Prevention efforts will be aided by improvements in training and education of staff responsible for providing AMBG services, oversight of staff practices, and licensing inspections of ALFs that include evaluation of AMBG. Following a similar outbreak [10], legislation was passed in North Carolina to increase selleck bio educational requirements for unlicensed staff in ALFs, increase infection control requirements for ALFs, and require public health authorities to assess infection control in ALFs annually [43]. North Carolina��s approach can serve as a model for other states. Acknowledgments We are indebted to Margaret Tipple, MD, Kaye Carrithers, BSN, MPH, Barbara Hummell, BSN, Donald R. Stern, MD, MPH, and Danny Avula, MD, MPH, Virginia Department of Health, Richmond, VA; Cathy Wyatt, BSMT, Division of Consolidated Laboratory Services, Virginia Department of General Services, Richmond, VA; Deborah A.

Lloyd, BSN, Lynne A. Williams, Lisa Abraham, BSN, Vashti L. Colson, and DeNyce B. Bonaparte, MSW, Virginia Department of Social Services, Richmond, VA; Natasha Khudyakov, Hong Thai, Guo-Liang Xia, MD, Dale Hu, MD, MPH, and Philip Spradling, MD, Division of Viral Hepatitis, CDC, Atlanta, GA; Joseph F. Perz, DrPH, Division of Healthcare Quality Promotion, CDC, Atlanta, GA; Sheryl B. Lyss, MD, MPH, Office of Surveillance, Epidemiology, and Laboratory Services, CDC, Atlanta, GA. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Use of trade names and commercial sources is for identification only and does not imply endorsement. Funding Statement These authors have no support or funding to report.
The human and animal intestinal tract provides a nutrient- and niche-rich ecosystem for trillions of symbiotic microorganisms. Cooperation between the host and its gut microbiota is largely beneficial for all partners, but shifts in microbiota composition can also violate this mutualism (dysbiosis) and result in severe intestinal disease. The lives of about 2 million and 1.4 million persons in Europe and the USA, respectively, are impaired by chronic intestinal disorders such as Crohn’s disease or ulcerative colitis (Loftus, 2004), two prominent examples of a range of inflammatory disorders of the intestinal mucosa collectively called inflammatory bowel disease (IBD).

IBD is the result of an Carfilzomib imbalance in the interaction of symbiotic microorganisms, epithelium and immune system (Braun and Wei, 2007). The composition of the gut microbiota is altered in patients with IBD (reviewed in Packey et al. (2009) and Reiff and Kelly (2010)) and animal studies have demonstrated that the presence of microorganisms is important to elicit colitis (K��hn et al., 1993; Dianda et al., 1997).