Antimicrobial usage and Antimicrobial resistance in Vietnam

Transcription

1 FMM/RAS/298: Strengthening capacities, policies and national action plans on prudent and responsible use of antimicrobials in fisheries Antimicrobial usage and Antimicrobial resistance in Vietnam Dr Nguyen Van Long, DVM, MSc, PhD. Dr Dang Thi Lua, PhD. Aquatic AMR Workshop 1: April 2017, Mangalore, India

2 PRESENTATION OUTLINE I. Background II. Antimicrobial usage and Antimicrobial resistance III. State management activities IV. National Action Plan

3 I. General background Area: 332,000 km 2 Population: 90 million (70% practice farming) Capital: Hanoi Agricultural production contributed about 18% of national GDP Aquaculture contributes about 26 % of total agricultural GDP

4 1.1. TOP FIVE AQUACULTURE SPECIES TT Species Estimate d areas (ha) 1 Shrimp Estimated productivity (cubic ton) Main production area White leg shrimp (Litopenaeus 100, ,000 MRD vannamei) Giant tiger prawn (Penaeus monodon) 600, ,000 MRD Giant freshwater prawn (Macrobrachium 28,000 60,000 Northern rosenbergii) provinces 2 Pangasius catfish (Pangasius hypophthalmus) ,500, MRD provinces 3 Tilapia (Oreochromis niloticus) ,000 4 Mollusca 50, ,000 5 Traditional fish (such as carp, ) 350, ,000 Northern provinces

5 Area and production of Tilapia (2014) Place Pond area (ha) Cage area (m3) Production (tonnes) Highlands in North , Red river Delta 10, ,597 72,303 North Central 2,927-12,080 South Central ,000 1,180 Highlands in South 1,578-5,750 South East 1,115 6,300 6,755 South West 1, ,008 62,641 Total 25,415 1,122, ,082

6 MAJOR AQUACULTURE AREAS 29 provinces produce brackish shrimps ( ha) 10 provinces produce pangasius (5.500 ha) A total of 1,3 million ha

7 Intensive shrimp production farm without using antibiotics

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10 The map of farming areas in Building the traceability process for pangasius products Developing e-commerce to expand market share: www. mekongfishmarket.com

11 Pangasius Processing Establishments Vam Cong IZ for fish processing factories Bien Dong Seafood Co., Ltd Sao Mai fish oil processing factory Cantho Import-Export Seafood JSC. (CASEAMEX)

12 Pangasius products

13 Shrimp: Market and Trade Vietnam exports shrimp to over 95 countries and territories Main markets: America, EU, Japan,China, Korea, Australia, Canada, ASEAN, Taiwan. Shrimp exports brought home about US$ 3.15 billion in Total production of farmed Pangasius by country (FAO statistics, 2008).

14 Pangasius: Market and Trade Vietnam is the world s largest producer of Pangasius: o Producing > 1.1 million tons per year o Exporting to over 161 countries and territories Pangasius accounted for over 25% of total seafood export turnover of Vietnam 2016: Production was 1.2 million tons and exports brought home US$ 1.67 billion. Total production of farmed Pangasius by country (FAO statistics, 2008).

15 Total production of farmed Pangasius by country (FAO statistics, 2008). Tilapia: Market and Trade Vietnam is one of five largest producer of tilapia in Asia: o Producing tonnes (2013) and tons (2015) o Exporting to over 60 countries and territories Tilapia exports brought home more than US$ 34 million in Tilapia still is mainly used for domestic consumption.

