Q Fever

Q fever is a worldwide disease with acute and chronic stages caused by the bacteria Coxiella burnetii. Cattle, sheep, and goats are the primary reservoirs although a variety of species may be infected. Organisms are excreted in milk, urine, and feces of infected animals. During birthing the organisms are shed in high numbers within the amniotic fluids and the placenta. The organism is extremely hardy and resistant to heat, drying, and many common disinfectants which enable the bacteria to survive for long periods in the environment.

Infection of humans usually occurs by inhalation of these organisms from air that contains airborne barnyard dust contaminated by dried placental material, birth fluids, and excreta of infected animals. Other modes of transmission to humans, including tick bites, ingestion of unpasteurized milk or dairy products, and human to human transmission, are rare. Humans are often very susceptible to the disease, and very few organisms may be required to cause infection.

The following is a list of symptoms commonly seen with acute Q fever. However, it is important to note that the combination of symptoms varies greatly from person to person.

• high fevers (up to 104-105°F)
• severe headache
• general malaise
• myalgia
• chills and/or sweats
• non-productive cough
• nausea
• vomiting
• diarrhea
• abdominal pain
• chest pain

Although most persons with acute Q fever infection recover, others may experience serious illness with complications that may include pneumonia, granulomatous hepatitis (inflammation of the liver), myocarditis (inflammation of the heart tissue) and central nervous system complications. Pregnant women who are infected may be at risk for pre-term delivery or miscarriage. The estimated case fatality rate (i.e. the proportion of persons who die as a result of their infection) is low,  at < 2% of hospitalized patients. Treatment with the correct antibiotic may shorten the course of illness for acute Q fever.

The best protection against Q fever infection is vaccination of those at risk (abattoir workers, vets, agricultural workers). In Australia most vet students are vaccinated prior to commencing their studies, and abattoir workers are strongly encouraged to become vaccinated.

Domestic cats and dogs have also been unrecognised intermediate hosts, spreading Q fever to veterinary staff assisting at surgical procedures.

Although protection for at-risk workers can be provided by Q fever vaccination, no licensed vaccine is available in the United States; a vaccine for use in animals has also been developed, but is not available in the United States (http://www.cdc.gov/qfever/prevention/index.html).

An Australian company makes a Q fever vaccine (Q-VAX) composed of formalin-inactivated suspension of _Coxiella burnetii_ organisms, which had been grown in the yolk sacs of embryonated eggs (http://www.csl.com.au/docs/39/836/Q-Vax_PI_V4_TGA-Approved-17%20January%202014.pdf). In Australia, Q fever vaccination is recommended for those working in "at-risk" occupations such as abattoir workers, farmers, stockyard workers, shearers, animal transporters, and others exposed to cattle, camels, sheep, goats and kangaroos or their products (including products of conception), veterinarians, veterinary nurses, veterinary students, professional dog and cat breeders, agricultural college staff and students, wildlife and zoo workers (working with high-risk animals) and laboratory personnel handling veterinary specimens or working with the organism; workers at pig abattoirs do not require Q fever vaccination (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-15).

If the person has a positive history of previous infection with Q fever, vaccination is contraindicated; in others, serum antibody determination and skin tests must be done before vaccination to exclude those likely to have severe local or systemic hypersensitivity reactions to the vaccine resulting from previous unrecognized exposure to the organism (http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/handbook10-4-15). Q fever vaccine is not routinely recommended for children aged less than 15 years of age and pregnant or breastfeeding women because safety of the vaccine in these situations has not been established. Revaccination is not indicated due to the possibility of severe hypersensitivity reactions.

Global Leaders Raise Alarm on Antibiotic Resistance

Poor diagnostic tools, inappropriate use of antibiotics and a lack of new replacement drugs are causing a global crisis of antimicrobial resistance, according to global health leaders.

"A post-antibiotic era - in which common infections and minor injuries can kill - far from being an apocalyptic fantasy, is instead a very real possibility in the 21st century," warned WHO's Assistant Director-General for Health Security Dr. Keiji Fukuda. The World Health Organization (WHO) recently issued its first-ever global report on antibiotic resistance, deeming it a serious, worldwide threat to public health.

"Unless we take significant actions to improve efforts to prevent infections and also change how we produce, prescribe and use antibiotics, the world will lose more and more of these global public health goods and the implications will be devastating," according to Fukuda.

