�ݺ�ߣ

NATURE STRIKES BACK

A Global Problem
Bangkok March 2013
CEO Summit Animal Health

deWitAgroAdvies Bangkok 2013

What is Resistance?

It means that microbes have become
immune against the drugs used to
treatisinfections.
What resistance?

This occurs as a result of the use of
antibiotics.


The Human Health
We have a situation


History antibiotics
1928 Fleming

1938 Chain and Florey make penicillin useful in
humans
1942 First life saving treatment
1944 D-day; enough penicillin for all soldiers

1946-1960 Wonder drug era; discovery of
tetracycline, chloramphenicol, many others

Early sixties: First signs of resistance

Late sixties – early seventies: analogs

Eighties and nineties: Resistance crisis
reduction of agricultural use, restrictive use
in humans

20?? Postantibiotic ??

Use of antibiotics outside the hospital
in Europe


European Antimicrobial Resistance
Surveillance Network (EARS-Net)

The report reflects the state of submissions in
TESSy as of 2013-02-19 at 11:30


Meticillin Resistant Staphylococcus
aureus (MRSA)


Fluoroquinolones Resistant (R)
Escherichia coli


3rd gen. cephalosporins Resistant (R) Klebsiella
pneumoniae Isolates


Emerging Risks
an example

Dissertation Liny Keessen 2013
Man and Pigs:
Sharing the same C. difficile


C. difficile subtype 078
• Found in man and pigs ( 10%)
• No difference in organic production
• Air inside and outside ( up to 20 m.) is
contaminated
• Causes severe diarrhea


Some figures
• Antibiotic-resistant bacteria cause 25 000
deaths in EU every year and cost economy
€1.5 billion. (IMI/EFPIA project)
• If no action is taken to address these issues,
we risk leaving society in a situation where
doctors will have few, if any, options to treat
bacterial infections.


• Oct. 16, 2007 -- It appears that more people in
the U.S. now die from the mostly hospital-
acquired staph infection MRSA than from AIDS,
according to a new report from the CDC.
• Methicillin-resistant Staphylococcus
aureus (MRSA) was responsible for an estimated
94,000 life-threatening infections and 18,650
deaths in 2005, CDC researchers report in the Oct.
17 issue of The Journal of the American Medical
Association.


Totally Drug-Resistant
Tuberculosis in India

Oxford journals
The most recent version of this article [] was
published on 2012-01-31


Resistance
• More infections
• Higher costs
• Higher mortality
• Higher risks in human health
• Lower Food Safety
• Higer Risks in Labour circumstances


The environment


Increase antibiotic resistence in archived soils
Environ Sci.Techn. 2010;44;580-7


Relation Human Health and
Agriculture

Of the strains ( ESBL Coli)causing urinairy
tract infections in humans in 2009, 13 % was
identical to “chicken” strains. Trend shows
increase of transfer.


Belgium 2011


ESBL source

•Poultry 88%
•Beef/Porc meat 20%


The security of our food supply is at risk in ways
more noxious than anyone had feared.


Use of antibiotica


EHEC

2005, South Korea, meat
2011 Germany, fenugreek
2012 Germany, ?
2013 Sweden, meat


Special strain of Methicillin Resistant
Staphylococcus aureus (MRSA) found in pigs
is also found in pig farmers and, less often,
their families

All evidence taken together suggests that
resistance is transfered from agricultural to the
human sector. How much it contributes to total
resistance in human pathogens is unclear.

Seagulls 'may be spreading superbugs‘
By Michelle Roberts, Health reporter, BBC
News

Scientists fear migratory birds may be spreading
hard-to-treat infections after discovering seagulls
can carry antibiotic-resistant bacteria.