16 Major disease concerned 1.2. DISEASE SITUATION In shrimp WSSD AHPND IHHNV MBV EHP Taura? In Pangasius Edwardsiella ictalura Aeromonas hydrophila In mollusca Environmental change VLPs in Otter clam Perkinsus? In tilapia Streptococcus spp TiLV? In marine fish VNN Vibrio spp. In traditional fish Aeromonas infection Pseudomonas infection

17 Situation of shrimp diseases By infected species Year Areas (ha) of giant tiger prawn (Penaeus monodon) with disease Areas (ha) of white leg shrimp (Litopenaeus vannamei) with disease Total infected areas (ha) By disease Year WSSD (ha) AHPND (ha) IHHND (ha) Local endemic diseases (ha) Total (ha) ,872 5,552 1,211 11,511 42, ,337 9, ,906 17, ,892 6, ,052 11,313

18 SPATIAL DISTRIBUTION OF AREAS WITH DISEASED SHRIMP IN In 2014 In 2015 In 2016

19 Situation of pangasius diseases TT Disease Year 2014 Year 2015 Year Disease caused by Edwardsiella ictalura (ha) Disease caused by Aeromonas hydrophila (ha) Local endemic diseases (ha) Total 1, Some pangasius ponds infected with more than one disease, so if we sum-up by disease, total infected areas slightly higher than the total mentioned above table

20 SPATIAL DISTRIBUTION OF AREAS WITH DISEASED PANGASIUS IN In 2014 In 2015 In 2016

21 Situation of Tilapia disease Steptococosis disease caused by Streptococcus iniae, S. agalactiae The first outbreak was reported in Vietnam in 2009 Occur every year during the summer (high temperature) Susceptible at marketable size with high mortalities (60%-100%) Can be treated by antibiotics, start using vaccination

22 PRESENTATION OUTLINE I. Background II. Antimicrobial usage and Antimicrobial resistance III. State management activities IV. National Action Plan

23 2.1. Summary of veterinary products are licensed in Vietnam Total: 814 products produced by 51 domestic manufactures and 53 importers 609 products produced by 51 domestic manufactures 105 produced from 53 importers We also have a list of chemicals and antibiotics banded for production, trading and using in aquaculture

24 2.1. THE LIST OF CHEMICALS, ANTIBIOTICS BANNED FOR PRODUCTION, TRADING IN AQUACULTURE (Circular No. 10/2016/TT-BNNPTNT) No Chemicals, antibiotics Applied for 1 Aristolochia spp and by products 2 Chloramphenicol 3 Chloroform 4 Chlorpromazine 5 Colchicine 6 Dapsone 7 Dimetridazole 8 Metronidazole 9 Nitrofuran (bao gồm cả Furazolidone) Animal feed, veterinary 10 Ronidazole medicines, chemicals, 11 Green Malachite (Xanh Malachite) environmental treatment 12 Ipronidazole substances, disinfectants, 13 Các Nitroimidazole khác substances for maintain, hand 14 Clenbuterol cream in all breeding facilities, 15 Diethylstilbestrol (DES) aqua culture, processing and 16 Glycopeptides storage for fishery services. 17 Trichlorfon (Dipterex) 18 Gentian Violet (Crystal violet) 19 Trifluralin 20 Cypermethrin 21 Deltamethrin 22 Enrofloxacin 23 Ciprofloxacin 24 Fluoroquinolones

25 2.2. AMU Beside many good aspects for management of AMU, some issues to be discussed as follows: In 2015 and 2016, DAH carried out three surveys of AMU 714 aquaculture farming households in 3 pangasius production provinces (Ben Tre, Dong Thap, An Giang) and 2 shrimp production provinces (Soc Trang and Bac Lieu) In 3 pangasius production provinces: 216/272 (79,4%) households used at least one antibiotic In 2 shrimp production provinces: 256/436 (67,9%) households used at least one antibiotic This means that antibiotics have been used widely and frequently in aquacultre. Antibiotics are used without any prescription; farmers used for both prevention and treatment of diseases. Reasons, because they invested a lot of money and they dont want to lose their products

26 USE OF OXYTETRACYCLINE Before 2016, antibiotics were very commonly used in aquaculture

27 USE OF OXYTETRACYCLINE Farmers just bought some kg of Oxytetracycline and kept them for their daily use Antibiotic without label was used in aquaculture

