡¯s in your loaf, or make your own.
WHY YOU NEED A PROPER DIAGNOSIS: ¡®The main nutritional deficiency from cutting out wheat is the B vitamins, essential for energy production and a healthy nervous system,¡¯ says Dr Venter. ¡®Wheat is also a good source of iron - a deficiency can affect your concentration and make you more susceptible to infection.¡¯
ALLERGY SYMPTOMS: Heart palpitations, a sensation of intense heat and crushing headaches - usually caused by a deficiency of the enzyme aldehyde dehydrogenase needed to metabolise alcohol (an estimated 50 per cent of Chinese, Japanese, and Koreans lack this enzyme).
INTOLERANCE SYMPTOMS: Facial flushing, sneezing and congestion.
COULD THE SYMPTOMS BE SOMETHING ELSE? Some people react to sulphites and salicylates in wine.
These are substances found naturally in grapes, but that are also added by wine makers to develop flavours. Symptoms of sulphite sensitivity include wheezing, rashes and nausea, whereas salicylates can cause symptoms similar to hay fever. Salicylates are also found in beers.
But you could also be reacting to the fish and dairy products often used for fining wines, a process that removes any insoluble material that may cause a wine to become, for instance, cloudy (these, along with sulphites, have to be flagged up on the wine¡¯s label).
ALLERGY SYMPTOMS: Shock, tightened airways and loss of consciousness.
COULD THE SYMPTOMS BE SOMETHING ELSE? You might have just eaten fish that¡¯s off (scromboid poisoning) - the British Nutrition Foundation says almost half of all food poisoning cases are caused by raw or out-of-date fish.
Dr Venter explains: ¡®Scrombroid poisoning causes red flushing, hives and diarrhoea, as often seen in fish allergy - however, scrombroid poisoning does not cause anaphylaxis. There is no such thing as fish intolerance, as far as I know.
Sudden onset: King prawns pictured in sweet chilli sauce. Symptoms of seafood allergy include shock and loss of consciousness
¡®Fish allergies tend to be severe, where people can react by merely inhaling fish, or touching a work surface where fish was prepared,¡¯ she says. ¡®Also, you can be allergic to freshly cooked tuna but not canned tuna, or cod but not salmon - it¡¯s often a very precise allergy.¡¯
WHY YOU NEED A PROPER DIAGNOSIS: Cutting all fish from your diet deprives you of a prime source of lowfat protein, not to mention the hearthealthy omega-3 oils in fatty fish such as mackerel or salmon (although there are plant sources of omega-3s).
Read more:

China declares new national food-safety campaign
By CARA ANNA (AP) ? 1 day ago
BEIJING ? China declared a new food-safety campaign Wednesday after contaminated milk products from an earlier scandal showed up repackaged in several places around the country, exposing weaknesses in the country's promise to stop such problems from happening again.
Vice Premier Li Keqiang told the first meeting of a newly established food-safety commission that "We should understand the foundation for the country's food safety is still weak and the situation is grave," the state-run Xinhua News Agency reported Wednesday.
Li promised to "thoroughly" investigate the re-emergence of milk products tainted with the industrial chemical melamine, destroy all the products and punish those responsible, Xinhua said.
The vow came two days after state media reported that officials recalled 170 tons of tainted milk powder in the northern region of Ningxia and said almost 100 tons of the powder had not yet been found. Two dairies were closed.
An emergency 10-day crackdown on tainted milk products is set to end Wednesday, and the Health Ministry did not say whether it will be extended.
The original milk scandal in 2008 sickened hundreds of thousands of children, and at least six died.

China ordered tens of thousands of milk products laced with the industrial chemical melamine burned or buried. But the government did not carry out the destruction itself.
Some profit-hungry producers were accused of adding melamine to watered-down milk to make it appear to still be rich in protein in quality tests that measure nitrogen, found in both the melamine and protein. Health problems from the chemical include kidney stones and kidney damage.
Tainted dairy products have recently been found in China's largest city, Shanghai, and in the provinces and regions of Shaanxi, Shandong, Liaoning, Guizhou, Ningxia, Jilin and Hebei.
