dr. david leger - the canadian integrated program for antimicrobial resistance surveillance:...
DESCRIPTION
The Canadian Integrated Program for Antimicrobial Resistance Surveillance: Building a Voluntary Farm Surveillance Framework - Dr. David Leger, Veterinary Epidemiologist, Public Health Agency of Canada, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA. More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardshipTRANSCRIPT
The Canadian Integrated Program for Antimicrobial Resistance Surveillance
Building a Voluntary Farm Surveillance Framework
NIAA Symposium – Antibiotic Use & Resistance: Moving Forward Through Shared Stewardship
November 13, 2014 – Session III Metrics of Success to Minimize Resistance
Dr. Dave Léger, Laboratory for Food-borne Zoonoses
Presentation Outline
• Background and the CIPARS Program• Farm surveillance framework development process» Building collaboration
• CIPARS Farm Surveillance» Grower-Finisher Swine
» Broiler Poultry
• Surveillance Framework implementation / sustainability
• CIPARS Farm Surveillance Summary» Outputs – Example data
• Acknowledgements
2
Recommendation
To establish a national surveillance system to monitor antimicrobial resistance and use in the agri-food and aquaculture sectors…
3
Background: Calls for surveillance of AMR and AMU
Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS)
• Coordinated by the Public Health Agency of Canada (PHAC)» Veterinary epidemiologists» Species/commodity specialists
• Partnerships include:» Veterinary Drugs Directorate (VDD), Health Canada» Canadian Food Inspection Agency (CFIA)» Agriculture & Agri-foods Canada (AAFC)» Provincial agriculture and public health» Academia» Private industry
http://www.phac-aspc.gc.ca/cipars-picra/pubs-eng.phphttp://www.phac-aspc.gc.ca/cipars-picra/pubs-fra.php4
5
CIPARS: Active and Passive Surveillance Components
6
CIPARS Farm Surveillance
Objectives
•Establish an infrastructure supporting a national farm surveillance program for the collection of antimicrobial use and resistance data
•Describe trends in farm AMU and AMR
•Investigate associations between farm antimicrobial use and resistance•Provide sound data for human health risk assessments
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CIPARS Farm Surveillance
National Farm Surveillance
System
Contentious Issue
• Data confidentiality
• Farm biosecurity
• Time investment
• Findings... Communication
• Big Government
• Challenging existing
management practices
• “Not on our radar!”
Anxiety... Fear... Mistrust
Volunteer Data Providers
Obstacles to
Collaboration
Obstacles to
Collaboration
Mandate
For Farm
Surveillance
$Funded
Mandate
For Farm
Surveillance
$Funded
8
CIPARS Farm Surveillance: Framework development
• National in scope
• Sentinel farm network design• Surveillance pilot: Swine (2006)
» Grower-Finisher (G-F) production
• Broiler Poultry (2013)» Hatchery (AMU) and Broiler flocks
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Multi-Commodity ConsultationsMulti-Commodity ConsultationsDRAFT
1CIPARS Farm Working GroupCIPARS Farm Working Group
CIPARS Farm Surveillance: Framework development
DRAFT1CIPARS Farm Working GroupCIPARS Farm Working Group
Expert Review Panel – Round 1Expert Review Panel – Round 1
Expert Review Panel – Round 2Expert Review Panel – Round 2
Swine/Poultry Working GroupSwine/Poultry Working Group
Producer/Veterinarian Sub-CommitteeProducer/Veterinarian Sub-Committee
DRAFT 3:Implementation Framework (2006)
DRAFT3
DRAFT2
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• Operational logistics• Sampling kits and protocols• Questionnaires development
CIPARS Farm Surveillance: Framework development
Recommendations - Expert Panel / Working Group
• Approve objectives
• Herd selection/recruitment: inclusion/exclusion criteria
• Field work: Herd veterinarians» Confidentiality and biosecurity» Compensation for producers and vets
