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Consumer PerceptionSuperbugs in the Food
Supply
National Institute for Animal
Agriculture
Susan Vaughn Grooters, MPH
Research and Policy Associate
Kansas City, MO
November 13th 2013
Center for Science in the
Public Interest - CSPI
CSPI is a bi-national consumer advocacy organization
founded in 1971 by Michael Jacobson, Ph.D.
Focuses on nutrition, health, and food safety
Publishes the award-winning Nutrition Action
Healthletter
Approaching 1 million subscribers in the United
States and Canada
Accepts no government or industry funding
CSPI Reports and
Research
CSPI
Activities

Strong Food Safety Laws
• FSMA
Petitions for Government Action
• USDA – Salmonella
Comments on Food Regulations

Collaborative work
• Safe Food Coalition
• Make Our Food Safe
• Keep Antibiotics Working
CSPI’s
Research
Policy
Advocacy
ď‚– Study of 55 Outbreaks in the U. S. 1973-2011

Antibiotic
Resistance in
Foodborne
Outbreaks CSPI Report

ď‚– does not include the two Foster Farms assoc.
outbreaks

ď‚– Analyzes:
ď‚–
ď‚–
ď‚–
ď‚–

Food Vehicle
Etiology
WHO categories
Multi-drug resistance

 Outlier – 1985 Samonella Typhimurium outbreak in
pasteurized milk in which 16,659 were
sickened, 2,777 were hospitalized, and 18 died
ď‚– Aminoglycosides

ď‚– Streptomycin

ď‚– Carbapenems
ď‚– Cephalosporins (3rd and 4th generation

World Health
Organization’s
List of
Critically
Important
Antibiotics

ď‚– Ceftriaxone

ď‚– Macrolides
ď‚– Fluoro- and other Quinolones
ď‚– Ciprofloxacin
ď‚– Nalidixic acid

ď‚– Glycopeptides

ď‚– Vancomycin

ď‚– Penicillins (natural aminopenicillins and antipseudomonals)
ď‚–
ď‚–
ď‚–
ď‚–

Amocicillin/claulanic acid
Ampicillin
Carbenicillin
Penicillin

Source: http://apps.who.int
ď‚– Amphenicols
ď‚– Chloramphenicol

ď‚– Cephalosporins (1st and 2nd generation) and
Cephamycins

World Health
Organization’s
List of Highly
Important
Antibiotics

ď‚– Cephalothin
ď‚– Cefoxitin

ď‚– Lincosamides
ď‚– Streptogramins

ď‚– Sulfonamides, et al.
ď‚– Sulfamethoxazole
ď‚– Sulfisoxazole

ď‚– Tetracyclines
Source: http://apps.who.int
Drug Resistance Profiles by WHO categories
50

47

45
40

36

35

# of Outbreaks

Antibiotic
Resistant
Bacteria and
Foodborne
Outbreaks

39

30

25

25
20

19

15

15

17
14

10

10
5

15

2

1

3

4
1

10
5

3

0

Critically Important

Highly Important

Not classified on WHO's list

4
1
Year Location Bacteria

Food/Source

Cases Hosp Death Resistances

1973 ME

S. Typhimurium

Eggs

32

NR

NR

unknown

1975 MD, FL,
CO

S. Newport

Ground beef

27

NR

NR

1979 CA, OR

S. Dublin

Raw milk

39

NR

NR

NR

NR

critically important

sulfonamides

highly important

tetracycline

highly important

ampicillin

penicillin

critically important

penicillin

critically important

kanamycin
penicillin
streptomycin
tetracycline

3

aminoglycosides

carbenicillin

Raw milk

streptomycin
sulfamethoxazole

S. Typhimurium

WHO Status

tetracycline
1977 KY

Drug Family

aminoglycosides
penicillin
aminoglycosides
tetracycline

highly important
critically important
critically important
highly important

unknown

ABR Foodborne Outbreaks
1970s
Year

Location

Bacteria

Food/Source

1980

MT

S. Typhimurium

Raw milk

1983

AZ

S. Typhimurium

Raw milk

1987

GA

S. Havana

Chicken

16659

73

2777

36

18

1

tetracycline

highly important

tetracycline

tetracycline

highly important

aminoglycosides

critically important

ampicillin

penicillin

critically important

amphenicol

highly important

aminoglycosides

highly important

aminoglycosides

critically important

sulfonamides

highly important

tetracycline

highly important

ampicillin

penicillin

critically important

aminoglycosides

highly important

aminoglycosides

critically important

sulfonamides

highly important

tetracycline

Pasteurized milk

critically important

sulfamethoxazole

S. Typhimurium

penicillin

streptomycin

IL

2

critically important

kanamycin

1985

22

penicillin

tetracycline

298

highly important

ampicillin

sulfamethoxazole

Ground beef

highly important

tetracycline

streptomycin

S. Newport

unknown

1

0

sulfonamides

kanamycin

CA

NR

NR

45

critically important

chloramphenicol

1985

715

highly important

aminoglycosides

streptomycin

Salad bar

highly important

aminoglycosides

tetracycline
S. Typhimurium

amphenicol

carbenicillin

OR

Resistances

1

critically important

tetracycline

1984

Death

11

penicillin

sulfonamide*
18

ampicillin

streptomycin

Ground beef

WHO Status

kanamycin

MN, SD, NE, IA S. Newport

Hosp
NR

12

Drug Family

chloramphenicol

1983

Cases

tetracycline

highly important

tetracycline

tetracycline

highly important

ABR Foodborne Outbreaks
1980s
Year

Location Bacteria

1994

WI

ABR
Foodborne
Outbreaks
1990s

1997

sulfonamides

*

ampicillin

penicillin

critically
important

amphenicol

highly important

aminoglycosides critically
important
sulfonamides

highly important

tetracycline

highly important

NR

amoxicillin/clavulanat penicillin
e

critically
important

ampicillin

13

0

highly important

penicillin

critically
important

amphenicol

highly important

aminoglycosides critically
important
sulfonamides

highly important

tetracycline
Mexican-style 79
cheese (raw
milk)

5

tetracycline

sulfamethoxazole

S. Typhimurium
DT104

Mexican-style 89
soft cheese
(queso fresco)
(raw milk)

aminoglycosides highly important

streptomycin

CA

S. Typhimurium
DT104

0

kanamycin

chloramphenicol

0

aminoglycosides critically
important

chloramphenicol

1997

WA

Unknown,
19
chocolate milk
suspected

highly important

tetracycline

S. Typhimurium
DT104

NR

highly important

sulfonamides

sulfonamide*

NE

5

tetracycline

streptomycin

1996

Alfalfa sprouts 19

critically
important

trimethoprimsulfamethoxazole

S. Stanley

NR

penicillin

tetracycline

AZ

NR

ampicillin

streptomycin

205

WHO Status

sulfisoxazole

E. coli O153:H45 Unknown,
(ETEC)
banquet food

Drug Family

tetracycline

1995

Food/Source Cases Hosp Death Resistances

tetracycline

highly important

ampicillin

penicillin

critically
important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides critically
important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important
1997

ABR
Foodborne
Outbreaks
1990s cont.

