New testing options.

In the early 1980’s when AIDS was still unexplained and HIV was spreading unchecked so was HCV. Both agents are blood borne viruses that struck intravenous drug users and blood transfusion recipients.  In 1989 Hepatitis C virus was identified and now estimates are about 130-200 million people are affected worldwide. About 35,000 people worldwide die every year from HCV related liver disease. 30% of people infected with HIV are also infected with HCV as well. Many of the antiretrovirals used to treat HIV build up in poisoning the organ the HCV drugs are trying to Save. “Their differences are greater than their similarities.” Says Miriam Alter an epidemiologist at the university of texas medical branch in galveston. 80% of people affected with HIV know they have it yet only 30% of people with HCV know they have it. Worldwide number drops to 5% “it doesn’t matter how good your treatments are if the majority of your affected population is not diagnosed” Gregory Dore Head of viral hepatitis clinical research program at university of new south Wales in Sydney. One of the more recent developments in testing for HCV has been the development of rapid test for anti-HCV. The OraQuick HCV Rapid Antibody Test was approved by the FDA in February 2011. As we know presence of the antibody does not mean that the person is infected with the virus but only shows exposure to the virus. Further testing will need to be done to confirm current infection. But the development of this assay allows for faster screening of larger numbers of people and can be used to rule out infection. For additional information on this assay refer to http://www.orasure.com/docs/pdfs/products/hcv/us/OraQuick_HCV_Package_Insert.pdf

Smallpox in Birmingham!

On August 11, 1978 Janet Parker, a medical photographer at University of Birmingham Medical School, in the United Kingdom, fell ill with headache and pains in her muscles. She begins to develop a rash that the doctors assume is just a benign rash. Not until 14 days later does she finally get confirmation on the true cause of her illness. She has contracted Variola major, the worst form of the virus causing smallpox. On September 11, 1978, one month after first becoming ill, she dies becoming the last person to die from smallpox. Her mother became infected but did not die from smallpox. Two Biomedical Scientist, the equivalent to a medical technologist in England, were also quarantined until October 10, 1978. It was determined that she contracted the virus from faulty ventilation from the laboratory on a floor below that was conducting research on the virus. I think this makes a very good case for the importance of laboratory safety. Ironically enough thought she had been vaccinated for smallpox in 1966. But the problem with the vaccine is initial vaccination only provides a high level of protection for 3 to 5 years. In 1796 Edward Jenner discovered that a person could be immunized from smallpox by being exposed to cowpox. Cowpox along with the Variola virus is a member of the Poxviridae family. Current vaccines use the Vaccinia virus which is also a member of Poxviridae. Talking of smallpox reminded me of one of my favorite episodes of House, a medical television show that aired on the Fox network. The episode was titled “A Pox on Our House” and if you ever get a chance to watch it I recommend it(http://www.youtube.com/watch?v=-sq5iXIc1fw). So now to what makes it difficult for medical professional like you and I to watch medical programs. In the episode they are fearful that the father of the suspected infected girl has also been exposed to the virus so he is given the vaccine by the CDC. Dr. House who has decided that the girl doesn’t have smallpox becomes confused when the father starts to develop a rash very similar to smallpox. The brilliant Dr. House decides that the father must have contracted smallpox from the vaccine. So there lies what we should all have a problem with. The vaccine is made up of a live virus but it is the Vaccinia virus and not the Variola virus. Not to say that the vaccine doesn’t have problems but you cannot get smallpox from the vaccine.

