Implementation of a National Action Plan and International standards especially with regard to Responsible and prudent use of antimicrobials

Implementation of a National Action Plan and International standards especially with regard to Responsible and prudent use of antimicrobials Dr. Sasi Jaroenpoj, D.V.M Head of Veterinary Products and AMR containment Section, Division of Animal Feed and Veterinary Products Control Division Department of Livestock Development, Ministry of Agriculture and cooperative Thailand

Antimicrobial Resistance Threats in Humans in Thailand (Professor Visanu) AMR Bacteria with Urgent Threat Extended spectrum β-lactamase (ESBL) producing GNRs Carbapenem-resistant Acinetobacter spp. & P.aeruginosa Carbapenem-Resistant Enterobacteriaceae (CRE) AMR Bacteria with Serious Threat Drug-resistant Neisseria gonorrhoeae Drug-resistant Salmonella, Shigella, Campylobacter spp. Methicillin-resistant Staphylococcus aureus (MRSA) Drug-resistant Streptococcus pneumoniae Vancomycin-resistant Enterococci (VRE) Colistin-resistant GNRs

Polymyxins: Colistin An old generation of antimicrobial drugs Bactericidal Bind to LPS and Phospholipids of gram negative bacteria Disruption of bacterial cell membrane Human medicine Treatment of nosocomial infections in critically ill patients due to carbapenem-resistant Gram-negative bacteria Last line treatment of multidrug resistance of gram negative bacteria such as: Veterinary medicine Abundant used in food producing animals especially pig Oral administration for control Enterobacteriaceae infection such as: Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobateriaceae E. Coli and Salmonella spp. 13 July 2013 EMA/755938/2012

How good is antibiotic stewardship

Colistin mg/pcu Sales of colistin in for use in animals in mg/pcu in 2013 (ESVAC data), including the 5 and 1 mg/pcu levels. No sales reported in Finland, Iceland and Norway. 66% and 93% of reduction respectively. 11 EMA AMR

Control measures on the use of Colistin Control the use of colistin at farm Department of Livestock Development (DLD) Proclamation on February 8, 2017 Do not allow for the use of disease prevention (Allow only for treatment!) Selecting appropriate antimicrobial agents for treating infections. Colistin can be used only in the case of without any effective antimicrobial drugs. Report the usage of colistin to local DLD province office Monitor & Sampling feed for the testing of colistin Local official: Schedule & Unscheduled inspection at farm Suspension/Revocation of license of farm veterinarians when cannot act in accordance with this proclamation!

Control measures plan for colistin in animal Thai FDA Reclassification of colistin to Prescription-only withdraw the registered combination products of colistin and other antibiotics Label updating (indication, types of animal, withdrawal time, special warning etc. Revision of appropriate dosage form & strengths in line with EU/JAPAN (USA not register colistin for food producing animal)

Active Ingredient Animal Species Strengths of the Veterinary Medicinal Products (registered medicated premix) South East Asia countries Premix Concentration Japan (MAFF) European Union (EMEA) Colistin Pig - 40% premixes -1%, 2%, 4% premixes -1%, 2%, 4% premixes Amoxicillin -Pig -Poultry - 50 % premix - - 10, 20% premixes High concentration of premix look like active pharmaceutical ingredient which is cheap cost to sell when comparing low concentration of premix It contributes irrational use of drug in feed in Asia and farm mixer does not have capability of mixing it well. They can cause residues and AMR in ASIA higher than other regions of the world

Over the counter sale Internet sale

18.96 % of total sows in Netherlands vaccinated bacteria autogenous vaccine

Thai prime minister participated in UN assembly as leader of G77 and made a commitment to combat AMR (21 Sep 2016, New York, USA)

National Strategy on AMR (2017-2021)

Endorsement: By the cabinet on 17 Aug 2016 Vision : Reduction of mortality, morbidity and economic impacts from AMR Mission: Establish policies and national multi-sectoral mechanisms which support effective and sustained AMR management system Consist of 6 strategies Goals 50% reduction in AMR morbidity 20% reduction in antimicrobial use in human 30% reduction in antimicrobial use in animal 20% increase of public knowledge on AMR and awareness of appropriate use of antimicrobials AMR management system meets universally accepted standards 23

