DANMAP and VetStat. Monitoring resistance and antimicrobial consumption in production animals

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Janis Rosalyn Newman
5 years ago
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Flemming Bager Head Division for Risk Assessment and

1 DANMAP and VetStat Monitoring resistance and antimicrobial consumption in production animals Flemming Bager Head Division for Risk Assessment and Nutrition Erik Jacobsen Danish Veterinary and Food Administration

2 Trend in use of antimicrobials in Denmark Figure 4.1. Prescribed antimicrobial agents for humans, and for animals compared with the number of pigs produced, Denmark 220 DANM AP Antimicrobial agents (tonnes) Pigs produced (mill. heads) Prescribed human antibacterials Prescribed veterinary antimicrobials Antimicrobial growth promoters Pigs produced (mill. heads) 2 National Food Institute, Technical University of Denmark

3 DANMAP objectives The original (1995) DANMAP objectives were Monitor antimicrobial resistance in Zoonotic bacteria Indicator bacteria (E. coli/ enterococci) Animal pathogens In production animals and meat (Danish and imported) Monitor resistance in bacteria fra humans Zoonotic bacteria (domestic/travel associated) Human pathogens Monitor antimicrobial usage in production animals and in humans Explore association between antimicrobial usage and resistance 3 National Food Institute, Technical University of Denmark

4 Copenhagen Recommendations (1998) vs. EU Council Recommendation ( ) (Ref. Niels Frimodt Møller) Copenhagen Recommendations: Recognise AMR as major EU and global problem Encourage search for new AM Setup EU surveillance on AMR Collect data on supply and consumption of AM agents EU Encourage prudent use of AM EU, member states and nat.res.councils research on AMR high priority Review progress on recommendation EU Council recommendation: I Recognise problem and promote strategy for prudent use of AM Establish surveillance on AMR - and AM use Prescription only, guidelines, good practise for managing comm.dis., education of health professionals and information of public Cooperate, coordinate and report to EU II Intersectorial mechanism for coordinated implementation of strategy 4 National Food Institute, Technical University of Denmark

5 VetStat herd level monitoring of antimicrobial agents Objectives to obtain data, facilitating control of prudent use strategies and possible interventions to contribute to clarification of the complex epidemology of resistance through investigations on the relationsship between use of antibiotic and resistence. to help veterinarians in their daily routine 5 National Food Institute, Technical University of Denmark

6 Key premises Danish veterinarians do not have a significant income from selling medicine All medicine are sold exclusively from licensed pharmacy or similar organisation (dealers), excp. medicated feed sale from wholesalers only to licensed pharmacies 94% of all antibiotics for production animals are being sold directly from pharmacies to farmer In 2014 about 75% of all antibiotics used in pigs 6 National Food Institute, Technical University of Denmark

7 VetStat infrastructure requirements Detailed information about all farms in database (Central Herd Register, CHR) Unique farm ID No. of animals /pen places Type of use, eg. Poultry layers/broilers/breeders Cattle dairy/beef ID of owner and veterinary practitioner Animal movements (flock or individual) Use of veterinary medicines All antibiotics prescription-only Sold only through pharmacies Vet s profit from sale of medicines severely limited Ie no economic incentive to over prescribe 7 National Food Institute, Technical University of Denmark

8 VetStat data capture Prescriptions will only be processed by a pharmacy when following information is present ID of farm of destination Target species and target age group Disease code (categories) Data are captured automatically during billing Relevant data transferred electronically to VetStat Data on antibiotics used by veterinary practitioners are captured automatically during billing and transferred electronically to VetStat 8 National Food Institute, Technical University of Denmark

9 Denominator information biomass estimation Information on target species available from VetStat National production data available from Danish Statistical Office Primary producer organisations Risk days estimated Eg. broiler chickens live to 36 days and 2 kg live weight 9 National Food Institute, Technical University of Denmark

10 Data to be reported to Vetstat Identification number for the veterinarian (Aut) Identification number for the farm (CHR) Identification number for the product (Vnr) Amount of product sold Code for animal species Code for age of animal Code for disease Date for receiving the medicine 10 National Food Institute, Technical University of Denmark

11 94% 85% 98% 4% Danish Medicines Agency 2 % VETSTAT Medicated feed Coccidiostatics 11 National Food Institute, Technical University of Denmark

12 Raw data in Vetstat 12 National Food Institute, Technical University of Denmark

13 Comparing consumption: the Animal Daily Dose (ADD) It is the average dose given to a specific animal species on one day. Therefore it is to be considered as an statistic figure, rather than an absolut dose. It is a valuble tool whenever you follow a trend in consumption, or compare consumption between farms 13 National Food Institute, Technical University of Denmark

Risk management and communication using VetStat National level: Developments over years Unacceptable trends spotted Risk based control Action plans: 2005 swine, 2007 all food animals and 2010 yellow

14 Risk management and communication using VetStat National level: Developments over years Unacceptable trends spotted Risk based control Action plans: 2005 swine, 2007 all food animals and 2010 yellow card Vets and herd owners: Comparison of usage by ADD /region/herd/country Comparison of prescription patterns between vets Comparison of vets actual usage to guidelines Audits and supervision of vets and yellow card in herds 14 National Food Institute, Technical University of Denmark

15 Antibiotic consumption over a 3 year periode XXXX Name of owner and address of farm 15 National Food Institute, Technical University of Denmark

16 Yellow card system XXXX Name of farmer and address of farm 16 National Food Institute, Technical University of Denmark

17 Consumption in pigs by dispensing form 17 National Food Institute, Technical University of Denmark

18 Antibiotic used in dairy cattle 18 National Food Institute, Technical University of Denmark

19 ESVAC 19 National Food Institute, Technical University of Denmark

20 Cephalosporin use , kg. active comp Systemic treatment of pigs Systemic treatment of cattle Intramammary treatment of cattle 20 National Food Institute, Technical University of Denmark

21 Resistance to Cephalosporins 21 National Food Institute, Technical University of Denmark

22 Resistance in Campylobacter jejuni 22 National Food Institute, Technical University of Denmark

23 AM consumption association with AMR At population (national) level, resistance does reflect usage of antimicrobials domestic product, vs. imports However, also many exceptions clonal spread of resistant strains, eg. monophasic Salmonella animal trade, eg. broiler parent stock I.e. the epidemiology of AMR is multifactorial New approach: mapping AMR genes of entire microbiota? 23 National Food Institute, Technical University of Denmark

24 Effect of prudent use in food animals on human medicine? Yes! eg Campylobacter ESBL genes FQ resistance Continued effect of penicillins i primary health care However: the epidemiology of AMR is complex! travel associated cases imported food stuffs, incl. RTE greens 24 National Food Institute, Technical University of Denmark

25 Doctors vs. Veterinarians: who s responsible? 25 National Food Institute, Technical University of Denmark

DANMAP Danish Integrated Antimicrobial Resistance Monitoring and Research Programme

DANMAP Danish Integrated Antimicrobial Resistance Monitoring and Research Programme Hanne-Dorthe Emborg Department of Microbiology and Risk Assessment National Food Institute, DTU Introduction The DANMAP