最近,愛荷華大學的流行病學教授Tara Smith和她的學生,在愛荷華州和俄亥俄州的農場,抽查豬和養豬人的鼻腔樣本,發現有75%以上的豬,和45%的養豬人,是MRSA,抗藥性金黃色葡萄球菌的帶原者。
抗藥性金黃色葡萄球菌是在1960年代,在醫療工作者、安養之家的老人和長期住院接受抗生素治療的病人身上發現的。因為這群人常有和抗生素接觸的機會,他們身上的細菌,也就演化成能不被抗生素,尤其是青黴素殺害的品種。但到了90年代,隨著養殖業濫用抗生素,這株菌終於在社區、學校、軍隊等健康人聚集之處殺出一條血路,在美國,一年內死於MRSA感染的人,比愛滋病人還多;2005年,約95000個感染者中,將近19000個人死亡。
MRSA潛伏在鼻腔之中,健康的人不會有任何症狀。但是免疫力差的人,若是傷口被MRSA感染,可能會因為沒有無藥可治而死亡。萬古黴素(Vancomycin)是目前唯一能用來治療MRSA的抗生素,然而,已經有細菌演化成萬古黴素也無用的超級細菌。
歐陸、北歐和加拿大都有研究顯示在家禽家畜或飼養者身上有MRSA。今年年初,加拿大的Scott Weese教授在加拿大四個省抽查212個豬肉樣本,發現約10%有MRSA,他也指出,其他的肉品包括牛肉、雞肉和羊肉都有可能被MRSA感染。上週,在蘇格蘭發現三名MRSA的病人,他們都不是在農場工作,或是跟家禽家畜有密切關係的人,顯示MRSA有可能已經隨著生肉進入一般人的生活圈。
在美國,負責檢驗肉品生菌的美國農業局(U.S. Department of Agriculture, USDA)和疾病管制局CDC都沒有實驗室檢查MRSA,而另一個負責檢查食品中生菌的組織,國家微生物抗藥性檢測系統(National Antimicrobial Resistance Monitor System),檢查的項目包括沙門氏菌(Salmonella)、彎曲桿菌(Campylobacter)和大腸桿菌,不含MRSA。
在美國國會,養豬業的聯盟和部分國會議員正爲是否該將MRSA列入常規檢查進行攻防。
一般人想預防MRSA其實不困難。只要處理完生肉後馬上洗手,髒手不要碰鼻子,和將肉煮熟都可以大大減少MRSA的感染機率。
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對我來說,這則新聞在某種程度上,是前幾天寫的〈美國肉牛的故事〉番外篇。
也許在看《The Ominvore's Dilemma》之前,我不會對以前學校裡感染科老醫師所說的「抗生素濫用」有這麼深的感觸;在看這篇報導時,會很理直氣壯的說:「那就去驗MRSA啊!」;或是對報導裡CDC和USDA的人閃閃躲躲,只會說美國境內絕對沒有MRSA感染肉品的情形只覺嗤之以鼻。
但是,一旦明白,整個農業和食品業工業化後,從上游的玉米到下游的食品或肉品之間的環環相扣,就會發現這些人有此反應的原因。
他們都是微生物學專家,他們不會不懂MRSA是怎麼突破醫院或療養院的高牆進到社區裡的。但是,一個MRSA,很有可能讓美國朝著單一化流程的肉品業,一夕之間崩盤。
這麼說好了,USDA之所以不支持小農,是因為工業化後的肉品業能養活許多人,包括石化業、飼料業和藥廠的工作人員。也因為工業化後的肉品業,抗生素的使用是必要之惡,一但在美國的肉品上找到MRSA,追根究底還是抗生素的使用,必須禁用抗生素,原本依靠這個龐大的肉品業製造流程生存的人,要怎麼活?
