DANMAP and VetStat Monitoring resistance and antimicrobial consumption in production animals Flemming Bager Head Division for Risk Assessment and Nutrition Erik Jacobsen Danish Veterinary and Food Administration

2 National Food Institute, Technical University of Denmark

Figure 4.1. Prescribed antimicrobial agents for humans, and for animals compared with the number of pigs produced, Denmark

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DANMAP objectives • The original (1995) DANMAP objectives were

– Monitor antimicrobial resistance in

• Zoonotic bacteria • Indicator bacteria (E. coli/ enterococci) • Animal pathogens

– In production animals and meat (Danish and imported)

– Monitor resistance in bacteria fra humans • Zoonotic bacteria (domestic/travel associated) • Human pathogens

– Monitor antimicrobial usage in production animals and in humans

– Explore association between antimicrobial usage and resistance

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Copenhagen Recommendations (1998) vs. EU Council Recommendation (15.11.2001) (Ref. Niels Frimodt Møller)

Copenhagen Recommendations:

• Recognise AMR as major EU and global problem

• Encourage search for new AM

• Setup EU surveillance on AMR

• Collect data on supply and consumption of AM agents

• EU Encourage prudent use of AM

• EU, member states and nat.res.councils research on AMR high priority

• Review progress on recommendation

EU Council recommendation: I Recognise problem and

promote strategy for prudent use of AM

Establish surveillance on AMR - and AM use • Prescription only, guidelines,

good practise for managing comm.dis., education of health professionals and information of public

• Cooperate, coordinate and report to EU

II ”Intersectorial mechanism” for coordinated implementation of strategy

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VetStat – herd level monitoring of antimicrobial agents

Objectives

• to obtain data, facilitating control of prudent use strategies and possible interventions

• to contribute to clarification of the complex epidemology of resistance through investigations on the relationsship between use of antibiotic and resistence.

• to help veterinarians in their daily routine

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Key premises • Danish veterinarians do not have a significant income from selling

medicine

• All medicine are sold exclusively from licensed pharmacy or similar organisation (dealers), excp. medicated feed

– sale from wholesalers only to licensed pharmacies

• 94% of all antibiotics for production animals are being sold directly from pharmacies to farmer

• In 2014 about 75% of all antibiotics used in pigs

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VetStat – infrastructure requirements

• Detailed information about all farms in database (Central Herd Register, CHR)

– Unique farm ID – No. of animals /pen places – Type of use, eg.

• Poultry – layers/broilers/breeders • Cattle – dairy/beef

– ID of owner and veterinary practitioner – Animal movements (flock or individual)

• Use of veterinary medicines

– All antibiotics prescription-only – Sold only through pharmacies – Vet’s profit from sale of medicines severely limited

• Ie no economic incentive to over prescribe

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VetStat – data capture • Prescriptions will only be processed by a pharmacy when following

information is present

– ID of farm of destination – Target species and target age group – Disease code (categories)

• Data are captured automatically during billing

• Relevant data transferred electronically to VetStat

• Data on antibiotics used by veterinary practitioners are captured

automatically during billing and transferred electronically to VetStat

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Denominator information – biomass estimation

• Information on target species available from VetStat

• National production data available from – Danish Statistical Office – Primary producer organisations

• Risk days estimated

– Eg. broiler chickens live to 36 days and 2 kg live weight

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Data to be reported to Vetstat

• Identification number for the veterinarian (Aut)

• Identification number for the farm (CHR)

• Identification number for the product (Vnr)

• Amount of product sold

• Code for animal species

• Code for age of animal

• Code for disease

• Date for receiving the medicine

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Danish Medicines Agency

4%

85%

VETSTAT

Medicated feed

Coccidiostatics

98% 94%

2 %

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Raw data in Vetstat

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Comparing consumption: the Animal Daily Dose (ADD)

• It is the average dose given to a specific animal species on one day.

• Therefore it is to be considered as an

statistic figure, rather than an absolut dose.

• It is a valuble tool whenever you follow a trend in consumption, or compare consumption between farms

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Risk management and communication using VetStat

National level: • Developments over years • Unacceptable trends spotted • Risk based control

Vets and herd owners: • Comparison of usage by ADD /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

Action plans: 2005 swine, 2007 all food animals and 2010 yellow card

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Antibiotic consumption over a 3 year periode

XXXX

Name of owner and address of farm

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Yellow card system

XXXX Name of farmer and address of farm

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Consumption in pigs by dispensing form

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Antibiotic used in dairy cattle

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ESVAC

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Cephalosporin use 2001-14, kg. active comp.

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Systemic treatment of pigs Systemic treatment of cattle Intramammary treatment of cattle

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Resistance to Cephalosporins

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Resistance in Campylobacter jejuni

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AM consumption – association with AMR • At population (national) level, resistance does reflect usage of

antimicrobials – domestic product, vs. imports

• However, also many exceptions

– clonal spread of resistant strains, eg. monophasic Salmonella – animal trade, eg. broiler parent stock

• I.e. the epidemiology of AMR is multifactorial

• New approach: mapping AMR genes of entire microbiota?

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Effect of prudent use in food animals on human medicine?

• Yes!

– eg Campylobacter – ESBL genes – FQ resistance – Continued effect of penicillins i primary health care

• However: – the epidemiology of AMR is complex!

• travel associated cases • imported food stuffs, incl. RTE greens

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Doctors vs. Veterinarians: who’s responsible?