Managing the risk associated with use of antimicrobials in pigs

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1 Managing the risk associated with use of antimicrobials in pigs Lis Alban DVM, Ph.D., DiplECVPH, DiplECPHM Chief Scientist, Danish Agriculture & Food Council Adjunct professor, University of Copenhagen Vienna, February 27, 2014

2 About Denmark 44,000 km million inhabitants Oldest kingdom in the world Currently ruled by Queen Margaret II 2

3 Pig country Largest exporter of pork in the world 85 % pork exported = 1.9 million tons of pork - Value of Danish pork export (2013) 4.3 billion 29 million pigs produced annually 9.6 million of these exported as 30 kg pigs Among others to Germany, Italy, and Russia 3

4 Introduction to subject Diseased animals should be treated Antimicrobials often form part of correct treatment The vet is a core person for prevention and treatment A large pig production is associated a nonnegligible use of antimicrobials Will lead to development of antimicrobial resistance Several initiatives have been put in place to mitigate the risk of antimicrobial resistance Again, the vet plays a central role 4

5 Antibiotics in tons Consumption of antimicrobials in Danish livestock In Denmark, 80% of antibiotic use for all livestock is for pig production Theraputic Growth promoter (AGP)

6 4 questions regarding antimicrobials 1. Which initiatives have been put in place? 2. How is the consumption monitored? 3. What is the yellow card and what is the effect of it? 4. What about use of the critically important drugs? For each question, the reactions of farmers and vets will be mentioned

7 Antibiotics in tons Question 1 Initiatives put in place in Denmark Ban on AGPs to finishers Ban on AGPs to weaners Ban on cephalosporins + Yellow card initiative 150 Ban on flouroquinolones Theraputic Growth promoter (AGP)

Other initiatives Vets may prescribe - but not sell antibiotics

veterinary medicines to farmers Focus on withdrawal periods to

use of medicine prescribed for livestock DANMAP survey tracking

8 Other initiatives Vets may prescribe - but not sell antibiotics Treatment guidelines developed Not permitted to advertise veterinary medicines to farmers Focus on withdrawal periods to avoid antibiotic residues in pig meat VETSTAT database - records use of medicine prescribed for livestock DANMAP survey tracking development of antibiotic resistance in livestock, food and human population since 1995

9 Impact of split between prescribing and dispensing vets In place since 1995 Herd health agreements also required from 1995 Changed focus from treatment to prevention through advisory service Vet pays monthly/quarterly visit to pig herd Prescription are given at visit Consultations by phone between visits also possible Quarterly reports written Status about use of antimicrobials is part of report Vets did not loose their income but some needed to improve their advising skills OK for farmers 9

10 Treatment guidelines Guidelines regarding which antimicrobial to use Only useful if focus is on both effect of treatment and risk of antimicrobial resistance Danish Veterinary and Food Administration has launched new guidelines for use in pigs These guidelines accepted by vets and farmers Because they are meaningful, timely, and practical Enables practitioner to evaluate effect of different treatment regimes

11 Risk profile - according to the Danish Food Institute 11

12 Q2- How is antimicrobial consumption monitored? All medicine used by the farmer is prescribed by the veterinary practitioner and recorded centrally in a database (VetStat) Enables to identify trends in usage By farm, veterinary practice or at national level By animal species or age groups Run by The Danish Veterinary and Food Administration 12

13 Consumption/Production Anitimicrobial per pig in g Despite of actions taken, consumption of antimicrobials in pigs increased from 2008 to 2009 this lead to new actions Year Consumption in pigs (tons) Production of pigs (mio.) Antimicrobial per pig in g

Question 3 The Yellow Card Adapted in July 2010 by Danish Veterinary and Food Administration Make use of data recordings in Vetstat Restrictions imposed on pig farmers who use more antimicrobials

14 Question 3 The Yellow Card Adapted in July 2010 by Danish Veterinary and Food Administration Make use of data recordings in Vetstat Restrictions imposed on pig farmers who use more antimicrobials than twice the average Divided into one of three age groups Age group Permit limit* Sows and piglets 5.2 Weaners 28 Finishers 8 * Animal daily doses (ADD) per 100 animal days limits have later been reduced further 14

15 Annual evaluation of antimicrobial consumption in sows and piglets in one herd Official permit limit for age group ADD Moving average consumption of antimicrobials for age group in herd Monthly consumption in ADD

16 Actions related to Yellow Card Over Over 9 mths Over Source: Andreasen, Alban, Dahl & Nielsen J. Agricult. Sci. Techn. A 2,

17 Effect of the Yellow Card The next slides show: Monthly consumption of antimicrobials and use of vaccines between 2009 and 2011 Comparison between meat inspection lesions from before and after the Yellow Card Source: Alban, Dahl, Andreasen, Petersen & Sandberg Prev. Vet. Med. 108,