VITROS 5600 Part 2

               Last post I discussed some of the properties of the VITROS 5600 integrated system. So lets say you have reviewed my previous post decided you have room for this 2300 pound 9 foot wide instrument in your laboratory. I know you want one for your bedroom as well so how much will it cost you? The list price for the VITROS 5600 integrated system is $410,000 but don’t write that check just yet. According to one report by the ECRI institute, they also list other factors that will affect cost such as service contract, which was quoted at $23,546.25 per analyzer per year and a shipping cost of $1,400.00 per analyzer. Reagent pricing will vary depending on many factors but they quoted a price for the ECi A-HCV as $4.18 per test. ECRI institute recommends that prices be negotiated in order to decrease cost of the analyzer, reagents, service, and shipping. The VITROS 5600 employs 5 different measurement principles: Colorimetric/Rate, Potentiometric (direct ISEs), Immuno-rate, Turbidimetric, and Enhanced Chemiluminescence. The VITROS 5600 offers over 120 available assays. The principle behind the assay for HCV is Enhanced Chemiluminescence. The assay is FDA approved for in vitro qualitative detection of immunoglobulin G antibody to hepatitis C virus (anti-HCV) in human serum and plasma. No reagent preparation is needed for VITROS 5600. The VITROS 5600 integrated system offers advantages including the variety of assays included in the menu and automation. However this system has disadvantages such as initial high cost and a large footprint for the size of the instrument.

Don't get TB!

         Having done my annual Tuberculosis skin test the day before we talked about it in class got my attention a little. I know we talked about it some in immunology so some of this may be a review. The Mantoux tuberculin skin test is used to determine if a person is infected with Mycobacterium tuberculosis. First step in the test is 0.1 ml of tuberculin purified protein derivative is injected in the inner surface of the forearm with the bevel of the needle facing up. The time frame in which the test is read is critical to correctly identifying a positive test. The test must be read after 48 hours but before 72 hours. So you may remember from class that the area is measured in millimeters to determine a positive test. What is measured is the raised hardened area or area of swelling and not any redness. I initially thought the report I was given was reported out incorrectly because they reported it as 0.0mm when there was clearly a small area of redness at the site of injection but the area if redness is not measured it is the raised area of which I had none. What is considered positive? According to the CDC 5mm or more in: HIV-infected persons, a recent contact of a person with TB disease, persons with fibrotic changes on chest radiograph consistent with prior TB, patients with organ transplants, or persons who are immunosuppressed for other reasons. If you have 10mm or more and Recent immigrants (< 5 years) from high-prevalence countries, injection drug users, residents and employees of high-risk congregate settings, mycobacteriology laboratory personnel, persons with clinical conditions that place them at high risk, children < 4 years of age, or infants, children, and adolescents exposed to adults in high-risk categories are also considered positive. Additionally anyone with test result greater than 15mm, even with no known risk factors. Some potential false positives include: Infection with nontuberculosis mycobacteria, previous BCG vaccination, incorrect method of TST administration, incorrect interpretation of reaction, or incorrect bottle of antigen used. False negatives can result from the following: Cutaneous anergy (anergy is the inability to react to skin tests because of a weakened immune system), recent TB infection, very old TB infection, very young age, recent live-virus vaccination, overwhelming TB disease, some viral illnesses, incorrect method of TST administration, or incorrect interpretation of reaction. So be careful and don’t get TB once your out working please!

http://www.cdc.gov/tb/

VITROS 5600 Part 1

       One method for the detection of HCV is the VITROS 5600 integrated system by Ortho Clinical Diagnostics (Raritan, NJ). This summary will examine the instruments application, methodology and performance characteristics in general for the instrument and as it relates to HCV testing. The VITROS 5600 integrated system is produced by Ortho Clinical Diagnostics. Ortho Clinical Diagnostics is a part of the Johnson and Johnson Family of companies. The company has roots that date back to 1937 with the establishment of the Ortho Product division by Johnson and Johnson. In 1989 Ortho Clinical introduced the first assay for the detection of antibodies to hepatits C virus. In 2001 they became the first company to receive U.S. Food and Drug Administration approval for automated random access hepatitis test, performed on the VITROS ECi Immunodiagnostic system.

         The Vitros 5600 is an integrated system that integrates immunoassay testing and clinical chemistry testing all in one platform. This high-capacity system is the first of its kind. The instrument was cleared by the FDA in October 2008 and there is currently greater than 900 units in clinical use worldwide.

