Foodborne botulism is a severe illness that results from the ingestion of a preformed toxin produced by a bacterium, Clostridium botulinum, in contaminated food. Death can occur in up to 60% of untreated cases; supportive care and prompt administration of antitoxin have reduced mortality in the United States to less than 10%. Outbreaks of botulism have been linked to improperly preserved vegetables, fruits, and meats including fermented fish products, sausages, smoked meat, and seafood.
With foodborne botulism, symptoms begin within 6 hours to 10 days (most commonly between 12 and 36 hours) after eating food that contains the toxin. Symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness that moves down the body, usually affecting the shoulders first, then the upper arms, lower arms, thighs, calves, etc. Paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with breathing (mechanical ventilation) is provided.
Botulism is not spread from one person to another. Foodborne botulism can occur in all age groups. A supply of antitoxin against infant botulism is maintained by the California Department of Public Health’s Infant Botulism Treatment and Prevention Program, and a supply of antitoxin against other kinds of botulism is maintained by the Centers of Disease Control and Prevention (CDC). The antitoxin is most effective in reducing the severity of symptoms if administered early in the course of the disease. Most patients eventually recover after weeks to months of supportive care.
Botulinum toxin has been of concern to the US military and its allies as a biowarfare weapon since World War II and, in more recent times, by the CDC as a potential bioterrorist threat to the public. The most effective means of defending against the toxin is by inducing a protective immune response through vaccination. Vaccination with an appropriate antigen will produce neutralizing antibodies that will bind to and clear the toxin from circulation before it can enter nerve cells and block neurotransmission. Immunity from botulism, however, has the disadvantage of precluding an individual from realizing the potential benefits of therapeutic botulinum toxin, if such a need were to arise. Botulinum toxin has been used in the treatment of numerous neuromuscular, autonomic, and sensory disorders since it was first approved for the management of strabismus and blepharospasm by the Food and Drug Administration (FDA) in 1989. Notwithstanding the value of the neurotoxin as a therapeutic drug, vaccines have been and will continue to be an important line of defense for those who work with the toxin (at-risk workers) and a select population of the military, law
CASE STUDY #3 BOTULISM
enforcement, and first responders. The first vaccine used to protect against botulinum neurotoxin was a chemically detoxified extract from Clostridium botulinum. A Pentavalent botulinum toxoid (PBT) vaccine in service today is administered under an Investigational New Drug (IND) application held by the CDC. Recombinant subunit vaccines are in development and a bivalent H(c) vaccine (rBV A/B (Pichia pastoris)) is presently being evaluated in a phase II clinical trial. This review focuses on botulism and the development of vaccines for its prevention.
On January 01, 2016, a physician at a Florida hospital telephoned the Directorate of Epidemiology of the Florida Health and Hospital Services (FHHS) to report two possible cases of botulism. The patients, both women, presented with drooping eyelids, double vision, difficulty swallowing, and respiratory problems. One patient had onset of symptoms on December 28 and the other on December 29. The physician had drawn blood and collected stool specimens from the women to test for botulinum toxin but no results were available.
Upon questioning, it was learned that both patients were drivers for the same bus company and drove the same route and shift. The patients knew each other but worked on different days of the week. They had not eaten together in more than a month. To find additional cases, the FHHS contacted all employees of the bus company with the ill drivers to see if any had symptoms suggestive of botulism.
Botulinum toxin, also called “miracle poison,” is one of the most poisonous biological substances known. It is a neurotoxin produced by the bacterium, an anaerobic, gram-positive, spore-forming rod commonly found on plants, in soil, water and the intestinal tracts of animals. Currently it is used in almost every subspecialty of medicine. In 2002, the FDA approved the use of Botox® (Botulinum toxin-A) for the cosmetic purpose of temporarily reducing forehead frown lines.
As the chief of biostatistics, you were provided a data set of botulism outbreaks among cities in the state of Florida. During 2010–2016, a total of 27 cities in Florida experienced outbreaks of foodborne botulism.
QUESTIONS -As a public health practitioner in Florida, what are the major concerns raised by these two possible cases of botulism?
-How might you go about swiftly determining if there are other cases of botulism associated with the cases and how would you use your data analysis to advise the community and the Director of FHHS?
-What key points would you include in the press release?