1998

KS

S. I 4,[5],12:i-

Campylobacter
jejuni

Unknown,
86
dinner
reception
multiple foods
suspected

Unknown,
128
gravy, potato,
pineapple
suspected

2

0

0

tetracycline

highly important

ampicillin

penicillin

critically
important

amphenicol

highly important

aminoglycosides critically
important
sulfonamides

highly important

tetracycline

highly important

ampicillin

penicillin

critically
important

streptomycin

31

aminoglycosides critically
important

aminoglycosides critically
important
sulfonamides

highly important

tetracycline

NY

NR

highly important

aminoglycosides highly important

sulfonamide*

1998

1

tetracycline

kanamycin

tetracycline

9

highly important

sulfamethoxazole

Raw milk

sulfonamides

streptomycin

S. Typhimurium

2

highly important

aminoglycosides critically
important

chloramphenicol

VT

NR

amphenicol

tetracycline
1997

706

chloramphenicol

streptomycin

Pork

NR

critically
important

tetracycline
S. Heidelberg

14

penicillin

sulfonamide*

MD

S.Typhimurium var Mexican-style 31
Copenhagen
cheese (raw
DT104b
milk)

ampicillin

streptomycin

1997

CA

tetracycline

highly important

sulfonamides

*

fluoroquinolone

critically
important

tetracycline

highly Important

trimethoprimsulfamethoxazole
ciprofloxacin
tetracycline
Year

Location Bacteria

Food/Source

2000

TN

Staphylococcus
aureus (MRSA)

Pork, barbeque, 3
vegetable
salad, cole slaw

0

0

2000

PA, NJ

S. Typhimurium

Pasteurized
milk

6

0

12

0

*

ampicillin

penicillin

critically important

aminoglycosides

highly important

aminoglycosides

critically important

sulfonamides

highly important

tetracycline

highly important

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

cefoxitin

ABR
Foodborne
Outbreaks
2000s

Italian-style soft 27
cheese (raw
milk)

penicillin

tetracycline
S. Newport

methecillin

sulfamethoxazole

CT

WHO Status

streptomycin

93

Drug Family

kanamycin

2001

Cases Hosp Death Resistances

cephamycin

highly important

ceftiofur

cephalosporin (3G) *

cephalothin

cephalosporin (1G) highly important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides

critically important

sulfamethoxazole

sulfonamides

highly important

tetracycline

tetracycline

highly important

tetracycline

highly important

2001

WI

E. coli O169:H41/ST Quesadilla,
(ETEC)
fajitas, nacho
chips, beans

21

0

0

tetracycline

2002

NY, MI,
PA, OH,
CT

S. Newport

47

17

1

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

cefoxitin

cephamycin

highly important

ceftiofur

cephalosporin

*

cephalothin

cephalosporin (1G) highly important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides

critically important

sulfamethoxazole

sulfonamides

highly important

tetracycline

tetracycline

highly important

kanamycin (2/3
resistant)
ceftriaxone (2)

aminoglycosides

highly important

Ground beef

cephalosporin (3G) critically important
2002

OR

E. coli O27:H7/ST Chicken
(ETEC)
lasagna

2003

sulfonamides

highly important

tetracycline

highly important

tetracycline

highly important

Ground beef

56

11

0

ampicillin

penicillin

critically
important

amphenicol

highly important

aminoglycosides critically
important
sulfonamides

highly important

tetracycline

highly important

ampicillin

penicillin

critically
important

amphenicol

highly important

nalidixic acid

quinolone

critically
important

streptomycin

aminoglycosides critically
important

sulfisoxazole

sulfonamides

highly important

trimethoprimsulfamethoxazole
S. Newport

tetracycline

chloramphenicol

CA

0

tetracycline

2004

2

sulfamethoxazole

E. coli O6:H16
(ETEC)

41

streptomycin

NV

Catfish,
coleslaw

chloramphenicol

ABR
Foodborne
Outbreaks
2000s cont.

9 states S. Typhimurium
DT104

2004

E. coli O169:H49
(ETEC)

0

aminoglycosides critically
important

tetracycline
TN

0

streptomycin
sulfamethoxazole

2003

49

sulfonamides

*

Shrimp

Pasteurized
milk

130

100

0

5

0

0

amoxicillin/clavulanat penicillin
e

critically
important

ampicillin

penicillin

critically
important

cefoxitin

cephamycin

highly important

ceftiofur

cephalosporin
(3G)

*

ceftriaxone

cephalosporin

highly important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides critically
important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important
2004

cephalosporin

highly important

amphenicol

highly important

aminoglycosides

highly important

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important

sulfonamide*

sulfonamides

highly important

tetracycline

0

*

streptomycin

6

highly important

cephalosporin
(3G)

kanamycin

24

NR

cephamycin

chloramphenicol

Sandwich,
turkey

NR

critically important

ceftriaxone

ABR
Foodborne
Outbreaks
2000s cont.

2

penicillin

ceftiofur

S. Agona

Unknown

critically important

cefoxitin

MN

S. Newport

amoxicillin/clavulanat penicillin
e
ampicillin

2004

IL

tetracycline

highly important

2004

NY

S. Istanbul

Chicken

42

14

0

tetracycline

tetracycline

highly important

2005

MN

S. Heidelberg

Chicken

4

1

0

gentamicin
streptomycin
sulfonamide*

aminoglycosides
aminoglycosides
sulfonamides

critically important
critically important
highly important

2005

TN

S. Heidelberg

Unknown

19

2

0

gentamicin

aminoglycosides

critically important

nalidixic acid

quinolone

critically important

streptomycin

aminoglycosides

critically important

tetracycline

tetracycline

highly important

ampicillin

penicillin

critically important

gentamicin

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important

2005

IN, MI,
S. Braenderup
MO, OH

Tomato

84

8

0
2005

cephalosporin

highly important

amphenicol

highly important

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

chloramphenicol

amphenicol

highly important

streptomycin

ABR
Foodborne
Outbreaks
2000s cont.

