Ask about sore throats
Source: Fiji Times (http://www.fijitimes.com/story.aspx?id=270557)
Thursday, June 05, 2014
Rheumatic heart disease patient Tomasi Torowale undergoes a scan at the CWM Hospital yesterday. Picture: JONE LUVENITOGA
SPECIFICALLY ask health workers about strep throats — this is the advice CWM Hospital head of pediatric and consultant Dr Joseph Kado is giving to parents and guardians when they take children to medical centres for a sore throat.
Dr Kado said all clinics around the country, whether run by nurses or doctors are able to confirm whether sore throats are strep throats.
"What we want parents and guardians to do is specifically ask about a strep throat," Dr Kado said.
"So the question is, do I or my child have a strep throat? And the doctor or nurse will respond accordingly."
He said parents should also teach their children, especially toddlers, where their throat is on their body.
"One of the most difficult things is that culturally we do not teach our children where their throat is.
"We need to teach our children where their throat is and if they don't feel like eating, ask a specific question if their throat is sore.
"If they say yes or nod, are not able to feed or have gone off their feeds, take them to a health provider."
Resistance to antibiotics leading to resurgence of many fatal illnesses
A World Health Organisation report suggests a growing immunity to these drugs poses a major global threat to public health.
Source: The Irish Times (http://www.irishtimes.com/news/health/resistance-to-antibiotics-leading-to-resurgence-of-many-fatal-illnesses-1.1824901)
In 1943, during the twilight of the second World War, the impact of the first non-experimental doses of penicillin was difficult to overstate: illnesses that were once death sentences became not just survivable but readily treatable.
Soldiers who would have previously succumbed to their wounds recovered and lived into old age; infections from accidents, cuts and childbirth no longer carried the sting of death in their tail. The success of penicillin led to new antibiotics and advances; within decades, diseases like tuberculosis, which had once killed thousands annually in Dublin alone, had ceased to be the threat they once were.
Yet even as he accepted the 1945 Nobel Prize for the discovery of Penicillin, Alexander Fleming issued a salient warning: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” These prophetic words have fallen Cassandra-like on deaf ears and now the spectre of antibiotic resistance threatens us all. Recently, Dr Keiji Fukuda of the World Health Organisation said: “Without urgent, co-ordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill.”
This is not some potentiality in the hazy distant future – it is already happening worldwide. Diseases like gonorrhoea, pneumonia, ecoli infections, staph’ and tuberculosis have acquired immunity to many classes of antibiotics, and have begun claiming lives on an unprecedented scale.
Once treatable diseases The Centres for Disease Control and Prevention
estimate that in America alone at least two million people a year develop a serious antibiotic resistant infection and 23,000 die from these infections, with a similar number in European dying from these once treatable diseases.
This eventuality is not unexpected; bacteria are quick to divide and evolve rapidly. As a consequence doses below the threshold required to kill the malignant bacteria might reduce symptoms in the carrier but promote the evolution of disease strains capable of shrugging off our arsenal of antibiotics, returning us to a darker era where a minor cut or scrape could again be fatal, and where a simple bacterial infection might spell death.
One common misconception is that antibiotics are a panacea for minor illnesses, when in fact they have no effect whatsoever on viral ailments and are frequently over-prescribed, dispensed by put-upon GPs to patients eager for a totem to their discomfort.
To further exacerbate the issue, there has been severe stagnation on the development of new antibiotics – pharmaceutical companies have become wary of sinking money into agents which are only used for a short period per patient and quickly rendered obsolete due to overuse.
Surprisingly, the majority of all antibiotics are consumed not by humans but by animals – given in sub-therapeutic amounts, antibiotics act as growth promoters. In 2006, the EU banned antibiotics in livestock for anything other than medicinal use, but in the US up to 80 per cent of antibiotics are given to livestock.
Front-line drugs A growing weight of evidence indicates that while this increases profitability, it
reduces the effectiveness of our front-line drugs.
The question is how we mitigate this disaster; first, we owe it to ourselves to be better informed about when antibiotics should be used, and better communication between physician and patient might help spare overprescription.
Reducing antibiotic use in livestock is of paramount importance, and it is encouraging that the EU is taking steps in the right direction. We also cannot rely solely on profit-motivated drug companies to offer us new solutions, and part of the solution may be to invest more public money in research.
We are all guilty of the ignorance that Fleming warned of almost 70 years ago and if we are to avoid disaster, it is vital we educate ourselves in their proper usage.
Dr David Robert Grimes is a science writer and physicist at Oxford University. He blogs at davidrobertgrimes.com
Drug Dangers
Source: Drug Dangers
Infant immunity, though fleeting, found to be strong
Source: Medical Press (http://medicalxpress.com/news/2014-05-infant-immunity-fleeting-strong.html) May 2014
Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Credit: NIAID
(Medical Xpress)—"Forgetful" immune systems leave infants particularly prone to infections, claims a new Cornell study. Upending the common theory that weak immune cells are to blame, the study has found that infants' immune systems in mice actually respond to infection with more speed and strength than adults. Yet the immunities they create fail to last.
Published in the Journal of Immunology in May, the discovery suggests a new angle immunizations could take to better protect infants and children from infectious diseases.
Infectious disease accounts for more than one-third of infant deaths worldwide, according to the World Health Organization. Immunizations protect people by "teaching" immune systems to remember pathogens. But infant immunities rapidly wane, often requiring extra booster shots after an initial vaccination.
"The perfect vaccine would be a single dose given at birth that generates long-lasting immunity," said immunologist Brian Rudd at the College of Veterinary Medicine, the study's lead author. "No such vaccine exists because we haven't understood why infants rapidly lose immunities. Our finding could change the way we immunize infants and ultimately lead to more effective ways of enhancing immunity in early life."
