Document ID: FDA-2009-P-0405-0020
Agency: fda
Document Type: Supporting & Related Material
Title: 
Posted Date: 2009-09-30T04:00Z

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<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:742.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 1 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:83.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 16.02pt">Salmonella </FONT></FONT></i><FONT COLOR="0000ff"><FONT STYLE="font-size: 16.02pt">Heidelberg – Ceftiofur-Related Resistance in</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:101.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="0000ff"><FONT STYLE="font-size: 16.02pt">Human and Retail Chicken Isolates</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:69pt;top:120pt;width:473pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:140.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) provided</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:137pt;width: 1pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:66pt;top:137pt;width:481pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:137pt;width: 1pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:66pt;top:138pt;width: 1pt;height:13pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:138pt;width: 1pt;height:13pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:152.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">data to stakeholders leading to a voluntary withdrawal in Québec chicken hatcheries of the extra-</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:151pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:151pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:164.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">label use of ceftiofur.  After the withdrawal, a significant decrease in ceftiofur-resistance was seen</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:94.80pt;top:164.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:163pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:163pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:176.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg isolates from retail chicken and humans (Figure 1).  Such a reduction</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:175pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:175pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:188.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">can protect the efficacy of related cephalosporin drugs, which are used to treat several types of</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:187pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:187pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:200.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">infections, including severe cases of salmonellosis in children.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:199pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:199pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:66pt;top:211pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:211pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:224.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">The Public Health Agency (PHAC) supports and encourages all Canadian hatcheries to apply</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:223pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:223pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:236.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">similar efforts as those undertaken by Qu</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">é</FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">bec in order to limit the emergence and spread of</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:235pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:235pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:248.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">cephalosporin-resistant S. Heidelberg from poultry to humans, via reductions in ceftiofur use</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:247pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:247pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:260.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">PHAC needs to enter into discussions with provincial and industry representatives to promote the</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:259pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:259pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:272.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS findings as an impetus to responsible use of antimicrobials in veterinary medicine across</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:271pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:271pt;width: 1pt;height:12pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:72.00pt;top:284.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Canada.</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:66pt;top:296pt;width: 1pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:66pt;top:296pt;width:481pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:296pt;width: 1pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:66pt;top:283pt;width: 1pt;height:13pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:546pt;top:283pt;width: 1pt;height:13pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:314.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 1.  Past three quarters moving average of the percentage of isolates resistant to ceftiofur</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:325.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">for retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">E. coli</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">clinical </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">S. </FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Heidelberg </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates, and quarterly</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:337.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human consumption of 3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:189.80pt;top:335.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">rd</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:199.00pt;top:336.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">generation cephalosporins dispensed at retail pharmacies (</FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">IMS Health</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">)</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:499.75pt;top:337.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">2</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:348.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in Québec.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:120.40pt;top:601.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:572.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">10%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:544.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:516.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">30%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:487.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:459.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">50%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:431.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:402.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">70%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:374.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:138.00pt;top:609.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">12341234</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:233.45pt;top:609.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">1234123</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:316.95pt;top:609.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">4123412341234</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:150.85pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2000</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:198.60pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:246.30pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2002</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:294.05pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:341.80pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:389.50pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:437.25pt;top:621.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:276.65pt;top:632.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Year and quarter</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:548.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:540.80pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:525.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:522.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:508.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:490.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:482.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:466.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:456.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:453.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:449.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:439.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:437.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:429.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:601.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:578.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.02</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:555.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.04</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:533.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.06</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:510.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.08</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:487.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:465.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:442.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:419.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.16</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:397.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.18</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:374.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:492.00pt;top:528.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:492.00pt;top:502.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:384.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Consumption of third-generation cephalosporins in humans</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:401.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">S. Heidelberg retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:418.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">S. Heidelberg human isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:436.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">E. coli retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:367.90pt;top:377.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Voluntary</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:363.20pt;top:385.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">withdrawal in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:368.80pt;top:392.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Québec*</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:676pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:683.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:75.80pt;top:684.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Extra-label involves use other than what is on the label such as use for a different species, different age class, different indication,</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:693.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">or at a different dose/duration.  This use is considered unapproved although veterinarians have the legal authority to use drugs in</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:703.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">this manner if the situation is warranted.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:710.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:76.40pt;top:712.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">IMS=Intercontinental Medical Statistics</FONT></FONT></i></FONT></SPAN>
<span style="position:absolute;font-size:0;left:120pt;top:43pt;width: 1pt;height: 5pt;background-color:#221f1f;"></span><span style="position:absolute;font-size:0;left:144pt;top:43pt;width: 1pt;height: 5pt;background-color:#221f1f;"></span><span style="position:absolute;font-size:0;left:195pt;top:51pt;width: 1pt;height: 5pt;background-color:#221f1f;"></span><span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:0.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background0.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:792.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:1534.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 2 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:863.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">*Voluntary withdrawal of ceftiofur use by Québec hatcheries in February 2005.  At the time of publishing, human consumption data</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:872.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">was only analyzed up to the first quarter of 2006.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:901.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Further details for the following sections can be found in the appendix or by CTRL+clicking on</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:912.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">identified links.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:941.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">1.  Rationale for concern about this serovar and its resistance profile:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:958.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg is a prevalent serovar in North America (</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Table 1</FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.25pt;top:973.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg was the third most common serovar in humans in Canada in 2004, the fifth most</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.25pt;top:984.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">common serovar in the US, but not found among the top six serovars for other continents.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:999.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg is a relatively invasive serovar and thus causes more severe illness in humans,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.25pt;top:1013.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">including in children, than other non-typhoidal serovars (click on ‘</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">An invasive serovar</FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">’).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1028.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">The resistance profile of this serovar often include resistance to ceftiofur and reduced susceptibility to the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.15pt;top:1042.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">related antimicrobial ceftriaxone, which could limit the options for treatment of pregnant women</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.15pt;top:1054.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and children (and possibly others) that develop extra-intestinal salmonellosis from this serovar</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.15pt;top:1065.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(click on ‘</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Resistance to ceftiofur and possible failure of ceftriaxone therapy in extra-intestinal S.</FONT></FONT></u></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.15pt;top:1077.