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Puncture wounds produced by contaminated objects or trauma wounds are espe cially dangerous generic albuterol 100 mcg without prescription asthma definition in kannada. Surgical interventions and induced abortions performed without adequate asepsis have given rise to tetanus generic albuterol 100 mcg with mastercard asthma definition banal. Distribution of tetanus morbidity according to political division and climate albuterol 100 mcg mastercard asthma attack symptoms 2 year old, Argentina cheap albuterol 100 mcg otc asthma symptoms home remedies, 1967�1977. Political Average number Population at middle Rate per division of notified of reporting period 100,000 and climate cases per year (in thousands) inhabitants Subtropical 168. The spores enter through a wound that may be an anaerobic medium, especially if there is tissular necrosis. The disease is due to tetanospasmin, a very potent neurotoxin (see the section on etiology). It enters the nervous system through the neuromuscular junctions of alpha motor neurons. Tetanospasmin inhibits the release of various neurotransmit ters, allowing the lower motor neurons to increase muscle tone and produce convul sions simultaneously in the agonist and antagonist muscles (Cate, 1990). The patient must be kept in an intensive care unit and treated with benzodi azepines to reduce anxiety, and to obtain a central anticonvulsive effect and muscu lar relaxation. Administration of penicillin or other antibiotics is recommended to reduce the toxin load (Cate, 1990). The Disease in Animals: Horses are very susceptible to tetanus and usually acquire it from shoeing nails. Localized rigidity appears first, due to tonic convulsions of the masseter muscles, the neck muscles, and the hind legs, fol lowed by generalized rigidity. Reflexes are increased and the animals are easily star tled by noise, which causes general convulsions. Cattle have a high rate of neutralizing antibodies against the neurotoxin (tetanospasmin) of C. In calves and lambs, tetanus often follows castration, especially when rubber bands are used, since the necrotic tissue left by this opera tion favors anaerobiosis. Good results can be obtained in horses if they are treated at the onset of the disease. The wound must also be cleaned and drained, and broad spectrum antibiotics administered (Fraser et al. Source of Infection and Mode of Transmission: the reservoir and source of infection is soil containing C. The etiologic agent is found in many soils, par ticularly cultivated soil rich in organic matter. It has also been found in other species, such as cattle, sheep, dogs, rats, and chickens; similarly, man may harbor C. In Paraguay, of 2,337 cases studied from 1946 to 1972, the portal of entry was the umbilical stump in 31. Role of Animals in the Epidemiology of the Disease: Tetanus is a disease common to man and animals, not a zoonosis. Some authors ascribe the role of reservoir to animals (McComb, 1980; Benenson, 1990), but it is more likely that the disease agent derives from the soil, and that it is present in the digestive tract of herbivores and omnivores only transitorily and does not multiply there (Wilson and Miles, 1975; Smith, 1975). Diagnosis: Prior existence of a wound and accompanying symptoms are the bases for diagnosis. Control: In man, given the soil origin of the infection, the only rational means of control is active immunization with toxoid. They should then receive a booster, preferably administered 18 months after the last dose. An initial series of three doses induces protective titers of antitoxin for 5 to 13 years in 90% or more of those vac cinated. Booster shots ensure higher titers of the antitoxin and probably confer immunity throughout a womans childbearing years (Halsey and de Quadros, 1983). Periodic boosters of tetanus toxoid every 10 years are recommended, particularly for population groups most at risk. In developing countries, immunization is recommended for pregnant mothers to prevent tetanus mortality in newborns. The effectiveness of prenatal immunization with tetanus toxoid (anatoxin) has been demonstrated. Primary immunization con sists of administering two doses, one at the start of pregnancy and another one month later, but not beyond three weeks before birth. If a pregnant woman has already been immunized, she only needs a booster and probably has enough anti bodies to protect the children she bears over the next five years (Stanfield and Galazka, 1984). Passive immunization with antitoxin should be reserved for persons with no pre vious active immunization who must undergo surgical operations, as well as for women after abortion or birth and for their newborn children in high-risk areas. The use of human antitoxin serum is preferable, but if unavailable, horse or bovine hyperimmune serum can be used after the patient is tested for a possible allergic reaction to the serum. Persons who have previously received basic toxoid treatment should be given a booster if the wound is small and more than 10 years have passed since the last dose. If the patient has a large, contaminated wound, a booster toxoid should be given if he was not vaccinated in the last five years. Persons who did not receive a full primary series of tetanus toxoid should receive a dose of toxoid and may require an injection of human tetanus immunoglobulin, if it is a major wound and/or is contaminated (Benenson, 1990). Horses in particular should be vacci nated with toxoid; two doses given one to two months apart are sufficient. If the horse suffers from a potentially dangerous wound, another toxoid injection should be given. At the same time, one dose of toxoid should be given and repeated one month later. Operations such as dehorning, castration, and tail docking should be done in the most aseptic conditions possible and antiseptics should be applied to surgical wounds.