28 And many other antibiotics are used

29 Even a farm has a list of antibiotics t be used at their farm

30 2.3. AMR WHO warns that Vietnam is one of the top country where have high rate of AMR In aquaculture (pangasisu production): AMR for disease caused by Edwardsiella ictalura Number of resistances Number of sensitivities

31 2.3. AMR In aquaculture (pangasisu production): AMR for disease caused by Aeromonas hydrophila Number of resistances Number of sensitivities

32 PILOTING SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE IN AQUACULTURE SECTOR IN VIETNAM sponsored by WHO One of major objective: Study prevalence of enteric bacteria (E. coli and Salmonella) and aquatic bacteria (Aeromonas spp and Vibrio spp) in catfish aquaculture in Can Tho province. In 2014

33 Antimicrobial resistance test for Aeromonas spp. TT Antimicrobi als Aeromonas spp. Water Sediment Fish S I R S I R S I R 1 FFC 148/167 2/167 17/ /182 6/182 12/ /169 6/169 33/169 2 OXT 118/167 0/167 49/ /182 2/182 26/182 89/169 6/169 74/169 3 ENR 45/167 77/167 45/ /182 55/182 24/182 87/169 55/169 27/169 4 AMP 1/167 0/ /167 5/182 0/ /182 1/169 0/ /169 5 AMO 1/167 0/ /167 5/182 2/ /182 1/169 0/ /169 6 NOR 150/167 6/167 11/ /182 0/182 7/ /169 3/169 4/169 7 SXT 154/167 2/167 11/ /182 0/182 13/ /169 2/169 9/169 8 GN 135/167 11/167 21/ /182 8/182 29/ /169 2/169 67/169 9 SDM 0/167 0/ /167 0/182 0/ /182 0/169 0/ /169 S Susceptible I- Intermediate R- Resistance

34 Resistance rate among Aeromonas isolates 536 isolates of Aeromonas spp.

35 Antimicrobial resistance test for Vibrio spp. TT Antimicrobials Water Sediment Fish S I R S I R S I R 1 FFC 103/117 5/117 9/ /134 11/134 6/134 62/77 4/77 11/77 2 OXT 81/117 0/117 36/117 74/134 22/134 38/134 57/77 2/77 18/77 3 ENR 62/117 19/117 36/117 91/134 18/134 25/134 42/77 22/77 13/77 4 AMP 75/117 17/117 25/ /134 17/134 10/134 52/77 4/77 21/77 5 AMO 74/117 27/117 16/ /134 20/134 7/134 44/77 15/77 18/77 6 NOR 101/117 5/117 11/117 99/134 11/134 24/134 57/77 8/77 12/77 7 SXT 66/117 5/117 46/117 60/134 3/134 71/134 25/77 6/77 46/77 8 GN 72/117 5/117 40/117 89/134 17/134 28/134 56/77 0/77 21/77 9 SDM 0/117 0/ /117 0/134 0/ /134 0/77 0/77 77/77 S Susceptible I- Intermediate R- Resistance

36 Resistance rate among Vibrio spp. isolates 346 isolates of Vibrio spp.

37 PRESENTATION OUTLINE I. Background II. Antimicrobial usage and Antimicrobial resistance III.State management activities IV. National Action Plan

38 III. State management activities 3.1. National aquatic animal health strategy In : FAO Project TCP/VIE/3304 FAO supported Vietnam to identify pathogens of AHPND (Dr Melba Reantaso and other international experts) And the National Aquatic Animal Health Strategy: 1. Policy legislations and institutional framework 2. Epidemiology (surveillance, monitoring), Emergency preparedness and reporting 3. Diagnostics and laboratory systems 4. Quarantine, inspection and health certification 5. Veterinary drugs/chemicals and vaccine management 6. Capacity building 7. Research and Development 8. Communication and international collaboration 9. Resources and funding