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Heidelberg human infections</FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">’).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1106.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">2.  Link  between ceftiofur resistance in human and chicken isolates:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1122.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">In order to prevent and control </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Escherichia coli </FONT></i><FONT STYLE="font-size: 10.02pt">infections, some broiler chicken hatcheries alternated the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1134.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">use of ceftiofur (extra-label use) with gentamicin until 2003, when the gentamicin formulation became</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1145.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">unavailable.  Published information (Boulianne, 2005 ) indicated that 100% of the Québec hatcheries</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:304.30pt;top:1146.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1157.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">surveyed were using ceftiofur in 2004 (in hatching eggs and/or day old chicks).  No published information</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1168.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">is available from other provinces and therefore we have no information to suggest that Québec was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1180.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">unique in terms of ceftiofur utilization at the hatchery level. Our CIPARS 2003 annual report highlighted</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1191.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">higher rates of ceftiofur resistance in retail chicken and human isolates of </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg from Québec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1203.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">compared to Ontario. In Québec, resistance was also higher in retail chicken than among human isolates.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1214.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(click on ‘</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Link between ceftiofur resistance in human and chicken isolates </FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">’. Resistance had however risen</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1226.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in 2004 in Ontario to reach levels similar to those in Québec in 2003 and 2004 in both humans and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1237.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">chicken.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1266.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">3.  Action:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1283.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">To address these public health concerns raised by the publication of the 2003 CIPARS Report, all broiler</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1295.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">chicken hatcheries in Québec voluntarily stopped all use of ceftiofur in February 2005.   PHAC provided</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1306.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">detailed information regarding this issue to other provincial agriculture representatives and the Canadian</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1318.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">poultry industry via email, meetings, and presentations.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1347.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">4.  Effect of the withdrawal, other temporal changes, and current status:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1363.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">We saw a marked decrease in the prevalence of ceftiofur-resistant isolates in both chicken and human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1375.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg isolates and chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Escherichia coli </FONT></i><FONT STYLE="font-size: 10.02pt">following the voluntary withdrawal of ceftiofur in hatching</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1386.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and day-old chicks in Québec (</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Figure 1</FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">). Details, including current status of resistance levels, can be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1398.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">found at ‘</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Effect of the withdrawal, </FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">temporal changes, and current status’.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1427.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Since 2003, there has been a decline in the incidence of human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg cases in most of the largest</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1438.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Canadian provinces.  Concurrently we observed a decline in the relative proportion of this serovar among</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1450.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">abattoir and retail chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">isolates from 2003-2006.  CIPARS-Retail data in Ontario and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1461.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Québec as well as CIPARS national abattoir data suggest that the niche occupied by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg may</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:1487pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1495.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Boulianne, 2005. Results from a large poultry study in Québec examining antimicrobial use and antimicrobial resistance.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1504.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Agriculture's Role in Managing Antimicrobial Resistance Conference. Toronto, October 2005.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="position:absolute;left:71.76pt;top:1584.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:2326.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 3 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1655.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">have been replaced by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Kentucky and to a lesser extent by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Enteritidis from 2004 to 2006. (click on</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1666.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">‘</FONT></FONT><u><FONT COLOR="3365ff"><FONT STYLE="font-size: 10.02pt">Changes in the incidence of Salmonella serovars and relative </FONT></FONT></u><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">ranking in Canada’.  However, these</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1678.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">variations in the prevalence of the main chicken serovars are unlikely to be related to the voluntary</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1689.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">ceftiofur withdrawal since these temporal changes started before February 2005.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1718.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">5.  Next Steps:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1735.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">PHAC supports and encourages continuance of the efforts undertaken by Québec to limit the emergence</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1747.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and spread of cephalosporin-resistant </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg from poultry to humans, via reductions in ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1759.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">use.  PHAC is interested in participating in discussions with provincial and industry representatives to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1771.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">promote similar actions on a national basis. This is an opportunity to use the CIPARS findings as an</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1783.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">impetus to responsible use of antimicrobials in veterinary medicine.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1812.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">PHAC will continue to monitor and communicate the situation through data collected and analyzed by</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1824.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS, and we will expand our retail surveillance to include additional provinces to better describe</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1835.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">regional similarities and differences.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1864.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Summary:</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1881.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS has identified and recognized the clinical significance of this prevalent, invasive, and often multi-</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1893.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">drug resistant </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">serovar.  We recognize that although ceftiofur is a veterinary drug only used in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1904.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">animals, cross-resistance to this drug can threaten the effectiveness of important human therapies for</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1916.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">salmonellosis among other conditions.  CIPARS data supports the hypothesis that the use of ceftiofur in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1927.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">broiler chicken hatcheries was selecting for the presence of ceftiofur-resistant </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg strains in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1939.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">chicken meat and subsequently in human cases of S. Heidelberg.  We have observed that resistance in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1950.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">commensal chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">follows the same long-term fluctuations as for </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg.  This supports the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1962.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">hypothesis that this resistance was driven by a common exposure to ceftiofur use, rather than solely the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:1973.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">natural spread of a ceftiofur-resistant </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg resistant clone.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2002.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Resistance data from Québec and Ontario tend to be very similar across time.  In the absence of drug</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2014.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">consumption data in broiler chickens in Canada, we cannot verify if the withdrawal in Québec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2025.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">subsequently led Ontario broiler chicken hatcheries to change their use of ceftiofur.  However, a</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2037.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">proportion of Ontario commercial broiler chickens may be raised from hatching eggs produced in Québec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2048.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and some retail chicken meat sold in Ontario could have been from chickens grown in Québec.  Similarly,</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2060.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">a proportion of the chicken produced or purchased in Québec could have originated in Ontario. These</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2071.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">inter-provincial exchanges could possibly explain some of the similarities observed between the two</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2083.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">provinces.  Exposure to sources of contamination other than chicken may also play a role in the resistance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2094.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">observed in human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg isolates.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2123.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">To our knowledge, Québec is the only province that has taken voluntary action to stop the extra-label use</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2135.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">of ceftiofur in broiler hatcheries. In 2006, resistance in retail chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">was significantly higher in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2146.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Ontario than in Québec and Saskatchewan.  Limited abattoir and retail data from British Columbia also</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2158.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">indicates the presence of ceftiofur resistance among chicken </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">E. coli</FONT></FONT></i><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">. </FONT></FONT><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">PHAC supports and encourages</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2169.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">continuing the efforts undertaken by Québec to limit the emergence and spread of cephalosporin-</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2181.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">resistant S. Heidelberg from poultry to humans, via reductions in ceftiofur use.  PHAC will</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2192.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">continue to monitor and communicate the situation through data collected and analyzed by</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2204.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><b><FONT COLOR="0000ff"><FONT STYLE="font-size: 10.02pt">CIPARS, and will expand the CIPARS retail program into other provinces.  </FONT></FONT></b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">PHAC needs to enter into</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2215.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">discussions with provincial and industry representatives to promote the CIPARS findings as an impetus to</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2227.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">responsible use of antimicrobials in veterinary medicine.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2256.