Immunity against most microbes depends on forming memory T cells that remember specific pathogens and can rapidly respond to future infections. Adults almost always generate large numbers of effective memory T cells during infection, around 10 percent of which stay in a long-lived memory pool to rapidly respond next time.
Rudd found that newborn T cells generated in response to infection met dramatically different fates. When met with the same pathogen, newborn immune systems in mice made T cells that responded more rapidly to infection than adult cells, but quickly became terminally differentiated, never making it into the memory pool. This disproves the common theory that newborn immune cells have a weak or suboptimal response to infection.
"Surprisingly, we found that newborns' cells actually responded more vigorously to infection compared to adults," said Rudd, assistant professor of immunology. "We also found that newborns' cells go through their lifespans more quickly and die off sooner, before they can give rise to memory T cells and remember what they've learned. So the immune system is forced to start the learning process over again when infected by the same pathogen later in life."
Rudd's lab is adjusting the expression of different proteins in different-aged T cells to determine how developmental variation in these factors influences memory cell behavior and fate. The researchers are also performing genomewide analyses of different-aged T cells to find the genes that code these differences.
"We hope to find a way to make neonatal cells behave more like adult cells in how they learn from vaccines and respond to infection," said Rudd. "Knowledge gained from these studies could be used to design more effective therapeutic interventions and vaccines that can be safely administered in early life."
$10m for better oral health for children and adolescents
Source:http://www.voxy.co.nz/politics/10m-better-oral-health-children-and-adolescents/5/190902
Associate Health Minister Tariana Turia announced an additional health initiative in Budget 2014 today, new operating funding of $10 million for Better Oral Health for children and adolescents over the next four years.
Associate Health Minister Tariana Turia says the Better Oral Health announcement aligns with the Government's preventative health measures and has been recommended by the Health Select Committee. The new funding will support a range of activities that promote better oral health for children and adolescents. In particular, the promotion will aim to increase regular tooth brushing (with fluoride toothpaste) among pre-school children, and to increase the number of adolescents using the free oral health services that are available to them. As well health promotions will include information about the importance of reducing the intake of sugary food and drink as part of a healthy diet.
"The oral health of our families starts when they are young. We need to start educating our children when they are babies about the importance of brushing teeth twice daily from an early age. We should also continue to actively campaign against foods and drinks with high levels of sugar and particularly the impact of juices and sugary drinks in babies’ bottles. It is vital that we get the necessary information to our communities in the right way so that they are able to make informed choices about their health and the health of their children," Mrs Turia says.
"There is also a budget of $10 million which has been set aside for at least 480 bariatric surgery operations over four years within the elective-surgery initiative of $110 million announced on Budget day last week," Mrs Turia says.
"Bariatric surgery can improve health dramatically for those who suffer from obesity and are struggling to lose weight through diet and/or exercise. Weight-related illnesses such as diabetes, sleep apnoea and hypertension can also be improved through bariatric surgery, and I am pleased that this Government has strengthened its commitment to fund this type of surgery," Mrs Turia says.
The Maternal Microbiome
Source: TheScientist (http://www.the-scientist.com/?articles.view/articleNo/40038/title/The-Maternal-Microbiome/)
Popular thinking has held that as a baby works his way through a birth canal teeming with microorganisms, his body is colonized with its first commensal bacteria. But a new study shows that a bevy of microbes exist in the womb.
The findings, published today (May 21) in Science Translational Medicine, add to a growing body of literature suggesting that tissues once thought to be germ-free are crawling with microbes, and that babies’ introduction to the microbial world comes from multiple maternal sources.
“[It’s an] interesting study that continues to build the snowball that no tissue in the human body is sterile, including reproductive tissues and, for that matter, the unborn child,” Seth Bordenstein, a biologist at Vanderbilt University who was not involved in the work, said in an e-mail to The Scientist.
Hints that the uterine environment harbors bacteria began to emerge several years ago. In 2008, for instance, Juan Miguel Rodríguez’s group at the Complutense University of Madrid in Spain inoculated pregnant mice with a labeled bacteria and later identified the strain in the meconium (the poop that develops in a fetus) of pups delivered by C-section. In combination with other studies of the placenta, amniotic fluid, and umbilical cord blood, it now seems apparent that an infant’s first meeting with microbes is not at birth.
“Based on the sum of evidence it is time to overturn the sterile womb paradigm and recognize the unborn child is first colonized in the womb,” said Bordenstein.
A diversely populated placenta
Throughout her training in obstetrics, Kjersti Aagaard was taught that the womb is a sterile sanctuary for baby to develop. “The only time it’s not is when we have a pathogenic infection,” said Aagaard, who studies the in utero environment of humans and animal models at Baylor College of Medicine and Texas Children’s Hospital. But the evidence didn’t seem to support such an idea.
In 2012, Aagaard and her colleagues found that while the vaginal microbiome did change during pregnancy, it didn’t resemble the microbial makeup of newborn babies: the vagina harbored bacterial communities of about 80 percent Lactobacillus, while newborn humans have a relatively greater abundance other taxa, such as Actinobacteria, Proteobacteria, and Bacteroides. “We were curious about where microbes in the infants’ gut are coming from,” said Aagaard, who decided to look for bacteria in the placenta.
In her latest study, Aagaard’s team collected placental tissue from 320 mothers immediately after they gave birth and documented diverse microbes, including E. coli, Bacteroides, Prevotella tannerae,and Neisseria lactamica, among others. In terms of species composition, the placental microbiome more closely resembles the mother’s oral microbial community than any other site on the body. But when Aagaard’s group looked at the metabolic pathways of the bacteria, “interestingly, they’re far overrepresented for metabolism of cofactors and vitamins relative to other body site microbiomes,” such as the gut or the mouth.