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Dregea volubilis (Apocynaceae) Annona squamosa (Annonaceae) Holarrhena pubescens (Apocynaceae) Venereal disease. Plumeria rubra (Apocynaceae) Bryophyllum pinnatum (Crassulaceae) Zingiber montanum (Zingiberaceae) Eclipta prostrata (Asteraceae) -too little urine Momordica charantia (Cucurbitaceae) 340 Robert A. Krupnick / PhytoKeys 102: 1�341 (2018) Mucuna pruriens (Fabaceae) Ipomoea aquatica (Convolvulaceae) Plumbago indica (Plumbaginaceae) Mucuna pruriens (Fabaceae) Rauvolfa serpentina (Apocynaceae) Piper betle (Piperaceae) Rotheca incisa (Lamiaceae) Piper cubeba (Piperaceae) Senna alata (Fabaceae) Senna alata (Fabaceae) Smilax glabra (Smilacaceae) Sesbania sesban (Fabaceae) Smilax guianensis (Smilacaceae) Vitex trifolia (Lamiaceae) Urena lobata (Malvaceae) Vitiligo Volkameria inermis (Lamiaceae) Clitoria ternatea (Fabaceae) -joint infammation from Millingtonia hortensis (Bignoniaceae) Clerodendrum indicum (Lamiaceae) Terminalia bellirica (Combretaceae) -sores Vomit Carica papaya (Caricaceae) Acacia concinna (Fabaceae) Ficus religiosa (Moraceae) Acalypha indica (Euphorbiaceae) Plumeria rubra (Apocynaceae) Amaranthus spinosus (Amaranthaceae) Syzygium cumini (Myrtaceae) Apium graveolens (Apiaceae) -vaginal discharge due to, Aquilaria malaccensis (Tymelaeaceae) Amaranthus spinosus (Amaranthaceae) Arundo donax (Poaceae) Syzygium cumini (Myrtaceae) Basella alba (Basellaceae) Tamarindus indica (Fabaceae) Cinnamomum tamala (Lauraceae) Vermifuge Citrus aurantiifolia (Rutaceae) Asclepias curassavica (Apocynaceae) Coix lacryma-jobi (Poaceae) Calotropis gigantea (Apocynaceae) Coriandrum sativum (Apiaceae) Eurycoma longifolia (Simaroubaceae) Curcuma longa (Zingiberaceae) Passifora quadrangularis (Passiforaceae) Cymbopogon citratus (Poaceae) Senna tora (Fabaceae) Euphorbia hirta (Euphorbiaceae) Solanum anguivi (Solanaceae) Foeniculum vulgare (Apiaceae) Syzygium aromaticum (Myrtaceae) Hydnocarpus kurzii (Achariaceae) Vesicant Justicia adhatoda (Acanthaceae) Cleome gynandra (Cleomaceae) Ocimum americanum (Lamiaceae) Virility Rauvolfa serpentina (Apocynaceae) Acalypha indica (Euphorbiaceae) Strychnos potatorum (Loganiaceae) Allium sativum (Amaryllidaceae) Syzygium aromaticum (Myrtaceae) Arundo donax (Poaceae) Tanacetum cinerariifolium (Asteraceae) Coix lacryma-jobi (Poaceae) Terminalia citrina (Combretaceae) Cuscuta refexa (Convolvulaceae) Trachyspermum ammi (Apiaceae) Datura stramonium (Solanaceae) -of blood Diospyros malabarica (Ebenaceae) Mimosa pudica (Fabaceae) Dregea volubilis (Apocynaceae) Sinapis alba (Brassicaceae) Gossypium barbadense (Malvaceae) Tinospora cordifolia (Menispermaceae) Gossypium hirsutum (Malvaceae) Tradescantia spathacea (Commelinaceae) Ipomoea aquatica (Convolvulaceae) Vulnerary. Mirabilis jalapa (Nyctaginaceae) Celosia argentea (Amaranthaceae) Piper betle (Piperaceae) Wasting Urena lobata (Malvaceae) Plumbago zeylanica (Plumbaginaceae) Vitality Weakness Acalypha indica (Euphorbiaceae) Alstonia scholaris (Apocynaceae) Allium cepa (Amaryllidaceae) Boerhavia difusa (Nyctaginaceae) Coptis teeta (Ranunculaceae) Cardiospermum halicacabum (Sapindaceae) Diospyros malabarica (Ebenaceae) Cinnamomum bejolghota (Lauraceae) Dregea volubilis (Apocynaceae) Vitex trifolia (Lamiaceae) Eclipta prostrata (Asteraceae) -during menstruation The medicinal plants of Myanmar 341 Citrus limon (Rutaceae) Leea macrophylla (Vitaceae) Weight gain -intestinal worms Alstonia scholaris (Apocynaceae) Aegle marmelos (Rutaceae) Aquilaria malaccensis (Tymelaeaceae) -threadworms, roundworms Catharanthus roseus (Apocynaceae) Alstonia scholaris (Apocynaceae) Ficus religiosa (Moraceae) Gloriosa superba (Colchicaceae) Gossypium barbadense (Malvaceae) Moringa oleifera (Moringaceae) Gossypium hirsutum (Malvaceae) Wounds Mucuna pruriens (Fabaceae) Allium sativum (Amaryllidaceae) Nyctanthes arbor-tristis (Oleaceae) Asclepias curassavica (Apocynaceae) Oroxylum indicum (Bignoniaceae) Calophyllum inophyllum (Calophyllaceae) Plumbago indica (Plumbaginaceae) Curcuma longa (Zingiberaceae) Senna alata (Fabaceae) Cycas rumphii (Cycadaceae) Weight loss Diospyros malabarica (Ebenaceae) Urena lobata (Malvaceae) Eucalyptus globulus (Myrtaceae) Vitex trifolia (Lamiaceae) Ficus retusa (Moraceae) Whooping cough Heliotropium indicum (Boraginaceae) Boerhavia difusa (Nyctaginaceae) Mimusops elengi (Sapotaceae) Croton tiglium (Euphorbiaceae) Zingiber montanum (Zingiberaceae) Eucalyptus globulus (Myrtaceae) Zingiber ofcinale (Zingiberaceae) Piper betle (Piperaceae) Yaws Rotheca serrata (Lamiaceae) Alstonia scholaris (Apocynaceae) Senna alata (Fabaceae) Exact purposes not given Syzygium aromaticum (Myrtaceae) Culinary purposes: Worms Trachyspermum roxburghianum (Apiaceae) Acorus calamus (Acoraceae) Medicinal values/purposes: Annona squamosa (Annonaceae) Acalypha wilkesiana (Euphorbiaceae) Azadirachta indica (Meliaceae) Amherstia nobilis (Fabaceae) Clerodendrum indicum (Lamiaceae) Bougainvillea spectabilis (Nyctaginaceae) Coccinia grandis (Crassulaceae) Clerodendrum thomsoniae (Lamiaceae) Combretum indicum (Combretaceae) Delonix regia (Fabaceae) Eclipta prostrata (Asteraceae) Eucalyptus globulus (Myrtaceae) Holarrhena pubescens (Apocynaceae) Grewia asiatica (Malvaceae) (root) Momordica charantia (Cucurbitaceae) Grewia hirsuta (Malvaceae) Mucuna pruriens (Fabaceae) Kopsia fruticosa (Apocynaceae) Nyctanthes arbor-tristis (Oleaceae) Linostoma pauciforum (Tymelaeaceae) Piper longum (Piperaceae) Spatholobus parviforus (Fabaceae) Plumbago zeylanica (Plumbaginaceae) Terminalia catappa (Combretaceae) Tadehagi triquetrum (Fabaceae) Trachyspermum roxburghianum (Apiaceae) Zingiber montanum (Zingiberaceae) Oral medications: -guinea worm Ricinus communis (Euphorbiaceae). If this trend continues, 33% or one in three Oregonians could be Latino / Hispanic by 2020. Oregons economy relies on nursery, agriculture, manufacturing, forestry, construction, food processing, restaurants, hospitality, and services. The first is Oregon English-speaking employers and the second is Oregon limited English-Speaking Latino / Hispanic workers supervisors and employers wishing to improve occupational safety and health communication. In preparing this dictionary, every effort has was made to provide the most current, correct, and clearly expressed information. I am looking for busco I am sorry lo siento I am very sorry lo siento mucho I do not understand no comprendo I donflt think so creo que no I hope so espero que si I need an interpreter necesito un interprete I need it for tomorrow lo necesito para manana I need it in one hour lo necesito en una hora I need it now lo necesito ahora I need it tomorrow lo necesito manana I need to know necesito saber I speak a little English hablo ingles un poco I speak a little Spanish hablo espanol un poco I think so creo que si I would like to know quisiera saber itfls no trouble no es molestia no no perhaps tal vez please por favor please repeat repitalo por favor please write it down escribalo por favor speak more slowly please hable mas despacio por favor thank you gracias truefl P187 2001 En the Pan American Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and inquiries should be addressed to the Publications Program, Pan American Health Organization, Washington, D. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the Pan American Health Organization concerning the status of any country, ter ritory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the Pan American Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. Foods giving rise to botulism, and number of outbreaks, United States of America, 1899�1977. Distribution of tetanus morbidity according to political division and climate, Argentina, 1967�1977. Infections and parasitoses of cattle can reduce meat or milk production and can lead to the death or destruction of the animals, all of which diminishes the supply of available food for man. These diseases are also an obstacle for international trade, as well as a serious financial drain for cattle farmers and, more broadly, for a com munitys or a countrys economy, which can have wide repercussions for a societys health. An example of this work is the preparation of several publications, among which the two previous Spanish and English editions of Zoonoses and Communicable Diseases Common to Man and Animals stand out. Also, the countries of the Americas have modified their livestock production strategies in recent years, which has affected the transmission of zoonotic infections and their distribution. The third edi tion is presented in three volumes: the first contains bacterioses and mycoses; the second, chlamydioses, rickettsioses, and viroses; and the third, parasitoses. We believe that this new edition will continue to be useful for professors and stu dents of public health, medicine, and veterinary medicine; workers in public health and animal health institutions; and veterinarians, researchers, and others interested in the subject. In summary, we are confident that this book will contribute to the application of the knowledge and resources of the veterinary sciences for the protection and improvement of public health. In the first group, animals play an essential role in maintaining the infection in nature, and man is only an accidental host. In the sec ond group, both animals and man generally contract the infection from the same sources, such as soil, water, invertebrate animals, and plants; as a rule, however, animals do not play an essential role in the life cycle of the etiologic agent, but may contribute in varying degrees to the distribution and actual transmission of infections. No attempt has been made to include all infections and diseases comprised in these two groups. A selection has been made of some 150 that are of principal inter est, for various reasons, in the field of public health. The number of listed zoonoses is increasing as new biomedical knowledge is acquired. Moreover, as human activ ity extends into unexplored territories containing natural foci of infection, new zoonotic diseases are continually being recognized. In addition, improved health services and better differential diagnostic methods have distinguished zoonoses pre viously confused with other, more common diseases. A number of diseases described in this book have only recently been recognized, examples of which include the Argentine and Bolivian hemorrhagic fevers, angiostrongyliasis, rotaviral enteritis, Lassa fever, Marburg disease, and babesiosis.