At the NIH, experts said researchers play a critical role in the unending battle against antimicrobial resistance. In March, the National Institute of Allergy and Infectious Diseases (NIAID) published a report [PDF <1M, 15 pages] concerning the threat, laying out its strategy to refocus its research efforts to address key scientific challenges. Under the plan, NIAID will examine the comprehensive biology and genetic makeup of specific microbes to understand how bacteria become resistant and will also identify new targets for point-of-care diagnostics. In addition, it will develop vaccines to prevent infection with drug-resistant microbes and design new antibiotics, among other priorities.

"As long as antibiotics are used to kill bacteria, resistance will continue to emerge," the NIAID report noted, and as this resistance builds, scientists are in a race to 'outsmart' the bacteria by working around the mechanisms that cause resistance.

In a related commentary in the Journal of the American Medical Association (JAMA), NIAID Director Dr. Anthony S. Fauci and colleague Dr. Hilary D. Marston called antibiotic resistance "a global crisis." They urged colleagues around the world to act on many fronts at once, especially in developing countries, where "the challenges are compounded by limited capacity for surveillance and poorly regulated sales."

Global antibiotic consumption increased by an astonishing 36 percent between 2000 and 2010, according to a recent article published in The Lancet. Dr. Ramanan Laxminarayan and colleagues found much of the growth occurred in low- and middle-income countries where "antibiotics are used as a substitute for public health measures," and over-the-counter sales are unregulated.

Health authorities must promote more judicious use of antibiotics and develop new infection prevention measures, according to the NIAID report. This necessarily involves collaborations among partners from different disciplines and swiftness in identifying and acting on threats as they emerge. NIAID noted, "Because antibiotic resistance is a complex problem with many drivers, combating it requires a multifaceted approach."

Other scientists are more focused on developing tools to properly identify bacterial infections and prevent their spread in the first place. As Fauci and Marston noted, "The importance of accurate diagnostics at point-of-care in efforts to thwart antimicrobial resistance cannot be overstated." These tools can help expand surveillance and curb inappropriate antibiotic use, for instance by distinguishing between viral and bacterial causes of respiratory illnesses - the majority of which are viral but are often incorrectly treated with antibiotics.

Meanwhile, two prominent scientists in the U.K. are calling for a new world organization to fight antimicrobial resistance on a similar scale to the U.N. Intergovernmental Panel on Climate Change. In a recent editorial in Nature, Wellcome Trust Director Dr. Jeremy Farrar and University of Edinburgh's Professor Mark Woolhouse suggested the new group could marshal evidence and catalyze policy across governments and stakeholders. Antimicrobial resistance resembles climate change in that both operate on a global scale for which humans are responsible and the practices of one country affect many others, the authors observed.

"We need a new independent body that will not only monitor the spread of antimicrobial resistance, but also drive and direct efforts to contain it," said Farrar.

Some encouraging changes are already underway in the bacteria battle, Fauci and Marston noted in their recent article. Industry incentives, such as longer market exclusivity, are encouraging drug development and currently 14 novel antibacterial agents are being tested for their effectiveness in humans. Meanwhile, hospitals around the world are devising systems to prevent patients developing opportunistic infections during their stay.

The NIAID continues to fund research to add to the arsenal available to combat harmful bacteria. In one project, a potential novel class of antibiotics targeting resistant Staphylococcus aureus is now in a trial to test its safety. A new $12 million NIAID initiative aims to develop new diagnostics that can quickly detect the resistant bacteria commonly found in hospitals. Other potential tacks for stopping harmful bacteria include creating vaccines, enlisting harmless bacteria already in the microbiome to bolster the body's defenses and spurring monoclonal antibodies that attack bacterial proteins.

In the U.S., a recent assessment of antibiotic resistance by the CDC found more than two million people each year get infections that are resistant to antibiotics and at least 23,000 people die as a result. The report classified the threats posed by the antibiotic-resistant germs. Deemed most urgent were drug-resistant gonorrhea, carbapenem-resistant Enterobacteriaceae, and Clostridium difficile, a serious diarrheal infection usually associated with antibiotic use. C. difficile alone causes about 250,000 hospitalizations and at least 14,000 deaths in the U.S. every year.

"The bottom line is that we have to protect patients by protecting antibiotics," said CDC Director Dr. Tom Frieden. "The drugs we have today are endangered. And any new drugs we get could be lost just as quickly if we don't improve the way we prescribe and use them."