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Since this issue was identified, Health Canada’s Veterinary Drugs Directorate has revised the ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2267.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">prescription label to emphasize to veterinarians and producers that this product should not be used</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:1584.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background2.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:2376.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:3118.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 4 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2447.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">outside of the specification on the label .  Although ceftiofur is labeled for use in turkey, ceftiofur should</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:245.05pt;top:2445.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:2458.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">also be used judiciously in this commodity.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:3050pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3056.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:75.85pt;top:3060.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">In Canada, ceftiofur has been labelled for use in certain food-producing animals but has not been labelled for use in chickens (or</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3069.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 7.98pt">eggs). Thus, such use of ceftiofur in chicken eggs is considered to be extra-label drug use</FONT></i><FONT STYLE="font-size: 7.98pt">.  </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Given the concern with the development</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3079.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">and dissemination of antimicrobial resistance with such mass-medication in an extra-label manner, the labels of ceftiofur products in</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3088.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Canada have been updated with warning statements to include that extra-label drug use of ceftiofur products is not recommended.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="position:absolute;left:71.76pt;top:3168.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:3910.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 5 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:265.15pt;top:3248.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 16.02pt">APPENDIX</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3303.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">A prevalent serovar in North America</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3334.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg is one of the top three serovars isolated from human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">cases in Canada</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3345.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and among the top five serovars in the United States.  International comparisons of human data from 2000</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3357.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">to 2004 suggest that </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg is more common in North America than in other regions of the world</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3368.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(Table 1).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3397.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Table 1.  International comparison of </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">serovars isolated from </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">humans </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in 2004 (Canada</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3409.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and US) and in other continents (2000-2004).</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Rank</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.40pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Canada</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:147.60pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">1</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:187.30pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">US</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:201.25pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">2</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:244.90pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Africa</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:273.30pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:313.30pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Asia</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:334.50pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:362.95pt;top:3431.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Central and</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:376.30pt;top:3442.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">South</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:370.75pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">America</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:372.65pt;top:3465.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">and the</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:364.20pt;top:3477.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Caribbean</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:413.15pt;top:3475.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:437.65pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Europe</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.15pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:498.85pt;top:3454.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 10.02pt">Oceania</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:537.80pt;top:3452.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ffffff"><FONT STYLE="font-size: 6.48pt">3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:67pt;top:3426pt;width:355pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:423pt;top:3426pt;width:64pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:487pt;top:3426pt;width:64pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3494.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:102.40pt;top:3494.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Typhimurium Typhimurium Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:303.75pt;top:3494.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Enteritidis Enteritidis Enteritidis Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:67pt;top:3492pt;width:355pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:423pt;top:3492pt;width:64pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:487pt;top:3492pt;width:64pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">2  Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:174.05pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:238.90pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:297.65pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Weltevreden</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:361.65pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Typhimurium Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:502.25pt;top:3507.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Virchow</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3519.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">3</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:105.40pt;top:3519.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:177.50pt;top:3519.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Newport Isangi Anatum  Typhi  Hadar Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3532.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">4 Thompson</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:178.85pt;top:3532.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Javiana Livingstone Stanley Montevideo Virchow  Saintpaul</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3545.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">5 Hadar </FONT></FONT><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:248.65pt;top:3545.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Typhi Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:364.60pt;top:3545.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Paratyphi B Infantis Birkenhead</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:80.35pt;top:3558.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">6 Typhi Montevideo Corvallis Rissen</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:376.05pt;top:3558.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Agona Newport Chester</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:98pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:163pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:227pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:292pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:357pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:422pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="position:absolute;font-size:0;left:487pt;top:3569pt;width:65pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3568.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:75.80pt;top:3570.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Government of Canada. Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS): 2004 Annual report.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3579.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Public Health Agency of Canada. 2005.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3590.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">2</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:75.80pt;top:3591.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">CDC. Salmonella Surveillance: Annual Summary, 2004. Atlanta, Georgia: US Department of Health and Human Services, CDC, 2005.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3602.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">3</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:75.80pt;top:3603.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">World Health Organization. WHO Global Salm-Surv. Progress Report (2000-2005). Department of Food Safety, Zoonoses and</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:3612.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Foodborne Disease, WHO, 2006.</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:3168.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background4.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:3960.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:4702.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 6 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4031.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">An invasive serovar</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4062.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg appears to be more invasive in humans than other non-typhoidal serovars.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:299.90pt;top:4062.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4073.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Overall, approximately 9% of human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg isolates collected since 2003 have been recovered</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4085.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">from blood samples (Figure 2).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4114.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS receives </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">isolates (except for </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Newport and </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Typhi) during the first half of each</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4125.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">month from the more populated provinces (British Columbia, Alberta, Ontario, and Québec) and all</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4137.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates from the remaining provinces.  Assuming the beginning of the month is representative of the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4148.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">second half in the larger provinces, the total number of invasive </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg cases between 2003 to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4160.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">2005 was estimated at roughly 280 cases, with approximate 100 of them in children under the age of 13</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4171.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(Figure 3).  Of all serovars causing invasive salmonellosis in children under the age of 13, the largest</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4183.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">numbers of cases were due to </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg infection. Although </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Paratyphi A, </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Paratyphi B, and </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4194.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Typhi are more frequently associated with extra-intestinal/invasive infections (Figure 2), these serovars</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4206.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">are less frequently observed in Canada.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4235.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 2.  Proportions of isolates recovered from human blood specimens for each of the most</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4246.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">prevalent human non-typhoidal and typhoidal Salmonella serovars in Canada; CIPARS, 2003-2005.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:91.20pt;top:4470.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4440.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">10%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4410.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4380.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">30%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4349.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4319.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">50%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:88.20pt;top:4289.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:121.60pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Newport</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:173.45pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:234.20pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:285.25pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Other serovars</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:347.00pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Heidelberg</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:398.00pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Paratyphi A & B</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.80pt;top:4478.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Typhi</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:264.10pt;top:4488.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.51pt">Serovars (CIPARS, 2003-2005)</FONT></FONT></b></FONT></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:84.25pt;top:4347.35pt;z-index:3;"></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:84.25pt;top:4330.50pt;z-index:3;"></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:4664pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4672.