Aagaard says that the placental microbiome likely represents a baby’s first meeting with the microbial world. The birthing process, then, would be the second stop on a tour of the maternal microbiome. Once on the outside, a baby’s first embrace with his mother is really a group hug with her skin microbiome. And then there’s breastmilk, which for many decades was also considered sterile, but which is in fact a creamy bacterial soup.
Mother’s microbial milk
“The overwhelming dogma before the microbiome world really started was that milk was sterile, that the only time you could culture an organism out of milk was when a woman had mastitis,” an infection of the breast tissue, said Mark McGuire, a milk researcher at the University of Idaho. So when Complutense University’s Rodríguez first began examining breast milk in the 1990s and found evidence that it served as a potential source of microbes in infant feces, many people didn’t believe him. They assumed that his samples were contaminated, “maybe from the mother’s skin or maybe the mouth of baby,” he said, but the bacterial strains he found in breast milk didn’t exist in the mouth or on the skin. And later, his group confirmed that these breast-milk bacteria were finding their way into the infant gut.
In 2011, McGuire’s team characterized the microbiome of human breast milk from 16 women. “It’s quite a diverse [microbial] community,” McGuire told The Scientist. The most abundant bacteria wereStreptococcus, Staphylococcus, Serratia, and Corynebacteria, although each woman’s sample was different. “It was very personalized,” said McGuire. “Part of that personalization means she’s sampling her environment and providing that environment to her offspring, and maybe that’s a way to train the immune system and help the infant expand what it’s going to be exposed to early in life.”
Research by Rodríguez, Aagaard, and others is now looking into what impacts these various microbial sources might have when babies encounter them. Yesterday (May 20), Aagaard reported inNature Communications that macaques who ate a high fat diet during pregnancy and lactation had babies with altered gut microbiomes. Although it’s not yet known what’s driving these changes, “clearly breastfeeding is a key and critical component,” said Aagaard—“not just how it introduces and influences the gut microbiome of the infant, but how it changes its whole metabolic milieu.”
For mom’s sake
While many questions remain, it’s pretty much taken for granted that the microbial communities of the placenta, vagina, and breast milk are important for fetal and infant development. But there is also an emerging appreciation for the role of the mother’s microbiome during pregnancy and lactation on the health of the woman herself. For instance, a 2012 study in Cell found that gut microbiome changes during pregnancy correlate with gains in body fat and dips in insulin sensitivity in mice exposed to the bacteria.
Several years ago, Rodríguez stumbled upon the idea that the microbiome of breast milk is important for the health of the mother. Mastitis, which can cause such severe pain and is often treated with antibiotics, is characterized by a “huge dysbiosis” of the breast-milk microbiome, said Rodríguez. A single strain of pathogenic bacteria would dominate the sample, while Lactobacillus would disappear.
McGuire’s wife and colleague, Michelle (Shelley) McGuire, a lactation researcher at Washington State University, recently got a similar result in when she and her colleagues collected breast milk samples from a group of women. Once in a while the researchers would find a bacterial community that was dominated by a single strain, and in those cases, “nine times out of 10 [the woman with the dysbiosis] had taken an antibiotic or complained there was a little discomfort in that breast,” Shelley McGuire said. “We could see it in her milk.” (The results of this work are still unpublished.)
The lack of Lactobacillus levels in the milk that Rodríguez observed offered him an opportunity to test whether bacteria in breast milk originate in the gut. He designed a study in which women took supplements containing the missing bacteria, and found that, sure enough, the same strains ofLactobacillus showed up in their breast milk. Unexpectedly, after about three weeks on the supplements, the women reported that their mastitis had cleared up. “For the first time we said, Maybe this is important for the treatment of mastitis or painful breastfeeding,” said Rodríguez, whose team is now wrapping up subsequent trials to treat mastitis during breastfeeding with bacteria, rather than antibiotics.
And even when not lactating, the breast itself has its own microbiome, according to the work of Gregor Reid, a microbiologist at Western University and Lawson Health Research Institute in London, Ontario, who suspects that the bacteria in the breast might play a role in disease, such as cancer. But to look for a link between the breast microbiome and health requires characterizing what’s normal, which is not so easy, researchers agree. One thing that is becoming clear, however, is that a healthy microbiome, whether it’s in the baby or the mother, harbors a diversity of bacteria. “In the big picture of life, we’re just appreciating that diversity is a really good thing to have,” said Aagaard. “The more diversity we can pick up, probably the healthier we’ll be over time.”
Babies given antibiotics have higher asthma risk
Source: The Times of India (http://timesofindia.indiatimes.com/home/science/Babies-given-antibiotics-have-higher-asthma-risk/articleshow/35138444.cms?google_editors_picks=true)
LONDON: Scientists have discovered that children who are given antibiotics before their first birthday have an increased risk of developing asthma.
UK researchers examined data from the Manchester Asthma and Allergy Study (MAAS) which has followed over 1000 children from birth to 11 years.
Antibiotics are routinely given to children to treat respiratory infections, ear infections, and bronchitis.
The study's findings are believed to be the first to show that children with wheezing who were treated with an antibiotic in the first year of life were more than twice as likely as untreated children to experience severe wheeze or asthma exacerbations and be hospitalized for asthma.
Of particular interest was that these children also showed significantly lower induction of cytokines which are the bodies' key defence against virus infections such as the common cold. The researchers also identified two genes in the 17q21 region that were associated with an increased risk of early life antibiotic prescription.
Lead author Adnan Custovic from the University of Manchester said, "We speculate that hidden factors which increase the likelihood of both antibiotic prescription in early life and subsequent asthma are an increased susceptibility to viral infections due to impaired antiviral immunity and genetic variants on 17q21. But further studies will be needed to confirm that the impaired immunity was present at the time of the early childhood respiratory symptoms and predated antibiotic prescribing rather than as a consequence of the antibiotics."