0

highly important

cephalosporin (3G) *

streptomycin

0

0

cephamycin

chloramphenicol

25

1

critically important

ceftriaxone

Sushi

100

penicillin

ceftiofur

S. Typhimurium

S. Unknown

critically important

cefoxitin

CO

S. Typhimurium
Newport

amoxicillin/clavulanate penicillin
ampicillin

2005

CO

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

trimethoprimsulfamethoxazole

sulfonamides

*

tetracycline

tetracycline

highly important

2006

AR

S. I 4,[5],12:i-

Unknown

14

4

0

nalidixic acid

quinolone

critically important

2006

PA

S. Typhimurium

Queso fresco, 20
unpasteurized;
raw milk

2

0

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

cefoxitin

cephamycin

highly important

ceftiofur

cephalosporin (3G) *

ceftriaxone

cephalosporin

highly important

chloramphenicol

amphenicol

highly important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important

2006

UT

S. Typhimurium

Root vegetable 3

NR

NR

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important
2006

ABR
Foodborne
Outbreaks
2000s cont.

2006

2007

TN

S. Hadar

CA, AZ, ID, S. Newport
NV

Mexican-style
96
cheese (cotija), (raw
milk)

Unknown

Ground beef

9

43

1

15

highly important
highly important

amoxicillin/clavulanate

penicillin

critically important

penicillin

critically important

cephamycin
cephalosporin (3G)

highly important
*

cephalosporin
amphenicol
aminoglycosides

highly important
highly important
critically important

sulfonamides

highly important

tetracycline

highly important

amoxicillin/clavulanate

penicillin

critically important

ampicillin

36

sulfonamides
tetracycline

penicillin

critically important

cephamycin
cephalosporin (3G)

highly important
*

amphenicol

highly important

aminoglycosides

critically important

sulfamethoxazole
tetracycline

S.

highly important
highly important
critically important

streptomycin

S. Newport
Meleagridis

cephalosporin
amphenicol
aminoglycosides

chloramphenicol

IL

highly important
*

cefoxitin
ceftiofur

2006

cephamycin
cephalosporin (3G)

tetracycline

3

critically important

sulfonamide*

9

penicillin

ceftriaxone
chloramphenicol
streptomycin

Unknown

highly important
critically important

cefoxitin
ceftiofur

S. Newport

cephalosporin
penicillin

ampicillin

IL

*

ceftriaxone
amoxicillin/clavulanate

sulfonamide*
tetracycline

NR

highly important

cephalosporin (3G)

ceftriaxone
chloramphenicol
streptomycin

24

critically important

cephamycin

cefoxitin
ceftiofur

Multiple foods

0

critically important

ampicillin

S. Newport

6

penicillin

ceftiofur

2006

Unknown

penicillin

cefoxitin

CA

S. Schwarzengrund

amoxicillin/clavulanate
ampicillin

2006

PA

0

sulfonamides
tetracycline

highly important
highly important

0

streptomycin

aminoglycosides

critically important

0

tetracycline
amoxicillin/clavulanate

tetracycline
penicillin

highly important
critically important

ampicillin

penicillin

critically important

cefoxitin

cephamycin

highly important

ceftiofur

cephalosporin (3G)

*

ceftriaxone

cephalosporin

critically important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides

critically important

sulfonamide*

sulfonamides

highly important

tetracycline

tetracycline

highly important

NR

0

0
2007

ABR
Foodborne
Outbreaks
2000s cont.

critically important

ampicillin

penicillin

critically important

amphenicol

highly important

aminoglycosides

critically important

sulfonamides

highly important

tetracycline

highly important

amphenicol

highly important

aminoglycosides

critically important

sulfamethoxazole

sulfonamides

highly important

tetracycline
NR

cephalosporin (1G) highly important

streptomycin

NR

highly important

cephalosporin (3G) *

chloramphenicol

2

critically important

cephamycin

cephalothin

Ground beef

penicillin

ceftiofur

S. Newport

critically important

cefoxitin

AZ

amoxicillin/clavulanate penicillin
ampicillin

2009

0

highly important

aminoglycosides

tetracycline
4

highly important

tetracycline

sulfamethoxazole

68

sulfonamides

streptomycin

Ground beef

critically important

chloramphenicol

14 states S. Newport

highly important

aminoglycosides

streptomycin

2009

amphenicol

tetracycline

0

highly important

cephalosporin (3G) *

sulfamethoxazole

6

0

cephamycin

streptomycin

14

0

critically important

chloramphenicol

Ground beef

11

penicillin

ceftiofur

S. Typhimurium
DT104

Unknown

critically important

cefoxitin

7 states

S. Newport

amoxicillin/clavulanate penicillin
ampicillin

2009

MN

tetracycline

highly important

amoxicillin/clavulanate penicillin

critically important

ampicillin

penicillin

critically important

cefoxitin

cephamycin

highly important

ceftiofur

cephalosporin (3G) *

cephalothin

cephalosporin (1G) highly important

chloramphenicol

amphenicol

highly important

streptomycin

aminoglycosides

critically important

sulfamethoxazole

sulfonamides

highly important

tetracycline

tetracycline

highly important
2011 10 states S. Hadar

S. Typhimurium

Ground beef

20

0

37

1

8

0

penicillin penicillin
cephalosporin
penicillin
aminoglycosides

critically important
critically important
critically important
critically important

tetracycline

highly important

gentamicin
2011 7 states

3

ampicillin
amoxicillin/clavulanate
ampicillin
streptomycin
tetracycline

2011 34 states S. Heidelberg

Ground turkey 12
(Jennie-O
Ground turkey 136
(Cargill)

aminoglycosides

critically important

amoxicillin/clavulanate penicillin
ampicillin
penicillin

ABR Foodborne Outbreaks
2010s

critically important
critically important
Antibiotic
Resistant
Bacteria and
Foodborne
Outbreaks

NUMBER OF OUTBREAKS

OUTBREAKS BY FOOD
CATEGORY

14

13
10
7
4

2

1

1

3
Antibiotic
Resistant
Bacteria and
Foodborne
Outbreaks

Number of Outbreaks

OUTBREAKS BY ETIOLOGY
19
16

15

5

* Multiple Salmonella serotypes implicated in two outbreaks

1

1
Antibiotic
Resistant
Bacteria and
Foodborne
Outbreaks

Number of Outbreaks

Individual Drug Resistances per
Outbreak
20
15
10
5

0

Number of Ineffective Drugs
Risk
Management
Concepts

ď‚– Hazard resonably likely to occur (foundation of
HACCP-based controls)