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">The proportion of strains isolated from “Blood” were used as a surrogate measure of invasiveness.</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:3960.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background5.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:4752.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:5494.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 7 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4837.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 3.  Number of </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates recovered from blood specimens across age</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:4849.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">classes and the main human serovars in Canada; </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, 2003-2005.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:96.65pt;top:5102.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:93.30pt;top:5066.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">50</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:89.90pt;top:5030.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">100</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:89.90pt;top:4994.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">150</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:89.90pt;top:4959.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">200</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:89.90pt;top:4923.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">250</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:89.90pt;top:4887.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">300</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.50pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Heidelberg</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:183.45pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Typhi</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:229.95pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Other serovars</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:287.40pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Paratyphi A & B</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:349.80pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Typhimurium</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:412.65pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Enteritidis</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.30pt;top:5111.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Newport</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:245.10pt;top:5121.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">Most frequent serovars (CIPARS, 2003-2005)</FONT></FONT></b></FONT></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:86.95pt;top:4989.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4986.20pt;z-index:3;"></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4979.10pt;z-index:3;"></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:86.95pt;top:4934.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4930.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4928.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.95pt;top:4918.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4913.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4911.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4908.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:85.30pt;top:4904.30pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:4954.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">unavailable</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:4963.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">70 and more</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:4973.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">50-69</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:4983.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">30-49</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:4993.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">18-29</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:5003.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">13-17</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:5013.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">5-12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:467.95pt;top:5023.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.11pt">less than 5</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:465.05pt;top:4944.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="7f0000"><FONT STYLE="font-size: 6.11pt">Age classes</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:476.00pt;top:5082.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n= 470</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.25pt;top:4894.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n*= 1581</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:179.80pt;top:4962.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n= 373</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:297.40pt;top:5002.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n*= 139</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:351.20pt;top:5044.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n*= 1767</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:410.45pt;top:5044.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n*= 1637</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:236.35pt;top:4944.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.36pt">n*= 3520</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5140.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 7.98pt">* n=estimated total number of isolates received (except for S. </FONT></i><FONT STYLE="font-size: 7.98pt">Typhi </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 7.98pt">and S. </FONT></i><FONT STYLE="font-size: 7.98pt">Newport</FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">). Values were corrected for differences in</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5150.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">submission by the four largest provinces.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5191.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Resistance to ceftiofur and possible failure of ceftriaxone therapy in extra-</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5205.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">intestinal S. Heidelberg human infections</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5236.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Ceftiofur (a third-generation cephalosporin used only in animals) resistance among </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5247.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">is highly correlated with resistance to ampicillin, amoxicillin-clavulanic acid, and cefoxitin (A2C-AMP</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5259.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">resistance pattern).  It is also associated with reduced susceptibility (intermediate resistance) to</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5270.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">ceftriaxone, another third generation cephalosporin used exclusively in humans.  Ceftriaxone is identified</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5282.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">as a drug of Very High Importance to Human Medicine according to Health Canada’s Veterinary Drugs</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5293.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Directorate. It is a drug of choice for the treatment of extra-intestinal salmonellosis in children and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5305.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">pregnant women .  Hence, patients with extra-intestinal infections caused by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg strains with</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:145.30pt;top:5305.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5316.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">intermediate resistance to ceftriaxone are at risk of ceftriaxone therapy failure.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:5447pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5455.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Katherine M. Shea, Nontherapeutic Use of Antimicrobial Agents in Animal Agriculture: Implications for Pediatrics.  Committee on</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5464.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Environmental Health and Committee on Infectious Diseases. Pediatrics 2004; 114: 862-868.</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:4752.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background6.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:5544.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:6286.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 8 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5615.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Link between ceftiofur resistance in human and chicken isolates</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5648.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">In order to prevent and control </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Escherichia coli </FONT></i><FONT STYLE="font-size: 10.02pt">infections, a certain number of broiler chicken hatcheries</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5660.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">alternated the use of ceftiofur with gentamicin until 2003 when the gentamicin formulation became</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5671.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">unavailable.  Published information (Boulianne, 2005 ) indicated that 100% of the Québec hatcheries</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:304.30pt;top:5672.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5683.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">surveyed were using ceftiofur in 2004 (in hatching eggs and/or day old chicks).  No published information</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5694.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">is available from other provinces and therefore we have no information to suggest that Québec was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5706.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">unique in terms of ceftiofur utilization at the hatchery level. Anecdotal information also indicates that</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5717.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">ceftiofur was also used in chickens outside of the province of Québec.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5746.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Our CIPARS 2003 annual report highlighted higher rates of ceftiofur resistance in retail chicken and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5758.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human isolates of </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg from Québec compared to Ontario (Figure 4). In Québec, resistance was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5769.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">also higher in retail chicken than among human isolates (Figure 4).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5798.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">In Ontario in 2004 we saw increases in ceftiofur resistance levels in retail chicken and human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5810.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg isolates similar to those observed in Québec in 2003 and 2004 (Figure 5).  Also in 2004, the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5821.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">level of ceftiofur resistance in Ontario retail chicken isolates was higher than that observed for human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5833.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Heidelberg isolates (Figure 5).  In Québec, ceftiofur resistance levels remained similar between 2003 and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5844.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">2004.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5876.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 4.  Individual antimicrobial drug resistance in </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Heidelberg </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolated from retail</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5888.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(n=20) and </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human cases </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(n=167) in Québec, and from retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(n=19) and </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:5899.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">cases </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(n=172) in Ontario in 2003.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:212.75pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:265.50pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:319.95pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:374.40pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:428.95pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:481.65pt;top:6173.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">100%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:182.15pt;top:6143.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">tetracycline</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:165.35pt;top:6129.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:168.35pt;top:6115.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">chloramphenicol</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:181.70pt;top:6101.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">cephalothin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:190.30pt;top:6087.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">cefoxitin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:187.70pt;top:6073.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">ampicillin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:129.40pt;top:6059.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">trimethoprim-sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:178.25pt;top:6045.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">streptomycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:178.30pt;top:6031.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">nalidixic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:183.60pt;top:6017.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">kanamycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:183.25pt;top:6003.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">gentamicin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:143.20pt;top:5988.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">amoxicillin-clavulanic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:188.50pt;top:5974.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">amikacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:178.85pt;top:5960.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">ciprofloxacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:182.90pt;top:5946.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">ceftriaxone</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:190.90pt;top:5932.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:123.50pt;top:6158.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:123.50pt;top:6109.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:123.50pt;top:6016.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:123.50pt;top:5945.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6112.