Role of veterinary profession in antimicrobial resistance prevention

Paris, 13th – 15th March 2013

OIE – Global Conference on the Responsible and Prudent Use of Antimicrobial Agents for Animals

Herzog U., Fuchs K.

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Contents

• General remarks

• Antimicrobial use in Austrian poultry production

• Future data acquisitions on antimicrobial consumption

• Summary

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International activities

• WHO – European strategic action plan on antimicrobial resistance http://www.euro.who.int/en/what-we-do/health-topics/disease-prevention/antimicrobial-resistance

• OIE – What does OIE do on antimicrobial resistance? http://www.oie.int/fileadmin/Home/eng/Media_Center/docs/pdf/AMR_OIE.pdf

• USA & EU - Transatlantic Taskforce on Antimicrobial Resistance http://ecdc.europa.eu/en/activities/diseaseprogrammes/tatfar/pages/index.aspx

• EU – Commission - Action plan against the rising threats from Antimicrobial

Resistance http://ec.europa.eu/health/antimicrobial_resistance/policy/index_en.htm

• EU – Council – Council conclusions on the impact of antimicrobial resistance

in the human health sector and the veterinary sector – a „One Health“

perspective http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2012:211:0002:0005:DE:PDF

• EU – Parliament - ENVI– 6. November „The Microbial Challenge – Rising

threats from Antimicrobial Resistance“ http://www.europarl.europa.eu/meetdocs/2009_2014/documents/envi/am/914/914122/914122en.pdf

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EU – Parliament - Statement

• EU – Parliament - ENVI– 6. November „The Microbial Challenge

Rising threats from Antimicrobial Resistance“

– Considers that the pending revision of Directive 2001/82/EC

offers an important opportunity to take effective measures to

reduce AMR through strengthening the provisions for veterinary

medicines, such as:

– limiting the right to prescribe antimicrobials to professionally

qualified veterinarians only;

– separating the right to prescribe from the right to sell

antimicrobials thus eradicating economic incentives to

prescribe;

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Does it help to meet our

challenges ??

My answer is NO!!

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Agricultural structure in

Austria

Species Livestock Holdings Average

Cattle 1.976.527 69.586 28

Pigs 3.097.253 31.726 98

Sheep 431.083 16.374 26

Goats 92.816 10.901 9

Equids 73.202 15.257 5

Poultry 11.848.183 52.849 224

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Source: Austrian Veterinary Report 2011

Animal Health Services (AHS or VHS)

Participation rate (2010) • Public Private Partnership

– Authority of federal and provincial

level

– Chamber of Agriculture,

Veterinarians, Consumers and

Economy

• The objectives

– Improvement of animal health

– Prevention of infectious diseases

– Best possible diagnosis

– Advice

– Quality assurance of foodstuffs

– Increasing the productivity

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Use of veterinray medicines

• Contract between livestock

owner and veterinarian

• Education of livestock

farmer

• Documentation

• Regularly implemented

livestock surveys

• Sanctions

• Animal health programmes

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Contents

• General remarks

• Antimicrobial use in Austrian poultry production

• Future data acquisitions of antimicrobial consumption

• Summary

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Which questions are

important?

• Analysis of the data which was collected by the

“Austrian Poultry Health Service” (QGV) over the

period 2008 – 2011.

• Three main questions

– Does antimicrobial treatment change with time?

– Are there „special“ premises which use markedly more

or less antimicrobial agents?

– Are there differences between Vets concerning

diagnoses and use of antimicrobial agents?

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Question 1:

Does antimicrobial treatment

change with time?

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Broilers, AB-treatment / time

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Year of treatment

2008 2009 2010 2011

Treatment Livestock with

treatment number 106 105 134 132

Livestock without

treatment number 331 344 318 332

Year of treatment

2008 2009 2010 2011

Substance [tons] 2,39 2,42 2,38 2,35

Antimicrobial [g] and

n PDD / Livestock unit (LU)

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Antimicrobial [g] / LU and year “prescribed daily doses”

(PDD) [n] / LU and year

for example : broiler

Question 2:

Are there „special“ premises which

use markedly more or less

antimicrobial agents?