Thailand s National Strategic Plan on AMR consists of 6 strategies 1 2 3 4 5 6 AMR surveillance system using a One-Health approach Regulation of antimicrobial distribution Infection prevention and control and antimicrobial stewardship in human AMR prevention and control and antimicrobial stewardship in agriculture and animals Public knowledge on AMR and awareness of appropriate use of antimicrobials Governance mechanisms to develop and sustain AMR-related actions

Integrating Committee on AMR Human Animal& Agriculture Environment The Committee consists of representatives from the Ministry of Public Health and the Ministry of Agriculture and Cooperatives as well as academia, professional societies and civil society organizations

AMR awareness week 2017: Thailand marks the spot to stop AMR To drive national action plan on AMR

Global Consumer campaign in 2016

National Strategic Plan on AMR Strategy 1 AMR surveillance system using a One-Health approach Strategic action Develop the national integrated system of AMR surveillance and signaling Activities DLD Surveillance of AMR bacteria in livestock composing of Salmonella spp. Campylobacter spp., E. coli and Enterococcus spp. DOF Surveillance of AMR bacteria in fisheries composing of Salmonella spp., E. coli and Vibrio cholerae DLD: Department of Livestock development DOF: Department of Fisheries

AMR surveillance system National surveillance of infections caused by AMR pathogens in livestock has been planned since 2016 Scientific survey 5900 samples / year Comply with OIE guideline and EFSA Collect caecum and meat from chicken and pig at slaughterhouse and retailers Isolation & Identification, and Antimicrobial susceptibility testing (MIC) Salmonella spp., Campylobacter spp., E. coli, Enterococcus spp. 29

National Strategic Plan on AMR Strategy 1 AMR surveillance system using a One-Health approach Strategic action Strengthen capacity and networking of microbiology laboratories Activities DLD & DOF : Enhancing laboratory capacities of AMR detection in livestock and fisheries Harmonize and implement standard method for AMR testing Training courses on AMR detection for laboratory staff DLD: Department of Livestock development DOF: Department of Fisheries

National Strategic Plan on AMR Strategy 2 Regulation of antimicrobial distribution Strategic action Strengthen the antimicrobial distribution control system for both humans and animals Activities Cooperation between DLD & Thai FDA Reclassify and control distribution channel of antimicrobials Develop program of National drug account (NDA) and Thai surveillance antimicrobial consumption (Thai-SAC) (Monitor values, consumption rates and distribution of all medicines) DLD: Department of Livestock development Thai FDA: Thailand Food and Drug Administration

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce use of antimicrobials in livestock farming and fisheries Activities Reduce use of antimicrobials in livestock Cooperation between DLD & Stakeholder Develop regulation to control of manufacture, import, sale and use of medicated feed Training veterinarians who responsible for a mixing of antimicrobial drugs at feed mills Training farm veterinarians who control the use of antimicrobial drugs at farms DLD: Department of Livestock development

AMU surveillance system Control the use of Antimicrobial drugs Develop regulation to control of manufacture, import, sale and use of medicated feed under Animal Feed and Quality Control Act 2015. (become effective by this year) Training veterinarians who responsible for a antimicrobial drugs at feed mills 33

Notification of Ministry of Agriculture and Cooperative : Control of manufacture, import sale and use of medicated feed

Farm veterinarian (FV) means a veterinarian who has a license and certify by DLD to control an animal farm according to the regulation of the Department of Livestock Development concerning to use veterinary medicinal products and manage animal health issues for food safety Medicated feed mill veterinarian (MFMV) means the veterinarian who is assigned by feed business operator to control the medicated feed production system and notify to DLD ** DLD may set criteria to issue the license for MFMV in line with this MoA notification as necessary in the future

Medicated premix Manufacturer - Wholesale Order by vet Sell premix Manufacturer of medicated feedingstuffs Selling MF Dispensing MF: 1 copy of the prescription 3 Farmer 2 copies for the farmer 1 copy for the vet or 1 Wholesaler 2 copies of the prescription Veterinarian

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce use of antimicrobials in livestock farming and fisheries Activities Reduce use of antimicrobials in livestock Cooperation between DLD & Stakeholder Project of Reduction of antibiotic used in livestock animal Project of Raised without antibiotics in livestock animal (pig farm) DLD: Department of Livestock development

Industry s approach Withdrawn Medication program Stepwise approach

Example of action plan (private sector)