ď‚– Known safety risk of a particular food (FDA FSMA)
ď‚– Performance standards (contaminant specific and
science-based); appropriate to reduce the risk of
serious illness or death to humans or animals (FDA
FSMA)
Prevention /
Crisis
Communication

ď‚– What we are AIMING for :
“An ounce of prevention is worth a pound of cure”

ď‚– What we too often HIT
“Don’t let a good crisis go to waste”
 Anticipating BSE’s emergence in North America
started in 1996; emergence in the early 2000s

Planning a
response

ď‚– Result:
ď‚– Well researched risk communication strategy and a
clear statement of the risk in relation to other
hazards in consumers’ diets resulted in only short
term declines in consumer consumption of beef
The
Alternative:
Consumer
Confidence
in Freefall

Source: University of Minnesota Food Industry Center; Louisiana State University AgCenter
ď‚– The interactive exchange of information and
opinions concerning risk and risk management
among risk assessors, risk
managers, consumers, and other interested
parties

Risk
Communication

ď‚– Transparency is a key objective and its importance
can not be overemphasized
ď‚– Involvement of stakeholders can contribute to issue
identification and characterization, provide data
and other inputs for risk assessment, provide
alternatives for options assessment, develop
consensus or provide an outlet for public concern
Relation of Data
Gathering to
Risk
Management &
Communication

ď‚– The data collection function of AGISAR will
generate information of interest to multiple
parties, including risk managers, the food
industry, retailers and consumers
ď‚– Producers may be concerned about disclosure of
information about practices that they are not
prepared to address
ď‚– Consumers may be concerned that the results
demonstrate that their food is highly contaminated
ď‚– Risk managers must be prepared to address
concerns of stakeholders at any point during the
data collection process
ď‚– World Health Day Focus with WHO/ FAO/OIE

Risk
Management:
WHO/OIE
even USDA

ď‚– Core actions for antimicrobial use in food producing
animals:
ď‚– Provide national leadership and collaboration
ď‚– Create and enforce regulatory framework
ď‚– Strengthen surveillance and monitoring
ď‚– Promote education and training on antimicrobial use in
food-producing animals
ď‚– Reduce the need for antimicrobials through better
animal husbandry

ď‚– U.S. Department of Agriculture
“Animals, when exposed to antimicrobial agents, may
serve as a significant reservoir of resistant bacteria
that can transmit to humans through the food
supply.”
“The economic impact of antimicrobial resistance is
significant. Insufficient or failed treatment … is a huge
human cost.”
June 10, 2011 Food Safety Research Information Office
Table 1. Antimicrobial Drugs Approved for Domestic Use in Humans and Food-Producing Animals*.
Sales and Distribution Data Reported to FDA by Drug Class.
2009 Animal Annual
Totals (LBS)

2010 Animal Annual
Totals (LBS)

2011 Animal Annual
Totals(LBS)

Aminoglycosides

748,862

442,675

473,762

Critically / highly

Cephalosporins

91,113

54,207

58,667

Critically / highly

8,246,671

8,424,167

9,090,230

Ionophores
Lincosamides

WHO Status

Not ranked

Antibiotic
Sales Data Animal and
Human by
WHO Status

255,377

340,952

419,101

Macrolides

1,900,352

1,219,661

1,284,933

Critically

Penicillins

1,345,953

1,920,112

1,940,427

Critically / highly

Sulfas

1,141,715

1,116,020

817,959

Highly

10,167,481

12,328,521

12,439,744

Highly

Tetracyclines
Other (Not Independently Reported (NIR))**

Total

4,910,501

3,345,398

3,330,241

28,808,024

29,191,712

29,855,066

2009 Human
Annual Total (LBS)
Aminoglycosides
Cephalosporins
Ionophores

Important

2010 Human
Annual Total (LBS)

2011 Human
Annual Total (LBS)

WHO Status

20,682

15,413

14,297

Critically / highly

1,101,465

1,107,957

1,095,499

Critically / highly

0

0

0

Lincosamides

153,744

152,637

157,531

Important

Macrolides

388,626

362,239

361,620

Critically

Penicillins

3,217,027

3,174,502

3,219,677

Critically / highly

Sulfas

1,039,352

1,057,081

1,061,887

Highly

289,108

284,800

250,957

Highly

1,102,567

1,074,121

1,089,921

7,312,570

7,228,750

7,251,390

Tetracyclines
Other (Not Independently Reported (NIR))**

Total

* For all classes except aminoglycosides and ionophores, data includes antimicrobial drug
products which are approved and labeled for use in both food- and non-food- producing animals.
** NIR is used for antimicrobial classes with fewer than three sponsors actively marketing
products. This category includes fluoroquinolones and streptogramins.
*** Human drug use data is based on data from the IMS Health, IMS National Sales Perspectives.

Not ranked
Government
Monitoring
& Reporting
What’s in the
meat we eat?
NARMS
Salmonella
& Resistance
NARMS
Salmonella
& Resistance
NARMS
Salmonella
& Resistance
Petition
Regulations
ADUFA
Sec. 105
ď‚– On April 11, FDA issued new guidelines intended to
curb the non-therapeutic uses of antibiotics in food
animal production.
ď‚– This first step:

Guidance for
Industry 209 & 213
VFD

ď‚– Voluntarily seeks to ban the use of antibiotics to
grow animals faster.
ď‚– Moves all over the counter (OTC) uses under
veterinary supervision.

Concerns with the guidances:
ď‚– Do not outline how FDA will monitor the
effectiveness of the guidelines.
ď‚– Do not clearly outline what uses are considered
prevention
Litigation
PAMTA (Preservation of Antibiotics for Medical Treatment Act)
HR 1150: Rep. Slaughter
PARA (Prevention of Antibiotic Resistance Act)
S. 1256:

Endorsed by:
• American Medical Association
• American Nurses Association
• American Academy of Pediatrics
• American Public Health Association
• More than 400 other organizations!
Consumer
advocates’
understanding
Antibiotics are important
in human medicine
Antibiotics treat infections
Antibiotics don’t work on
the Flu, Colds – e.g. Viral
infections
Consumer Logic

Consumer
advocates’
understanding

ď‚– People take antibiotics when they are sick.
ď‚– Antibiotics are only available with medical consult
from a clinician.
ď‚– Antibiotics only available with a prescription.
 Giving antibiotics to animals must mean they’re
sick, too.
ď‚– When consumers learn that antibiotics are given
preventatively, for animals that aren’t sick – lack of
understanding.
ď‚– Lack of consistent veterinary oversight different
from human medicine.
Consumer
advocates’
understanding
Giving antibiotics to healthy
animals in low doses, helps
speed along the emergence of
antibiotic resistant bacteria.