In this study, information on antibiotic prescription, wheeze and asthma exacerbations were taken from medical records. Skin reaction tests that show whether a child is sensitized to allergens were done when they were three, five, eight, and 11 years old.
At age 11, blood was collected from children who had received at least one course of antibiotics or children who had received no antibiotics in the first year of life to compare their immune-system cell response to viruses (rhinovirus; the virus responsible for the common cold) and bacteria.
Genetic testing was also done to look at the links between common genetic variations on chromosome 17, 17q21, and antibiotic prescription.
Antibiotic-Resistant Germs, Lying in Wait Everywhere
Source: New York Times (May 2014) http://www.nytimes.com/2014/05/08/science/antibiotic-resistant-germs-lying-in-wait.html?_r=0
The Lechuguilla Cave in New Mexico is a network of chambers stretching 1,600 feet underground. The bacteria that grow on the walls of its most remote recesses have been living in complete isolation for more than four million years.
In 2010, Gerry Wright, a microbiologist at McMaster University in Ontario, ran an experiment on those long-lost bacteria. He and his colleagues doused them with antibiotics, the drugs that doctors have used for the past 70 years to wipe out bacterial infections.
But many of the Lechuguilla bacteria would not die.
“Most of them were resistant to something,” said Dr. Wright. Some strains, he and his colleagues found, could resist 14 commercially available antibiotics.
Dr. Wright’s discovery didn’t fit the conventional story of antibiotics. Antibiotics were introduced in the mid-1900s. Each time a new drug was introduced, it would take years before bacteria that could resist it became common.
Continue reading the main story
RELATED COVERAGE
More Matter Columns
In the decades since, this trend has turned into a crisis. Last week, the World Health Organization reported that antibiotic resistance is now a major threat to public health across the entire planet. “We will soon hit the wall,” warned Joseph Nesme, a microbiologist at the University of Lyon in France.
At first, the antibiotics crisis seemed like a simple story of evolutionary cause and effect. Whenever bacteria reproduce, there’s a tiny chance that a mutation will emerge that lets them resist an antibiotic. When we take that antibiotic, the mutant microbes can thrive while susceptible bacteria die.
If that were all there was to the story, the Lechuguilla Cave bacteria should have been easy targets. Cut off from the world, they never had a chance to evolve resistance to our drugs.
But Dr. Wright discovered that they were already prepared. They had many genes that allowed them to survive what should have been a fatal dose of antibiotics.
Their resistance hinted that antibiotic-resistance genes were not just the product of modern medicine, but an ancient part of nature.
Now a new study from Mr. Nesme and his colleagues reveals just how widespread resistance is.
To carry out their study, Mr. Nesme and his colleagues took advantage of the fact that many teams of scientists are gathering huge amounts of DNA from all over the world. They’ve cataloged millions of genes, and made them available in online databases.
Mr. Nesme and his colleagues searched the databases from 71 of those places — everywhere from Antarctic ice to the bottom of the ocean. They looked for genes that were similar to the ones that disease-causing bacteria use to resist antibiotics.
As the authors report in the journal Current Biology, they hit the jackpot. “We find them in all environments,” said Mr. Nesme.
Dr. Wright, who was not involved in the research, said that Mr. Nesme’s study confirms the work that he and his colleagues have been doing. “This paper reinforces that resistance is everywhere,” he said.
Scientists are puzzled about why resistance genes should be so old and so widespread. If the genes didn’t evolve recently to fight against modern medicine, what are they doing in other bacteria?
They’re probably doing a lot of things. Bacteria make their own antibiotics, for example, which they sometimes use to fend off competitors. Some of their competitors have evolved ways to resist those deadly molecules.
In addition, some resistance genes can be found in antibiotic-producing bacteria themselves. These bacteria can defend against their own poisons. “Otherwise, they make antibiotics once and commit suicide,” said Dr. Wright.
Continue reading the main storyContinue reading the main story
Advertisement
But a number of studies suggest that bacteria use resistance genes for jobs that have nothing to do with antibiotics.
Last week, for example, Dr. Wright and his colleagues published a study they had conducted on bacteria that live in soil. They found a gene in these bacteria that provides resistance to an antibiotic called rifamycin.
Or rather, it would provide resistance if the bacteria actually used the gene. But when Dr. Wright and his colleagues exposed the bacteria to rifamycin, the gene remained silent and the bacteria died.
Dr. Wright suspects that the soil bacteria use the rifamycin-resistance gene to perform a different job. But what that job is, he has no idea.
The global supply of resistance genes that scientists are uncovering appears to be fueling the antibiotics crisis. That’s because disease-causing bacteria can pick up resistance genes from other species and use them to fight our drugs.
Resistance genes can move between different species of microbes in many ways. Viruses, for example, can pick up DNA from one microbial host and then ferry it to another.
In some cases, disease-causing bacteria are simply borrowing genes that other bacteria were already using to resist antibiotics in nature. In the 1980s, for example, doctors saw an abrupt rise of bacteria resistant to the antibiotic vancomycin. Dr. Wright and his colleagues later discovered the source of their genes. They came from the very bacteria that make vancomycin in nature.
In other cases, Dr. Wright suspects, disease-causing bacteria pick up genes that other microbes used for different jobs. It just so happens that those genes can also make bacteria able to withstand to a particular antibiotic.
“All of a sudden you get something we recognize as resistance,” said Dr. Wright.