KEY BIOSTATISTICS TASKS
A. Test the hypothesis that vaccination of the population is effective in the prevention of foodborne related outbreaks.
B. Calculate the attack rate for foodborne botulism.
C. Regression Analysis of the relationship between:
-Population size and number of cases
-Average age and Population size
-Vaccination number and population
As a public health practitioner in Florida, what are the major concerns raised by these two possible cases of botulism? -How might you go about swiftly determining if there are other cases of botulism associated with the cases and how would you use your data analysis to advise the community and the Director of FHHS? -What key points would you include in the press release? KEY BIOSTATISTICS TASKS A. Test the hypothesis that vaccination of the population is effective in the prevention of foodborne related outbreaks. B. Calculate the attack rate for foodborne botulism. C. Regression Analysis of the relationship between: -Population size and number of cases -Average age and Population size -Vaccination number and population
The contention on whether God is existent or non-existent is one that has gone on for a considerable length of time. A few logicians and scholars have contended on the two sides however a strong confirmation for or against the presence of God have not been given. Nonetheless, a few confirmations for or against God's presence have been given. The paper contends based on the non-presence of God from a philosophical perspective. Hypotheses, for example, the issue of malevolence, guideline of nature, and the niggardliness contentions show that God does not exist and religion is an only an insignificant conviction made in human personalities. Clearly, God isn't ubiquitous, omnibenevolent, omniscience, or supreme. Presentation The possibility of God is relatively worldwide among social orders of mankind, despite the fact that it has diverse social definitions. The contentions in help of and those against God's presence have been proposed by a few researchers, rationalists, and scholars. As per Murray and Rea (2008) thoughtfully, the contentions for and against God's presence include predominantly the philosophy (idea of being) and epistemological (hypothesis of information) sub-teaches and additionally the hypothesis of significant worth since flawlessness ideas are regularly associated with thoughts of God (157). Nonetheless, the level headed discussion on God's presence has raised a significant number of philosophical issues. The primary hazardous issue is the presence of both polytheistic and monotheistic recognitions. A few meanings of the presence of God are so non-particular while others are self-opposing. It is conceivable to make the determination that all definitions given on God by people are presumably bogus portrayals of what God represents the being of people on earth and the universe (Everitt 159). Additionally, one can likewise infer that the entire thought of any God has no premise since it isn't supported by any confirmation. Thirdly, it might be proposed that the astuteness of people is most likely not adequate to dissect ideas that are completely in light of human comprehension and convictions, for example, God's presence as a maker. The key issue here isn't whether God exists or not, but rather whether there is adequate proof to help his reality or non-presence (Murray and Rea 157). The religious convictions of God's presence are likely out of human enthusiastic requirement for insurance and having a place since there is no solid proof to help these contentions. God does not exist. Procedure Books by popular savants who have composed on the non-presence of God will be utilized to accumulate adequate data on the theme. The Bible will likewise be utilized to show the conflicting idea of God. Discourse As indicated by Oppy and Scott (2010), "God is boundless goodness and in this manner if God genuinely exists at that point there is no abhorrent" (82). Be that as it may, considering that there is detestable on the planet, God doesn't exist. This thinking bodes well since how might it be conceivable that God, a vast goodness be made and in that capacity secures a world loaded with debasement and flaws. On the off chance that God truly existed then ghastly and awful things wouldn't happen on the planet as they do today. For example, there would be no starvation like there is in underdeveloped nations where a huge number of adults and guiltless youngsters kick the bucket of yearning each year. Likewise, things like damaging wars which result to a considerable measure of human anguish and enduring would not exist. In this unique situation, the Holy Bible which is accepted to be God's total word denounces burglary, murder, and infidelity. In accordance with Khashaba (2006, it is very hard to trust that a divine and ground-breaking being that is unendingly great made the whole world however isn't equipped for controlling the things that occur in it. Rather than simply denouncing them in an antiquated book he could most likely have nullified all types of malevolence (119). Also, a similar Bible says that God is a "great dad". In the event that that was the situation, at that point he would have let his youngsters to be great and free from like him henceforth wiping-out all fiendishness from the substance of the earth. As indicated by Murray and Rea (2008), the non-presence of God might be demonstrated by the standard of nature which is quantifiable, straightforward, and unmistakable as opposed to trusting in a complex being that can not be estimated, seen or considered. Truly, logical hypotheses have given clarifications to nature's presence and thus nature could be utilized