The Danish risk management strategy for veterinary antimicrobial usage

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1 The Danish risk management strategy for veterinary antimicrobial usage Annette Cleveland Nielsen, DVM, Ph.D. epidemiology Unit for Veterinary Epidemiology and Health Management Danish Veterinary and Food Administration

2 Actions to reduce resistant bacteria Monitor AMR usage and resistance Reduce need Reduce disease prevalence and spread of bacteria i.e. vaccination programmes management AI/AU etc. alternatives ZnO Prudent use Narrow, short, sufficient No sales profit Proper diagnostic tests No prophylactics Follow treatment guidelines Cooperate and coordinate national risk management DANMAP and Council Risk assesment and risk communication education and research VetStat, CHR, audits International commitment - EU, ECDC, EFSA, Codex

3 Veterinary risk analysis organised in DK Risk assesment DIF at DTU VetStat monitoring DANMAP (Food(DIF(DTU)), Humans (SSI) and Animals (DVFA and DMA) Risk management DVFA VetStat and CHR (Central Husbandry register) - grafical displays on national, vet and herd usage - regulations on AM in general and CIA specific - and yellow card in swine herds - treatment guidelines - audit and supervision of every vet Risk communication DVFA self recognition via VetStat, herdowner and vet supervision vet and yellow card to herd owners - NEW Titel 3

4 Desired results for for risk management of veterinary AM usage Reduced AM usage in swine by 10% in 2013 compared to 2009 usage No use of CIA (3+4 gen cephalopsporins and fluorokinolones) only welfare cases Change of attitudes in AM treatment prudent use No bans - consumption reduction - peroral vs. parenteral - initiating treatment - management - alternatives to AM and vaccination - change treatment patterns - follow guidelines - short and sufficient - reduced risk of development of resistant bacteria especially in CIA for human treatment

5 Risk management and communication using VetStat Country: 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/ACD vet /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

6 Tonnes (active co m ponent) Examples of risk management strategies for antibiotic usage No profylax, no sales profit preventive 94 40% drop Avoparcin ban DANMAP AGP for finishers and broilers Removed 98 Virginiamycin ban Therapeutic Strategic use Fluoroquin 02 AGP for weaners Removed 00 VetStat 00 Task force Medicine Control Action plan 2005 swine Treatment guide swine Audit of some vets AGPs Action plan 2007 all Treatment guide all Supervision all Codex Task Force AM Action plan 2010 Threshold Yellow card

7 Increase in pig production still total AM consumption below GP days Grow th promotor Therapeutic Pig production

8 Éxample of use of VetStat data on national level Liberalising the sale of vetrinary medicine Antibiotic consumption pr. produced pig in ACD and average price pr. ACD ACD (animal course dose) -Seasonal variation Fix-point 4 quater yearly ACD 25 /svin produceret* Increase 0,15 ACD from Evens out in Stabile consumption Av. course dose price reduced >6 kr to >4 kr for 25 kg pig Liberalisering pris (kr) produktion (mill svin) Increase consump. Qa to caused by watermedication Kvartal 0 Kilde: VetStat Fodermedicinering Injektionsmedicinering Mill- svin produceret/kvartal Totalt antbiotikaforbrug/svin produceret Vandmedicinering Gns. pris pr. kg Gns.pris pr. kurdosis (ACD25) 8

9 ACD 25 /svin produceret* Tiamulin Liberalisering pris (kr) produktion ( mill svin) Very large price reduction makes Tiamulin cost effective to use and in line with treatment guidelines Kvartal 0 Fodermedicinering Vandmedicinering Injektionsmedicinering Gns. pris pr. kg Mill- svin produceret/kvartal Gns. pris pr kurdosis (ACD25) Totalt antbiotikaforbrug/svin produceret Titel 9

10 Risk communication/management Audits and supervision Action plan Objective: Discuss and clarify the vets prescription and treatment patterns graphs from VetStat vets self-recognition reduce AM consumption motivate prudent usage Discuss treatment strategies and laboratory testing in diagnostic work Direct control of herd reports diagnosis/tests Compare the vets prescription patterns to the treatment guidelines

