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Foodborne Pathogens and Antibiotic Resistance: Consequences and Possible Solutions. Stacy Holzbauer, DVM, MPH Foodborne and Diarrheal Diseases Branch National Center for Infectious Diseases Centers for Disease Control and Prevention. Overview.

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foodborne pathogens and antibiotic resistance consequences and possible solutions

Foodborne Pathogens and Antibiotic Resistance: Consequences and Possible Solutions

Stacy Holzbauer, DVM, MPH

Foodborne and Diarrheal Diseases Branch

National Center for Infectious Diseases

Centers for Disease Control and Prevention

overview
Overview
  • Trends in Foodborne Diseases and Antimicrobial Resistance
  • National and State Antimicrobial Resistance Programs
  • Ways to work together
important declines in foodborne pathogens
Important Declines in Foodborne Pathogens
  • FoodNet reported important declines in the major foodborne diseases in 2004 compared to 1996
    • E. coli O157:H7, Campylobacter, Salmonella have declined from 8-42%
    • MMWR April 2005
slide4

2

Campylobacter

E. coli O157

Listeria

Salmonella

1

Relative Rate

0.8

0.7

0.6

0.5

1996-1998

2005

1999

2000

2001

2002

2003

2004

Year

Trends in Selected Pathogens, 1996-98 to 2004

reasons for e coli 0157 declines
Reasons for E. coli 0157 declines
  • Important changes by major cattle slaughter plants
    • Prevent contamination when remove hide
    • Steam pasteurization after process
    • Test and hold meat
relative incidence baseline 2004 top 5 salmonella serotypes
Relative Incidence baseline - 2004: Top 5 Salmonella Serotypes

Pathogen Change 95% Conf. Interval

Declined

S Typhimurium -41% -48% to -34%

No Change

S Enteritidis 0% -21% to +25%

S Heidelberg +3% -16% to +26%

Increased

S Newport +41% +5% to +89%

S Javiana +167% +75% to +306%

slide7

Antimicrobial Resistance Trends

  • Increase in multi-drug resistance
    • Salmonella Typhimurium DT104
    • MDR-AmpC Salmonella Newport
  • Increase in resistance to clinically important antimicrobial agents
    • Third generation cephalosporins – Salmonella
    • Fluoroquinolones – Campylobacter, Salmonella including S. Typhi, Shigella
percentage of s newport with at least acssut and mdr ampc resistance pattern 1996 2003
Percentage of S. Newport with at least ACSSuT and MDR-AmpC resistance pattern, 1996-2003*

Newport MDR-AmpC

% ACSSuT

*2003 preliminary data

slide9

MDR Salmonella Newport in Animals

  • 2004 Salmonella outbreak in horses in Pennsylvania
  • Highly resistant Newport strain
  • Significant mortality associated with infection
bridging the gap
Bridging the Gap
  • Can public health and animal health work together?
  • Is there really a gap??
public health s mission
Public Health’s Mission
  • CDC's MissionTo promote health and quality of life by preventing and controlling disease, injury, and disability.
  • APHL’s Mission

The Association of Public Health Laboratories

(APHL) works to safeguard the public's health by

strengthening public health laboratories in the

United States and across the world.

veterinary oath
Veterinary Oath
  • Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for thebenefit of society through theprotection of animal health, the relief of animal suffering, the conservation of livestock resources,thepromotion of public health,and the advancement of medical knowledge.
common theme
Common Theme
  • Society
  • Prevent Disease
  • Control Disease
  • Public Health
is there a gap
Is There A Gap?
  • On paper….
    • NO!
  • Ability to communicate…
    • YES!
slide15

12 Step Program, DHQP

GET SMART, DBMD

Reduce the Spread of

Antimicrobial Resistance

NARMS-EB, DBMD

get smart know when antibiotics work
Get Smart: Know When Antibiotics Work
  • Established in 1998
  • 115 Partners
  • $17.5 million in-kind support
  • Over 1300 people working on the campaign around the country
get smart know when antibiotics work on the farm
GET SMART: Know When Antibiotics Work on the Farm

Educational Activities to Promote Appropriate Use of Antimicrobial Agents in Animals