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Animal Toxicity Studies: Animal studies have also confirmed that this herb buy albuterol 100mcg low cost asthma x-ray in children, when taken internally as an infusion cheap 100mcg albuterol free shipping asthmatic bronchitis pdf, has no toxic properties purchase albuterol 100 mcg without a prescription asthma prophylaxis definition. In one study albuterol 100mcg visa uncontrolled asthma definition gina, no toxic effects were induced when doses up to 20 times 342 greater than the estimated corresponding human dosage were administered orally to male and female rats; when given to rodents prior to mating or during pregnancy, no evidence of toxicity was observed in their offspring (Souza et al. In laboratory and preclinical studies, this medicinal plant and/or its constituents have demonstrated the following effects: antibacterial, antifungal, anti-inflammatory, antimalarial, antimicrobial, antinociceptive, antioxidant, antitumor, carcinogenesis inhibition, chemopreventive, enzyme inhibition (acetylcholinesterase, butyrylcholinesterase and lipoxygenase), heart rate-lowering, hypocholesterolemic, polyphenol oxidase inhibition and vasorelaxant (see Laboratory and Preclinical Data table below). Major chemical constituents identified in this plant include: 1,8-cineole, alpha-citral (geranial), alpha-pinene, alpha-terpineol, caprylic acid, caryophyllene, citral, citronellal, citronellol, cymbopogone, diacetyl, dipentene, farnesal, farnesol, furfural, geraniol, geranyl acetate, isopulegol, isovaleraldehyde, isovaleric acid, limonene, linalyl acetate, luteolin, myrcene, neral, nerol, quercetin, rutin, saponin and triacontanol (Duke & Beckstrom-Sternberg 1998). Indications and Usage: Typical administration is as a tea prepared with 2 g of dried leaf in 150 mL of boiling water. Laboratory and Preclinical Data: Cymbopogon citratus Activity/Effect Preparation Design & Model Results Reference Antibacterial Essential oil In vitro: against Exhibited dose dependent Katewa et al. Antibacterial Essential oil In vitro: agar diffusion Exhibited significant Nguefack et al. Hortus Third: A Concise Dictionary of Plants Cultivated in the United States and Canada. Lippia alba, Melissa officinalis and Cymbopogon citratus: effects of the aqueous extracts on the isolated hearts of rats. In vitro enzyme inhibition activities of crude extracts derived from medicinal plants of Pakistan. The effects of Cymbopogon citratus (Serai) on the heart, liver and kidney of normal and hypercholesterolaemic rats. Five essential oils from aromatic plants of Cameroon: their antibacterial activity and ability to permeabilize the cytoplasmic membrane of Listeria innocua examined by flow cytometry. Ohno T, Kita M, Yamaoka Y, Imamura S, Yamamoto T, Mitsufuji S, Kodoma T, Kashima K, Imanishi J. Puatanachokchai R, Kishida H, Denda A, Murata N, Konishi Y, Vinitketkumnuen U, Nakae D. Inhibitory effects of lemon grass (Cymbopogon citratus, Stapf) extract on the early phase of hepatocarcinogenesis after initiation with diethylnitrosamine in male Fischer 344 rats. Polyphenol oxidase inhibitory activity of essential oils of Cymbopogon nardus and Cymbopogon citratus. Vasorelaxation induced by common edible tropical plant extracts in isolated rat aorta and mesenteric vascular bed. Effects of daily two month administration in male and female rats and in offspring exposed in utero. In vivo antimalarial activity of essential oils from Cymbopogon citratus and Ocimum gratissimum on mice infected with Plasmodium berghei. Note: Because of their similar appearance and comparable properties, the two species Plantago major and P. This plant should not be confused with the banana-like fruit called plantain (platano, Musa spp. Traditional Preparation: the fresh leaves can be crushed or liquefied to extract their juice or a tea can be prepared by decoction of the fresh or dried leaves, either alone or in combination with other medicinal herbs. For external application, the fresh leaves are crushed or warmed and applied topically to the affected area. Traditional Uses: Llanten is considered a cooling (fresco) plant with many traditional uses as a remedy. If the fresh plant is available, it can be crushed and liquefied (using a blender, juice extractor, grater or mortar and pestle) to extract the green juice of the leaves which is reported to have numerous therapeutic applications, including wound-healing properties. For liver disorders, vaginal infections, high cholesterol, stomach ache and abdominal pain, menopausal hot flashes or conditions associated with excess heat in the body, a refreshing tea is prepared of the leaves and can be sweetened with molasses (melaza). For treating headache, migraines (jaqueca) and nausea, the leaves are slightly warmed and combined with animal lard or sheeps tallow (sebo de flande) and