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6087.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6064.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6042.30pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6003.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.80pt;top:6000.45pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:306.55pt;top:6183.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Percentage of Isolates Resistant</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:383.95pt;top:5938.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Chicken - Retail Surveillance - Quebec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:383.95pt;top:5950.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Human - Passive Surveillance - Quebec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:383.95pt;top:5962.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Chicken - Retail Surveillance - Ontario</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:383.95pt;top:5973.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Human - Passive Surveillance - Ontario</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:454.15pt;top:6043.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.54pt">Categories of</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.90pt;top:6050.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.54pt">Human Medicine</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:456.40pt;top:6055.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.54pt">Importance</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.10pt;top:6064.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 4.54pt">Category I </FONT></b><FONT STYLE="font-size: 4.54pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:451.40pt;top:6069.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Very high importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:448.15pt;top:6077.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Category II</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:479.10pt;top:6077.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.10pt;top:6090.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Category III</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:480.90pt;top:6089.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:451.40pt;top:6107.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Category IV</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:484.65pt;top:6106.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.50pt;top:6120.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Source: VDD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.50pt;top:6126.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Health Canada</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:452.75pt;top:6097.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Medium importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:454.15pt;top:6082.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">High importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:451.85pt;top:6112.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.54pt">Low importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:6239pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6247.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Boulianne, 2005. Results from a large poultry study in Québec examining antimicrobial use and antimicrobial resistance.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6256.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Agriculture's Role in Managing Antimicrobial Resistance Conference. Toronto, October 2005.</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:5544.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background7.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:6336.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.50pt;top:7078.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 9 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6407.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 5.  Individual antimicrobial drug resistance in </FONT></FONT><i><FONT COLOR="ce0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Heidelberg </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolated from </FONT></FONT><FONT COLOR="ce0000"><FONT STYLE="font-size: 10.02pt">human</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6418.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">cases </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in Ontario in 2003 (n=172) and 2004 (n=186), and from retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in Ontario in 2003</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6430.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">(n=19) and 2004 (n=32).</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:178.20pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:243.05pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:309.55pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:375.95pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:442.45pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:507.30pt;top:6678.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">100%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:150.05pt;top:6651.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">tetracycline</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:135.10pt;top:6638.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:137.70pt;top:6626.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">chloramphenicol</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:149.70pt;top:6613.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">cephalothin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:157.80pt;top:6600.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">cefoxitin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:155.15pt;top:6588.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">ampicillin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:102.60pt;top:6575.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">trimethoprim-sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:146.70pt;top:6562.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">streptomycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:146.70pt;top:6550.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">nalidixic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.55pt;top:6537.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">kanamycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.20pt;top:6524.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">gentamicin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.70pt;top:6511.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">amoxicillin-clavulanic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:156.10pt;top:6499.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">amikacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:147.35pt;top:6486.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">ciprofloxacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.10pt;top:6473.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">ceftriaxone</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:158.30pt;top:6461.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6665.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6620.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6619.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6617.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6537.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6535.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.20pt;top:6473.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6623.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6613.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6608.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6606.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6593.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6575.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6558.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6555.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6542.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:87.80pt;top:6539.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6512.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:86.30pt;top:6509.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:305.80pt;top:6688.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">Percentage of Isolates Resistant</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:406.80pt;top:6470.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">Chicken - Retail surveillance - Ontario 2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:406.80pt;top:6482.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">Human - Passive surveillance - Ontario 2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:406.80pt;top:6493.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">Chicken - Retail surveillance -  Ontario 2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:406.80pt;top:6505.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.48pt">Human - Passive surveillance - Ontario 2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.75pt;top:6527.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.52pt">Categories of</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:463.50pt;top:6533.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.52pt">Human Medicine</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:469.00pt;top:6538.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 4.52pt">Importance</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:461.65pt;top:6547.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 4.52pt">Category I </FONT></b><FONT STYLE="font-size: 4.52pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:463.90pt;top:6552.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Very high importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.75pt;top:6560.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Category II</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:491.70pt;top:6560.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:461.65pt;top:6574.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Category III</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:493.50pt;top:6572.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:463.90pt;top:6590.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Category IV</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:497.25pt;top:6589.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:463.00pt;top:6603.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Source: VDD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:462.10pt;top:6609.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Health Canada</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:465.30pt;top:6580.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Mediumimportance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:466.75pt;top:6565.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">High importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:464.40pt;top:6595.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.52pt">Low importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6722.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Action</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6753.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">To address public health concerns raised by the publication of the 2003 CIPARS Report, all broiler</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6764.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">chicken hatcheries in Québec voluntarily stopped the use of ceftiofur in February 2005.  PHAC provided</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6776.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">detailed information regarding this issue to other provincial agriculture representatives and the Canadian</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6787.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">poultry industry via email, meetings, and presentations.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6817.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Effect of the withdrawal, temporal changes, and current status</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6848.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 1 shows the marked decrease in prevalence of ceftiofur-resistant isolates in both chicken and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6859.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg isolates and chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">following the voluntary withdrawal of the use of ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6871.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in hatching and day-old chicks in Québec.  Ceftiofur resistance in chicken generic </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">isolates is used</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6882.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in these figures as a surrogate indicator for ceftiofur use.  To reduce variation due to the small number of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6894.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg and </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">recovered in retail chicken on a quarterly basis and in order to use the same</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6905.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">time scale for all ceftiofur resistance data, resistance results are presented as the moving average of the</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6917.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">past three quarters.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6946.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Data available at time of web-posting indicated that in Québec, ceftiofur resistance in chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6957.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S. </FONT></i><FONT STYLE="font-size: 10.02pt">Heidelberg is continuing to decline, while resistance in chicken S. Heidelberg seems to be</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6969.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">stabilizing around 10%.  The estimated use of 3 -generation cephalosporins in humans in this province</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:281.60pt;top:6967.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">rd</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6980.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">shows a steady decreasing trend since 2000 (with seasonal fluctuations of use), but this does not</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:6992.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">correlate well with the fluctuation of ceftiofur resistance observed in human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg isolates.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7003.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">However, the drug use data do not include hospital use of cephalosporins (data not available at the time of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7015.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">analysis).</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:6336.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background8.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:7128.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.90pt;top:7870.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 10 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7199.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Generally, similar trends have been seen in Ontario (Figure 7) since the volontary withdrawal in Québec.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7210.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">However, resistance to ceftiofur among </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg and </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">from Ontario retail chicken started</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7222.