The first thing to be reviewed will be application characteristics of the VITROS 5600. The instrument is 2.79m /109.7inches wide, 0.85m/33.5 inches in depth, 1.64m/64.5 inches in height, and weighs 1062kg/2340 pounds. The power requirements for voltage are two dedicated 20 amp power lines or one dedicated 30 amp power line with UPS, nominal 200-240V AC and the requirements for frequency is 47-63Hz. Environmental requirements include operating temperature 15°-30°C, ambient relative humidity 15%-75% RH, and altitude of up to 8,000 feet. The instrument does not require a water source or a drain. It is designed with a self-contained onboard waste management system in order to eliminate requirements for off board plumbing. The instrument generates 60 decibels of noise at idle and 65 while operational. The operator interface is a color coded graphical interface that uses an ergonomic flat low-glare 17inch touchscreen LCD. There is a numeric keypad that is also included on the monitor. In order to provide maximum flexibility the included keyboard is detachable. The time it takes for a single result will vary depending on the principal of the assay being performed. The range is as short as about 2.5 minutes for potentiometric assays and as long as about 16 to 73 minutes for microwell assays. In the case of the anti-HCV assay the estimated time for results is less than 60 minutes. The typical delay from ordering a stat test to aspiration of the sample is about 10 seconds. Sample types include serum, plasma, urine, CSF, whole blood, and amniotic fluid (not available in US). The type of sample will be dependent on the assay being performed. The anti-HCV assay is approved for serum and plasma samples. Sample volumes range from 2-180 µL. Samples can be continuously be loaded and unloaded as instrument is in operation and can hold 80 samples in universal sample trays and 10 samples in dedicated STAT lane. Stay tuned for more to come on the VITROS 5600.

I get all the best Porin Channels!

    Porins are proteins that are located in the outer membrane of gram negative bacteria. The porin functions as a channel from outside of the cell to the periplasm. Periplasm is the region between the outer and inner membranes of the bacteria. Porin channels vary in the size of the pore in the cell. Bacteria typically have a variety of porins that are important for the transport of nutrients needed by the cell. Passage of antibiotics into gram negative cells occurs through the porin channels. Many bacteria have developed resistance to antibiotics by altering the porin channel so that the antibiotic can no longer pass into the cell. For example the porin OprD is utilized for the transport of imipenem into the bacteria. In some strains of Pseudomonas aeruginosa they have altered the structure of the OprD porin channel and as a result become resistant the antibiotic imipenem. Some other strains that have developed resistance include: Enterobacter aerogenes and Klebsiella spp. against imipenem, Vancomycin intermediate-resistant S. aureus or VISA strains with thickened cell wall trapping vancomycin, Many Gram-negative bacteria against aminoglycosides, and Many Gram-negative bacteria against quinolones.

Gold for the win!

      The American University in Cairo are working on a test to detect HCV RNA in a single reaction without amplifying the RNA first. Using gold nanoparticles . Gold particles have an unusual optical property known as surface plasmon resonance. When particles are distributed evenly in liquid they reflect light in a way that makes them appear red. When they clump together they appear blue. Patient serum and Short pieces of DNA designed to match the HCV RNA is added to solution the Gold nanoparticles added. If HCV RNA is present the DNA pieces will bind with it. And the gold particles will clump together appearing blue. If the HCV RNA is not present then the DNA pieces will bind to the Gold particles preventing them from clumping resulting in the solution turning red. The test cost about 1/7 the cost of the current HCV RNA test and only takes about 30 minutes.

With the increasing number of diagnostic technologies the CDC has begun discussion with the world health organization about collaborating to create standards to ensure that results of different test can be compared. In developed countries  like the US the overall prevalence mass screening is not cost effective. The current CDC guidelines were developed in the late 1990’s recommend testing those known to have been at risk of exposure to the virus. But a lot of the people who contracted the virus several decades ago don’t realize they are at risk and do not come forward to be tested

In the united states 1 in 33 baby boomers might be infected according to a model designed by Lisa McGarry of i3 Innovus part of health care information technology company Ingenix.

