Necrotic enteritis in poultry. United States
Economic impact of this disease in United States, is huge and the global cost is estimated to be above 2 billion dollars annually. These losses are related to the mortality, worsening of productive performance, treatment costs and condemnation in processing plants.

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Prevalence and economic impact of necrotic enteritis in the Unites States
Necrotic enteritis one of the most prevalent diseases in US poultry farms [1]. A survey to poultry producers pointed out that the diagnosis in farms increased in the last years, from 4% in 2013 to 40% in 2017. This is probably related with the growing number of farms with systems that limit the use of antibiotics, which is now above 50% of all farms in the country [2].
The increasing prevalence also varies depending on the environmental and management conditions: any factor causing an increase in litter humidity [3], such as high relative humidity or diseases with rapid gastrointestinal transit, may lead to necrotic enteritis.
Economic impact of this disease is huge and the global cost is estimated to be above 2 billion dollars annually [4–6]. These losses are related to the mortality, worsening of productive performance, treatment costs and condemnation in processing plants.
The increase in the last decade of farms that limit antibiotics, such as Antibiotic Free (ABF), No Antibiotic Ever (NAE) and organic farms, together with the development of resistances, created the need for natural solutions to control necrotic enteritis¡ [7].
Characteristics of this disease
Necrotic enteritis is an acute infection caused by an excessive proliferation of Clostridium perfringens and its capacity to produce toxins. This bacterium is part of the normal intestinal microflora and outbreaks are related to predisposing factors that promote its multiplication.
2 to 5-week-old chickens are more likely to be affected and show dehydration, diarrhea and, especially, a marked increase in mortality. Necropsied animals have necrotic foci in the small gut mucosa with loss of intestinal villi (concave-shaped lesions) [8]. C. perfringens can also be observed in the transit area between the ventriculus and proventriculus. Toxins produced by C. perfringens can also damage the liver.

Predisposing factors
There are many predisposing factors for this disease. Coccidiosis, either clinical or subclinical, is among the most important ones [3,5] as C. perfringens takes advantage of the lesions and mucosal weakness it produces.
Another factor to consider is the presence of undigested feed, particularly protein, in the gut that acts as substratum for the growth of Clostridium [9]. Therefore, it is essential to optimize digestive processes in poultry by using well-formulated diets with the necessary enzymes to make sure carbohydrates and protein are properly digested.
Cimenol ring as a natural control mechanism against necrotic enteritis
Cimenol ring is an effective solution to control necrotic enteritis [10] available for ABF, NAE and organic farms or conventional systems where traditional antibiotics are inefficient due to the development of resistances.
This molecule from botanical extracts was studied and patented by Biovet S.A., and has excellent bactericidal and fungicidal properties [11]. Its efficacy against C. perfringens was observed in many laboratory and field trials following the scientific methodology.

Cimenol ring is a versatile solution available in premix and liquid presentations to be administered in the feed and the water. In the former, it preventively limits C. perfringens and other pathogens overgrowth; in the drinking water it helps to control multiplication in a faster, intermittent way.
In addition, it does not leave residues nor create resistances, it does not interact with other products from the diet, it is not corrosive, and it is safe for animals and manipulators.
Evaluation of cimenol ring’s efficacy in US farms
This product, administered at 1 ml/l in two US farms, reduced mortality caused by necrotic enteritis outbreaks. In the first farm, cimenol ring decreased mortality by 77.72%, while, in the second farm, the decrease was of 74.82%. In both farms, the product recovered the standard mortality results that were to be expected in these farms.

In other trials in US broiler farms, the cimenol ring in the feed from the start until the end of the rearing period showed to be effective to control necrotic enteritis and improved feed conversion rate (2% better), weight gain (4% better) and decreased mortality, compared to farms without the product.
Conclusions
Necrotic enteritis is one of the most important diseases for US poultry producers because of the high prevalence and economic impact.
There is a lack of efficient solutions due to the development of resistances and limitations in antibiotic use in ABF, NAE and ecologic farms that created the need for natural effective products against necrotic enteritis that suit the changes in poultry production.
Cimenol ring is an effective tool, a natural product that does not create resistances available for ABF, NAE and ecologic production systems. Its efficacy was proved in many laboratory, experimental and commercial farms following the scientific methodology. Trials conducted in the US show that cimenol ring in the drinking water reduces mortality caused by a necrotic enteritis outbreak by 70%, while, continuously in the feed, improves productive performance (2% improvement in FCR and 4% improvement in weight gain) thanks to a better balance of the gut microflora and limitating C. perfringens overgrowth.
Cimenol ring is marketed under the name Alquermold Natural (AMN in the US) by Biovet S.A, in premix and liquid. Available for antibiotic free and organic production systems.
Bibliography
- Mississippi State University. Diseases of Poultry [Internet].
- Poultry Health Today. World Poultry Industry Still Struggling with Necrotic Enteritis [Internet]. 2017.
- Hermans PG, Morgan KL. Prevalence and associated risk factors of necrotic enteritis on broiler farms in the United Kingdom; a cross-sectional survey. Avian Pathol. 2007;36(1):43–51.
- Poultry World. The true cost of necrotic enteritis [Internet]. 2015.
- Adhikari P, Kiess A, Adhikari R, Jha R. An approach to alternative strategies to control avian coccidiosis and necrotic enteritis. J Appl Poult Res [Internet]. 2020;29(2):515–34.
- Paiva D, McElroy A. Necrotic enteritis: Applications for the poultry industry. J Appl Poult Res. 2014;23(3):557–66.
- Hofacre C. Veteran poultry scientist optimistic about managing necrotic enteritis in NAE flocks. Food Safety and FDA Regulatory Climate 2017 International Poultry Scientific Forum [Internet]. 2017
- Enteritis necrótica aviar [Internet]. Veterinaria Digital. Atlas de Patología. 2020. Disponible en: https://www.veterinariadigital.com/post_blog/enteritis-necrotica-aviar-8/
- Deficiencia enzimática y enteritis necrótica [Internet]. Veterinaria Digital. Atlas de Patología. 2020. Disponible en: https://www.veterinariadigital.com/post_blog/deficiencia-enzimatica-y-enteritis-necrotica/
- Anillo cimenol, la solución natural para la prevención de la enteritis necrótica en broiler. Vet Digit Technonews [Internet]. 2020; Disponible en: https://www.veterinariadigital.com/post_blog/anillo-cimenol-prevencion-enteritis-necrotica/
- Borrell J. Metabolitos fúngicos en los alimentos. Real Acad Ciencias Vet España. 1990;
MV. Júlia Pié Orpí
Veterinary Technical support to the area of Latin America at Biovet S.A. Laboratories Official Veterinary Services (SVO) in poultry slaughterhouse
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