Sister program of GET SMART: Know When Antibiotics Work

antimicrobial resistance a complex problem in veterinary medicine
Antimicrobial Resistance: A Complex Problem In Veterinary Medicine
  • Companion animals
  • Farm animals, including food animals
  • Individual patients, herd health, human health
  • Antimicrobial agent use without direct veterinary supervision
    • Over the counter sales
  • Client education
    • Pet owners like parents
    • Food animal producers
slide20
Get Smart on the FarmEducational Activities to Promote Appropriate Use of Antimicrobial Agents in Animal Health
  • Veterinary Curriculum
  • State-based Interventions
slide21

Veterinary Curriculum

  • Enhance veterinary education in antimicrobial resistance
  • Promote appropriate use of antimicrobial agentsin veterinary medicine
  • Web-based with background, species specific sections
  • Microbiology, pharmacology, public health
slide22
State-based InterventionsFoster Collaboration between state public health and veterinary communities
  • Establish local surveillance of antimicrobial resistance among enteric bacteria from humans and animals
  • Develop community-based programs on appropriate use

of antimicrobial agents in animals

slide23

Animal Health Practices on Washington Dairy Farms

A Tacoma-Pierce County Health Department

Antibiotic Resistance Task Force Project

Primary Investigator: Monica Raymond, MPH, MS, RN

Project Coordinator: Ron Wohrle, DVM

Advisory Board Chairman: Robert Whitney, DVM

slide24

Background

  • Focus on dairy industry
  • Collect real-world data on use of antibiotics and biosecurity practices on farm
  • Establish relationships with dairy producers, dairy organizations, and veterinarians
project methods
Project Methods
  • Initiate dialogue with veterinarians, producer organizations, local health departments, other constituencies
  • Survey producers on knowledge, attitudes, and practices related to antibiotic use and biosecurity
project approach
ProjectApproach
  • Voluntary
  • Supportive
  • Focus on benefits to producers
  • COLLABORATIVE
slide27

Survey of Animal

Health Practices on Washington

Dairy Farms

July 2003

Endorsed by the

Washington State

Dairy Federation

This is a collaborative effort between professional veterinary, animal agricultural, human health, and public health communities in Washington State

slide28

“FARM SOCIOLOGY 101"

WE “MANAGE’ ORGANISMS--- PRODUCERS “MANAGE”

ANIMALS

WE VALUE “INFORMATION”---PRODUCERS VALUE “A WAY

OF LIFE”

WE STRIVE FOR “FREEDOM FROM DISEASE”---PRODUCERS

STRIVE FOR “THE OPTIMUM LEVEL OF DISEASE THEY

CAN LIVE WITH AND SURVIVE”

needs assessment survey
Needs Assessment Survey
  • Producer knowledge
  • Attitudes and practices
  • Biosecurity and antibiotic use
  • Four major areas
    • Herd characteristics
    • Colostrum & calf management
    • Animal health management practices
    • Producer background information
needs assessment survey1
Needs Assessment Survey
  • 15 page (65 questions) self-administered mail questionnaire with $5 incentive
  • Pre-notice letter of endorsement by Washington State Dairy Federation
  • Representatives from partners aided in question and survey design
summary
Summary
  • Approximately 600 dairy operations in WA State
  • Major uses of antibiotics in dairy cattle:
    • Calf milk replacer
    • Dry-off lactating cows
    • Treatment of mastitis, calf diarrhea, respiratory illness
  • Major biosecurity issues
    • calf immunity
    • introduction of newly purchased animals
    • calving and sick pens
washington conclusions
Washington Conclusions
  • Given openness on both “sides” - public health and industry, a collaborative approach can be an effective method for addressing antibiotic use in agriculture
  • There is willingness in the DAIRY industry to examine antibiotic use and take steps to use antibiotics more judiciously
important points
Important Points
  • There are many silos
    • Lack of communication
    • Lack of understanding other disciplines
  • A need to share commonalities
bridge building
Bridge Building
  • The gap is not that large
    • Communication is a must
  • Positive examples to follow
  • Silos still need to be broken down
  • Many potential collaborations/sources of information