Working across sectors: a public health approach to to antimicrobial resistance

1. Working across sectors:a public health approach to to antimicrobial resistance

2. 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

3. Antibiotic consumption in animals, 2000 Source: Follet,G (2000) Agbioforum

4. Primary effects sought from antibiotic growth promoters • increased growth • improved feed efficiency • lower incidence of certain diseases Source. Doyle E, Food Research Institute, University of Wisconsin

5. European ban on the use of antibiotic growth promoters, 1998 - 2006

6. Antibiotics: therapeutic use and growth promotion, pigs, Denmark 1992 - 2008 Mg/kg Source: Aarestrup F. Danish Government

7. Annual antibiotic use for human and veterinary practice in Denmark

8. Success factors, Danish ban on growth promoters

9. 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.

10. Antibiotic use in animal husbandry Source: New England Journal of Medicine, 1999

11. Antimicrobial resistance at animal/human interface: US awareness campaign

12. 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.

13. 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.

14. Fireblight(Erwiniaamylovora), fruit trees, USA 1994 Source: McManus L, American Phytological Society, 1994

15. Microbial-resistant plant agriculture

16. *Bacterial resistance, aquaculture sludge, Puget Sound, 1992 Aquaculture Puget Sound *pseudomonads, E.coli,enterobacter,enterococci, other

17. Vaccination in aquaculture, US and Norway

18. Antimicrobial use and salmon/trout production, Norway, after introduction of vaccination, 1994 Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006

19. Complexity of the antimicrobial web Source:Cantasl.Front. Microbiol., 14 May 2013 |

20. Antimicrobial resistance: two independent mechanisms Selection pressure: over/under-use of antimicrobials Plasmid exchange: environmental exposure to other organisms

21. Principal transfer pathways, antibiotic resistance genes: humans, animals, food and the environment Plants Source: DARC/ARHAI joint report, UKI

22. Risks at animal/animal and animal/human interface

23. Reservoirs of bacteria causing human infections Source: WHO

24. Multidrug-resistant Definitive Type (DT) 104 Salmonella Typhimurium, Europe, 1982-1996 cattle humans 50 40 30 20 10 0 1982-85 1986-90 1991-94 1995-96 Salmonella Typhimurium isolates from both cattle and humans % Source: WHO from published data

25. Clinician-perceived contribution(%) of individual bacteria species, EU 2000 Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000

26. Possible alternatives to growth promoters • 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

27. Putting it all together: antimicrobial resistance in animals, plants and fish 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

28. 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

29. Leading infectious causes of mortality, 2008 estimates, with smallpox 1967 Smallpox 1967 3.5 > 5 years old < 5 years old 3.0 2.5 Deaths (millions) 2.0 1.5 1.0 0.5 0 ARI TB Malaria Measles AIDS Diarrhoea