39 III. State management activities 3.2. Policy legislations and institutional framework New Veterinary Law has been effective since 01 July 2017 Degree 35/2016/ND-CP dated 15/5/2016. Degree 39/2017/ND-CP dated 04/4/2017 on animal feeds with addition of antibiotics which will be totally eliminated from animal feeds in Circulars of MARD on disease control, AMU and AMRD MARD established National Steering Committees for Prevention and Control of Aquatic Animal Diseases; for AMU and AMR Ministry of Health (MoH) initiated national activities to tackle AMR with the publication of the National Action Plan on Combatting Drug Resistance from 2013 to MoH also established National Steering Committee for controlling AMU and AMR, including representatives rom 31 relevant agencies Three ministries, MoH, MARD and MONRE signed the Multi-stakeholder Engagement to combat AMR in Vietnam MARD issued more than 20 official letters to direct and enforce controlling AMU &AMR

40 III. State management activities 3.3. National programmes National Programme for Prevention and Control of Diseases in Pangasisus Animals between 2015 and 2020 (Decision 4995/QĐ-BNN-TY dated 20/11/2014) National Programme for Establishment of Disease Free Compartments and Zones for Shrimp Production (Decision 4088/QD-BNN-TY dated 07/10/2016) National Programme for Active Surveillance of Diseases in Shrimp and Pangasius Animals and Products to be exported between (Decision 1038/QD-BNN-TY dated 29/3/2017) Annually, both National and Local Government issues the National and Local Action Plans for Disease Control Objectives: Early warning More effective and timely detection, response to aquatic animal diseases Disease free compartments and zones Meet requirements from importers (currently 161 countries import aquatic animals and aquatic animal products from Vietnam)

41 3.4. Aquaculture management system in Vietnam

42 Animal Health System of Viet Nam MINISTRY OF AGRICULTURAL AND RURAL DEVELOPMENT NAFIQAD Regional Animal Health Offices (RAHOs) No. 1 No. 2 No. 3 No. 4 No. 5 No. 6 No. 7 Regional Sub Departments of Animal Quarantine and Inspection in Lang Son, Lao Cai and Quang Ninh DEPARTMENT OF ANIMAL HEALTH (Divisions) 1. Epidemiology 2. Aquatic Animal Health 3. Animal Quarantine 4. Drug & Vaccine Management 5. Veterinary Public Health 6. Legislation & Inspection 7. Plan (Inter. Cooperation & Science) 8. Finance 9. Personnel and Administration 10. International Cooperation and Com. Provincial Sub-Department of Animal Health District Veterinary Station Communal Veterinary Team Domestic Animal Quarantine Station Directorate of Fishery; RIA1,2,3; Universities Professional Centers The National Center for Vet. Diagnosis The National Center for Vet. Bio-products Inspection 1, 2 The National Center for Hygiene Inspection 1, 2 Direct state management (Technical + personnel + financial approval) Only technical supervision and/or collaboration

43 Animal health staff Institution Number of staff Qualification (%) Post.Grad Graduate Technicians Basic training DAH and RAHOs Provincial SDAH Commune vets , , Private vets 30,

44 National Committee for Controlling Diseases in Aquatic Animals in Vietnam: 30 members come from various national and local agencies involve in aquaculture management and veterinary services

45 National Committee for AMU and AMR Lead by Deputy Prime Minister 32 Members come from all relevant ministries: MoH, MARD, Ministry of Trade, Ministry of Police, Custom, etc. One Health Office

46 The OIE PVS Tool Evaluation of the Performance of Veterinary Services - First PVS evaluation of aquatic animal health system in the world in Level 2 (the best level 5) - First follow-up PSV evaluation of aquatic animal health system in the world in 2015: level 3 (the best level 5)