At least five companies are suspected of reselling tainted products that should have been destroyed, the Health Ministry said last week.
The problem products uncovered have so far been limited to the domestic market.
The Health Ministry has not commented since the new crackdown began, and the China Dairy Association has remained quiet as well.

Food safety regulations eat away at small farmer wallets
Alison Morrow Updated: 2/9/2010 7:07:14 PM Posted: 2/9/2010 6:32:12 PM

Recent outbreaks of foodborne illnesses have some grocery stores demanding tougher safety regulations, but the standards may make it more difficult for East Tennessee farmers to stay in business.
"We're trying to get ready for this food safety on fruits and vegetables," Steve Longmire said, pointing to construction on a new packing facility for his Grainger County tomatoes.
Longmire remembers growing tomatoes with his grandfather.
His family has been in the tomato growing business since the 1940s, but a lot has changed since then.
"All the plugs we do out there need to be this kind - weatherproof," Longmire said.
That's because the facility needs to be hosed down daily in order to pass a food safety audit now required by one of the vendors where Longmire sells his tomatoes.
Another requirement is that produce cannot be exposed to open air once it's packed.
"What they're doing on the front of the dock is enclosing it to where the trucks, when they back up, won't be loaded into open air," Longmire added.
The food safety audits are becoming a common requirement for major grocery stores, following outbreaks of E. coli and salmonella.
The audits don't differentiate between large industrial farms and small family farms like Longmire's, so small farmers are having to make major changes to the way they've grown, packed, and sold their produce for years.
"They're looking at every single section of their operation and basically having to change it," said Grainger County UT Extension Agent Anthony Carver said.
For Longmire, it's coming at a baseline cost of $150,000, which doesn't include hiring a new employee to oversee all the paperwork that's required.
"We're going to do whatever it takes to get in line with it, but it's hard," Longmire said. "For years and years, we've looked after our stuff. We're getting classified the same as a guy who grows 500 or 1,000 acres. Here we are growing 15 acres. To the best of my knowledge, no one's gotten sick off our product and same with Grainger County."
Right now, all the work is a choice, but it may soon become mandatory for everyone.
Both the U.S. House and the Senate are working on legislation that would make food safety audits mandatory for everyone who sells produce.
"If this comes down to the small producers, they'll stop producing, because they will not go into debt hundreds of thousands of dollars to comply. They can't afford to do so and continue to be a farmer," Carver said.

India Suspends Introduction of GM Crop
by Zach Mallove | Feb 10, 2010
On Tuesday, India denied permission for commercial cultivation of what would have been its first genetically modified (GM) vegetable crop. Amid controversy and protest, the Environment Minister Jairam Ramesh deemed BT brinjal--a strain of GM aubergine, or eggplant--unsafe for immediate public consumption.
BBC News reported late yesterday afternoon that after much debate, Mr. Ramesh decided more studies were needed to ensure GM aubergines were safe for consumers and the environment. It is an issue that has severely polarized the country, one that required several weeks for the Environment Minister to make. He reportedly traveled the country, canvassing public opinion and even consulting outside experts from the United States and China.
In the end, Mr. Ramesh placed an indefinite moratorium on cultivating GM vegetables in India.
"Public sentiment is negative," he said. "It is my duty to adopt a cautious, precautionary, principle-based approach. The decision is responsible to science and responsive to society."
His decision, Mr. Ramesh said, would make "50 percent of India happy, while 50 percent of India will be unhappy with me. I can't ignore public opinion, but I can't ignore science either. I have to tread a fine line."
Champions of the crop argue that it contains a toxic gene that poisons insect pests and will boost yields while reducing independence on pesticides. They cite BT cotton, which India has grown widely since 2002, as a successful example.
"BT cotton has improved our life. Do not succumb to false propaganda--BT will not harm anybody," one farmer told Ramesh.
"BT as a protein is highly degradable and doesn't persist in the environment and hence is not a threat," said a pro-GM scientist. "Chemical pesticides used in regular crops do more damage to the environment."