18 Consumption (kg) Consumption of antibiotics in Danish pig production Yellow Card warning Yellow Cards sent out Month From 2010 to 2011: increase in production of 810,000 pigs

19 Doses of vaccine (x1,000) Consumption of vaccines: changes in use seen over 12 months 6000 Respiratory: +21% PCV2-related: + 90% Respiratory Gastro-intestinal PCV2-related Other _2009 4_2009 1_2010 2_2010 3_2010 4_2010 1_2011 2_2011 Gastrointestinal: +43% Others: -7% Quarter and year

20 Comparison of lesions at meat inspection year 2011 versus 2010 Lesion Parameter estimate Odds Ratio Standard error 95% C.I. P-value Chronic peritonitis < Umbilical hernia < Chronic enteritis < Condemnation Osteomyelitis Chronic arthritis Chronic pleuritis Chronic pneumonia < Chronic pericarditis < Tail bite infection <0.0001

21 ADG in g per day FU/kg or mortality (%) Effect on production Year ADG (g) FCR (FU/kg) Mortality( %) 5 4,5 4 3,5 3 2,5 2 1,5 1 0,5 0 Source: Vinther, 2012

22 Summary: Effect of Yellow Card Documented effect: Decreased use of antimicrobials Increased use of vaccines Minor impact on health assessed on average Reports from the field: Minor reduction in productivity In some herds, necessary to change management Vets: positive Farmers: negative

23 Use is on the increase again By 16% between Jan 2011 and May 2013 But still lower than before the Yellow Card Scheme Jan 11 Mrz 11 Mai 11 Jul 11 Sep 11 Nov 11 Jan 12 Mrz 12 Mai 12 Jul 12 Sep 12 Nov 12 Jan 13 Mrz 13 Mai 13 Source: VETSTAT 23

24 Secondary effect of Yellow Card - According to DANMAP 2012 DAPD = Number of standard doses for 1 kg animal divided by the estimated live biomass in age group

26 Question 4 - What about use of critically important drugs? WHO has defined a list of antimicrobials as critically important drugs The assessment is based on the importance of antimicrobial for human treatment The list includes - among others - flouroquinolones and cephalosporines but also macrolides such as tylosine 26

27 Fluoroquinolones & cephalosporins Fluoroquinolones banned in DK since 2002 Only allowed under certain conditions and only by the veterinarian personally In practice: not in use in DK Cephalosporins Voluntary ban from July 2010 AIM: to reduce potential risk for resistance in human pathogens Veterinarians have found alternative treatments Challenges: Sporadic cases where cephalosporins are the only drug of choice (e.g. some E. coli) Responsible actions taken by industry

28 Active compound (kg) Use of cephalosporins and fluoroquinolones for pigs Fluoroquinolones Cephalosporins DANMAP, Vetstat

29 Producing pigs without fluoroquinolones & cephalosporins We can do without these drugs in most cases because: Pig vets are good at their job SPF-system results in high health High level of management in Danish herds in general Vaccination strategies in place Use of other efficient antibiotics based on resistance pattern Farmers and vets: OK with bans but it would be nice to have access to fluoroquinolones in case of outbreaks of Actinobacillus pleuropneumoniae

30 Macrolides and pigs Big debate about first version of guidelines for pigs Authorities: Do not use macrolides for treatment of diarrhoea Presumed risk: Macrolide-resistant Campylobacter a risk to humans? Farmers and vets disagreed! Risk assessment undertaken: Negligible - because almost no Campylobacter in porkbecause of blast chilling at slaughter => Official recommendations changed subsequently Source: Alban et al., Prev. Vet. Med., 83,

31 Discussion Did the actions have any impact on the overall use? YES Did we lower the human health risk? MAYBE at least the industry improved their image 31

32 Explanation for relative low use of antimicrobials in Danish pig production Primary factors The pig vet focuses more on advisory service than treatment Farmers are well-educated The pressure put on production by Danish Veterinary and Food Administration acts as incentive Other factors Unique Danish SPF health management system High level of management in general 32

33 Tools: Manual Regarding use of antimicrobials Promoting prudent use Developed in collaboration with pig vets Published in Danish, English and Russian Can be found at: ldgangen/manualer/antibiotika praksis.aspx

34 Summary Danish experience Which initiatives have been put in place? How is the consumption monitored? What is the effect of the yellow card? Several Vetstat database Great effect initially What about the critically important drugs? Limit/ban use and show responsibility but don t touch the macrolides

35 Thank you for your attention

Managing the risk associated with use of antimicrobials in pigs

Managing the risk associated with use of antimicrobials in pigs - Effect of the Yellow Card Lis Alban DVM, Ph.D., DiplECVPH, DiplECPHM Chief Scientist, Danish Agriculture & Food Council Adjunct professor,