It’s sobering to realize that we’re up against a planet’s worth of resistance genes. But understanding our enemy is better than ignorance. Dr. Wright thinks that new antibiotics should be tested not just against the bacteria that live inside of us and make us sick. They should also be tested on bacteria living in the soil or the ocean. Scientists would discover the resistance genes that will someday threaten the usefulness of a new drug.
“It would be an early warning system, so you could at least be on the lookout,” he said.
A new study found that BLIS K12 probiotic (Streptococcus salivarius) from Stratum Nutrition, helps prevent two common illnesses in children:
streptococcal and viral pharyngotonsillitis (Drug Healthc Patient Saf. 2014 Feb 13;6:15-20).
The study looked at 60 children between the ages of 3 and 13 with a history of recurrent throat infection. Thirty children consumed lozenges containing BLIS K12 probiotic for 90 days, while the other 30 children served as control group. The results of the study found a 96 percent reduction in the incidence of streptococcal sore throat in children taking BLIS K12. The study also demonstrated an 80 percent reduction in episodes of viral infections and a reduction in the number of days with antibiotics (amoxicillin) and antipyretics were used. The total number of absent days from school or work in the BLIS K12 group went from 228 down to 16.
BLIS K12 is a specific, probiotic strain of Streptococcus salivarius, one of the most numerous bacteria found in the oral cavity of healthy individuals. The K12 strain of S. salivarius secretes proteins called Bacteriocin-Like-Inhibitory-Substances, which have ability to inhibit undesirable bacteria such as S. pyogenes and S. pneumonia.
Ban sought on animal antibiotics as human resistance grows
Stacy Finz. Published 5:23 pm, Tuesday, April 29, 2014. http://www.sfgate.com/health/article/Ban-sought-on-animal-antibiotics-as-human-5439995.php
Health professionals and public interest groups, supporting a proposed California law that would ban the sale of meat and poultry fed on nontherapeutic antibiotics, say human resistance to the lifesaving drugs has reached critical mass.
Antibiotics, the best weapon in a doctor's arsenal for killing infections in people, are quickly losing their effectiveness, and antibiotics in livestock are playing a role, doctors say.
People are dying - 23,000 a year in the United States from infections that can't be cured, according to the Centers for Disease Control and Prevention. Overuse of antibiotics contributes to the problem, but the medical and science communities say that if farmers and ranchers don't change their practices, it will get worse.
"We shouldn't see the day when a mother can't use antibiotics to treat her child's strep throat because of livestock interests," said Cami Gordon, co-chairwoman of the Los Angeles Leadership Council for the Natural Resources Defense Council, an international nonprofit environmental organization.
It's a long-standing practice in some livestock sectors to regularly feed animals antibiotics to help them grow fatter faster and as a prophylactic against illness and death, especially when the animals are housed in crowded conditions. Dr. Robert Gould, president of the nonprofit public policy organization Physicians for Social Responsibility, said 73 percent of important medical antibiotics are used on food animals.
Dangerous microbes
Overuse has contributed to creating superbugs, human-killing microbes, which medicine simply can't cure, according to scientists, who in the past decade have grown particularly concerned.
"If we used the same warped logic on our day care and nursery school attendees as those who add antibiotics to animal feed, we would be sprinkling antibiotics into children's PB&J sandwiches and milk to prevent infections and ensure better weight gain," said Dr. John Bolton, former president of the Northern California Chapter of the American Academy of Pediatrics and a clinical professor of pediatrics at UCSF. "This would, of course, be quite insane."
On Wednesday, the California State Assembly's Committee on Agriculture is scheduled to take up AB1437, a bill introduced in January by Assemblyman Kevin Mullin, D-San Mateo. The proposed legislation would require meat and poultry sold in California to be free of antibiotics, granting exceptions for livestock that need to be treated for sickness and allowing the use of antimicrobials not used on humans.
Stronger than FDA's plan
Mullin said the proposed legislation is stronger than the Food and Drug Administration's three-year plan to curb the use of antibiotics in food animals.
"The FDA's recent voluntary regulations are not enough to stop the inappropriate use of antibiotics in livestock and leave the public's health at risk," Mullin said.
The FDA program, announced in December, says antibiotics should be used only on livestock with a veterinarian's authorization. Until the FDA acted, ranchers and farmers could buy most antibiotics over the counter and put them in their animals' feed and water at will.
Under the FDA plan, 26 pharmaceutical companies have agreed to voluntarily phase out the use of antibiotics for growth promotion in livestock produced for meat.
The livestock industry says it is not averse to reducing its use of important human antibiotics, but it says the FDA's guidelines are better thought-out than Mullin's plan, which it says is too severe. It would do significant harm to producers' ability to treat and prevent the spread of disease in their animals, according to many in the industry.
Antibiotics can become too much of a good thing
Source: The Boston Globe
The drugs we have relied on for 70 years to fight bacterial infections — everything from infected cuts to potentially deadly pneumonia — are becoming powerless. Why? Because antibiotics are often misused by doctors, patients, and even people raising animals for meat.
And that misuse, which includes prescribing or using those drugs incorrectly, breeds “superbugs”— dangerous antibiotic-resistant bacteria that can’t be easily controlled.
Many of us now use antibacterial cleaning products in our homes. “They contain triclosan or other antibiotics,” says Urvashi Rangan, director of the Consumer Reports Center for Safety and Sustainability. “These products may promote resistance, and plain soap and water is enough to get most cleaning jobs done.”
Every time you use an antibiotic it kills some — but not all — of the bacteria in your body. The survivors might mutate, modifying their genetic material so that they are no longer vulnerable to the drugs.