However, many scientists have warned that not enough is known about the effects of the new variety on human beings and the environment. It is unclear how BT will affect the land and the biodiversity of the country, they say, and the country's rural masses are angry at the prospect of relying on overseas suppliers for expensive new seeds.
"By controlling the seeds these (GM companies) will control Indian agriculture and the entire food system," said Balbir Singh Billing, a farmers' union leader.
"This is potentially very dangerous," warned Pushpa Bhargava of the Genetic Engineering Approval Committee, India's GM regulator. "Once you release a GM crop, you can't recall it." He said the safety data on BT brinjal was "unacceptable and incomplete," partly because it was supplied by Mahyco, an Indian partner of the American GM giant Monsanto.
"These are the same companies that introduced fertilizers and pesticides, suggesting we could not do without them," alleged Singh Billing. "Now, because of the consequent ill effects, the same companies want to introduce GM foods."

NEW YORK, Feb. 9, 2010
Animal Antibiotic Overuse Hurting Humans?
Katie Couric Investigates Feeding Healthy Farm Animals Antibiotics. Is it Creating New Drug-Resistant Bacteria?
(CBS) "It's scary, I mean, you just can't describe it really," said Bill Reeves.
Two years ago, 46-year-old Bill Reeves, who worked at a poultry processing plant in Batesville, Arkansas, developed a lump under his right eye.
"It went from about the size of a mosquito bite to about the size of a grapefruit," he said.
CBS Evening News anchor Katie Couric reports doctors tried several drugs that usually work on this potentially deadly infection: methicillin resistant staph or MRSA - before one saved his life.
"You go from a just regular day to knowing you may die in a couple of hours," Reeves said.
He wasn't the only worker from this farming community to get sick. Joyce Long worked at the hatchery, handling eggs and chicks. She got MRSA at least a dozen times, and had to try several drugs as well.
"It was real painful. Shots don't help, because it's so infected, it don't help much," she said.
Within weeks, 37 people at the hatchery got sick. They've filed personal injury claims against the company, Pilgrims Pride, which has no comment.
This is not an isolated incident and chickens aren't the only concern. A University of Iowa study last year, found a new strain of MRSA -- in nearly three-quarters of hogs (70 percent), and nearly two-thirds of the workers (64 percent) -- on several farms in Iowa and Western Illinois. All of them use antibiotics, routinely. On antibiotic-free farms no MRSA was found.
Health officials are concerned if workers who handle animals are getting sick - what about the rest of us? Drug resistant infections have sky-rocketed over the past two decades, killing an estimated 70,000 Americans last year alone. It's an emerging health crisis that scientists say is caused not only by the overuse of antibiotics in humans, but in livestock as well. Antibiotics fed to healthy animals to promote growth and prevent disease.
"My fear is that one of these days we are going to have an organism that's resistant to everything that we know, and we'll be left powerless," said Thomas Cummins, Batesville's chief medical officer.
"There are a lot of concerns about antibiotics being added to animal feeds that may be contributing to MRSA as well as other antibiotic resistance," Cummins said. "Certainly the more bacteria are exposed to antibiotics in any shape or form, the more tendency there is for resistance."
There are different types of drug-resistant bacteria. Some, like e coli and salmonella, can be passed on to people by consuming undercooked meat and poultry. Now, scientists are worried that Americans may be acquiring drug-resistant MRSA - not from eating, but from handling tainted meat from animals that were given antibiotics.
Evidence of MRSA has been found in the nation's meat supply. But it's unclear how widespread it may be, because only a small fraction is tested for MRSA.
Shelley Hearne has studied the health effects of factory farming for 25 years.
"How does this go from the farm to the meat counter, to having an adverse effect on humans," Couric asked.
"If the bacteria becomes resistant to antibiotics, it can actually spread in many ways," Hearne said. "It could be in the food supply, but it also can be in waters that runoff in a farm. It could be in the air. It can happen very quickly in many different ways. It's why it's a practice that has to stop on the farms."