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">increasing again in 2006 to around 20% by the end of 2006.  Ceftiofur resistance among human isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7233.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">decreased after 2004 until the third quarter of 2006 where it seems to stabilize around 10%.  The</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7245.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">estimated use of 3 -generation cephalosporins in humans in Ontario has been higher from 2000 to 2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:152.60pt;top:7243.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">rd</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7256.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">than in Québec, but it too has steadily declined since 2000 and does not correlate well with resistance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7268.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">data in human isolates, although again, hospital drug use information is lacking.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7297.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">In 2006, resistance to ceftiofur was significantly higher for Ontario retail chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">E. coli </FONT></i><FONT STYLE="font-size: 10.02pt">isolates than for</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7308.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Québec or Saskatchewan isolates (Figure 8).  Resistance to ceftiofur for chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">isolates was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7320.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">not apparently different across any of the three provinces (Figure 9), but the number of </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Salmonella</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7331.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">recovered in 2006 in each province was not sufficient to detect significant differences of resistance for</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7343.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">such small differences.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7372.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 6.  Past three quarters moving average of the percentage of isolates resistant to ceftiofur</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7383.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">for retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">E. coli</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">clinical </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">S. </FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Heidelberg </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates, and quarterly</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7395.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human consumption of 3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:189.80pt;top:7393.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">rd</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:199.00pt;top:7395.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">generation cephalosporins dispensed at retail pharmacies (</FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">IMS Health</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">)</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:499.75pt;top:7395.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7406.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in Québec.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:120.40pt;top:7659.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7630.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">10%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7602.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7574.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">30%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7545.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7517.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">50%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7489.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7460.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">70%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:117.05pt;top:7432.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:138.00pt;top:7668.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">12341234</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:233.45pt;top:7668.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">1234123</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:316.95pt;top:7668.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">4123412341234</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:150.85pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2000</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:198.60pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:246.30pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2002</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:294.05pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:341.80pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:389.50pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:437.25pt;top:7679.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:276.65pt;top:7690.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Year and quarter</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7606.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7598.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7584.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7580.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:7566.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7548.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7540.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7524.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:7515.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7511.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.15pt;top:7507.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7497.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7495.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7493.45pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.50pt;top:7487.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7659.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7636.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.02</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7613.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.04</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7591.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.06</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7568.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.08</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7545.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7523.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7500.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7477.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.16</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7455.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.18</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:472.40pt;top:7432.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0.2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:492.00pt;top:7586.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:492.00pt;top:7560.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:7442.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Consumption of third-generation cephalosporins in humans</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:7459.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">S. Heidelberg retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:7477.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">S. Heidelberg human isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:180.35pt;top:7494.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">E. coli retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:367.90pt;top:7435.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Voluntary</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:363.20pt;top:7443.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">withdrawal in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:368.80pt;top:7450.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Québec*</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7710.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">* Voluntary withdrawal of ceftiofur use by Québec hatcheries in February 2005.  At the time of publishing, human consumption data</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7719.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">was only analyzed up to the first quarter of 2006.</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:7832pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7840.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">IMS=Intercontinental Medical Statistics</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:7128.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background9.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:7920.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.90pt;top:8662.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 11 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:7991.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 7.  Past three quarters moving average of the percentage of isolates resistant to ceftiofur</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8002.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">for retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">E. coli</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">and </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">clinical </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">S. </FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Heidelberg i</FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">solates , and quarterly</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8014.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">human consumption of 3</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:189.80pt;top:8012.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.48pt">rd</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:199.00pt;top:8014.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">generation cephalosporins dispensed at retail pharmacies (</FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">IMS Health</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">)</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8025.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">in Ontario.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:121.85pt;top:8278.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8250.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">10%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8221.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8193.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">30%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8165.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8136.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">50%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8108.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8079.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">70%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:118.50pt;top:8051.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:139.45pt;top:8287.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">1234123</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:222.95pt;top:8287.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">4123412</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:306.45pt;top:8287.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">3412341</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:390.00pt;top:8287.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2341234</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:152.30pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2000</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:200.05pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2001</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:247.65pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2002</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:295.45pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:343.20pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:390.90pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:438.65pt;top:8299.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:278.05pt;top:8309.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Year and quarter</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8225.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8203.30pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8199.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8196.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.65pt;top:8192.80pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.65pt;top:8185.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8167.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8143.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.65pt;top:8134.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8130.45pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.65pt;top:8126.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8116.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8114.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8112.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:114.00pt;top:8106.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8278.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8255.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.02</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8233.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.04</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8210.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.06</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8187.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.08</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8165.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8142.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8119.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8096.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.16</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8074.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.18</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:473.75pt;top:8051.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">0.2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:493.45pt;top:8206.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:493.45pt;top:8159.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:167.15pt;top:8057.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Consumption of third-generation cephalosporins in humans</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:168.80pt;top:8072.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">S. Heidelberg retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:167.15pt;top:8088.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">S. Heidelberg human isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:168.80pt;top:8103.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">E. coli retail chicken isolates</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:357.20pt;top:8048.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Voluntary</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:352.45pt;top:8056.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">withdrawal in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:358.10pt;top:8063.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.06pt">Québec*</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8329.