People can get sick with
antibiotic resistant infections
when food is contaminated.
Consumers
want
alternatives
Media
Messaging
Media
Messaging
Danielle
Wadsworth,
Salmonella
Typhimurium
survivor
The Alliance
for the
Prudent
Use of
Antibiotics

ď‚–Antibiotic Resistant
bacteria generate
ď‚–$16.6 billion - $26
billion annually in
extra costs to the US
Healthcare system
ď‚– Antibiotic Resistance
ď‚– Antibiotics are losing their effectiveness due in part
to overuse in food animal production

ď‚– Consumer Interest

Fighting
Antibiotic
Resistance

ď‚– Preserving effective medicines for fighting
infections
ď‚– Resistant bacteria associated with foodborne
diseases
ď‚– Residue issues (allergens, side effects)

ď‚– Recommendation
ď‚– Adopt EU policy banning non therapeutic use
ď‚– Remove critically important human drugs from
animal food chain
Susan Vaughn Grooters, MPH
Research and Policy Associate
Center for Science in the Public Interest
1220 L St. NW, Suite 300
Washington, DC 20005

THANK YOU!

Phone: 202.777.8377
Email: sgrooters@cspinet.org
On the Internet: www.cspinet.org
www.FoodDay.org

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Ms. Susan Vaughn Grooters - Consumer Perceptions-Superbugs In Our Food Supply