• Composite pen fecal samples» E. coli, Salmonella (Campylobacter)» AMR testing: Sensititre® System
– NARMS panel of antimicrobials
• Questionnaires» Antimicrobial use data» Herd demographics, pig inventory and animal health data
• Communication process
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WINTER SUMMER FALL
A1
B1A2
B2
Cohort Herds
Regular Herds
COHORT Arrival and Close-to-market (CTM)* Sampling
A1
B1
A2
B2
Site InfoPig #sAM use
Composite samples: Regular CTM* pens
Composite samples: Cohort pens on arrival
CTM* Sampling Day Questionnaires:• Herd & Site Info. (winter only)• Sample Information• AMU, pig inventory and health
Pig #sAM use
Composite samples: Cohort CTM* pens* CTM = Close-To-Market, pigs > 80 Kgs (175 Lbs)
Sampling Seasons
Site InfoPig #sAMU
Pig #sAM use
Sample & Data Collection - Implementation
Pig #sAM use
Site InfoPig #sAMU
Pig #sAM use
Pig #sAM use
Approximately 30% of enrolled herds in 2006-08
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268
155
123
277
286
Nationally: 108 Herds29 Vets
Distribution of Sentinel Swine Herds & Vets
•At implementation, herds were allocated per province proportional to the number of Grower/Finisher Units in each province
•Provincial funding provided 10 additional herds in Alberta and Saskatchewan during the 2006-07 surveillance periods
• AF Lab
• PDS Lab
• PHAC-LFZ Lab
• PHAC-LFZ Lab
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DRAFT1CIPARS Farm Working GroupCIPARS Farm Working Group
Expert Review Panel – Round 1Expert Review Panel – Round 1
Expert Review Panel – Round 2Expert Review Panel – Round 2
Swine/Poultry Working GroupSwine/Poultry Working Group
Producer/Veterinarian Sub-CommitteeProducer/Veterinarian Sub-Committee
Swine/Poultry Working GroupSwine/Poultry Working Group
Collaborating VeterinariansCollaborating Veterinarians
CIPARS Farm Working GroupCIPARS Farm Working Group
DRAFT 3:Implementation Framework (2006)
DRAFT3
DRAFT2
CIPARS Data AnalysisCIPARS Data Analysis
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CIPARS Farm Surveillance: Framework development
WINTER SUMMER FALL
Herd dataPig #sAM useHealth
Composite fecal samples from CTM* pens collected & submitted by the herd veterinarian
CTM* Questionnaire:• Herd/site demographic data • Number of pigs, mortalities, marketed• Antimicrobial use data• Animal Health data
* CTM = Close-To-Market, pigs > 80 Kgs (175 Lbs)
Sampling Seasons
Herd dataPig #sAM usePig Health
• One sampling/data collection visit per herd per year
• Veterinarians distribute sampling of herds over the calendar year
Sample & Data Collection - Refined
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21 >301
Hatchery Stage Broiler BarnAT PLACEMENT
Characterization of : 1)Vertically-transmitted E. coli and Salmonella spp2)Carry-over 3) AMR emergence associated with subcutaneous & in-ovo drug uses
- Reflects barn-level AMR associated with total antimicrobial exposure and barn characteristics;- Proximal to consumer
Subcutin-ovo
Broiler Barn PRE-HARVEST
1
AGE TO MARKET
Feed & Water AMU
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Placement Pre-harvest
Sampling points
Stage (Days)
Antimicrobial Use
Signi f icance
Broiler Poultry Surveillance: Methods
16
15130
3 304
304
Nationally: 105 flocks
12 Vets
•At least 30 flocks in major poultry producing provinces or in FoodNet Canada Sentinel Sites (chicks sourced from major hatcheries=16 hatcheries)
• AF Lab
• PHAC-LFZ Lab
• PHAC-LFZ Lab
Poultry: Distribution of sentinel flocks and veterinarians
In 2014 – 30 flocks in AB; 9 flocks in SK
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National Farm Surveillance
System
Contentious Issue
• Data confidentiality
• Farm biosecurity
• Time investment
• Findings... Communication
• Big Government
• Challenging existing
management practices
• “Not on our radar!”