With this in mind the CDC may release recommendations in the guidelines for age based screening.

I hear you!

      As most of you know I have a 2 year old daughter. About a year ago she began to have chronic ear infections with fluid buildup in her ear. Ear infections are more common in children because the Eustachian tube is shorter and horizontal. This makes it easier for bacteria to enter and the smaller diameter hinders the movement of fluids. The Eustachian tube is a tube that links the nasopharynx to the middle ear. Additionally inflammation of the tube due to infection can cause swelling and trap fluid in the ear allowing bacteria to grow in the fluid. Some of the signs of infection are fever, irritability, and ear pain as a result of the buildup of pressure. Hearing loss may also result from the buildup of pressure but most children do not have long term affects to their hearing. Antibiotics can be given to treat ear infections but they may resolve on there own. In our case most of the time a round of antibiotics would clear up the ear infection within a week. In a few cases we had to change antibiotics in order to resolve the problem. This became an ongoing process with about 1 to 2 ear infections per month. Our pediatrician recommended a more invasive procedure of having myringotomy tubes put in. myringotomy tubes more commonly known as ear tubes are small tubes made of plastic, metal, or Teflon. The tube is inserted through a incision made into the eardrum while the child is under general anesthesia. The insertion of these myringotomy tubes allow the trapped fluid to flow out of the middle ear. Since we had the procedure done this past January we have only had one ear infection.

Just being me!

            With an estimated 5.2 million people infected with Hepatitis C Virus (HCV) you probably know someone that is infected. A lot of famous people have come out and stated that they are infected with HCV. One of the more famous people that claimed to be infected with HCV is Keith Richards. Keith Richards is most famously known for being the founding member of The Rolling Stones. Keith Richards in relation to Hepatitis C Virus is noted for his statement that he was cured of HCV by "just being me." So you probably don't believe him but what if I told you that it very well could be true. In fact 14 to 40% of those exposed to HCV spontaneously clear the virus. Some of the major factors associated with spontaneous clearance include a single exposure, younger age at infection, female sex, and certain HLA genes. Additionally African Americans and Asian Americans appear to be less likely than Hispanic or white Americans to clear the virus spontaneously. Of those who do not clear the virus and progress into chronic Hepatitis C Virus there are some treatment options. The treatment itself is one of the main problems associated with Hepatitis C virus. The current treatment for chronic Hepatitis C virus is pegylated interferon along with ribivarin. The results of this expensive treatment only cure patients approximately 50% of the time and have toxic side effects associated with it. Multiple factors have been found to be associated with response to this treatment including viral and host factors. The viral factor that has been found to be the best predictor of response to treatment is virus genotype, with genotype 2 and 3 reaching 70% to 80% sustained response. Several commercial assays for HCV genotyping are available for use in clinical laboratories.

You injected what into your face?