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">* Voluntary withdrawal of ceftiofur use by Québec hatcheries in February 2005.  At the time of publishing, human consumption data</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8339.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">was only analyzed up to the first quarter of 2006.</FONT></FONT></i></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:7920.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background10.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:8712.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.90pt;top:9454.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 12 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8783.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 8.  Individual antimicrobial drug resistance in retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">E. coli </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates from Ontario,</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:8794.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Québec, and Saskatchewan; </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Retail Meat Surveillance, </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">2006.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:200.45pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:258.65pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.60pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:378.55pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:438.45pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:496.65pt;top:9076.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">100%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:168.55pt;top:9044.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">tetracycline</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.15pt;top:9028.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:154.30pt;top:9012.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">chloramphenicol</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:113.90pt;top:8997.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">trimethoprim-sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:164.65pt;top:8981.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">streptomycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:164.60pt;top:8965.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">nalidixic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:170.15pt;top:8950.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">kanamycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:169.75pt;top:8934.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">gentamicin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:177.10pt;top:8918.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">cefoxitin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:174.30pt;top:8903.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ampicillin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:175.30pt;top:8887.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">amikacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:165.20pt;top:8871.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ciprofloxacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:169.40pt;top:8856.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ceftriaxone</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:177.70pt;top:8840.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:128.05pt;top:8825.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">amoxicillin-clavulanic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9060.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9029.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:8942.15pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:8847.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9011.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9002.80pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8991.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8977.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.55pt;top:8970.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8961.70pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8954.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8948.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8941.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8929.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.55pt;top:8922.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8908.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8904.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8895.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8884.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8880.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:8871.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:307.40pt;top:9087.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">Percentage of isolates resistant</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:8845.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.82pt">Saskatchewan (n=85)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:8856.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.82pt">Quebec (n=135)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:8867.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.82pt">Ontario (n=152)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:453.25pt;top:8918.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Categories of</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.30pt;top:8925.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Human Medicine</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:455.40pt;top:8931.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Importance</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:448.60pt;top:8941.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category I </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.70pt;top:8947.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Very high importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:447.80pt;top:8956.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category II </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:448.60pt;top:8972.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Category III</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:477.90pt;top:8970.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.70pt;top:8990.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category IV </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.90pt;top:9005.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Source: VDD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.05pt;top:9012.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Health Canada</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:452.00pt;top:8980.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Medium importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:453.25pt;top:8962.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">High importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:451.15pt;top:8996.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Low importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9106.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 9.  Individual antimicrobial drug resistance in retail </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates from</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9118.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Ontario, Québec, and Saskatchewan; </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Retail Meat Surveillance</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, 2006.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:200.45pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:258.65pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:318.60pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:378.55pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:438.45pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:496.65pt;top:9400.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">100%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:168.55pt;top:9367.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">tetracycline</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.15pt;top:9352.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:154.30pt;top:9336.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">chloramphenicol</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:113.90pt;top:9320.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">trimethoprim-sulfamethoxazole</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:164.65pt;top:9305.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">streptomycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:164.60pt;top:9289.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">nalidixic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:170.15pt;top:9273.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">kanamycin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:169.75pt;top:9258.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">gentamicin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:177.10pt;top:9242.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">cefoxitin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:174.30pt;top:9226.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ampicillin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:175.30pt;top:9211.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">amikacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:165.20pt;top:9195.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ciprofloxacin</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:169.40pt;top:9179.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ceftriaxone</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:177.70pt;top:9164.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">ceftiofur</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:128.05pt;top:9148.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">amoxicillin-clavulanic acid</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9384.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9382.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9352.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9265.80pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.80pt;top:9171.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9334.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9326.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9317.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9315.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9305.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9296.30pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9289.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9285.45pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.55pt;top:9281.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9272.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9256.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9249.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:97.55pt;top:9238.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9222.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9218.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9207.85pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9204.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9200.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9198.75pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:95.80pt;top:9193.45pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:307.40pt;top:9411.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.32pt">Percentage of isolates resistant</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:9169.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.83pt">Saskatchewan (n=25)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:9179.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.83pt">Quebec (n=33)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:424.25pt;top:9190.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.83pt">Ontario (n=36)</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:453.25pt;top:9242.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Categories of</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.30pt;top:9249.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Human Medicine</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:455.40pt;top:9254.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="ff0000"><FONT STYLE="font-size: 5.21pt">Importance</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:448.60pt;top:9265.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category I </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.70pt;top:9271.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Very high importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:447.80pt;top:9280.65pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category II </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:448.60pt;top:9295.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Category III</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:477.90pt;top:9294.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.70pt;top:9314.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><b><FONT STYLE="font-size: 5.21pt">Category IV </FONT></b><FONT STYLE="font-size: 5.21pt">=</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.90pt;top:9329.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Source: VDD</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.05pt;top:9336.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Health Canada</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:452.00pt;top:9303.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Medium importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:453.25pt;top:9285.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">High importance</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:451.15pt;top:9320.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 5.21pt">Low importance</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:8712.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background11.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:9504.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.90pt;top:10246.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 13 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9575.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><i><FONT COLOR="0000ff"><FONT STYLE="font-size: 12.00pt">Changes in the incidence of Salmonella serovars and relative ranking in Canada</FONT></FONT></i></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9606.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Since 2003, a decline in the incidence of human </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg cases (based on extrapolated numbers of</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9617.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">laboratory submissions to CIPARS) has been noted in most of the largest Canadian provinces (Figure 10).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9629.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Concurrently CIPARS also observed a decline in the relative proportion of this serovar among abattoir and</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9640.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">retail chicken </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></i><FONT STYLE="font-size: 10.02pt">isolates from 2003-2006.  CIPARS-Retail data in Ontario and Québec as well as</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9652.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS national abattoir data suggest that the niche occupied by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Heidelberg may have been replaced</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9663.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Kentucky and to a lesser extent, by </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Enteritidis from 2004 to 2006 (Figure 11).