Anxiety... Fear... Mistrust
Volunteer Data Providers
Obstacles to
Collaboration
Obstacles to
Collaboration
Mandate
For Farm
Surveillance
$Funded
Mandate
For Farm
Surveillance
$Funded
18
CIPARS Farm Surveillance: Framework development
National Farm Surveillance
System
Contentious Issue
• Data confidentiality
• Farm biosecurity
• Time investment
• Findings... Communication
• Big Government
• Challenging existing
management practices
• “Not on our radar!”
Anxiety... Fear... Mistrust
Volunteer Data Providers
Mandate
For Farm
Surveillance
$Funded
Mandate
For Farm
Surveillance
$Funded
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Transparent, consultative process• National consultations
• Expert Panel, Advisory Committee
• Vet-Producer Sub-committee
• Field work conducted by herd vet.
• Compensation for vets & producers
• Practical and efficient protocols
• Pre-publication notification to AC
• Data quality, findings and feedback
• Builds trust and contributes to sustainability
Responsiveness
SustainabilitySustainability
CIPARS Farm Surveillance: Framework implementation
Number of Farms Reporting Hogs
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
Fa
rms
Canada Maritimes Quebec Ontario Manitoba Sask Alberta BC
2000
2005
2010
Source: Statistics Canada, Agriculture Division
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Next steps• Established a national framework for farm-level antimicrobial use and resistance surveillance» On-going: G-F Swine and Broiler poultry » Expand Farm Surveillance - Collaboration with FoodNet Canada
• Beef, Cow-Calf and Feedlots (AB)• Dairy (BC, AB, ON… QC)• Turkey (BC)• Layer (BC and ON)
• Outputs: information for evidence/risk-based policy» Trends – Temporal (Years) and spatial (Regional)
• AMU (use frequency, quantitative – grams AI, PCU, ADD…)• AMR (prevalence, MCR, emergence)
» Integration of data across CIPARS components and agriculture industry/commodity sectors
CIPARS Farm Surveillance Summary
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Percentage of pig farms with reported use of antimicrobials in feed, by weight category of pig (n=89). Farm-Swine Surveillance, 2013
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Swine: Regional and temporal variation in feed AMU frequency (%Swine Farms)
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Quantitative estimates of AMU in feed (median grams/1000-pig-days) by reason for use. Farm-Swine Surveillance, 2013
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Ceftiofur use (n=31 flocks)
Poultry: Overview of antimicrobial use (n=99 flocks), 2013
8 flocks using TIO
15 flocks using TIO
0 flocks using TIO
Farm level results parallel the retail and abattoir results in 2013
Farm level results parallel the retail and abattoir results in 2013
Poultry: Temporal variation in ceftiofur resistant generic E. coli
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Broiler Poultry: Feed*G-F Swine: Feed*
Differences in reported antimicrobial use by food animal sector
* Based on kg active ingredients (PCU);* Estimates include ionophores and chemical coccidiostats.
Primary reasons for antimicrobial use in feed
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Reasons for AMU in feed*, 2013
Broiler Poultry
Swine: Feed
Swine: Trends in reasons for use in feed*
* Ionophores & chemical coccidiostats excluded
• Participating Veterinarians and Producers
• Canadian Pork Council and Provincial Pork Boards» Swine Industry Antimicrobial Resistance and Use Working Group (Veterinarians,
Pork Board and Ministry of Agriculture representatives)
• Chicken Farmers of Canada, Canadian Poultry and Egg Processors
Council, and Provincial Marketing Boards» Poultry Industry Antimicrobial Resistance/Antimicrobial Use Working Group
(Veterinarians and Feather Board representatives)
• Alberta Agriculture and Rural Development and Saskatchewan
Agriculture
• Agriculture and Agri-Food Canada
• Public Health Agency of Canada
Acknowledgements
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