11 Risk communication in supervisions Comparison of vets prescription patterns Tetracykliner 5% 10% 7% 25% Makrolider 5% 15% 5% 20% Lincosamider 19% 12% 22% All county vets Sulf/Trim 55% Vet nr. 1234

12 Risk communication in supervisions An vet s prescription pattern per age-group, administration route and drug-group

13 Risk communication first supervisions of 18 vets Differences in prescription patterns for slaughterpigs All 18 audit vets All Danish pig vets

14 Finishers Weaners Sows/piglets Pleuromutilins Combinations Fluoroquinolones Colistin Aminoglycosids Lincosamids Macrolids Sulfa/trimeth. Cephalosporins Penicillins, broad Penicillins Amphenicols Tetracyclins Results action plan 2005 in swine Percent in- or decrease of antibiotic classes for swine from AND overall 0,2 % decrease in 2005 and 1,2% in 2006 Despite an increase in pig production by 1%

15 Risk communication supervising vets usage country level CIA for swine Indeks Strategic ban Fluoroquin 02 Action plan 2007 all Treatment guide all Supervision all In 2010 so far - only 49 kg cephalosporins due to industry voluntary ban from July kg in kg in 2009 for humans * Cephalosporiner Fluorokinoloner

16 Increase in pig production still total AM consumption below GP days but action plan results wear out over time Grow th promotor Therapeutic Pig production

17 So new focus on herd owners Yellow card Antibiotics for swine in kg active compound January 2009 to October preliminary data om October A reduction of 19% from June to October.. maybe 2000 jan-09 feb-09 mar-09 apr-09 maj-09 jun-09 jul-09 aug-09 sep-09 okt-09 nov-09 dec-09 jan-10 feb-10 mar-10 apr-10 maj-10 jun-10 jul-10 aug-10 sep-10 okt-10

19 The concept Data: 1. Amount of antibiotics used on farm in a specific group in ADD (from VetStat) 2. Number of animal days for that specific animal group (from CHR) (Focus in relation to EU subsidies) 1. The Yellow Card Level 2. Based on 9 months average 3. Amount antibiotics used / Number of animal days

20 Risk communication and management in VetStat

21 Consequences for farms 9 months with Yellow Card Mandatory reduction in use of antibiotics Only one re-ordination of antibiotics for oral administration Inspection from DVFA in the 9 months restriction periode Increased frequency of consultancy visits from vet Intensified inspection Second opinion from vet from DVFA list of second opinion vets inhability Appropriate lab tests Treatment protocols (eg. vaccination) Management Etc. 12 months supervision and immediate actions if above limits again Control fee for inspections from DVFA Monthly inspection visits after appr. 18 months above limit

22 Yellow card administration in swine herds above limit for AM Swine herds with a herd health contract almost all Flagging and hearing Monitoring in 12 months after reduction (under yellow level) Under Yellow card Evaluation Over Second opinion Increased inspection/rules

23 Just talking about it. Antibiotics for swine in kg active compound January 2009 to October preliminary data om October jan-09 feb-09 mar-09 apr-09 maj-09 jun-09 jul-09 aug-09 sep-09 okt-09 nov-09 dec-09 jan-10 feb-10 mar-10 apr-10 maj-10 jun-10 jul-10 aug-10 sep-10 okt-10 A reduction of 19% from June to October.. maybe

24 Experiences Risk communication is key Let them know what we have on them self recognition Let them know how astray they are compare to colleges Action plans wear out over time, so new ones regularly Different targets vets and herd owners number of swine for treatment vs. EU subsidies

25 Thank you for your attention If you are interested in our paper on AMR risk management please contact me at me at

Risk management of antimicrobial use and resistance from food-producing animals in Denmark

Risk management of antimicrobial use and resistance from food-producing animals in Denmark A contribution to the joint FAO/WHO/OIE Expert Meeting on Critically Important Antimicrobials, Rome, Italy. 17-21