to represent humankind's continuous improvement. This advancement has been clarified by improvement of a life form that is single cell to one that is multi-cell. Then again, advancement has clarified the knowledge of the present man while "The Big Bang" hypothesis has clarified the making of planet earth (Murray and Rea 158). Conversely, those in help of the presence of God contend based on the causation hypothesis. The contention expresses that one thing causes another and in this manner there will be no impact if the principal cause did not exist. Nonetheless, the presence of this first reason can not be demonstrated or even decided under any conditions. For example, "The Big Bang" hypothesis existed and that is the reason it is conceivable to construct earth's creation with respect to it. By the by, something unique that caused the presence of this hypothesis more likely than not existed at first. In accordance with Johnson (2006), Philosophical religious philosophy journalists, for example, St. Anselm contend that if a man comprehends that a more noteworthy being exists however not ready to clarify its reality, at that point it exists actually (50). Along these lines, on the off chance that somebody comprehends that God exists, at that point he should exist truly. This contention is completely vain if there is no adequate proof to help it. The way that somebody comprehends the presence of God and totally comprehends God does not suggest that God really exists. For example, on the off chance that one comprehends in their brains and altogether that apparitions exist, anyway this isn't an assurance that without a doubt phantoms exist. It's much the same as in films where individuals altogether comprehend a character that they should speak to and even for all intents and purposes depict that character. Unquestionably this does not influence the motion picture to character a reality (Oppy and Scott 102). It's frequently guaranteed that the scriptural God is inescapable (wherever constantly, all-powerful (all-intense), omnibenevolent (boundlessly great), and omniscient (comfortable with everything). From a legitimate perspective, these ideas are altogether unimaginable suggesting that God doesn't exist. The Bible says that nothing is unimaginable with God yet there are a few examples in a similar Bible where he was not able accomplish something. In connection to Murray and Rea (2008) "The book of Judges 1:19â says that God was with Judah; he drove out the mountain occupants; yet couldn't send away the valley tenants, since they had press chariots" (158).â If God was so sympathetic then he would discharge individuals from the subjugations of wrongdoing and demolish the demon who drives his kin adrift. In the meantime, God would alleviate humankind of the first sin punishment on the off chance that he was all-powerful. Fundamentally, if God was intense and capable yet he lets individual experience the ill effects of wrongdoing, at that point it's not legitimate to contend that he is omnibenevolent. In accordance with Everitt (2004), God ought to have deleted the first sin and enabled men to be judged in light of their own behavior as opposed to paying for other individuals' transgressions (154). On a similar note, Christians say that God is ubiquitous implying that he is wherever in the meantime. On the off chance that God was ubiquitous then he would not need to walk like he says in the Bible that he will stroll with his kin. There would be no requirement for him to move starting with one place then onto the next keeping in mind the end goal to be with one of his since he as of now exist there. Essentially, God ought to never alter his opinion if at all he is omniscience on the grounds that an adjustment as a primary concern shows vulnerability. In connection to Oppy and Scott (2010) there are such huge numbers of cases in the Bible where God altered his opinion. For instance, in the Exodus story where the offspring of Israel worshiped icons and God chose decimating them, he later excused them after Moses argued for pardoning. This idea expedites a ton of uncertainty whether God extremely proposed on crushing the Israelites or he was not able do as such yet he knew this would become (110). On the off chance that God was in deed ubiquitous and onmibenevolent he would keep the event of wrongdoing and ruinous occasions. Conclusion/Recommendations There has been a noteworthy assault on the origination of God as religion goes under a more serious investigation. A few hypotheses and ideas have demonstrated that God to be sure doesn't exist. From a target impression of the Bible, it is anything but difficult to see that God isn't inescapable, omniscience, omni generous, or transcendent as asserted by the Bible. It is apparent that the scriptural God is conflicting and it isn't conceivable that he exists. Additionally, there is no sufficient proof that the book of scriptures isn't only a conventional book. Standards, for example, "The Big Bang" can be utilized to clarify the presence of nature subsequently can supplant the conviction that God exists. Hypotheses of nature adequately clarify the human convictions in God and the advancement of religion. The issue of the presence of wrongdoing extraordinarily challenges the presence of a God who is omnibenevolent and transcendent. It is either that God exists and sin doesn't, or God doesn't exist yet sin does. The presence of both is conflicting and it isn't conceivable. Additionally research and study might be essential in understanding the presence or non-presence of God. Essentially, there exists satisfactory confirmation that there is no God however a solid demonstrate has not been found yet.>GET ANSWER