bitter orange (naranja agria) leaves and applied to the forehead or affected area as a bandage, covered with a cloth. As an abortifacient, this plant is used either on its own or in combination with other plants in a multi-herb decoction or tincture (botella). Availability: this medicinal plant can be found growing along roadsides, sidewalks and parks in urban areas of New York City. Leaves grow directly from the base of the plant in a whorl-like pattern; each leaf is simple, widely-oval to lance or spatula-shaped (15-25 fl 6-10 cm), narrowing at the base, with numerous prominent parallel veins and leaf edges that are slightly wavy. Flowers are numerous, tiny and grow in a dense, elongated cluster or spike, born atop a central stalk with white petals. Fruits are tiny, round, dry, straw-colored capsules, each containing 15-20 wedge-shaped seeds (Acevedo-Rodriguez 1996). Distribution: Native to Eurasia, this plant is a cosmopolitan species that is often found in wet, moist areas and grows throughout the Americas (Acevedo-Rodriguez 1996). Animal Toxicity Studies: In an animal study, no evidence of acute toxicity or deaths were caused by doses of up to 2 g/kg body weight of the methanol seed and leaf extracts in mice (Atta & El Sooud 2004). In another clinical trial of this plant, no diuretic effect was observed on urine output or sodium excretion (see Effect Not Demonstrated table below). In laboratory and/or animal studies, Plantago major has demonstrated the following effects: antibacterial, antidiarrheal, antinociceptive, antitumor, antiviral, chemopreventive, cytotoxic, gastroprotective, immunomodulatory 349 and laxative (see Laboratory and Preclinical Data table below). The following additional pharmacological effects of llanten (Plantago lanceolata) have been demonstrated or suggested in the literature: antibacterial, blood clotting, epithelization and treatment of respiratory tract infections (Gruenwald et al. Biologically active constituents of Plantago major include: acetoside, adenine, alkaloids, allantoin, apigenin, aucubin, baicalein, baicalin, benzoic acid, caffeic acid, catalpol, chlorogenic acid, cinnamic acid, ferulic acid, fumaric acid, geniposidic acid, gentisic acid, hispidulin, luteolin, mucilage, neo-chlorogenic acid, nepetin, oleanolic acid, p-coumaric acid, p-hydroxybenzoic acid, salicyclic acid, sorbitol, syringin, tyrosol, ursolic acid and vanillic acid (Duke & Beckstrom-Sternberg 1998). Indications and Usage: Llanten (Plantago lanceolata) is approved by the Commission E for the following health conditions: common cold, cough, bronchitis, fevers, inflammation of the mouth and throat and inflammation of the skin (Blumenthal et al. Clinical Data: Plantago major Activity/Effect Preparation Design & Model Results Reference Bronchitis Plant extract; Clinical trial: n=25 Active; rapid effect on Matey et al.

Effcacy is unlikely to be infuenced by delaying prophylaxis for as long as 1 hour to facilitate parent-infant bonding cheap albuterol 100 mcg without a prescription asthma treatment by fish in hyderabad 2016. Hospitals should establish a process to ensure that infants are given prophylaxis appropriately buy 100mcg albuterol with visa asthma handouts. A disease may be added to the list as a new pathogen emerges or may be deleted as its incidence decreases albuterol 100mcg free shipping asthma symptoms getting worse. Reporting is only mandated (ie buy discount albuterol 100 mcg asthma vaccine, by legislation or regulation) at the local, state, and territorial jurisdictional level. The list of diseases that are considered reportable, therefore, varies by jurisdiction and from year to year. Health care professionals (eg, clinicians, hospitals, laboratories) in the United States are required to report diseases, conditions, or outbreaks as determined by local, state, or territorial law or regulation, as outlined in each jurisdictions list of reportable conditions. Additional and specifc reporting requirements should be obtained from the appropriate local, state, or territorial health departments. Staff members in the local, state, or territorial health departments implement disease-control and prevention measures as needed. The Council of State and Territorial Epidemiologists has established standard reporting and case classifcation methods for Conditions Under National Surveillance (campylobacteriosis, infuenza-associated hospitalizations, free-living amebae, and melioidosis), but these conditions are not considered nationally notifable. Reporting provides the timely informa tion needed to measure and demonstrate the effect of changed immunization laws or a new thera peutic modality. The fnalized annual data provide information on reported disease incidence that is necessary for study of epidemiologic trends and development of disease-prevention policies. Sometimes, these