這將是個動搖國本的問題,所以豬肉上不是沒有MRSA,而是不能有MRSA。
真正講起來,也許罪魁禍首還是人。如果不是人類有能力製造化學肥料,這世界上每五個人就有三個人不會存在,這多出來的三個人,是靠石油工業支持的食品業養大的。當人類再也沒有辦法從地底挖出一滴石油來,只能靠著將太陽能轉化成人類可以消化吸收的植物,和替我們轉化人類無法消化的植物能量的動物生存的時候,也許,這些因為石油而產生的食物問題,就不會再存在。
美國已經有石油專家預測三到五年內,汽油的價格就有可能漲到毎加侖(約3.8公升)14美金。那個時候生活在美國的人,將怎麼過日子呢?靠由玉米製造的生質燃料嗎?別忘了,美國現在這一大片一大片的玉米田,也是用石油養大的。也許再過不久的將來,玉米就會比汽油還貴。
也許,是該開始思考,建築在石油上的人類文明和都市生活,得何去何從的時候了。
Seattle PI
http://seattlepi.nwsource.com/local/366301_pigmrsa09.html
Potentially fatal bacteria found in pigs, farmworkers
Federal agencies urged to check for MRSA in meat
Last updated June 8, 2008 9:46 p.m. PT
By ANDREW SCHNEIDER
P-I SENIOR CORRESPONDENT
Federal food safety and public health agencies are being urged to begin checking meat sold across the country for the presence of MRSA, a potentially fatal bacteria. Scientists have found the infection in U.S. pigs and farmworkers.
Members of Congress and public health advocates are demanding that the government determine whether highly infectious MRSA has entered the food supply.
MRSA -- methicillin-resistant Staphylococcus aureus -- can be extremely dangerous, according to the federal Centers for Disease Control and Prevention. Dr. Monina Klevens examined the cases of the disease reported in hospitals, schools and prisons in one year and extrapolated that "94,360 invasive MRSA infections occurred in the United States in 2005; these infections were associated with death in 18,650 cases."
The infection has been reported among livestock and farmworkers in Europe, Scandinavia and Canada, but the U.S. government has yet to test animals in this country.
Last week, the Seattle P-I's "Secret Ingredients" blog disclosed that Tara Smith, an assistant professor at the University of Iowa Department of Epidemiology, and her graduate researchers found MRSA in more than 70 percent of the pigs they tested on farms in Iowa and Illinois.
In what is apparently the first testing of swine for MRSA in the U.S., Smith and her team swabbed the noses of 209 pigs on 10 farms. They also found the bacteria among livestock workers employed by those hog operations.
On Friday, at the annual meeting of the American Society for Microbiology in Boston, Abby Harper, one of Smith's graduate assistants, presented the results of the study on farmworkers. She said she and Michael Male tested 20 workers at the Iowa swine farms and found that 45 percent carried the same MRSA bacteria as the pigs.
Smith said she is working with collaborators in Minnesota, Ohio, North Carolina and other areas to examine more swine farms. "We're going to be looking at conventional, free-range and organic or antibiotic-free pigs," she said.
"We will be paying special attention to the antibiotics that are being used, because there are indications that the tetracycline used in swine farming may be the cause of the spread of MRSA," she explained.
A link between increased use of antibiotics and an increased incidence of MRSA is being hotly debated.
Long before MRSA was identified as a potential killer in the early 1960s, public health professionals anguished over the excessive use of antibiotics because they believed it caused bacteria to become resistant to the very medications used to control them.
From the 1960s to the 1980s, MRSA was considered mainly as a threat to hospital and nursing home patients and those who cared for them.
But in the mid-1990s, the CDC reported that the drug-resistant bacteria had broken out of the institutional medical setting and outbreaks were being found among the young and healthy. A virulent strain called CA-MRSA was being reported at schools and was being found in some military units and among high school, college and professional athletes.
During the same period, prophylactic use of antibiotics to prevent disease among livestock went from rare to commonplace. Today, the food fed to fish, fowl, cows, pigs and sheep raised for human consumption is laced with antibiotics.
The similarity between the timeline for increased use of antibiotics in livestock and the soaring rate of MRSA in the general population has already caught the attention of academic researchers and is likely to spark demands for additional research funds.
Earlier this year, Dr. Scott Weese of the Department of Pathobiology at the Ontario Veterinary College told those attending the International Conference on Emerging Infectious Diseases at the CDC that he and his colleagues had found MRSA in 10 percent of 212 samples of pork chops and ground pork bought in four Canadian provinces.
"I think it is very likely that the situation is the same in the U.S.," he told the P-I. "We've proven MRSA is in pigs and the marketed pork in Canada, and we know that it's also in U.S. pigs. It's inconceivable that it wouldn't also be found in the pork products from those pigs."
Dr. Rebecca Goldburg, senior scientist with the Environmental Defense Fund, said, "There are now more deaths in the USA from MRSA than from HIV-AIDS, but U.S. officials appear in denial about animal agriculture as a source of these deadly bacteria."