              Botulinum toxin is the most lethal protein known to man. Botulinum toxin is produced by Clostridium botulinum, an anaerobic gram positive spore forming rod. C. botulinum and its spores are found widely distributed in nature. There are seven types of C. botulinum based on the form of the toxin they produce. Toxin A, B, E, and F are the only ones that have been associated with causing human botulism. The botulism toxin is a very potent neurotoxin formed during bacterial growth. Only 75ng is enough to kill a person of about 165lbs. A single teaspoon of botulinum toxin is enough to kill about 1.2 billion people. The toxin functions by blocking motor nerve terminals at the neuromuscular junction (see diagram below).   Progression of paralysis usually starts with the eyes and face and progresses downward to the throat chest and extremities. Once the diaphragm and the chest muscles become affected respiration is inhibited and without intervention this results in death. There are three common ways that you can get botulism: foodborne botulism, infant botulism, and wound botulism. The first way, ingestion of foods containing the botulism toxins is the most common and occurs after the consumption of improperly processed and inadequately cooked home preserved foods. I like to make my own salsa and when I do I usually make a lot. I preserve the extra salsa I make by canning it. There are several precautions that must be taken to ensure that I don’t kill myself with the deadly food poison botulism. The USDA gives some recommendations that I follow and these include washing food, peeling some fresh food, hot packing (this is basically boiling it before canning), adding acids (lemon juice or vinegar), using appropriate jars and lids, processing jars in boiling water or pressure canner. Key factors to reduce the growth of Clostridium botulinum include pH less than 4.6 and salt concentration from 4 to 5%. The second way to get botulism is Infant botulism. Honey is the one dietary reservoir of Clostridium botulinum that has been linked to infant botulism. If you have ever heard not to give children under 12 months honey this is why. So what do we do with such a potent toxin? Many governments around the world have tried to weaponize botulinum toxin. The U.S. along with several other contries weaponized it in response to suspicions of Nazi Germany’s biological warfare development in 1941. Biological weapons were outlawed in 1972 by the Biological weapons convention but the threat of a possible terrorist use still remains. The FDA has produced a very interesting video on the history of botulinum toxin as a biological warfare agent(see below). So what else can we do with botulinum toxin? The drug BOTOX is actually botulinum toxin type A. It has many uses some of which include: to temporarily smooth frown lines (wrinkles between the eyebrows), to control severe underarm sweating, strabismus (an eye muscle problem that causes the eyes to turn inward or outward) and blepharospasm (uncontrollable tightening of the eyelid muscles that may cause blinking, squinting, and abnormal eyelid movements) and more. For more information about Clostridium botulinum /botulism visit the following  FDA , CDC , Bioterrorism.

Detection of the Hepatitis C Virus

     Because the clinical characteristics are the same for all types of acute viral hepatitis, laboratory testing is needed to identify the specific viral cause of illness. Confirmation of acute hepatitis C results when a negative test result occurs for Hepatitis A Virus and Hepatitis B Virus with one of the following: Antibody to hepatitis C virus (anti-HCV) screening-test-positive with a signal to cut-off ratio predictive of a true positive by CDC guidelines, Hepatitis C virus recombinant immunoblot assay (HCV RIBA) positive, or nucleic acid test (NAT) for HCV RNA positive. The two main classes of assays used in the diagnosis and management of HCV infection: serologic assays that detect specific antibody to hepatitis C virus (anti-HCV) and molecular assays that detect viral nucleic acid. The development of molecular assays for blood borne viral infections has made it possible to detect acute infections at an earlier stage than would be possible with conventional techniques and to measure the concentration of virus present in blood during the acute or chronic phases of infection. Molecular methods proved most useful for the identification of viruses that are either completely unable to be cultivated or can be cultivated only with great difficulty.  Several commercial assays for HCV genotyping are also available for use in clinical laboratories. Detection of HCV genotype is the most significant predictor of response to anti-HCV therapy and is used to predict treatment response and guide duration of therapy. The importance of nucleic acid testing over antibody testing can be seen in the blood banking industry. It is estimated that 9.7 Hepatitis C virus infected units per million donations go undetected by Antibody assays. With the use of nucleic acid test this risk is reduced to 2.72 infectious units per million donations. Nucleic acid testing reduces the detection window by an average of 25.8 days over antibody testing. Hepatitis C virus nucleic acid testing clearly increases the detection rate of HCV in donations that are immunosilent and help prevent these specimens from entering the blood supply. There are currently multiple nucleic acid assays available that use different methodology for the detection of the HCV nucleic acid RNA. For a full listing of the currently availible FDA approved testing methods for HCV refer to the following link. FDA approved

Your nice cool air is not so nice!