</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9692.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Although </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Kentucky was relatively more frequent than </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Enteritidis among chicken samples, this was</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9704.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">not reflected in human incidence rates where </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Enteritidis was more frequent than </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">. Kentucky (Figure</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9715.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">11).  These variations may be explained by differences of the infectivity and virulence of the various</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9727.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">serovars, by unidentified outbreaks and by the fact that chicken exposure is not the only risk factor for </FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 10.02pt">S</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9738.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Enteritidis infections in humans</FONT></FONT><FONT COLOR="000000"><i><FONT STYLE="font-size: 7.98pt">1</FONT></i><FONT STYLE="font-size: 10.02pt">.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9767.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Although there is an apparent correlation between the frequency of certain serovars in chicken and in</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9779.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">humans, we believe these variations of the prevalence of the main chicken serovars are unlikely to be a</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9790.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">result of the voluntary ceftiofur withdrawal since these temporal changes were started before February</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9802.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">2005.</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9831.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 10.  Estimated incidence of reported </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">human </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">cases per 1,000 inhabitants by province for the</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:9842.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">most frequent serovars identified in chicken; </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, 2003-2006.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.50pt;top:10103.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">0</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.50pt;top:10064.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">2</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.50pt;top:10024.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">4</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.50pt;top:9985.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">6</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.50pt;top:9946.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">8</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:108.80pt;top:9907.60pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">10</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:108.80pt;top:9868.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">12</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:123.35pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:131.35pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:139.40pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:147.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:163.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:171.55pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:179.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:187.60pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:203.65pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:211.70pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:219.65pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:227.75pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:243.80pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:251.80pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:259.90pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:267.90pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:283.90pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:291.95pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:300.05pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:308.05pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:324.10pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:332.10pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:340.20pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:348.25pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:364.25pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:372.25pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:380.35pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:388.40pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:404.40pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:412.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:420.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:428.50pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:444.55pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:452.65pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.60pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:468.65pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:484.70pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:492.80pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:500.80pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:508.80pt;top:10116.10pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:130.15pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Alberta</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:160.20pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">British Columbia</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:208.10pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Manitoba</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:241.65pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">New Brunswick</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:282.95pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Newfoundland</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:325.45pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Nova Scotia</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:370.85pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Ontario</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:403.05pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Prince Edward</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:412.45pt;top:10130.15pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Island</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:450.55pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Québec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:479.40pt;top:10123.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Saskatchewan</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:292.70pt;top:10134.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 5.05pt">Province and Year</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:10016.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:10013.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:10010.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:107.60pt;top:10002.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9992.35pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9985.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9977.00pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9965.05pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9963.65pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9961.95pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9959.20pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:106.20pt;top:9954.50pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:408.05pt;top:9880.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Heidelberg</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:461.80pt;top:9880.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Enteritidis</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:408.05pt;top:9890.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Hadar</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:461.80pt;top:9890.80pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 4.90pt">Kentucky</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="position:absolute;font-size:0;left:70pt;top:10189pt;width:144pt;height: 1pt;background-color:#000000;"></SPAN><SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:10197.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">1 </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">Cconsumption of poultry (particularly chicken, chicken strips and chicken nuggets) and shell eggs are documented risk factors for</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:10207.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">S. Heidelberg infection . Consumption of shell eggs, beansprouts and almonds are documented risk factors for S. Enteritidis</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:151.40pt;top:10205.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:10216.25pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 7.98pt">infection .</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:100.70pt;top:10214.95pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 4.98pt">1</FONT></FONT></FONT></SPAN>
<span style="color:#000000;background-color:#ffffff;position:absolute;left:0.00pt;top:9504.00pt;z-index:-1;"><img style="width:612pt;height:792pt;" src="outputfile-1516875116.htm_files\outputfile-1516875116_background12.png"></span>
<SPAN STYLE="position:absolute;left:71.76pt;top:10296.00pt"> </SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:460.90pt;top:11038.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Page 14 of 14</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:10367.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">Figure 11.  Proportions of the three most prevalent </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">Salmonella </FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">serovars and of </FONT></FONT><i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">S</FONT></FONT></i><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">. Enteritidis</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:70.85pt;top:10378.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">among </FONT></FONT><FONT COLOR="cc0000"><FONT STYLE="font-size: 10.02pt">chicken </FONT></FONT><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">isolates from abattoir and retail meat samples; </FONT></FONT><i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">CIPARS</FONT></FONT></i><FONT COLOR="000000"><FONT STYLE="font-size: 10.02pt">, 2003-2005.</FONT></FONT></b></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:122.40pt;top:10619.40pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">0%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10598.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">10%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10576.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">20%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10555.35pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">30%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10533.90pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">40%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10512.55pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">50%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10491.20pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">60%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10469.85pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">70%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10448.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">80%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:119.00pt;top:10427.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">90%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:115.60pt;top:10405.75pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">100%</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:138.10pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:156.50pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:174.70pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:193.05pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:229.75pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:248.10pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:266.40pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:284.75pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:321.40pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:339.75pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:358.00pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:376.35pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:413.00pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2003</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:431.35pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2004</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:449.65pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2005</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:468.00pt;top:10628.10pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">2006</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:171.05pt;top:10640.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Abattoir</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:253.95pt;top:10640.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Retail Québec</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:346.25pt;top:10640.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Retail Ontario</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:418.90pt;top:10640.05pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Retail Saskatchewan</FONT></FONT></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:236.95pt;top:10650.45pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><b><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Surveillance program, province (CIPARS 2003-2006)</FONT></FONT></b></FONT></SPAN>
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<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10587.60pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10584.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10581.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10578.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10575.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.10pt;top:10571.55pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.75pt;top:10502.40pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.20pt;top:10493.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:111.20pt;top:10485.90pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:112.75pt;top:10460.25pt;z-index:3;"></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:445.10pt;top:10409.00pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Heidelberg</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:445.10pt;top:10418.30pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Kentucky</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:445.10pt;top:10427.50pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Hadar</FONT></FONT></i></FONT></SPAN>
<SPAN STYLE="color:#000000;position:absolute;left:445.10pt;top:10436.70pt;z-index:3;"><FONT FACE ="Arial" style = "font-size: 12.00pt"><i><FONT COLOR="000000"><FONT STYLE="font-size: 6.05pt">Enteritidis</FONT></FONT></i></FONT></SPAN>
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