That practice occurs inside factory farms, where antibiotics help animals absorb and process food so they grow bigger, faster - a selling point pushed by the pharmaceutical industry. Because animals are packed into confinement pens, antibiotics are also used to keep disease from spreading like wildfire.
Liz Wagstrom is a veterinarian with the National Pork Board.
"Some people say giving animals antibiotics to prevent illness or promote growth is like putting antibiotics in a child's cereal," Couric said. "You know, save them so they'll work when they are needed."
"I'd say we do strategically place them," Wagstrom replied. "It's not an all day, every pig gets antibiotics every day of his life."
"So you don't think they're being overused by farmers anywhere in this country," Couric asked.
Wagstrom replied, "the vast majority of producers use them appropriately."
But drug distributers and dozens of farm workers in four farm belt states -Iowa, Missouri, Arkansas, and Oklahoma - told us antibiotic use to promote growth is widespread on factory farms.
Former hog worker, Kim Howland took CBS News inside a factory farm in Oklahoma where she worked two years ago.
"They administer drugs, you know, constantly, constantly, constantly," Howland said. "That's their fix for everything.
She said drugs like Tylan, Keflex, and Baytril, the same classes used to treat everything from skin to respiratory infections in humans - were given regularly to pigs that were not sick.
Her husband contracted MRSA and almost died.
"My conclusion was that I had carried it home," she said.
Dave Kronlage of Dyersville, Iowa says he uses antibiotics to accelerate growth and fend off disease. But, he says, he does so responsibly.
"You never worry about giving them antibiotics and having them develop bacterial disease that may be some sort of superbug for these animals," Couric asked.
"No. No," Kronlage replied.
"How do you prevent that from happening," Couric asked.
"We don't always use the same antibiotics for one thing," Kronlage replied.
Antibiotics, he says, keep the cost of meat at the supermarket lower - and his profits higher.
"Why do you think antibiotics are so necessary for your bottom line," Couric asked.
"Well, because the bottom line is how healthy you keep those pigs," Kronlage said. "The healthier those pigs are -- the bottom line looks better."
But the bottom line on antibiotic use in factory farming is this: no one is really monitoring it.
Joshua Sharfstein, is the deputy director of the FDA.
"We want to put in place measures to reduce inappropriate use and we want to see that those are working - in order to do that we have to have a good surveillance system," Sharfstein said. "There's no question that needs to be improved."
"I loved hog farming. And I miss it. I wish I could go back," Kim Howland said. "But until the walls come down and the roofs come off, there's no chance."

Denmark's Case for Antibiotic-Free Animals
Katie Couric Reports on Denmark's Ban on Antibiotics in Livestock
By Katie Couric
(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.
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.
"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.
"We thought we could not produce pigs as efficient as we did before," Helmer said. "But that was proven wrong."
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.
"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.
"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."
Without growth-promoting antibiotics, it only costs $5 more for every 100 pounds of pork brought to market in this country.
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.
"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."
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.
After the ban, a Danish study confirmed that removing antibiotics from farms drastically reduced antibiotic-resistant bacteria in animals and food.
Danish scientists believe if the U.S. doesn't stop pumping its farm animals with antibiotics, drug-resistant diseases in people will only spread.
"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.
Some American food producers agree.
"It's just gone too far," said Stephen McDonnell, CEO Applegate Farms.
"What most bothers you about the way industrial farmers in this country currently operate," Couric asked.
"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."
"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.
McDonnell helps farmers like Duane Koch kick the habit.
"How long have you been raising turkeys, Duane, without using antibiotics," Couric asked.
"We started running without antibiotics roughly 14 years ago," Koch replied.
"Does it make you feel better doing it this way," Couric asked.
"Yeah," Koch said. "Because really, from using the antibiotics so long, a lot of them didn't work well any way anymore."
Today his 18 poultry farms scattered throughout Pennsylvania are more profitable than when he used antibiotics.
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.
Koch says higher-quality feed and improving living conditions, his birds are naturally healthier.
Couric asked, "What's the importance of giving them more space?"
"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."
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.
"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.