In its analysis of antimicrobial resistance data from 114 countries, the WHO emphasized that every part of the world is affected and a coordinated response is imperative. The study found resistance across many different types of infectious pathogens, but focused on antibiotic resistance in nine different bacteria responsible for common, serious diseases. These include bloodstream infections (sepsis), diarrhea, pneumonia, urinary tract infections and gonorrhea. It's of "high concern" that bacteria have developed some resistance to all -including last-resort - antibiotics in all regions of the world, the report said. Aside from the risk of serious illness and death, resistance also burdens health system budgets, with lengthier hospital stays and more intensive care needs.

At a recent meeting, the WHO's General Assembly, delegates urged member countries to strengthen their antimicrobial drug management systems, support research to prolong the lifespan of current antibiotics, and spur new diagnostics and treatments for microbial infections. The WHO is now preparing a draft global action plan against antimicrobial resistance to be voted on in 2015.

"This serious threat is no longer a prediction for the future," the WHO report noted. "It is happening right now in every region of the world and has the potential to affect anyone, of any age, in any country."

Canada: French Cheese Recalled Due to E. coli

French Cheese Recalled Due to E. coli

La Fromagerie Hamel is recalling La fromagerie Hamel brand "St-Felicien lait cru France (Rhone-Alpes)" cheese from the marketplace due to possible E. coli O26:H11 contamination. Consumers should not consume the recalled product described below.

Recalled products

Brand Name	Common Name	Size	Code(s) on Product
La Fromagerie Hamel	"St-Felicien lait cru France (Rhone-Alpes)"	180 g	11772104 Best Before 19/08/2014

Check to see if you have recalled product in your home. Recalled product should be thrown out or returned to the store where it was purchased.

Food contaminated with E. coli O26:H11 may not look or smell spoiled but can still make you sick. Symptoms can include nausea, vomiting, mild to severe abdominal cramps and watery to bloody diarrhea. In severe cases of illness, some people may have seizures or strokes, need blood transfusions and kidney dialysis or live with permanent kidney damage. In severe cases of illness, people may die.

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Canada: White Pepper Powder Recalled Due to Salmonella

Clover Trading Company Ltd. is recalling Flying Swallow brand White Pepper Powder from the marketplace due to possible Salmonella contamination. Consumers should not consume the recalled product described below.

Recalled products

Brand Name	Common Name	Size	UPC
Flying Swallow	White Pepper Powder	55 g	7 77244 00012 6

What you should do

Check to see if you have recalled product in your home. Recalled product should be thrown out or returned to the store where it was purchased.

Food contaminated with Salmonella may not look or smell spoiled but can still make you sick. Young children, pregnant women, the elderly and people with weakened immune systems may contract serious and sometimes deadly infections. Healthy people may experience short-term symptoms such as fever, headache, vomiting, nausea, abdominal cramps and diarrhea. Long-term complications may include severe arthritis.

Faster, Easier Cures for Hepatitis C

Transformative advances in drug treatments approved by the Food and Drug Administration are giving the 3.2 million Americans with chronic hepatitis C a chance for a longer, healthier life without the virus. That’s welcome news for baby boomers—who make up three of four adults with the hepatitis C virus—and millions of other Americans, many of whom don’t yet know they are infected and carriers.

Hepatitis C can be cured, and today’s drug therapies are very effective and easier for patients to take, says Jeffrey S. Murray, M.D., the deputy director of the Division of Antiviral Products in FDA’s Center for Drug Evaluation and Research. Murray is an internist who specializes in infectious diseases.

A Preventable and Curable Disease

Hepatitis (inflammation of the liver) refers to a group of viral infections that affect the liver. The most common types are hepatitis A, hepatitis B and hepatitis C. Each is caused by a different virus.

Hepatitis C is the most common chronic bloodborne infection in the United States. There is no vaccine for this disease, but hepatitis C can be prevented by avoiding behaviors that can spread the virus—including sharing needles, syringes or other equipment to inject drugs.

A diagnosis of hepatitis C no longer means months and months of painful drug injections, which for decades were the only option. Science is making strides in therapies, giving patients new alternatives.

“Interferon-based injections often make patients feel ill and give them flulike symptoms,” Murray says. The treatment by interferon also lasts six months to a year, and cures only 40% to 50% of hepatitis C patients.

“Patients with very advanced liver disease couldn’t take the traditional treatment because often those injections could make them worse,” he adds. “Now, patients can treat their hepatitis C with only pills– drug combinations that are faster and have a higher cure rate.”