recommendations vary from those in the manufacturers package inserts. These guidelines, originally issued in 1993, have been updated to give recommendations as of 2012 (on the basis of information available as of January 2012). A panel of 1 experts, including people with experience in pediatric clinical and laboratory medicine, nursing, public health, and infectious diseases, developed the guidelines. Each recommendation included the quality of evidence and strength of recommendations. Immunization standards, overcoming barriers to immunization, vaccine safety, misconceptions, fnance, access, and strategies to improve coverage; 3. Following these guidelines should lead to optimal prevention of disease through 1 vaccination in multiple population groups while maintaining a high level of safety. Infants, children, adolescents, and adults should receive all age-appropriate vaccines recommended by the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics (A-I). Immunization programs for infants, children, adolescents, and adults: clinical practice guidelines by the Infectious Diseases Society of America. Immunization Standards, Overcoming Barriers to Immunization, Vaccine Safety, Misconceptions, Finances, Access, and Strategies to Improve Coverage 9. Standing orders for immunizations should be established in clinics, hospitals, and nursing homes (A-I). Regular assessments of immunization coverage rates should be conducted in provider practices (A-I). Specifcally, annual immunization with infuenza vaccine and receipt of a single booster dose of tetanus toxoid, reduced diphtheria toxoid, and acellular pertus sis (Tdap) should be ensured, as well as adequate immunization against measles, mumps, rubella, and varicella. People whose work anticipates that they may be exposed to blood or body fuids should be immunized against hepatitis B. Providers should administer appropriate vaccines to pregnant women with medical or exposure indications that put them at risk of certain vaccine preventable diseases (A-I). Providers who care for people who travel should ensure that all country-specifc vaccines are administered in a time frame that ensures optimal development of protection (A-I). Outbreak surveillance provides insights into the causes of foodborne illness, types of implicated foods, and settings of foodborne infections. Public health, regulatory, and agricultural professionals can use this information when creating targeted control strategies and to support efforts to promote safe food preparation practices among food industry employees and the public. Four general rules should be followed to maintain safety of foods: � Wash hands and surfaces thoroughly and often. The following preventive measures can be implemented to decrease the risk of infec tion and disease from contaminated food. The most vulnerable populations, such as children, pregnant women, elderly people, 1 Centers for Disease Control and Prevention. Serious systemic infections attributable to Salmonella species, Campylobacter species, Mycobacterium bovis, L monocytogenes, Brucella species, E coli O157:H7, and Y enterocolitica have been linked to consumption of unpasteurized milk, including certi fed raw milk. In particular, many outbreaks of campylobacteriosis among children are associated with school feld trips to farms that include consumption of raw milk. School offcials should take precautions to prevent raw milk from being served to children during educational trips. Cheeses made from unpasteurized milk also have been associated with illness attributable to Brucella species, L monocytogenes, Salmonella species, Campylobacter spe cies, Shigella species, M bovis, and E coli O157:H7. At-risk populations, including children, should not eat raw or undercooked eggs, unpasteurized powdered eggs, or products containing raw or undercooked eggs. Ingestion of raw or improperly cooked eggs can result in severe illness attributable to Salmonella species. Examples of foods that may contain raw or undercooked eggs include some homemade frostings and mayonnaise, ice cream from uncooked custard, tiramisu, eggs prepared sunny-side up, fresh Caesar salad dressing, Hollandaise sauce, cookie dough, and cake batter. Children should not eat raw or undercooked meat or meat products, particularly hamburger. Ground meats should be cooked to an internal temperature of 160�F; roasts and steaks should be cooked to an internal temperature of 145�F, and poultry should be cooked to an internal tempera ture of 165�F. Use of a food thermometer is the only sure way of knowing that food has reached a high enough temperature to destroy bacteria. Knives, cutting boards, plates, and other utensils used for raw meats should not be used for preparation of fresh fruits or vegetables until they have been cleaned properly.

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