Antibiotics also kill off some of the “good” bacteria that normally live in your intestines, which may allow resistant bacteria to fill the void. To read more, go to http://www.bostonglobe.com/business/2014/04/26/antibiotics-can-become-too-much-good-thing/5FnaYqx4tI2kY5mnYmINJI/story.html
Study casts doubt on Tamiflu value
Source: http://www.stuff.co.nz/national/health/9926276/Study-casts-doubt-on-Tamiflu-value
New Zealand will maintain its $32 million stockpile of influenza medicine Tamiflu, despite a major international study throwing doubt on the value of the treatment.
An updated review published by The Cochrane Collaboration, an independent global healthcare research network, and the BMJ said Tamiflu shortened the symptoms of influenza by half a day. There was no good evidence to support claims it reduced admissions to hospital or complications of influenza.
"Along with the evidence of harms from the medication, it raises the question of whether global stockpiling of the drugs is still justifiable given the lack of reliable evidence to support the original claims of its benefits," Cochrane said.
Medicines safety authority Medsafe said this country had a periodically refreshed stockpile of slightly more than 1 million doses of Tamiflu and more than 300,000 doses of another antiviral, Relenza. The Tamiflu stockpile was worth about $32m, out of a national pandemic stockpile, including items such as masks and syringes, worth about $46m.
"This study alone is not sufficient for New Zealand to be reconsidering its position of maintaining stockpiles of Tamiflu as an important precaution in case of a future global influenza pandemic," Medsafe general manager Dr Stewart Jessamine said.
About 100 countries had stockpiles of Tamiflu and Relenza, which was in line with World Health Organisation advice.
Regulators had to consider the widest possible range of research and information, and the Cochrane study had to be placed in that context, Jessamine said.
Another recent study showed clear benefits from the use of Tamiflu. It had looked at the use of Tamiflu in patients with influenza, as opposed to the clinical controlled trials in the Cochrane study.
"Maintaining a Tamiflu stockpile is international best practice. New Zealand will continue to monitor literature on this subject and the considerations of other regulators."
Tamiflu manufacturer Roche rejected Cochrane's findings saying it "fundamentally disagrees with the overall conclusions" of the study.
"We firmly stand by the quality and integrity of our data, reflected in decisions reached by 100 regulators across the world and subsequent real-world evidence demonstrating that Tamiflu is an effective medicine in the treatment and prevention of influenza," it said in a statement reported by Reuters.
The Cochrane finding was based on full internal reports of 20 Tamiflu and 26 Relenza trials. The medicines are both neuraminidase inhibitors used to treat and prevent influenza in healthy adults and children.
Tamiflu was stockpiled around the world during the 2009 swine flu pandemic. Forty-nine New Zealanders died from swine flu that year. Most of them were aged under 60.
Responding to the report, Dr Vanessa Jordan, the New Zealand Cochrane Fellow at the University of Auckland, said available data in 2009 had suggested antivirals such as Tamiflu and Relenza had potential benefits in reducing complications from influenza.
Based on that the Government - following the lead of overseas counterparts - bought and stockpiled 750,000 doses. Most of those doses had since been dumped after passing their expiration date.
The information had been incomplete. Through perseverance the Cochrane authoring group had obtained information on unpublished trials. The new synthesised evidence confirmed what had previously been suspected - "that there is currently no support for claims that Tamiflu or Relenza reduces admissions to hospital or complications of influenza," Jordan said.
"As a result of this latest Cochrane review we can see that there is not a case for widespread use of antivirals for influenza."
Pharmaceutical companies should be required to publish all the data related to effectiveness and safety, Jordan said.
Dr John Cameron, clinical director of Auckland region GP network ProCare Health, said the report raised significant questions about the benefit from either patient or government-funded stocks of neuraminidase inhibitors.
The data would allow planners to look at more effective management strategies such as the greater effectiveness of public health processes, infection control programmes and the early development and delivery of potentially more effective vaccine agents in the management of an influenza pandemic.
"At least now we should be able to reduce the potentially wasteful use of health resources on medications that have not shown to have significant beneficial effects for sufferers of current influenza viruses," Cameron said.
It was not a question of if but when a novel pandemic influenza virus, such as the one that caused the 1918 pandemic, would arise.
As well as questioning the usefulness of Tamiflu, the Cochrane report said the medicine increased the risk of nausea and vomiting in adults by about 4 per cent and in children by 5 per cent.
There was a reported increased risk of psychiatric events of about 1 per cent when Tamiflu was used to prevent influenza.
Evidence also suggested Tamiflu prevented some people producing sufficient numbers of their own antibodies to fight infection.
BMJ editor-in-chief Dr Fiona Godlee said the review was the result of many years of struggles to access and use trial data, which was previously unpublished and even hidden from view.
"We need the full data from clinical trials made available for all drugs in current use," Goodlee said.
- © Fairfax NZ News
Antibiotics overuse making it harder to fight superbugs
Source: Liv Osby, The Greenville News. http://www.greenvilleonline.com/story/news/health/2014/03/15/antibiotics-overuse-making-it-harder-to-fight-superbugs/6476961/
Kimberly Shivell was giving her baby girl a bath before church one Sunday morning when she noticed a strange, red, nickel-sized bump on her skin that wasn't there the day before.
By the next day, it was the size of a silver dollar. And terrifyingly, it was the size of her palm by the third day.
Doctors sent the otherwise healthy 15-month-old to the hospital where she wound up having surgery and getting intravenous drugs for what turned out to be an antibiotic-resistant superbug.
"The time in the hospital was horrible," Shivell told The Greenville News. "You just pray your child doesn't die from this crazy infection that's spread in such a small period of time."
More and more bacteria are becoming resistant to the drugs that have been used to treat them, leaving few treatments for some infections.
At least 2 million Americans contract an antibiotic-resistant infection every year, according to the U.S. Centers for Disease Control and Prevention. At least 23,000 of them die, the CDC reports, though other groups set that number much higher.
