David Heyman

1. Working across sectors:
a public health approach to
to antimicrobial resistance
December 2014 1

2. AAnnttiibbiioottiicc uussee:: uussee iinn ppllaannttss,, ffiisshh
aanndd aanniimmaallss
US: OVER-USE OF ANTIBIOTICS THREATENS HUMANS
by Danielle Knight
Washington,11 Oct. (IPS) –
More than half of the antibiotics used in the United States are
estimated to be used in animal feed for poultry, hogs, and
cattle. In 80 percent of cases, the drugs are used to fatten the
animals faster.
Between 40,000 and 50,000 pounds of tetracycline and
streptomycin - both used to treat infections in humans - are
sprayed to control bacterial disease among fruit trees.
In the United States nearly 150 pounds of antibiotic are
applied per acre of salmon
Source: Inter Press Service
December 2014 2

3. AAnnttiibbiioottiicc ccoonnssuummppttiioonn iinn
aanniimmaallss,, 22000000
Source: Follet,G (2000) Agbioforum
December 2014 3

4. Primary effects sought from
antibiotic growth promoters
• increased growth
• improved feed efficiency
• lower incidence of certain diseases
Source. Doyle E, Food Research Institute, University of Wisconsin
December 2014 4

5. EEuurrooppeeaann bbaann oonn tthhee uussee ooff aannttiibbiioottiicc
ggrroowwtthh pprroommootteerrss,, 11999988 -- 22000066
December 2014 5

6. AAnnttiibbiioottiiccss:: tthheerraappeeuuttiicc uussee aanndd ggrroowwtthh
pprroommoottiioonn,, ppiiggss,, DDeennmmaarrkk 11999922 -- 22000088
Mg/kg
Source: Aarestrup F. Danish Government
December 2014 6

7. AAnnnnuuaall aannttiibbiioottiicc uussee ffoorr hhuummaann aanndd
vveetteerriinnaarryy pprraaccttiiccee iinn DDeennmmaarrkk
December 2014 7

8. SSuucccceessss ffaaccttoorrss,, DDaanniisshh bbaann oonn ggrroowwtthh
pprroommootteerrss
December 2014 8

9. EEssttiimmaatteedd aannttiimmiiccrroobbiiaall uussee ttoo pprroodduuccee
oonn kkiillooggrraamm ooff mmeeaatt
Source: Grave K, Torren-Edo J, Mackay D. Comparison of the sales of veterinary antibacterial agents between 10 European countries. Journal of Antimicrobial Chemotherapy, 2010, 65(9):2037-40.
December 2014 9

10. AAnnttiibbiioottiicc uussee iinn aanniimmaall hhuussbbaannddrryy
Source: New England Journal of Medicine, 1999
1December 2014 0

11. AAnnttiimmiiccrroobbiiaall rreessiissttaannccee aatt aanniimmaall//hhuummaann
iinntteerrffaaccee:: UUSS aawwaarreenneessss ccaammppaaiiggnn
1March 2013 1

12. MMaaccrroolliiddee uussee aanndd eenntteerrooccooccccaall
rreessiissttaannccee iinn ppiiggss,, DDeennmmaarrkk
Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.
1December 2014 2

13. CCeepphhaalloossppoorriinn rreessiissttaannccee aafftteerr ssttooppppiinngg
uussee iinn ppoouullttrryy,, QQuueebbeecc,, CCaannaaddaa
Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.
1December 2014 3

14. FFiirreebblliigghhtt ((Erwinia amylovora)),, ffrruuiitt ttrreeeess,,
UUSSAA 11999944
Source: McManus L, American Phytological Society, 1994
1December 2014 4

15. MMiiccrroobbiiaall-rreessiissttaanntt ppllaanntt aaggrriiccuullttuurree
1December 2014 5

16. **BBaacctteerriiaall rreessiissttaannccee,, aaqquuaaccuullttuurree
sslluuddggee,, PPuuggeett SSoouunndd,, 11999922
Aquaculture Puget Sound
*pseudomonads, E.coli,enterobacter,enterococci, other
1December 2014 6