The FDA has for the first time come out against using certain antibiotics to promote growth in livestock.
And pending legislation in Congress would ban some types of antibiotics used to treat humans from being administered to healthy farm animals.

Key Facts Disagree with CBS Evening News
By Pork news source | Thursday, February 11, 2010
Several key facts disagree with this week's CBS Evening News reports on antibiotics, according to Scott Hurd, DVM, former USDA deputy undersecretary of food safety. Notably, Hurd is now director of the World Health Organization's Collaborating Center for Risk Assessment and Hazard Identification in Foods of Animal Origin, College of Veterinary Medicine, Iowa State University in Ames, Iowa.
He offers an account of the facts in order to expand the knowledge and information regarding the use of antibiotics in livestock and how they may affect the health of animals, people and food safety.
CBS: A University of Iowa study last year found a new strain of Methicillin-Resistant Staph Aureus (MRSA) ? in nearly three-quarters of hogs (70 percent), and nearly two-thirds of the workers (64 percent) ? on several farms in Iowa and western Illinois. All of them use antibiotics, routinely. On antibiotic-free farms no MRSA was found.
HURD: First, this was a very small pilot study, which sampled fewer than 300 pigs. In it, only six farms used antibiotic-free production methods. The implication that this type of production is always free of MRSA is not true as there have been organic farms in other countries that have been found to be 100 percent positive for MRSA. On the other hand, in this Iowa study, some of the conventional farms that did use antibiotics were 100 percent free of MRSA. Secondly, there were two studies by the University of Iowa on MRSA in swine. The study that went unreported by CBS found conventional farms with MRSA rates in pigs of 23 percent, not 70 percent. In personnel, the rate was 58 percent, not ¡°nearly two-thirds.¡±
What also was not communicated is that there are at least three general categories of MRSA. 1) Virulent forms of MRSA are a serious human health problem. These forms are most commonly found in healthcare settings such as hospitals, dialysis centers and long-term care facilities and are often referred to as healthcare- or hospital-acquired. They can cause serious, invasive illness and even death, particularly in people with weakened immune systems. 2) There are less virulent forms of MRSA commonly found throughout the general population (25-50 percent of people) that are also found in cats, dogs, horses and other animals. These are typically referred to as community-acquired forms and are often linked to shared areas, such as locker rooms. 3) A third form that is less invasive than the healthcare-associated form has been recently identified in European, Asian and North American swine farms. This livestock form (strain 398) does not transmit as easily between people as the other types. It has been found in some people who have close contact with livestock (pigs, calves, and poultry), although there is no data to indicate that these people have a higher-than-normal illness rate.
The type of MRSA that has been associated with livestock is unique (known as strain 398). This strain has not been found in human disease surveillance for MRSA conducted by either the U.S. Centers for Disease Control and Prevention (CDC) or the University of Iowa hospitals. It is very unlikely that the people interviewed for the CBS story had livestock-associated MRSA. However, it¡¯s much more likely these people had the very common community-acquired strain of MRSA from being in close contact with infected people ? not animals.
The types of antibiotics used in modern pork production are not associated with the development of MRSA. Methicillin has never been used in animals in the United States.
Countries that have banned growth promotion uses of antibiotics, such as Denmark, have similar levels of MRSA in their livestock herds. Additionally, Denmark has been struggling with a major outbreak of human MRSA.
CBS: Health officials are concerned if workers who handle animals are getting sick ? what about the rest of us? Drug resistant infections have sky-rocketed over the past two decades, killing an estimated 70,000 Americans last year alone.
HURD: The drug-resistant infections referred to here have little, to no, relationship to any antibiotic use in animal agriculture. The types of drug-resistant infections that are lethal are often associated with hospital-acquired infections ? and the antibiotic used in those facilities.
According to the FDA, resistance in food-borne illness is stable to declining over the last several years. Scientific risk assessments conducted by myself and others have shown a person is more likely to die from a bee sting than have a few extra days of diarrhea due to a resistant infection acquired from on-farm antibiotic use.