  • 1. Consumer PerceptionSuperbugs in the Food Supply National Institute for Animal Agriculture Susan Vaughn Grooters, MPH Research and Policy Associate Kansas City, MO November 13th 2013
  • 2. Center for Science in the Public Interest - CSPI CSPI is a bi-national consumer advocacy organization founded in 1971 by Michael Jacobson, Ph.D. Focuses on nutrition, health, and food safety Publishes the award-winning Nutrition Action Healthletter Approaching 1 million subscribers in the United States and Canada Accepts no government or industry funding
  • 4. CSPI Activities Strong Food Safety Laws • FSMA Petitions for Government Action • USDA – Salmonella Comments on Food Regulations Collaborative work • Safe Food Coalition • Make Our Food Safe • Keep Antibiotics Working
  • 6. ď‚– Study of 55 Outbreaks in the U. S. 1973-2011 Antibiotic Resistance in Foodborne Outbreaks CSPI Report ď‚– does not include the two Foster Farms assoc. outbreaks ď‚– Analyzes: ď‚– ď‚– ď‚– ď‚– Food Vehicle Etiology WHO categories Multi-drug resistance ď‚– Outlier – 1985 Samonella Typhimurium outbreak in pasteurized milk in which 16,659 were sickened, 2,777 were hospitalized, and 18 died
  • 7. ď‚– Aminoglycosides ď‚– Streptomycin ď‚– Carbapenems ď‚– Cephalosporins (3rd and 4th generation World Health Organization’s List of Critically Important Antibiotics ď‚– Ceftriaxone ď‚– Macrolides ď‚– Fluoro- and other Quinolones ď‚– Ciprofloxacin ď‚– Nalidixic acid ď‚– Glycopeptides ď‚– Vancomycin ď‚– Penicillins (natural aminopenicillins and antipseudomonals) ď‚– ď‚– ď‚– ď‚– Amocicillin/claulanic acid Ampicillin Carbenicillin Penicillin Source: http://apps.who.int
  • 8. ď‚– Amphenicols ď‚– Chloramphenicol ď‚– Cephalosporins (1st and 2nd generation) and Cephamycins World Health Organization’s List of Highly Important Antibiotics ď‚– Cephalothin ď‚– Cefoxitin ď‚– Lincosamides ď‚– Streptogramins ď‚– Sulfonamides, et al. ď‚– Sulfamethoxazole ď‚– Sulfisoxazole ď‚– Tetracyclines Source: http://apps.who.int
  • 9. Drug Resistance Profiles by WHO categories 50 47 45 40 36 35 # of Outbreaks Antibiotic Resistant Bacteria and Foodborne Outbreaks 39 30 25 25 20 19 15 15 17 14 10 10 5 15 2 1 3 4 1 10 5 3 0 Critically Important Highly Important Not classified on WHO's list 4 1
  • 10. Year Location Bacteria Food/Source Cases Hosp Death Resistances 1973 ME S. Typhimurium Eggs 32 NR NR unknown 1975 MD, FL, CO S. Newport Ground beef 27 NR NR 1979 CA, OR S. Dublin Raw milk 39 NR NR NR NR critically important sulfonamides highly important tetracycline highly important ampicillin penicillin critically important penicillin critically important kanamycin penicillin streptomycin tetracycline 3 aminoglycosides carbenicillin Raw milk streptomycin sulfamethoxazole S. Typhimurium WHO Status tetracycline 1977 KY Drug Family aminoglycosides penicillin aminoglycosides tetracycline highly important critically important critically important highly important unknown ABR Foodborne Outbreaks 1970s
  • 11. Year Location Bacteria Food/Source 1980 MT S. Typhimurium Raw milk 1983 AZ S. Typhimurium Raw milk 1987 GA S. Havana Chicken 16659 73 2777 36 18 1 tetracycline highly important tetracycline tetracycline highly important aminoglycosides critically important ampicillin penicillin critically important amphenicol highly important aminoglycosides highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important ampicillin penicillin critically important aminoglycosides highly important aminoglycosides critically important sulfonamides highly important tetracycline Pasteurized milk critically important sulfamethoxazole S. Typhimurium penicillin streptomycin IL 2 critically important kanamycin 1985 22 penicillin tetracycline 298 highly important ampicillin sulfamethoxazole Ground beef highly important tetracycline streptomycin S. Newport unknown 1 0 sulfonamides kanamycin CA NR NR 45 critically important chloramphenicol 1985 715 highly important aminoglycosides streptomycin Salad bar highly important aminoglycosides tetracycline S. Typhimurium amphenicol carbenicillin OR Resistances 1 critically important tetracycline 1984 Death 11 penicillin sulfonamide* 18 ampicillin streptomycin Ground beef WHO Status kanamycin MN, SD, NE, IA S. Newport Hosp NR 12 Drug Family chloramphenicol 1983 Cases tetracycline highly important tetracycline tetracycline highly important ABR Foodborne Outbreaks 1980s
  • 12. Year Location Bacteria 1994 WI ABR Foodborne Outbreaks 1990s 1997 sulfonamides * ampicillin penicillin critically important amphenicol highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important NR amoxicillin/clavulanat penicillin e critically important ampicillin 13 0 highly important penicillin critically important amphenicol highly important aminoglycosides critically important sulfonamides highly important tetracycline Mexican-style 79 cheese (raw milk) 5 tetracycline sulfamethoxazole S. Typhimurium DT104 Mexican-style 89 soft cheese (queso fresco) (raw milk) aminoglycosides highly important streptomycin CA S. Typhimurium DT104 0 kanamycin chloramphenicol 0 aminoglycosides critically important chloramphenicol 1997 WA Unknown, 19 chocolate milk suspected highly important tetracycline S. Typhimurium DT104 NR highly important sulfonamides sulfonamide* NE 5 tetracycline streptomycin 1996 Alfalfa sprouts 19 critically important trimethoprimsulfamethoxazole S. Stanley NR penicillin tetracycline AZ NR ampicillin streptomycin 205 WHO Status sulfisoxazole E. coli O153:H45 Unknown, (ETEC) banquet food Drug Family tetracycline 1995 Food/Source Cases Hosp Death Resistances tetracycline highly important ampicillin penicillin critically important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important
  • 13. 1997 ABR Foodborne Outbreaks 1990s cont. 1998 KS S. I 4,[5],12:i- Campylobacter jejuni Unknown, 86 dinner reception multiple foods suspected Unknown, 128 gravy, potato, pineapple suspected 2 0 0 tetracycline highly important ampicillin penicillin critically important amphenicol highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important ampicillin penicillin critically important streptomycin 31 aminoglycosides critically important aminoglycosides critically important sulfonamides highly important tetracycline NY NR highly important aminoglycosides highly important sulfonamide* 1998 1 tetracycline kanamycin tetracycline 9 highly important sulfamethoxazole Raw milk sulfonamides streptomycin S. Typhimurium 2 highly important aminoglycosides critically important chloramphenicol VT NR amphenicol tetracycline 1997 706 chloramphenicol streptomycin Pork NR critically important tetracycline S. Heidelberg 14 penicillin sulfonamide* MD S.Typhimurium var Mexican-style 31 Copenhagen cheese (raw DT104b milk) ampicillin streptomycin 1997 CA tetracycline highly important sulfonamides * fluoroquinolone critically important tetracycline highly Important trimethoprimsulfamethoxazole ciprofloxacin tetracycline
  • 14. Year Location Bacteria Food/Source 2000 TN Staphylococcus aureus (MRSA) Pork, barbeque, 3 vegetable salad, cole slaw 0 0 2000 PA, NJ S. Typhimurium Pasteurized milk 6 0 12 0 * ampicillin penicillin critically important aminoglycosides highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important cefoxitin ABR Foodborne Outbreaks 2000s Italian-style soft 27 cheese (raw milk) penicillin tetracycline S. Newport methecillin sulfamethoxazole CT WHO Status streptomycin 93 Drug Family kanamycin 2001 Cases Hosp Death Resistances cephamycin highly important ceftiofur cephalosporin (3G) * cephalothin cephalosporin (1G) highly important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfamethoxazole sulfonamides highly important tetracycline tetracycline highly important tetracycline highly important 2001 WI E. coli O169:H41/ST Quesadilla, (ETEC) fajitas, nacho chips, beans 21 0 0 tetracycline 2002 NY, MI, PA, OH, CT S. Newport 47 17 1 amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important cefoxitin cephamycin highly important ceftiofur cephalosporin * cephalothin cephalosporin (1G) highly important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfamethoxazole sulfonamides highly important tetracycline tetracycline highly important kanamycin (2/3 resistant) ceftriaxone (2) aminoglycosides highly important Ground beef cephalosporin (3G) critically important
