LA-MRSA in Norway. One Health Seminar 27 June 2017, Ålesund
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1 LA-MRSA in Norway One Health Seminar 27 June 2017, Ålesund Petter Elstrøm, Norwegian Institute of Public Health Merete Hofshagen, Norwegian Veterinary Institute
2 Outline Background Epidemiology of MRSA in Norway MRSA in humans MRSA in swine Antimicrobial usage A Norwegian One Health Study of LA-MRSA
3 MRSA in Europe Percentage (%) of invasive S. aureus isolates resistant to methicillin (MRSA), 2015 European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2017
4 Number of cases Notified human cases of MRSA in Norway MRSA bacteraemia Other MRSA infections MRSA colonisation MSIS, Norwegian Institute of Public Health
5 Number of cases Notified human cases of MRSA in Norway Infected in Norway Infected outside Norway Possibly infected outside Norway Unknown place of infection MSIS, Norwegian Institute of Public Health
6 MRSA Duration of colonisation 4 years follow up of MRSA pos. persons in Sweden Median time of colonisation (n=535): 179 days 43% became MRSA negative within 2 month Anna-Karin Larsson; Eva Gustafsson; Anna C. Nilsson; Inga Odenholt; Håkan Ringberg; Eva Melander; Scandinavian Journal of Infectious Diseases 2011, 43,
7 The public health implications of LA-MRSA Larsen J et al. Emergence of livestock-associated methicillin-resistant Staphylococcus aureus bloodstream infections in Denmark. Clin Infect Dis 2017 Larsen J et al. Evidence for Human Adaption and Foodborne Transmission of Livestock-Associated Methicillin-Resistant Staphylococcus aureus. Clin Infect Dis 2016
8 Pig production in Norway Animals Slaughter pigs: 1.6 million/year Sows: Herds Sow herds: 1200 Slaughter pig herds: 800 Negligible import of live animals
9 Antimicrobial usage in Norway Usage in Norway 88% for humans - 12% for animals Usage animals in Europe Source: NORM-VET 2015 Source: ESVAC report 2014
10 LA-MRSA in swine Europe: Up to >90% prevalence of LA-MRSA CC398 in swine herds in many European countries Norway: Surveys and tracing if MRSA is detected Year Survey/material Herds tested MRSA positive herds Type MRSA 2008 EU baseline - dust «non-la-mrsa» 2008 Nasal swabs - abattoir nasal swabs - abattoir (from 1 abattoir) CC skin swabs - at farm CC Sow farms CC Breeder/finisher farms CC1 (2), CC398 (2) 2016 Sow farms CC398
11 A Norwegian One Health Study
12 Study design All strains of MRSA CC398 from humans and swine Humans = 84 Swine herds = 26 Epidemiological data Collected during surveillance, investigations and MSIS All isolates: Whole Genome Sequenced by Statens Serum Institut, DK
13 Results Epidemiological data + results of WGS Three separate outbreaks identified - including 36 humans 2 slaughterhouses 26 swine herds 3 primary sow herds
14 Results Further spread of infection Probable routes of infection from 3 primary sow herds to other herds Trade with animals: 19 herds Infection via humans: 3 herds Infection via truck (used for transport of live animals): 1 herd
15 Results Contact tracing swine herds Type of herd Total (positive/contacts tested) (% positive) Cluster 1 Cluster 2 Cluster 3 Total 26/74 (35%) 12/26 (46%) 11/44 (25%) 3/4 (75%) Sow herds 7/24 (30%) 3/7 3/16 1/1 Slaughter herds 18/49 (37%) 9/19 8/28 2/3
16 Results Humans and risk of infection Type of exposure Total (positive/total tested) (% positive) Cluster 1 Cluster 2 Cluster 3 Total 36/272 (13%) 26/171 (15%) 9/97 (9%) 1/4 (25%) Working in sow herd 14/62 (25%) 10/19 3/39 1/4 Veterinarian 3/15 (20%) 2/11 1/4 - Working in slaughter herd 9/63 (14%) 5/29 4/34 - Working at slaughter house 10/124 (8%) 9/107 1/17 - Living in the same house as persons above 0/8 (0%) 0/5 0/3 -
17 Results MRSA CC398 in humans
18 Conclusions All three outbreaks: Primary introduction by humans Main route of secondary spread: Trading live animals So far, not discovered spread of MRSA CC398 to persons without contact with the animals
19 Number of cases Notified human cases of LA-MRSA in Norway Jan May in 2017 MSIS, Norwegian Institute of Public Health
20 Acknowledgements Carl Andreas Grøntvedt, Norwegian Veterinary Institute Mattilsynet Statens Serum Institut St. Olavs Hospital Animalia Nortura Norsvin KLF
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