And experts say it has become a public health crisis that could claim many more lives unless something is done.
"I don't remember a time when antibiotics weren't easily accessible, inexpensive and worked," said Dr. Ryan Hoffman, director of emergency services at Bon Secours St. Francis Health System.
"And I don't want to go back to a time when people died from scraping their knee or a sore throat," he added. "That would be my concern."
Overused
and misused
Antibiotics are commonly prescribed for strep throat, tuberculosis and staph infections, among other bacterial conditions. But they don't work for viruses like those that cause colds, even though they are prescribed for those ailments.
In fact, the CDC estimates that about half of all antibiotics aren't needed or effective as prescribed. And the bacteria that survive develop resistance to the drugs.
In a report last fall, the CDC sounded the alarm about three "urgent" threats — Clostridium difficile, a severe intestinal infection; a drug-resistant gonorrhea; and Carbapenem-resistant Enterobacteriaceae, like E. coli, which is resistant to most, and in some cases, all, antibiotics.
The report also cited 12 "serious" threats, including Methicillin-resistant Staphylococcus aureus, or MRSA; Vancomycin-resistant Enterococcus; multidrug-resistant Pseudomonas aeruginosa; drug-resistant Salmonella; and drug-resistant Streptococcus pneumoniae. Three more are "concerning threats."
MRSA caused about 80,461 severe infections and 11,285 deaths in 2011, according to CDC, while an unknown "but much higher number" of less severe infections occurred as well. And resistant S. pneumoniae causes about 1.2 million infections and 7,000 deaths a year, CDC reports.
What's more, these infections cost the health system more than $20 billion annually and there are few new antibiotics in development.
"The loss of effective antibiotic treatments will not only cripple the ability to fight routine infectious diseases, but will also undermine treatment of infectious complications in patients with other diseases," the CDC researchers said.
"Many of the advances in medical treatment — diseases such as diabetes, asthma, rheumatoid arthritis — are dependent on the ability to fight infections with antibiotics," they continued. "If that ability is lost, the ability to safely offer people many life-saving and life-improving modern medical advantages will be lost with it."
In the food
The medical community has been trying to reduce the amount of inappropriately prescribed antibiotics for several years, issuing guidelines for their use in common childhood ear infections, for example.
But these drugs are also in much of the food that winds up in Americans' diets. Cattle, hogs and chickens are routinely given antibiotics, not just to treat illnesses, but to promote growth or to prevent disease, according to the CDC.
"Unless you are eating grass-fed, organic beef, you are ingesting antibiotics every time you have a burger," said Tim Reihm, spokesman for the Alliance for Natural Health - USA, adding that the food chain is "saturated" with antibiotics.
The CDC says the practice of giving antibiotics to food animals is dangerous, unnecessary and should be phased out. And in December, the U.S. Food and Drug Administration announced a plan to do just that.
But critics say it will do little to change the status quo because it's voluntary, takes three years to implement and allows agribusinesses to continue using the drugs for disease prevention with veterinary oversight.
"It's useful that the (FDA) is now clearly on record that this is a health threat, that we should be reducing antibiotic use," Jonathan Kaplan, food and agriculture director for the Natural Resources Defense Council, told The News.
"But ... we have very little reason to believe it's going to reduce a lot of antibiotic use," he said. "It's voluntary and relies on industry to stop a production practice it has insisted on for the last four decades."
The NRDC, which says the drugs are given to prevent disease because the animals are kept in unsanitary and overcrowded living conditions, sued the FDA in 2012 to act on its own 1977 findings that antibiotics in livestock can lead to resistance. A federal judge ordered the agency to begin cancellation proceedings for two classes of antibiotics, Kaplan said, but FDA appealed and the matter is pending.
Phasing out
This month, the Animal Health Institute, a trade group representing the drug companies that make pharmaceuticals for animals, committed to adopting the FDA policy over the next three years.
The National Chicken Council has too, even though "several studies show the threat from antibiotic use in livestock and poultry production is negligible, if it exists at all," said spokesman Thomas Super.
Raising healthy birds is the top priority for the industry and antibiotics are just one tool used, he said, adding that the drugs are administered judiciously and only when needed to prevent and treat disease. Most of the antibiotics used in raising chickens aren't used in human medicine, he said.
"Still, chicken producers are phasing out subtherapeutic or 'growth uses' of antibiotics important to treating humans," he said. "We agree there needs to be dialogue about the use of antibiotics in farm animals, but we stand firm that antibiotics, when used properly and under veterinary oversight, are critical to keeping birds healthy and food safe."
Liz Wagstrom, chief veterinarian for the National Pork Producers Council, said that hog farmers have for years followed good production practices that include the responsible use of antibiotics to minimize the risk of resistance.
The industry also has spent millions of dollars trying to understand resistance, she said, adding that, from the farmer's point of view, the FDA guidance will significantly limit the antibiotics and uses available.
"Once those labels are gone, we will no longer have those products to use," she said. "And we fully expect our producers and feed mills they buy from will comply and will make a real difference in the types of antibiotics that are available and how they may be used."
National Cattlemen's Beef Association president Scott George said in a statement the association will review the FDA guidance to ensure it is based on sound science and address producers' concerns. Producers work with experts on health management plans, including the appropriate use of antibiotics "to prevent, control and treat diseases in their animals," he said.
"Only by carefully evaluating antimicrobial resistance in a comprehensive manner that evaluates all of the peer-reviewed science related to all animal and human use will we effectively address this important issue," he added.
First step
But Ami Gadhia, senior policy counsel with Consumers Union, said that while the new guidance is a good first step, the disease prevention use still permitted could leave a loophole for continued inappropriate use of the drugs. And, she said, FDA needs to be moving faster.
