Transcript No Slide Title

Working across sectors:
a public health approach to
to antimicrobial resistance
December 2014
1
Antibiotic use: use in plants, fish
and animals
US: OVER-USE OF ANTIBIOTICS THREATENS HUMANS
by Danielle Knight
Washington,11 Oct. (IPS) –
More than half of the antibiotics used in the United States are
estimated to be used in animal feed for poultry, hogs, and
cattle. In 80 percent of cases, the drugs are used to fatten
the animals faster.
Between 40,000 and 50,000 pounds of tetracycline and
streptomycin - both used to treat infections in humans - are
sprayed to control bacterial disease among fruit trees.
In the United States nearly 150 pounds of antibiotic are
applied per acre of salmon
Source: Inter Press Service
December 2014
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Antibiotic consumption in
animals, 2000
Source: Follet,G (2000) Agbioforum
December 2014
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Primary effects sought from
antibiotic growth promoters
•
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increased growth
improved feed efficiency
lower incidence of certain diseases
Source. Doyle E, Food Research Institute, University of Wisconsin
December 2014
4
European ban on the use of antibiotic
growth promoters, 1998 - 2006
December 2014
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Mg/kg
Antibiotics: therapeutic use and growth
promotion, pigs, Denmark 1992 - 2008
Source: Aarestrup F. Danish Government
December 2014
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Annual antibiotic use for human and
veterinary practice in Denmark
December 2014
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Success factors, Danish ban on growth
promoters
December 2014
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Estimated antimicrobial use to produce
on kilogram of meat
Source: Grave K, Torren-Edo J, Mackay D. Comparison of the sales of veterinary antibacterial agents between 10 European countries. Journal of Antimicrobial Chemotherapy, 2010, 65(9):2037-40.
December 2014
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Antibiotic use in animal husbandry
Source: New England Journal of Medicine, 1999
December 2014
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Antimicrobial resistance at animal/human
interface: US awareness campaign
March 2013
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Macrolide use and enterococcal
resistance in pigs, Denmark
Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.
December 2014
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Cephalosporin resistance after stopping
use in poultry, Quebec, Canada
Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.
December 2014
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Fireblight (Erwinia amylovora), fruit trees,
USA 1994
Source: McManus L, American Phytological Society, 1994
December 2014
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Microbial-resistant plant agriculture
December 2014
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*Bacterial resistance, aquaculture sludge,
Puget Sound, 1992
Aquaculture Puget Sound
*pseudomonads, E.coli,enterobacter,enterococci, other
December 2014
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Vaccination in aquaculture,
US and Norway
December 2014
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700 000
60 000
600 000
50 000
500 000
400 000
30 000
300 000
20 000
200 000
Antibiotics
(tons wfe)
Volume
40 000
(kg active substance)
Antimicrobial use and salmon/trout production,
Norway, after introduction of vaccination, 1994
10 000
100 000
0
0
1981
1984
1987
1990
1993
1996
1999
2002
Volume salmon and trout
Consumption antibiotics
Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006
December 2014
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Complexity of the antimicrobial web
Source:Cantas l.Front. Microbiol., 14 May 2013 |
December 2014
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Antimicrobial resistance: two
independent mechanisms
Selection pressure: over/under-use
of antimicrobials
December 2014
Plasmid exchange: environmental
exposure to other organisms
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Principal transfer pathways, antibiotic resistance
genes: humans, animals, food and the environment
Plants
Source: DARC/ARHAI joint report, UKI
December 2014
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Risks at animal/animal and animal/human interface
December 2014
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Reservoirs of bacteria causing human
infections
Source: WHO
December 2014
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Multidrug-resistant Definitive Type (DT) 104
Salmonella Typhimurium, Europe, 1982-1996
Salmonella Typhimurium isolates from both cattle and humans
cattle
humans
%
50
40
30
20
10
0
1982-85
Source: WHO from published data
December 2014
1986-90
1991-94
1995-96
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Clinician-perceived contribution(%) of
individual bacteria species, EU 2000
Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000
December 2014
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Possible alternatives to growth promoters
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Alternative husbandry practices leading to cleaner agriculture
Probiotics (e.g. lactic acid bacteria) and competitive exclusion of other
organisms
Organic acids (Acidifers) to acidify feed and encourage growth of
lactobacilli – PH monitoring/rumen chip technology
Gastrointestinal enzymes to increase digestability of feed
Immune modulators to enhance resistance to infection
Feed supplements (vitamins, protein supplements and minerals)
Nitric Oxide and respiratory disease - stressed animals
Source. Doyle E. Food Research Institute, University of Wisconsin
December 2014
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Putting it all together: antimicrobial
resistance in animals, plants and fish
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•
•
•
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December 2014
Increased public awareness
Clean agriculture
Use existing vaccines
Work across sectors
Regulation with enforcement
Monitoring effectiveness of above and other interventions
Research and development - newer technologies, point of care
diagnostics, vaccines
Select/hybridise/engineer microbial-resistant plants
Consider an international treaty
Do the bottom line mathematics
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The bottom line: do the maths
Human + antibiotic = saved life
Food animal, fish and plant + antibiotic = saved life
+ rapid growth, and equal or increased profit
December 2014
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Leading infectious causes of mortality,
2008 estimates, with smallpox 1967
3.5
3.0
2.5
2.0
Smallpox 1967
Deaths (millions)
> 5 years old
< 5 years old
1.5
1.0
0.5
0
December 2014
ARI
Diarrhoea
AIDS
TB
Malaria
Measles
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