       In 1976 the American Legion gathered in Philadelphia Pennsylvania at the Bellevue Stratford Hotel to prepare for a bicentennial celebration when 221 people were stricken with an unknown respiratory disease. Every known antibiotic was tried, most unsuccessfully, however erythromycin seemed to somewhat help. In the end, 34 people died. Two biologists, McDade and Shepard, with the CDC discovered that the causative agent was a small fastidious gram negative rod. They decided to name the bacteria for the unfortunate victims of the American Legion hence the name Legionella. The outbreak was thought to have been caused by contaminated water in the hotel’s air-conditioning system. Legionella bacteria are naturally occurring aquatic bacteria that grow in warm water, particularly in cooling towers, water heaters, and potable-water plumbing. Legionella species are intracellular pathogens residing inside of macrophages. Because of this, the antibiotics used to treat legionaire’s disease must remain active inside the macrophages. Currently macrolides and quinolones are the first choice of treatment.  Tetracyclines are also likely effective but Beta-lactam antibiotics are not. The outbreak in 1976 was a result of Legionella pneumophilia serogroup 1.  Legionella pneumophilia is the most common isolate accounting for 70-90%. There are 49 different Legionella species, 20 of which have been reported to infect humans. In addition, there are at least 16 different serogroups. Each year, between 8,000 and 18,000 people are hospitalized with Legionnaires' disease in the U.S. The actual number is thought to be higher since many infections are thought to be either not reported or not diagnosed. People most at risk of getting sick from the bacteria are people over 50, as well as people who are current or former smokers, or those who have a chronic lung disease like emphysema. The majority of the people at the American legion convention were over 50 making them at higher risk. People who take immunosuppressives are also at a higher risk. This was the case in a 47 year old man who received a heart transplant at UAB hospital in February 1986. In April 1986 a lung biopsy was performed on a lung lesion that had been identified. From that biopsy a new species of Legionella was identified and named Legionella birminghamensis.  Legionella is an obligate aerobe and best grown on BCYEa agar in about 2-5 days in the lab.  I have also added a short video that goes into more detail on the life cycle of Legionella.

Hepatitis C Virus

       Since its discovery in 1989, hepatitis C virus (HCV) has been recognized as a major cause of chronic liver disease worldwide. Hepatitis C virus is the leading cause of liver transplantation in developed countries, and the most common chronic blood borne infection in the USA. Using the most conservative estimates the prevalence of Hepatitis C Virus (HCV) in the US is estimated at 5.2 million people. That is approximately 2% of the US population. The CDC list an average of 12,000 deaths per year caused by chronic liver disease as a result of Hepatitis C Virus. Originally identified as non-A, non-B hepatitis (NANBH) has three common modes of transmission. These are blood to blood transfusions, sharing of injection equipment by illicit drug users and inadequately sterilized or unsterilized equipment in healthcare setting. Although less likely Hepatitis C Virus can also be spread from HCV infected child from mother, during sex with HCV infected person, sharing of personal items contaminated with blood. Human beings are the only known reservoirs for HCV. Species Hepatitis C virus is a positive stranded RNA virus of the family Flaviviridae, genus hepacivirus, that is approximately 9.6 kb in length. There are six major genotypes or clades numbered 1 to 6 with more than 70 confirmed or provisional subtypes identified.

       The gold standard for confirmation of HCV is liver biopsy making laboratory test for HCV much more practical. There are many blood tests available to detect HCV. Available assays include screening test for antibody such as enzyme immunoassay and enhanced chemiluminescence immunoassay. Also available are molecular assay to detect viral RNA such as polymerase chain reaction and transcription mediated amplification. Molecular assay are available in both qualitative and quantitative. Molecular assays are also available for genotyping of Hepatitis C virus.

        I will go into much more detail throughout the semester but I hope this introduction will provide a foundation for future HCV post.

Cantaloupe! yummy!