"Alarm bells have been ringing on this problem for a very long time," she said. "Clearly more needs to be done right away on this issue. We would like to see use of antibiotics in food animals limited to treating only sick animals."
The Infectious Diseases Society of America agrees, saying in a 2011 letter to Congress that "the evidence is so strong of a link between misuse of antibiotics in food animals and human antibiotic resistance that FDA and Congress should be acting much more boldly and urgently to protect these vital drugs for human illness."
Both Consumers Union and the NRDC have urged Congress to pass the Preservation of Antibiotics for Medical Treatment Act, or PAMTA, introduced by U.S. Rep. Louise M. Slaughter, D-NY, to ban eight classes of drugs for non-therapeutic uses.
"If we continue along the path we're going, there is significant worry that people are going to get sicker with antibiotic-resistant bugs," Gadhia said. "And once they get sick, the treatments we have now just aren't going to work. That could potentially affect all of us and is something every consumer should be concerned about."
But Slaughter spokesman Eric Walker said the bill has been stalled by industry lobbying and political contributions.
"In the 112th Congress, there were 225 lobbying reports filed on that bill," he said, "and 87.5 percent were filed from groups hostile to regulation."
Harmful bacteria
Meat is routinely contaminated with antibiotic-resistant bacteria, according to Keep Antibiotics Working, a coalition of health, consumer and other groups that works to end the inappropriate use of antibiotics in food animals.
More than half the chicken tested by FDA in 2010 was contaminated with antibiotic-resistant E. coli, according to NRDC, which reports that 80 percent of the antibiotics sold in the U.S., or about 29 million pounds, are used on livestock, and most on animals that aren't sick.
And Consumer Reports says that almost all the chicken breasts it recently tested from 26 states were contaminated by potentially harmful bacteria, and about half had at least one bug resistant to three or more common antibiotics.
Gadhia points to the ongoing outbreak of antibiotic-resistant salmonella in Foster Farms chicken, which has sickened nearly 500 people in 25 states.
"The science community has known for four decades that when you give herds and flocks of animals antibiotics day after day, you end up breeding antibiotic-resistant bacteria," said Kaplan. "They escape by colonizing workers, going into the environment, riding through the food system on fresh meat products, and can go straight to your kitchen from the grocery store."
And children are at greater risk of getting many of these infections, according to the American Academy of Pediatrics.
"Fifty years ago, we were able to keep up with the antibiotic resistance that would occur," said Dr. Joe Maurer of Greenville Health System's The Children's Clinic.
"But in recent years, we are losing. The antibiotics we use orally don't work any more and so we're having kids coming into the hospital. And these bacteria are not only resistant to antibiotics, they tend to cause more severe infections too," he said.
"Our concern is that we seem to be further and further limiting our ability to treat (bacterial infections) because of potential overuse of antibiotics, and from the other end the antibiotics given to animals and that get into the environment."
The good news is that parents increasingly understand that overuse of antibiotics can harm their children, and society as a whole, Maurer said. That's important because 70 percent of ear infections, upper respiratory infections and sore throats are viral at onset, he said.
So instead of prescribing antibiotics and stronger ones than needed as they often did in the past, he said, doctors don't give the drugs, wait two or three days to see if the condition improves, or use more selective antibiotics.
Good antibiotic stewardship, said Hoffman, is vital to trying to solve the problem.
Tipping point
One of Maurer's major concerns is day care centers that require a sick child to be on antibiotics and fever-free for 24 hours before returning even though the drugs won't help viruses.
"It's a tough balance," he said. "We don't want kids in day care that are sick and spreading disease, but families need their children in day care."
Still, he said, in the past 10 or 15 years, there's been a decrease in antibiotics being prescribed, though it seems to have hit a plateau.
"I don't know what the solution is," Maurer said. "But from my perspective, more needs to be done."
Kaplan believes the country is at a tipping point on the issue. More and more people are becoming aware of the problem and consumers are increasingly opting for antibiotic-free foods, he said.
"For the last several decades, the industry side has been to challenge the notion that there's a credible health threat here. They can't do that any longer," he said. "It's hard to argue with the CDC on whether this issue is a public health threat."
Kimberly Shivell said she has no idea how Mary Claire was infected.
She took the toddler to the doctor as soon as she noticed the bump and got antibiotics. But when her daughter developed a fever and began vomiting two days later, they were sent to the hospital. After another couple of days, Shivell and her husband, Andy, took their little girl home.
"It was a huge relief," said the Greenville woman. "She was in such pain and seeing a small child with the IV hooked up all the time was rough."
Before it happened, Shivell had no idea how common these infections are.
"They said it's almost as common as a cold," she said. "All it takes is an open sore to get infected."
And with two small, rough and tumble girls, the self-described neat freak has been even more meticulous about cleaning, washing hands and making sure any cuts and bruises are treated properly.
"Every night, I spray the tub down and take all the toys and put in the dishwasher to sanitize them," she said. "And I go straight to the doctor's office when they get sick now because of what we've experienced."
Beat the Bug
Source: Kids Eat Right (http://www.eatright.org/kids/article.aspx?id=6442460388)
The flu season is at your doorstep. How can you protect yourself? The best defense is a year-round offense: Eat smart, stay active, get enough rest, reduce stress.
Which nutrients enhance immunity? Several may play key roles: beta carotene in deep-yellow fruits and veggies and dark-green leafy greens; vitamin B6 in whole grains, legumes, chicken and pork; vitamin C in citrus fruit, berries, melon, tomatoes and broccoli; vitamin E in wheat germ and nuts; protein in dairy foods, meat, poultry, fish and legumes; selenium in meat and seafood; zinc in beef and seafood. Friendly bacteria in yogurt with live cultures also help build immunity.