Control of Foodborne Antimicrobial Resistance in the Agri Food Sector Jeffrey LeJeune, DVM, PhD
THE BURDEN OF AMR Deaths Distribution Dollars https://amr-review.org
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Rendering EPIDEMIOLOGY OF ANTIMICROBIAL RESISTANCE Dead stock Drinking water Farm Effluents and Manure Spreading Offal AQUACULTURE Rivers and Streams SOIL WILDLIFE Sea / Lakes Sewage Vegetation, Seed Crops, Fruit Drinking Water Swimming Industrial & Household Antibacterial Chemicals Animal Feeds SHEEP VEAL CALVES SWINE FOOD ANIMALS OTHER FARMED LIVESTOCK CATTLE POULTRY Commercial Abattoirs / Processing Plants Meat Handling Preparation Consumption HOSPITALIZED HUMAN EXTENDED CARE FACILITIES COMMUNITY - URBAN -RURAL COMPANION ANIMALS Direct Contact after Linton AH (1977), modified by Irwin RJ
(Berkner et al., 2014)
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The AMR Global Action Plan World Health Assembly -May 2014 World Health Assembly May 2015, endorsed World Organization for Animal Health (OIE) Resolution May 2015 Food and Agriculture Organization of the United Nations (FAO) Resolution - June 2015 FAO Action Plan on AMR UN General Assembly Declaration September 2016
FAO Action Plan on AMR
AMR and One Health Livestock Production Animal Health Feed Safety Communication Legal Framework Fisheries and aquaculture FAO Action Plan Regional / Sub regional level National level Codex Alimentarius Food Safety Water Plant health
1. Increased Awareness http://www.fao.org/antimicrobial-resistance/en/
2. Practices http://www.indiaspend.com/cover-story/keeping-chickenhealthy-threatens-indias-health-25011 o Pre-harvest Reducing use Not for growth promotion Only when needed d (OWN) Improving animal health biosecurity disease prevention e.g. vaccine use hygienic and management practices o Post harvest Food hygiene and sanitation istockphoto
(A) Largest five consumers of antimicrobials in livestock in 2010. 2010 2030 Increase % increase Thomas P. Van Boeckel et al. PNAS 2015;112:5649-5654 2015 by National Academy of Sciences
3. Improved Regulations and Guidelines National Legal Framework o Eliminating use as growth promoters o Requiring veterinary prescriptions o Justification of use of critically important antibiotics in animals o Environmental Discharge Gettyimages
Codex Alimentarius International group to establish standards guidelines and practices for food (1961) 186 countries + 219 observers FAO/WHO Joint Expert Committee on Food Additives (JECFA) Establish Maximum Residual Limits (MRLs) FAO/WHO Joint Expert Meeting on Microbiological Risk Assessment (JEMRA) FAO/WHO Joint Meeting on Pesticide Residues (JMPR) Codex Task Force on Antimicrobial Resistance (TFAMR5)
TASK FORCE Electronic Working Groups (EWG) (i) revision of the Code of practice to contain and minimise antimicrobial resistance; and (USA; CL, CN and UK) (ii) develop guidelines on surveillance of foodborne antimicrobial resistance. (NL; CN, KY NZ)
4. Surveillance o Antimicrobial Use o Antimicrobial Resistance o Integrated Approaches Humans Animals Foods Environment
Achieving Integrated Surveillance o Build on existing framework National WHO, OIE o Tailored to Country Situational Analysis Laboratory Assessment
Assessment Tool for Laboratories and AMR Surveillance Systems s ATLASS Activities, Capacity Compliance, Progress Mapping Monitoring Action, Advocacy National, GLASS Evidence Linkages
Progressive Management Pathway to Combat AMR o Roadmap (Guide) for progress and goals Awareness Governance Practices (Infection Control) Leadership Research and Development Evidence Surveillance Laboratory Capacity Reporting, Coordination, Integration Comp prehenivne ess 25 20 15 10 5 0 Stage 1 Stage 2 Time Stage 3 Stage 4 Stage 5
Progressive Management Pathway Labora atory Co omplexity Limited by Capacity (ATLASS) WGS Campylobacter Broth dilution PCR.. Enterococcus AST-KB CRE ESBL E.coli 0 0.2 0.4 0.6 0.8 1 Chicken Poultry Meat Inter-agency communications Water Vegetables Integrated Analysis Programme Complexity and Integration Dictated by Needs (Situational Analysis)
AMR: Key Messages for Countries 1. Improve overall coordination 2. Improve regulatory framework 3. Reduce the need for and promote prudent use of antibiotics 4. Improve surveillance 5. Advocate and communicate 6. Build capacity and provide training 7. Address knowledge gaps and research needs
ATLASS Structure ATLASS-Surveillance module ATLASS-Lab- Activity ATLASS-Lab module ATLASS-Lab- LMT filled once for each country, answers from several respondents filled for each laboratory assessed Lab 1 Lab 1 Lab 2 Lab 2 Etc. Etc.
Assessment Tool for Laboratories and AMR Surveillance Systems Assessment Tool for Laboratories and AMR Surveillance Systems Assessment Tool for Laboratories and AMR Surveillance Systems ATLASS o Contact us at: o EMPRES-Lab-Unit@fao.org