                You sit down for breakfast and decide you’re going to have that juicy slice of cantaloupe you have had your eye on. Little do you know that because you had that craving for some cantaloupe you will now die within 30 days. Does this sound farfetched?  Last fall that is exactly what happened to 30 people in the US. This week in infectious diseases we looked at infections of the central nervous system. In lab we received a cerebrospinal fluid (CSF) sample from a patient and we were tasked with attempting to isolate the causative organism of our patient’s symptoms. From my CSF I was able to isolate Listeria monocytogenes. This is the same bacterium that was the causative agent of an outbreak in September to October of 2011 that infected 146 persons across 28 states and led to 30 deaths and one miscarriage. The mortality rate from listeric meningitis is fairly high ranging from 20% - 80%. So if only 20% of the people that get listeric meningitis survive how do you get it? First of all not everyone exposed to the bacteria will get listeric meningitis. The infectious dose is not known but it is known that neonates, elderly, pregnant women and immunocompromised individuals are at the highest risk. People without those risk factors can be affected however it is rare. My patient was an elderly patient and this fits with meningitis since the elderly are at a higher risk for listeriosis. So you probably are thinking that you can just avoid cantaloupe and you will be ok. Listeria monocytogenes is widespread in the environment. It has been recovered from soil, water, vegetation animal products such as raw milk, cheese, poultry, and processed meats. The frequency of listeriosis according to a prospectively collected study by the CDC in 1987 showed 1600 cases of listeriosis with 415 deaths per year in the U.S. The outbreak of Listeria monocytogenes last fall was tracked back to cantaloupes from Jensen Farms in the southeast of Colorodo. This was actually the first listeriosis outbreak associated with a whole fruit or vegetable. Factors that the FDA list as possible contributing factors included:

Growing Environment:

·         Low level sporadic Listeria monocytogenes in the agricultural environment and incoming cantaloupe may have contributed to the introduction of the pathogen into the packing facility.

Packing Facility and cold Storage:

·         A truck used to haul culled cantaloupe to a cattle operation was parked adjacent to the packing facility and could have introduced contamination into the facility;

·         Facility design allowed for the pooling of water on the packing facility floor adjacent to equipment and employee walkway access to grading stations;

·         The packing facility floor was constructed in a manner that was not easily cleanable;

·         The packing equipment was not easily cleaned and sanitized;

·         The washing and drying equipment used for cantaloupe packing was previously used for postharvest handling of another raw agricultural commodity; and

·         There was no pre-cooling step to remove field heat from the cantaloupes before cold storage.

The FDA made recommendations for prevention of Listeria monocytogenes based on their findings and they included the following:

·         Assess produce facility and equipment design to ensure adequately cleanable surfaces and eliminate opportunities for introduction, growth, and spread of Listeria monocytogenes and other pathogens. 

·         Assess and minimize opportunities for introduction of Listeria monocytogenes and other pathogens in packing facilities. 

·         Implement cleaning and sanitizing procedures.

·         Verify the efficacy of cleaning and sanitizing procedures.

·         Periodically evaluate the processes and equipment used in packing facilities to assure they do not contribute to fresh produce contamination. 

 Let me know if you have additional questions. You can also find additional information about Listeria monocytogenes or the the outbreak previously discussed at: http://www.cdc.gov/listeria/

Welcome

This first post will just be a little information about me and the purpose of this blog. My name is Jared Swiney. I received my bachelor’s degree from Auburn University in Biomedical Sciences in 2005. I have been married since 2006 and have a 2 year old daughter. I have about 12 years’ experience in the pharmacy industry where I have performed several roles in participant services, client services, training, and quality. I am also a lean six sigma green belt. I am currently a graduate student at the University of Alabama at Birmingham studying Clinical Laboratory Sciences. This summer I am taking CLS 538 Infectious diseases. For this class my graduate assignment is to write this blog. Twice per week I will post in this blog. The first post for each week will be information regarding a topic covered in class that week and the second post will be in regards to my graduate topic which is Hepatitis C Virus. Thanks for reading and I hope you enjoy my posts.