Today’s pills have double the viral cure rates—90% to 100%—in just in 12 weeks’ time. Reducing the treatment from a year to three months is a huge advantage for people with hepatitis C, especially because it’s easier to swallow a pill than to get an injection, Murray says.

The new regimens include Sovaldi (sofosbuvir), which is the first drug approved to treat certain types of hepatitis C infection without the need to co-administer interferon. In recent years, FDA has also approved three protease inhibitors—Olysio (simeprevir), Victrelis (boceprevir) and Incivek (telaprevir)—to treat chronic hepatitis C virus infection. Olysio is a protease inhibitor that blocks a specific protein the hepatitis C virus needs to replicate. The drug is a component of a combination antiviral treatment regimen.

Baby Boomers and Hepatitis C

For most people, hepatitis is a silent disease until it causes substantial damage to the liver. That process may take several years, and can lead to liver failure, liver transplantation and liver cancer.

“Hepatitis C is a bit like smoking, the longer you’ve had it, the higher your risk of developing complications—in this case, liver cancer and end-stage liver disease. It’s a progressive disease that takes years, even decades, before the patient develops cirrhosis or cancer,” Murray says. “The good news is that when you cure hepatitis C, you also lower its risks, though you don’t completely erase the years of damage to your liver.”

Once infected with the hepatitis C virus, nearly 8 in 10 untreated people remain infected for life, according to the Centers for Disease Control and Prevention (CDC). Three in four patients with chronic hepatitis C are baby boomers (people born from 1945 to 1965), and many became infected before the virus was identified and the blood supply was tested for the disease. That’s why it’s important for baby boomers—there are 76.4 million of them, according to the U.S. Census Bureau—to take a simple blood test for hepatitis C.

“When it comes to hepatitis C, the outlook for the future is better, but the past is catching up with us—especially if you are a baby boomer,” Murray says. “Still, this is a fortuitous time because better hepatitis C treatments are becoming available just as the patient population at risk of long-term complications is about to peak. There are treatments for chronic hepatitis and many reasons to get tested now more than ever because of the availability of safe and effective therapies

Canada: Sweet Paprika Powder Recalled Due to Salmonella

Winners Merchants International LP is recalling Ecoato brand Sweet Paprika Powder from the marketplace due to possible Salmonella contamination. Consumers should not consume the recalled product described below.

Recalled products

Brand Name	Common Name	Size	Code(s) on Product
Ecoato	Sweet Paprika Powder	160 g	Lot#8147, October 2015

What you should do

Check to see if you have recalled product in your home. Recalled product should be thrown out or returned to the store where it was purchased.

Food contaminated with Salmonella may not look or smell spoiled but can still make you sick. Young children, pregnant women, the elderly and people with weakened immune systems may contract serious and sometimes deadly infections. Healthy people may experience short-term symptoms such as fever, headache, vomiting, nausea, abdominal cramps and diarrhea. Long-term complications may include severe arthritis.

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Organic Carob Powder Recalled Due to Salmonella

July 25, 2014 - CaCoCo, Inc. has been notified by its supplier of a recall of Organic Carob Powder due to possible health risks related to Salmonella contamination.

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail, or elderly people and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting, and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis, and arthritis.

CaCoCo, Inc. has taken immediate action to recall its products, CaCoCo “Original” and “Global Warrior” containing said Organic Carob Powder in order to ensure the safety of its consumers. CaCoCo, Inc. is working closely with the FDA on this matter. CaCoCo, Inc. is dedicated to providing the highest quality organic and raw products and the safety of our customers is our number one priority.

Products were sold to California distributors, retail outlets, and farmers markets in 8.14 oz. and 2 lbs. bags. The products in this recall include:

Product Name: Original and Global Warrior

Lot #	UPC Code	Exp. Date
OG99	091131352113	10/19/2014
OG100	091131352113	11/28/2014
OG101	091131352113	06/18/2015
GW99	091131352076	10/19/2014
GW100	091131352076	11/28/2014
GW101	091131352076	06/18/2015

No other CaCoCo, Inc. products are affected by this recall and no illnesses have been reported to date. This recall is initiated as a precautionary measure due to a possibility of contamination as notified by our suppliers.

Consumers that have purchased these products with the above stated lot numbers or expiration dates are asked not to consume the product and discard it according to your state/local regulation guidelines or return the product to the original point of purchase for exchange.

Consumers with questions may contact CaCoCo, Inc. at (530) 362-8632, Monday – Friday from 9:00 am – 5:00 pm PST. Email correspondence can be sent to recall@cacoco.co.