DLD Pilot Project on Reduction of AMU in Livestock Farming In the Northern Region of Thailand (2017) Target Result Way Forward 20 farms (chicken: broiler & layer and pig) No antimicrobial drug residues in livestock products (pork, chicken meat and eggs) 20% Reduction the amount of AMU in livestock farming 28 farms (broiler chicken 3 farms, layer chicken 8 farms, finished pig 17 farms) 79.93% Reduction of AMU in pig farm, 100% Reduction of AMU in broiler farm No AMU in layer farm both before & after % Production loss tend to be reduced related to good farm management and effective biosecurity system No antimicrobial drug residues in the samples of livestock products Government should take into account the proven capability of the marketing network and develop the strategy to communicate with the consumer Further develop the project of Raised without antibiotics in livestock farming

DLD Project on Reduction of AMU in Livestock Farming In the Northern Region of Thailand

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce use of antimicrobials in livestock farming and fisheries Activities Reduce use of antimicrobials in livestock Cooperation among ACFS, DLD, DOF, Vet council, Vet school, Associations Develop guideline of RDU in livestock and fisheries DOF Training staff on the RDU in fisheries Training staff on the regulation about Drugs Act and Food Act ACFS: National Bureau of Agricultural Commodity and Food Standards DLD: Department of Livestock development Thai FDA: Thailand Food and Drug Administration DOF: Department of Fisheries

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce use of antimicrobials in livestock farming and fisheries Activities Post marketing surveillance of antimicrobial drugs & Residue monitoring plan in livestock and fishery products DLD Post marketing surveillance of veterinary drugs DLD & DOF Monitoring plan of drug residues in livestock and fishery products DLD: Department of Livestock development DOF: Department of Fisheries

National residue monitoring plan Type of sample Drug residue Examination List Micro- Biology Drug residue & Microbiology (No. of sample) (No. of sample) (No. of sample) Feed 8,677 2,515 - Meat 500 24,998 6,310 Chicken egg - - 200 Carcass wash - 11,362 - Honey 89 - -

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce use of antimicrobials in livestock farming and fisheries Activities Develop alternative ways to reduce antimicrobial use DLD Study project in the use of herbs and alternative products in livestock animal Cooperation between DLD & Thai FDA Develop drug act to control autogenous vaccine DLD: Department of Livestock development Thai FDA: Thailand Food and Drug Administration

(import)

Develop regulation for autogenous vaccine Vac

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Reduce antimicrobial resistant bacteria in the food production chain Activities Develop regulations and measures about food safety in the food production chain ACFS Develop mandatory agricultural standard for GAP farming Develop agricultural standard for carcass transportation DLD Develop regulations in accordance with Control of Animal Slaughter for the Distribution of Meat Act, B.E. 2559 Promote national & international standards of slaughterhouse e.g. GMP ACFS: National Bureau of Agricultural Commodity and Food Standards DLD: Department of Livestock development

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Establish surveillance of antimicrobial use in crop production Activities DOA & Universities Study project in the use of alternative products to cure greening disease in mandarin oranges Develop guideline to control the use of chemicals in oranges DOA: Department of Agriculture

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Implement antimicrobial stewardship in animal hospitals and clinics Activities Cooperation among Vet council, Vet school, DLD and Associations Develop guideline on RDU in pets Project on RDU in small animal teaching hospital DLD: Department of Livestock development

National Strategic Plan on AMR Strategy 4 AMR prevention and control and antimicrobial stewardship in agriculture and animals Strategic action Educate relevant stakeholders in food animals and agriculture regarding appropriate use of antimicrobials Activities Cooperation between Vet school & DLD Research project about AMR in livestock products and education/communication with relevant stakeholders DLD, DOF and DOA Training course/public relations for staff and farmers to raise awareness about the problems of AMR DLD: Department of Livestock development DOF: Department of Fisheries DOA: Department of Agriculture

DEPARTMENT OF LIVESTOCK DEVELOPMENT MINISTRY OF AGRICULTURE AND COOPERATIVES Surveillance data on AMR & AMU DLD Project Surveillance resistance bacteria and resistance genes of Salmonella spp. in meat and meat products from slaughterhouse, meat processing plants and markets

Antimicrobial drugs the more you use,the faster you lose regardless if the use is in animals, or in humans

AMR borderless

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