  • 15. 2002 OR E. coli O27:H7/ST Chicken (ETEC) lasagna 2003 sulfonamides highly important tetracycline highly important tetracycline highly important Ground beef 56 11 0 ampicillin penicillin critically important amphenicol highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important ampicillin penicillin critically important amphenicol highly important nalidixic acid quinolone critically important streptomycin aminoglycosides critically important sulfisoxazole sulfonamides highly important trimethoprimsulfamethoxazole S. Newport tetracycline chloramphenicol CA 0 tetracycline 2004 2 sulfamethoxazole E. coli O6:H16 (ETEC) 41 streptomycin NV Catfish, coleslaw chloramphenicol ABR Foodborne Outbreaks 2000s cont. 9 states S. Typhimurium DT104 2004 E. coli O169:H49 (ETEC) 0 aminoglycosides critically important tetracycline TN 0 streptomycin sulfamethoxazole 2003 49 sulfonamides * Shrimp Pasteurized milk 130 100 0 5 0 0 amoxicillin/clavulanat penicillin e critically important ampicillin penicillin critically important cefoxitin cephamycin highly important ceftiofur cephalosporin (3G) * ceftriaxone cephalosporin highly important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important
  • 16. 2004 cephalosporin highly important amphenicol highly important aminoglycosides highly important aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important sulfonamide* sulfonamides highly important tetracycline 0 * streptomycin 6 highly important cephalosporin (3G) kanamycin 24 NR cephamycin chloramphenicol Sandwich, turkey NR critically important ceftriaxone ABR Foodborne Outbreaks 2000s cont. 2 penicillin ceftiofur S. Agona Unknown critically important cefoxitin MN S. Newport amoxicillin/clavulanat penicillin e ampicillin 2004 IL tetracycline highly important 2004 NY S. Istanbul Chicken 42 14 0 tetracycline tetracycline highly important 2005 MN S. Heidelberg Chicken 4 1 0 gentamicin streptomycin sulfonamide* aminoglycosides aminoglycosides sulfonamides critically important critically important highly important 2005 TN S. Heidelberg Unknown 19 2 0 gentamicin aminoglycosides critically important nalidixic acid quinolone critically important streptomycin aminoglycosides critically important tetracycline tetracycline highly important ampicillin penicillin critically important gentamicin aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important 2005 IN, MI, S. Braenderup MO, OH Tomato 84 8 0
  • 17. 2005 cephalosporin highly important amphenicol highly important aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important chloramphenicol amphenicol highly important streptomycin ABR Foodborne Outbreaks 2000s cont. 0 highly important cephalosporin (3G) * streptomycin 0 0 cephamycin chloramphenicol 25 1 critically important ceftriaxone Sushi 100 penicillin ceftiofur S. Typhimurium S. Unknown critically important cefoxitin CO S. Typhimurium Newport amoxicillin/clavulanate penicillin ampicillin 2005 CO aminoglycosides critically important sulfonamide* sulfonamides highly important trimethoprimsulfamethoxazole sulfonamides * tetracycline tetracycline highly important 2006 AR S. I 4,[5],12:i- Unknown 14 4 0 nalidixic acid quinolone critically important 2006 PA S. Typhimurium Queso fresco, 20 unpasteurized; raw milk 2 0 amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important cefoxitin cephamycin highly important ceftiofur cephalosporin (3G) * ceftriaxone cephalosporin highly important chloramphenicol amphenicol highly important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important 2006 UT S. Typhimurium Root vegetable 3 NR NR amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important
  • 18. 2006 ABR Foodborne Outbreaks 2000s cont. 2006 2007 TN S. Hadar CA, AZ, ID, S. Newport NV Mexican-style 96 cheese (cotija), (raw milk) Unknown Ground beef 9 43 1 15 highly important highly important amoxicillin/clavulanate penicillin critically important penicillin critically important cephamycin cephalosporin (3G) highly important * cephalosporin amphenicol aminoglycosides highly important highly important critically important sulfonamides highly important tetracycline highly important amoxicillin/clavulanate penicillin critically important ampicillin 36 sulfonamides tetracycline penicillin critically important cephamycin cephalosporin (3G) highly important * amphenicol highly important aminoglycosides critically important sulfamethoxazole tetracycline S. highly important highly important critically important streptomycin S. Newport Meleagridis cephalosporin amphenicol aminoglycosides chloramphenicol IL highly important * cefoxitin ceftiofur 2006 cephamycin cephalosporin (3G) tetracycline 3 critically important sulfonamide* 9 penicillin ceftriaxone chloramphenicol streptomycin Unknown highly important critically important cefoxitin ceftiofur S. Newport cephalosporin penicillin ampicillin IL * ceftriaxone amoxicillin/clavulanate sulfonamide* tetracycline NR highly important cephalosporin (3G) ceftriaxone chloramphenicol streptomycin 24 critically important cephamycin cefoxitin ceftiofur Multiple foods 0 critically important ampicillin S. Newport 6 penicillin ceftiofur 2006 Unknown penicillin cefoxitin CA S. Schwarzengrund amoxicillin/clavulanate ampicillin 2006 PA 0 sulfonamides tetracycline highly important highly important 0 streptomycin aminoglycosides critically important 0 tetracycline amoxicillin/clavulanate tetracycline penicillin highly important critically important ampicillin penicillin critically important cefoxitin cephamycin highly important ceftiofur cephalosporin (3G) * ceftriaxone cephalosporin critically important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfonamide* sulfonamides highly important tetracycline tetracycline highly important NR 0 0
  • 19. 2007 ABR Foodborne Outbreaks 2000s cont. critically important ampicillin penicillin critically important amphenicol highly important aminoglycosides critically important sulfonamides highly important tetracycline highly important amphenicol highly important aminoglycosides critically important sulfamethoxazole sulfonamides highly important tetracycline NR cephalosporin (1G) highly important streptomycin NR highly important cephalosporin (3G) * chloramphenicol 2 critically important cephamycin cephalothin Ground beef penicillin ceftiofur S. Newport critically important cefoxitin AZ amoxicillin/clavulanate penicillin ampicillin 2009 0 highly important aminoglycosides tetracycline 4 highly important tetracycline sulfamethoxazole 68 sulfonamides streptomycin Ground beef critically important chloramphenicol 14 states S. Newport highly important aminoglycosides streptomycin 2009 amphenicol tetracycline 0 highly important cephalosporin (3G) * sulfamethoxazole 6 0 cephamycin streptomycin 14 0 critically important chloramphenicol Ground beef 11 penicillin ceftiofur S. Typhimurium DT104 Unknown critically important cefoxitin 7 states S. Newport amoxicillin/clavulanate penicillin ampicillin 2009 MN tetracycline highly important amoxicillin/clavulanate penicillin critically important ampicillin penicillin critically important cefoxitin cephamycin highly important ceftiofur cephalosporin (3G) * cephalothin cephalosporin (1G) highly important chloramphenicol amphenicol highly important streptomycin aminoglycosides critically important sulfamethoxazole sulfonamides highly important tetracycline tetracycline highly important
  • 20. 2011 10 states S. Hadar S. Typhimurium Ground beef 20 0 37 1 8 0 penicillin penicillin cephalosporin penicillin aminoglycosides critically important critically important critically important critically important tetracycline highly important gentamicin 2011 7 states 3 ampicillin amoxicillin/clavulanate ampicillin streptomycin tetracycline 2011 34 states S. Heidelberg Ground turkey 12 (Jennie-O Ground turkey 136 (Cargill) aminoglycosides critically important amoxicillin/clavulanate penicillin ampicillin penicillin ABR Foodborne Outbreaks 2010s critically important critically important