47 III. State management activities 3.5. Diagnostics and laboratory systems A total of 32 national and local laboraties for aquatic animal diseases. Of which 19 laboratories are accreditaed with ISO All 12 National laboratories are at the level 2+ for biosecurity will all advanced facilities such as PCR, Real-time PCR, isolation and sequencing All 12 National laboratories are assigned for monitoring residues in aquatic animals and aquatic animal products Have participated the proficiency tests with the OIE/NACA reference labroratories, Arizonal, Australian Animal Health Laboratory Invited many international recognised experts came to Vietnam to support establishment of laboratories, training course; and send ky laboratory staff to the references for trainings on advanced techniques

48 Proficiency test with National laboratory and International reference laboratories No of Causative Arizona AAHL CSIRO ANQAP NACA Method developin agent Number of Equivalenc Number of Equivalency Number of Equivalency g protocol samples y rate (%) samples rate (%) samples rate (%) 1 WSSV qpcr : % 2012: % 2013: : 100% 2014: : 100% 2 TSV qrt-pcr : % 2012: % 2013: : 100% 2014: : 100% 3 YHV qrt-pcr : % 2012: % 2013: : 100% 2014: : 100% 4 IMNV qrt-pcr : % 2012: % 2013: : 100% 2014: : 100% 5 IHHNV qpcr, 2013: : 100% : % PCR 2014: : 100% 7 MrNV RT-PCR : % 2013: : 92% 2014: : 100% 8 SVCV qrt-pcr, 2013: : 92% : % RT-PCR 2014: : 100% 9 KHV qpcr : % 2013: : 100% 2014: : 100% 10 VNN qrt-pcr : : 100% 2014: : 100% 11 RSIV qpcr : % 2013: : 100% 2014: : 100% 12 EHN PCR : % 13 IHHNV RT-PCR : % 14 VHS qrt-pcr : %

49 II. NĂNG LỰC CHẨN ĐOÁN BỆNH THỦY SẢN INTER-COMPARISON LABORATORY - Arizona University (PCR technique )

50 II. NĂNG LỰC CHẨN ĐOÁN BỆNH THỦY SẢN INTER-COMPARISON LABORATORY - Arizona University (Histopathology technique-2012)

51 NACA project, Asian Regional Laboratory Proficiency Testing Program for Aquatic animal Diseases from 2013 to 2014 No Diseases Technique Report results 01 White Spot Disease (WSSV) Real-time PCR Pass 02 Taura Syndrome (TSV) Real-time PCR 03 Yellow Head Disease (YHV) Real-time PCR 04 Infectious Myonecrosis (IMNV) Real-time PCR Pass Pass Pass 05 Infectious Hypodermal and Haematopoetic Necrosis (IHHNV) Real-time PCR Pass 06 White Tail Disease (MrNV) Conventional PCR Pass 07 Viral Nervous Necrosis (VNN) Real-time PCR Pass 08 Spring Viraemia of Carp (SVCV) Conventional PCR Pass 09 Koi Herpes virus (KHV) Real-time PCR Pass 10 Red Sea Bream Iridovirus (RSIV) Real-time PCR Pass

52 PROFICIENCY TESTING (Conventional PCR and Real-time PCR technique)

53 Aquatic Animal Health Laboratory

54 Prof. Lightner, Arizona Uni came to Vietnam many times to help establishment of laboratories and training courses

55 ( Drs. Tim & Lightner have visited and worked at RAHO6 several times

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59 III. State management activities 3.6. Quarantine of animals, products of animal origin, including aquatic products a) DAH manage import/export all animal and animal products, including aquatic animals b) SDAH manage local transportation of animal and animals products

60 PRESENTATION OUTLINE I. Background II. Antimicrobial usage and Antimicrobial resistance III. State management activities IV.National Action Plan