Goldburg said that the identical strain of MRSA that the researchers in the Midwest and Canada identified in pigs has been linked "with serious human illness including skin, wound, breast, and heart infections, as well as pneumonia."
Last week, according to British newspapers, scientists reported that three patients in separate hospitals in Scotland were infected with the ST398 strain of MRSA, the same strain that Smith and her researchers found in Midwest farms.
What makes this particularly important, public health experts told the P-I, is that doctors reported that none of the patients worked on a farm or had a close association with farm animals, raising the possibility that the so-called superbug has entered the food chain in Britain.
So who is checking to see if antibiotic-resistant staph bacteria are in the 762 million pounds of Canadian pork that's imported into the U.S. each year and in the millions more pounds produced here?
Apparently no one.
That duty should belong to the U.S. Department of Agriculture for imported meat, and the Food and Drug Administration for meat sold domestically.
Dr. David Goldman is in charge of the USDA's four laboratories that examine imported food.
"Any pathogen or hazard that's transmitted through the foods we regulate is a potential issue for us, and so you know, certainly we are aware of the study (Weese) did," Goldman said during an interview at a recent food-safety meeting in Seattle.
"There is no indication MRSA has been identified in swine going into the retail market. Not in this country. Not in swine or other livestock being sold for food in this country," the doctor added.
But none of the USDA labs that he runs is checking for MRSA in imported meat.
"We just don't have a test for it," Goldman said.
The FDA is aware of Weese's study, but "we do not yet have similar data with regards to the MRSA situation among food animals and retail meats," said Mike Herndon, an agency spokesman.
Responding to questions before Smith's study was released, Herndon said there was one MRSA strain of "particular concern in the veterinary medicine and food safety arenas." That was the strain that Smith found in the Midwest swine and their farmers.
Nevertheless, the FDA and USDA eagerly pointed to a group called the National Antimicrobial Resistance Monitoring System as the protector of humans from bacteria in food.
The coalition of scientists from several federal agencies primarily target salmonella, campylobacter and E. coli.
However, according to USDA's Goldman, the group does not screen for MRSA.
The National Pork Producers Council said there is no cause for concern.
"There is nothing to worry about; MRSA (in pigs) has not been found this side of the border," a spokeswoman said. "USDA and CDC have given our pigs a clean bill of health."
A CDC spokeswoman said that she could find "no indication we made that statement."
According to congressional investigators, the pork lobbyists have said their industry would oppose any attempt to test all livestock for MRSA, calling the testing "unnecessary to protect public health."
Some members of Congress are insisting that the government do more to determine MRSA's threat to the food supply.
Rep. Henry Waxman, D-Calif., chairman of the House Committee on Oversight and Government Reform, warned last week that there is "overwhelming evidence" that the overuse of antibiotics in industrial livestock production is endangering the effectiveness of many of the most crucial antibiotics for humans.
"Americans have experienced firsthand the importance of ensuring that we preserve our arsenal (of antibiotics) to fight the new and emerging superbugs, like MRSA," Waxman said at a health hearing on FDA and animal drug issues.
"We know that the overuse of antibiotics hampers our ability to do that."
The issue was addressed in a report on industrial farm animal production by The Pew Charitable Trusts and Johns Hopkins' Bloomberg School of Public Health.
The recently issued report recommended: "Improve monitoring and surveillance of antimicrobial resistance in the food supply, the environment, and animal and human populations in order to refine knowledge of antimicrobial resistance and its impacts on human health."
Meanwhile, some infection-control experts say that proper cooking will kill the MRSA bacterium.
The health threat for butchers and cooks alike, if there is one, will come from improperly handled meat.
"If people wash their hands after handling raw pork and prevent cross-contamination, risks should be very low," Weese said from Canada.
"The main possible concern is that people could get MRSA on their hands from raw pork, then touch their nose. The nose is the prime site for MRSA to live," he said.
Some public-heath experts worry that butchers and professional and home cooks may be infected if MRSA bacteria on their hands entered a cut or a wound.
In a cautionary note, Weese warned that MRSA could also be in beef, chicken and lamb. But no one, he said, is checking.
P-I senior correspondent Andrew Schneider can be reached at 206-448-8218 or andrewschneider@seattlepi.com. Read his Secret Ingredients blog at blog.seattlepi.com/secretingredients.
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