  • 21. Antibiotic Resistant Bacteria and Foodborne Outbreaks NUMBER OF OUTBREAKS OUTBREAKS BY FOOD CATEGORY 14 13 10 7 4 2 1 1 3
  • 22. Antibiotic Resistant Bacteria and Foodborne Outbreaks Number of Outbreaks OUTBREAKS BY ETIOLOGY 19 16 15 5 * Multiple Salmonella serotypes implicated in two outbreaks 1 1
  • 23. Antibiotic Resistant Bacteria and Foodborne Outbreaks Number of Outbreaks Individual Drug Resistances per Outbreak 20 15 10 5 0 Number of Ineffective Drugs
  • 24. Risk Management Concepts ď‚– Hazard resonably likely to occur (foundation of HACCP-based controls) ď‚– Known safety risk of a particular food (FDA FSMA) ď‚– Performance standards (contaminant specific and science-based); appropriate to reduce the risk of serious illness or death to humans or animals (FDA FSMA)
  • 25. Prevention / Crisis Communication ď‚– What we are AIMING for : “An ounce of prevention is worth a pound of cure” ď‚– What we too often HIT “Don’t let a good crisis go to waste”
  • 26. ď‚– Anticipating BSE’s emergence in North America started in 1996; emergence in the early 2000s Planning a response ď‚– Result: ď‚– Well researched risk communication strategy and a clear statement of the risk in relation to other hazards in consumers’ diets resulted in only short term declines in consumer consumption of beef
  • 27. The Alternative: Consumer Confidence in Freefall Source: University of Minnesota Food Industry Center; Louisiana State University AgCenter
  • 28. ď‚– The interactive exchange of information and opinions concerning risk and risk management among risk assessors, risk managers, consumers, and other interested parties Risk Communication ď‚– Transparency is a key objective and its importance can not be overemphasized ď‚– Involvement of stakeholders can contribute to issue identification and characterization, provide data and other inputs for risk assessment, provide alternatives for options assessment, develop consensus or provide an outlet for public concern
  • 29. Relation of Data Gathering to Risk Management & Communication ď‚– The data collection function of AGISAR will generate information of interest to multiple parties, including risk managers, the food industry, retailers and consumers ď‚– Producers may be concerned about disclosure of information about practices that they are not prepared to address ď‚– Consumers may be concerned that the results demonstrate that their food is highly contaminated ď‚– Risk managers must be prepared to address concerns of stakeholders at any point during the data collection process
  • 30. ď‚– World Health Day Focus with WHO/ FAO/OIE Risk Management: WHO/OIE even USDA ď‚– Core actions for antimicrobial use in food producing animals: ď‚– Provide national leadership and collaboration ď‚– Create and enforce regulatory framework ď‚– Strengthen surveillance and monitoring ď‚– Promote education and training on antimicrobial use in food-producing animals ď‚– Reduce the need for antimicrobials through better animal husbandry ď‚– U.S. Department of Agriculture “Animals, when exposed to antimicrobial agents, may serve as a significant reservoir of resistant bacteria that can transmit to humans through the food supply.” “The economic impact of antimicrobial resistance is significant. Insufficient or failed treatment … is a huge human cost.” June 10, 2011 Food Safety Research Information Office
  • 31. Table 1. Antimicrobial Drugs Approved for Domestic Use in Humans and Food-Producing Animals*. Sales and Distribution Data Reported to FDA by Drug Class. 2009 Animal Annual Totals (LBS) 2010 Animal Annual Totals (LBS) 2011 Animal Annual Totals(LBS) Aminoglycosides 748,862 442,675 473,762 Critically / highly Cephalosporins 91,113 54,207 58,667 Critically / highly 8,246,671 8,424,167 9,090,230 Ionophores Lincosamides WHO Status Not ranked Antibiotic Sales Data Animal and Human by WHO Status 255,377 340,952 419,101 Macrolides 1,900,352 1,219,661 1,284,933 Critically Penicillins 1,345,953 1,920,112 1,940,427 Critically / highly Sulfas 1,141,715 1,116,020 817,959 Highly 10,167,481 12,328,521 12,439,744 Highly Tetracyclines Other (Not Independently Reported (NIR))** Total 4,910,501 3,345,398 3,330,241 28,808,024 29,191,712 29,855,066 2009 Human Annual Total (LBS) Aminoglycosides Cephalosporins Ionophores Important 2010 Human Annual Total (LBS) 2011 Human Annual Total (LBS) WHO Status 20,682 15,413 14,297 Critically / highly 1,101,465 1,107,957 1,095,499 Critically / highly 0 0 0 Lincosamides 153,744 152,637 157,531 Important Macrolides 388,626 362,239 361,620 Critically Penicillins 3,217,027 3,174,502 3,219,677 Critically / highly Sulfas 1,039,352 1,057,081 1,061,887 Highly 289,108 284,800 250,957 Highly 1,102,567 1,074,121 1,089,921 7,312,570 7,228,750 7,251,390 Tetracyclines Other (Not Independently Reported (NIR))** Total * For all classes except aminoglycosides and ionophores, data includes antimicrobial drug products which are approved and labeled for use in both food- and non-food- producing animals. ** NIR is used for antimicrobial classes with fewer than three sponsors actively marketing products. This category includes fluoroquinolones and streptogramins. *** Human drug use data is based on data from the IMS Health, IMS National Sales Perspectives. Not ranked
  • 39. ď‚– On April 11, FDA issued new guidelines intended to curb the non-therapeutic uses of antibiotics in food animal production. ď‚– This first step: Guidance for Industry 209 & 213 VFD ď‚– Voluntarily seeks to ban the use of antibiotics to grow animals faster. ď‚– Moves all over the counter (OTC) uses under veterinary supervision. Concerns with the guidances: ď‚– Do not outline how FDA will monitor the effectiveness of the guidelines. ď‚– Do not clearly outline what uses are considered prevention
  • 41. PAMTA (Preservation of Antibiotics for Medical Treatment Act) HR 1150: Rep. Slaughter PARA (Prevention of Antibiotic Resistance Act) S. 1256: Endorsed by: • American Medical Association • American Nurses Association • American Academy of Pediatrics • American Public Health Association • More than 400 other organizations!
  • 42.
  • 43. Consumer advocates’ understanding Antibiotics are important in human medicine Antibiotics treat infections Antibiotics don’t work on the Flu, Colds – e.g. Viral infections
  • 44. Consumer Logic Consumer advocates’ understanding ď‚– People take antibiotics when they are sick. ď‚– Antibiotics are only available with medical consult from a clinician. ď‚– Antibiotics only available with a prescription. ď‚– Giving antibiotics to animals must mean they’re sick, too. ď‚– When consumers learn that antibiotics are given preventatively, for animals that aren’t sick – lack of understanding. ď‚– Lack of consistent veterinary oversight different from human medicine.
  • 45. Consumer advocates’ understanding Giving antibiotics to healthy animals in low doses, helps speed along the emergence of antibiotic resistant bacteria. People can get sick with antibiotic resistant infections when food is contaminated.
  • 50. The Alliance for the Prudent Use of Antibiotics ď‚–Antibiotic Resistant bacteria generate ď‚–$16.6 billion - $26 billion annually in extra costs to the US Healthcare system
  • 51. ď‚– Antibiotic Resistance ď‚– Antibiotics are losing their effectiveness due in part to overuse in food animal production ď‚– Consumer Interest Fighting Antibiotic Resistance ď‚– Preserving effective medicines for fighting infections ď‚– Resistant bacteria associated with foodborne diseases ď‚– Residue issues (allergens, side effects) ď‚– Recommendation ď‚– Adopt EU policy banning non therapeutic use ď‚– Remove critically important human drugs from animal food chain
  • 52. Susan Vaughn Grooters, MPH Research and Policy Associate Center for Science in the Public Interest 1220 L St. NW, Suite 300 Washington, DC 20005 THANK YOU! Phone: 202.777.8377 Email: sgrooters@cspinet.org On the Internet: www.cspinet.org www.FoodDay.org