17. VVaacccciinnaattiioonn iinn aaqquuaaccuullttuurree,,
UUSS aanndd NNoorrwwaayy
1December 2014 7

18. AAnnttiimmiiccrroobbiiaall uussee aanndd ssaallmmoonn//ttrroouutt pprroodduuccttiioonn,,
NNoorrwwaayy,, aafftteerr iinnttrroodduuccttiioonn ooff vvaacccciinnaattiioonn,, 11999944
700 000
600 000
500 000
400 000
300 000
200 000
100 000
0
1981 1984 1987 1990 1993 1996 1999 2002
Volume
(tons wfe)
60 000
50 000
40 000
30 000
20 000
10 000
0
Antibiotics
(kg active substance)
Volume salmon and trout Consumption antibiotics
Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006
1December 2014 8

19. CCoommpplleexxiittyy ooff tthhee aannttiimmiiccrroobbiiaall wweebb
Source:Cantas l.Front. Microbiol., 14 May 2013 |
1December 2014 9

20. AAnnttiimmiiccrroobbiiaall rreessiissttaannccee:: ttwwoo
iinnddeeppeennddeenntt mmeecchhaanniissmmss
Selection pressure: over/under-use
of antimicrobials
Plasmid exchange: environmental
exposure to other organisms
2December 2014 0

21. Principal transfer pathways, antibiotic resistance
genes: humans, animals, food and the environment
Source: DARC/ARHAI joint report, UKI
Plants
2December 2014 1

22. Risks at animal/animal and animal/human interface
2December 2014 2

23. RReesseerrvvooiirrss ooff bbaacctteerriiaa ccaauussiinngg hhuummaann
iinnffeeccttiioonnss
2December 2014 3
Source: WHO

24. MMuullttiiddrruugg--rreessiissttaanntt DDeeffiinniittiivvee TTyyppee ((DDTT)) 110044
SSaallmmoonneellllaa TTyypphhiimmuurriiuumm,, EEuurrooppee,, 11998822--11999966
Salmonella Typhimurium isolates from both cattle and humans
cattle humans
2December 2014 4
%
50
40
30
20
10
0
1982-85 1986-90 1991-94 1995-96
Source: WHO from published data

25. CClliinniicciiaann--ppeerrcceeiivveedd ccoonnttrriibbuuttiioonn((%%)) ooff
iinnddiivviidduuaall bbaacctteerriiaa ssppeecciieess,, EEUU 22000000
Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000
2December 2014 5

26. PPoossssiibbllee aalltteerrnnaattiivveess ttoo ggrroowwtthh pprroommootteerrss
• Alternative husbandry practices leading to cleaner agriculture
• Probiotics (e.g. lactic acid bacteria) and competitive exclusion of other
organisms
• Organic acids (Acidifers) to acidify feed and encourage growth of
lactobacilli – PH monitoring/rumen chip technology
• Gastrointestinal enzymes to increase digestability of feed
• Immune modulators to enhance resistance to infection
• Feed supplements (vitamins, protein supplements and minerals)
• Nitric Oxide and respiratory disease - stressed animals
Source. Doyle E. Food Research Institute, University of Wisconsin
2December 2014 6

27. Putting it all together: antimicrobial
resistance in animals, plants and fish
• Increased public awareness
• Clean agriculture
• Use existing vaccines
• Work across sectors
• Regulation with enforcement
• Monitoring effectiveness of above and other interventions
• Research and development - newer technologies, point of care
diagnostics, vaccines
• Select/hybridise/engineer microbial-resistant plants
• Consider an international treaty
• Do the bottom line mathematics
December 2014 27

28. TThhee bboottttoomm lliinnee:: ddoo tthhee mmaatthhss
Human + antibiotic = saved life
Food animal, fish and plant + antibiotic = saved life
+ rapid growth, and equal or increased profit
2December 2014 8

29. LLeeaaddiinngg iinnffeeccttiioouuss ccaauusseess ooff mmoorrttaalliittyy,,
22000088 eessttiimmaatteess,, wwiitthh ssmmaallllppooxx 11996677
3.5
3.0
2.5
2.0
1.5
1.0
0.5
Smallpox 1967
2December 2014 9
Deaths (millions)
< 5 years old > 5 years old
0
ARI Diarrhoea AIDS TB Malaria Measles