CBS: Antibiotic resistance is an emerging health crisis that scientists say is caused not only by the overuse of antibiotics in humans, but in livestock as well. Antibiotics fed to healthy animals to promote growth and prevent disease.
HURD: Strategic use of antibiotics in animal agriculture prevents disease and produces safer food. A side benefit of this use is faster growth.
Since antibiotics have been used in humans for more than 60 years and in livestock for about 50 years, if there was going to be an epidemic of resistance related to antibiotic use in agriculture it would have occurred by now. The fact that it has not means that antibiotic use in animals is not a major risk to human health.
CBS: "My fear is that one of these days we are going to have an organism that's resistant to everything that we know, and we'll be left powerless," said Thomas Cummins, Batesville's chief medical officer. "There are a lot of concerns about antibiotics being added to animal feeds that may be contributing to MRSA as well as other antibiotic resistance. Certainly the more bacteria are exposed to antibiotics in any shape or form, the more tendency there is for resistance."
HURD: While the types of antibiotics used in animal feeds do not contribute to the development of MRSA, the concern over the development of antibiotic resistance is why veterinarians and farmers have spent more than 20 years continually improving their antibiotic use. The results of these improvements are evident in FDA-monitoring studies that show that resistance in target pathogens is stable to declining.
Since antibiotics have been used in humans for more than 60 years and in livestock for about 50 years, if there was going to be an epidemic of resistance related to antibiotic use in agriculture it would have occurred by now. The fact that it has not means that antibiotic use in animals is not a major risk to human health.
CBS: There are different types of drug-resistant bacteria. Some, like E. coli and salmonella, can be passed on to people by consuming undercooked meat and poultry. Now, scientists are worried that Americans may be acquiring drug-resistant MRSA ? not from eating, but from handling tainted meat from animals that were given antibiotics.
HURD: Research demonstrates that when MRSA has been found in meat, it is present in extremely low levels. Because of this, the United States Centers for Disease Control and Prevention (CDC) and the European Food Safety Authority both conclude that the likelihood of MRSA being spread by handling or eating meat is very low.
As always, when meat is handled and cooked properly, there is virtually no risk of becoming sick from a food-borne pathogen.
CBS: Evidence of MRSA has been found in the nation's meat supply. But it's unclear how widespread it may be, because only a small fraction is tested for MRSA.
HURD: MRSA is not a food-borne illness, thus testing meat is unnecessary. The CDC and the European Food Safety Authority agree that the risk of MRSA from handling or eating meat is very low.
CBS: "If the bacteria becomes resistant to antibiotics, it can actually spread in many ways," Hearne said. "It could be in the food supply, but it also can be in waters that runoff in a farm. It could be in the air. It can happen very quickly in many different ways. It's why it's a practice that has to stop on the farms."
HURD: There is no evidence to support that these routes contribute to the human health concerns around antimicrobial resistance. Food-borne illness rates are declining, and resistance in those pathogens is stable to declining. Environmental spread of these pathogens is largely theoretical.
CBS: Using antibiotics to help animals absorb and process food so they grow bigger, faster is a selling point pushed by the pharmaceutical industry. Because animals are packed into confinement pens, antibiotics are also used to keep disease from spreading like wildfire.
HURD: Antibiotic use is one very important tool to maintain animal health in farms of all sizes and structures. Other tools used include hygiene, proper diet and nutrition, providing the proper environment and vaccination. Antibiotics help the animals grow healthier, improve animal well-being and help provide safe food.
CBS: But the bottom line on antibiotic use is this: no one is really monitoring it.
HURD: The U.S. Food and Drug Administration (FDA) regulates antibiotic use in both humans and animals. The FDA inspects the feed mills that would produce medicated feed. The agency also evaluates the safety of antibiotics used in animals for human safety. And, the FDA works with the USDA to conduct tests in processing facilities to make sure those regulations for antibiotic use are followed. So, it¡¯s clearly a highly regulated practice ? one the pork industry has shown a long history of commitment to by demonstrating its ongoing compliance with those regulations that help ensure safe food.
Source: Iowa State University

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