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Special premises

Steps to do:

1. Select the population

For example: breeding young laying

hens

2. Statistical analysis of the

collected data.

For example: nPDD/LU and year

3. Define a threshold:

For example: outlier of boxplot

(4,46 PDD/ LU and year)

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Special premises – young laying hens

Deviation of n PDD per livestock unit and year from overall threshold Laying hens 2008 -2011

livestock

De

via

tio

n o

f n

PD

D/ L

U/ ye

ar

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Question 3:

Are there differences between Vets

concerning diagnoses and use of

antimicrobial agents?

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Relationship between

veterinarian and diagnoses

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Veterinarian- Code

Nu

mb

er

of

dia

gn

ose

s

Diagnoses - broiler ATC Code 1st level Total

number QA QJ01 QP % QJ01

Bacterial infection

VET-Code

QGV0144 0 152 0 152 100,0%

QGV0146 8 32 0 40 80,0%

QGV0150 0 14 0 14 100,0%

QGV1183 170 1184 0 1354 87,4%

QGV1713 271 2192 1 2464 89,0%

QGV1742 11 188 0 199 94,5%

QGV1778 44 1740 0 1784 97,5%

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For example: bacterial infection - broiler

Relationship between

vet, diagnoses and antibiotic

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Quantity of

antimicrobial

[g]/LU

n PDD/LU

Median Median

Vet-Code

QGV0144 2,8 0,1

QGV0146 1,6 0,2

QGV0150 1,2 0,2

QGV1183 2,3 0,1

QGV1713 0,6 0,1

QGV1742 0,5 0,1

QGV1778 1,0 0,2

Relationship between

vet and quantity of antibiotic

For example: bacterial infection – antimicrobial QJ01 (broiler)

Contents

• General remarks

• Antimicrobial use in Austrian poultry production

• Future data acquisitions of antimicrobial consumption

• Summary

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AMC – Three levels

Pharmaceutical industry

Veterinarian Veterinarian Veterinarian

Livestock Livestock Livestock Livestock

S A L E

T R E A T M E N T

D E L I V E R Y

P U R C H A S E

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Data acquisition

P R E M I S E –

R E G I S T E R

PRACTICE-

SOFTWARE

S AL E V E TP H AR M

( 2 0 1 5 )

TREATMENT

Database

(compulsary)

Database

(voluntary)

Livestock

T R E AT M E N T

Pharmaceut. industry

Livestock

DELIVERY (TAKG)

PURCHASE

ESVAC

P R A C T I C E

- S O F T WA R E

QGV, producer groups (Pig

or Beef, Milk, or breeding )

AB-Treatment

Bundler –

“bottle - neck”

Veterinarian

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What is the benefit?

– De-bureaucratization of recording obligations - when electronic

systems are used.

– Minimization of documentation deficiencies in Animal Health

Service - improving system performance.

– Use of existing information - arguments for the retail (- see Poultry

and antibiotics)

– Additional value for quality assurance systems.

– Discussion of the antimicrobial consumption in livestock

production on the basis of facts and not with the help of

assumptions! - Strengthens the credibility of the system

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Veterinarian´s role

• Veterinarians play key roles concerning

– prudent use of antibiotics

– documentation on the farm

– supervision of the farmer

– data collection

– data quality

• Veterinarians have to fulfil further obligations.

• Veterinarians should remain the right of prescription

and the right to sell antibiotics

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Contents

• General remarks

• Antimicrobial use in Austrian poultry production

• Future data acquisitions of antimicrobial consumption

• Summary

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Summary

• What does the future implicate?

– The use of antimicrobial agents determines future national and international discussions.

– Public discussions of use of antibiotics are often launched topics –

but the real issues are the agricultural systems, animal welfare or food production.

– Responsibility of veterinarians and livestock owners will be called.

– Electronic record keeping requirements will get standard.

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There is the need for substantive

arguments, which are supported by facts

in order to justify the use in livestock

production and to ensure the veterinary

medicine cabinet in the hands of veterinarians!

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Thanks to

Thank you for your attention !

Austrian Poultry

Health Service (QGV) www.qgv.at

Klemens Fuchs Austrian Agency for Health and Food Safety,

Department for Data, Statistics and Risk Assessment,

Vienna, Austria

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