61 IV. National Action Plan for the Reduction of Antibiotic Use and Resistance in Livestock Production and Aquaculture, FAO supported Vietnam to develop the NAP since 2016 Major activities: Objective 1: Enforce policy and governance related to AMR and AMU in livestock production and aquaculture Objective 2: Increase awareness on AMR and AMU among livestock and aquaculture professionals and consumers Objective 3: Implement good treatment and husbandry practices in livestock production and aquaculture Objective 4: Monitor AMR, AMU and antibiotic residues in food and agriculture Objective 5: Facilitate inter-sectoral collaboration in the management of the risk of AMR

62 IV Nat onal Act on Plan 4.1. Enforce policy and governance related to AMR and AMU in livestock production and aquaculture Training local staff to fully understand the legal regulation, action plans Communicate to improve public awareness Force farmers, traders, exporters, importers to comply with the regulations and technical guidelines Strictly handle administrative violations of the legal regulations (new Degree applied) Review the current regulations, policies and programmes to ensure that they cover well and more effective for AMU and AMR

63 IV Nat onal Act on Plan 4.2. Communication, workshops and meetings A large number of workshops and meetings between government agencies, companies, associations on AMU and AMR have been organized to identify current problems, gaps and difficulties in the control of AMU and AMR. Many training courses for management of AMU in veterinary services, animal production and aquaculture Mass media programmes on AMU and AMR At the national level, DAH established collaboration programme with VTV1, VTC16, key Newspapers

64 IV Nat onal Act on Plan 4.3. Implement good treatment and husbandry practices in livestock production and aquaculture - Improve aquaculture practices in shrimp, pangasius - Disease free compartments and zones

65 4.4. Survey of AMU IV Nat onal Act on Plan In 2015 and 2016, DAH carried out three surveys of AMU 714 aquaculture farming households in 3 pangasius production provinces (Ben Tre, Dong Thap, An Giang) and 2 shrimp production provinces (Soc Trang and Bac Lieu) In 3 pangasius production provinces: 216/272 (79,4%) households used at least one antibiotic In 2 shrimp production provinces: 256/436 (67,9%) households used at least one antibiotic Common antibiotics were used: Amex, Amoxicillin, Ampi, Colistin, Cephalosporin, Doxycycline, Cephalosporin, Enrofloxacin, Flofenicol, Tremi, Sunfa, Tetracyclin

66 4.4. Survey of AMU IV Nat onal Act on Plan Since 2013, Vietnam also carried monitoring residue of antibiotic in shrimp products at 199 main aquaculture areas of 37 provinces. Number of positive samples are presented in following table. Residue of antibiotic Year 2013 Year 2014 Year 2015 Year 2016 Chloramphenicol (CAP) Enrofloxacin Nitroimidazoles Ivermectin Trichlorfon MG/LMG Oxytetracycline Doxycyline Sulfonamides Total

67 Proportion (%) of shrimp products that were positive with one of any listed antibiotics 1.40% 1.20% 1.18% 1.00% 0.80% 0.60% 0.40% 0.38% 0.46% 0.30% 0.20% 0.00% Year 2013 Year 2014 Year 2015 Year 2016 Year Year 2013 Year 2014 Year 2015 Year 2016 Number of positive /tested samples 09/ / / /1692

68 IV Nat onal Act on Plan 4.5. Facilitate inter-sectoral collaboration in the management of the risk of AMR Inspection of all importers (28 companies) for veterinary medicine products and raw material, especial for antibiotic raw materials to identify how did they import, use and sell antibiotic products and antibiotic raw materials. Local manufactures are now only allowed to import antibiotic raw materials for their own production of antibiotic products. Inspection of veterinary drug shops to check whether they sell the registered antibiotic products and all shops are not allowed to sell antibiotic raw materials Implement the Aide Memoire on Multi-stakeholder Engagement to combat AMR in Vietnam ; leading by DAH (MARD) and Drug Administration of Vietnam (MoH)

69 DEPARTMENT OF ANIMAL HEALTH OF VIETNAM RESEARCH INSTITUTE FOR AQUACULTURE NO.1 THANK YOU VERY MUCH