Diverse and abundant antibiotic
resistance genes in Chinese swine
farms

Published online before printFebruary 11, 2013,
doi:10.1073/pnas.1222743110

PNAS February 11, 2013 201222743

Investigation University Linköping, Sweden

Effect of traveling
• Of 231 persons 4% was carrier of ESBL
bacteries before travel .
• After traveling this had increased to 32%
(nobody had been in hospital)
India 82% Egypt 57%
Thailand 37% Peru 36%
S.Africa 27% Tanzania 24%

Food Supply Chain

Source: RABOBANK

Strong increase of resistant strains
1994: strains isolated that are resistant
to all drugs available at that time

Cause: (over)use

USA,1951: 580 tons medical use, 110 tons
growth promotor
1978: 6080 tons medical use; 5580 tons
growth promotor

Intensive animal
husbandry is believed to be a
major contributor to the increased
environmental burden of AR


Antimicrobial resistance (AMR) is a
growing problem worldwide there is
an urgent need for :

• Reluctant use of antibiotics
• Reserve the better ones for man
• New medicines to treat resistant
infections


VIV Animal Health Summit Closing CEO-level Conference, Mr. Wim de Wit, VIV Asia 2013

The microbes strike back!
Resistance crisis

That which does not kill me, only
makes me stronger!!
Swammerdam Institute for Life Sciences

The system is overloaded. Can we lighten it?

What can we do?


Limiting density of
Farm Animals


140
Observed Expected Tolerance

120 Campylobacter
Weekly number of cases campylobacteriosis

100
Avian
influenza
80 outbreak

60

40

20

0
mrt

mrt
jul

okt

okt
jul
jul

okt

jan

jan
jun
feb

feb

jun
mei
apr
jun

mei
apr
nov
nov

dec
aug

aug
sep

sep
aug

dec
sep

2002 2003 2004
Avian-influenza outbreak (april-june) →17% reduction of
Campylobacter cases NL 2003
Wilfrid van Pelt, RIVM

Concentration of Cleared Farms


Wilfrid van Pelt,
RIVM
May-June 2003

Greatest reduction
around cleared
chicken farms

Actions by
International bodies
National governments
Pharma Industries
Feed and Food Producers
Farmers
Vets
Retail
Consumers


The consumers role, WHO


The Veterinarians


PRUDENT USE GUIDELINES
Federation of Veterinarians of Europe

1) Animals receiving antibiotics must be under the
care of the prescribing vet
2) Good administration
3) Species and indication approved, susceptible
4) Dosage regimen based on pharmacodynamics
5) Limit broad spectrum and multiple antibiotics
6) Flock/herd treatment only to prevent spreading

Different antibiotics for human usage
and for agriculture

Resistance patterns change rapidly
Hence reviews of the exclusively human
list every other year?

The Farmers


Eliminate improper incentives to
prescribe Antibiotics.

Good Agricultural Practice:
Cleaning carefully
Constant removal of refuse
Reduce density
Good quality feed

Exclusieve relationship
Goal: not to allow the farmer to shop
around for a vet who easily prescibes
antibiotics

What kind of measures are
implementable?

Broilers

Growth/day 65 g> 50 g
Time 40 days> 45 days


THE RETAIL


EUROPE


A new Animal Health Strategy
for the European Union
(2007-2013) where
“Prevention is better than
cure”

Goal 1
To ensure a high level of public
health and food safety by
minimising the incidence of
biological and chemical risks to
humans.

Goal 2

To promote animal health by
preventing/reducing the
incidence of animal diseases,
and in this way to support
farming and the rural economy.


Goal 3

To improve economic
growth/cohesion/competitiveness
assuring free circulation of goods
and proportionate animal
movements
.

Goal 4
To promote farming practices
and animal welfare which
prevent animal health related
threats and minimise
environmental impacts in
support of the EU Sustainable
Development Strategy

PHARMA INDUSTRY


The search for new antibiotics

• Innovative Medicines Initiative EU
• Cooperation with European
Federation of Pharmaceutical
Industries and Associations


Combacte
the IMI-funded COMBACTE
project, aims to give antibiotic
drug development a much-
needed boost by pioneering new
ways of designing and
implementing efficient clinical
trials for novel antibiotics.

Participants

• EFPIA companies
• GlaxoSmithKline Research and
Development Ltd, UK
• AstraZeneca AB, Sweden
• Janssen Infectious Diseases
Diagnostics BVBA, Belgium

16 Universities, research organisations, public
bodies, non-profit groups

Management group :
University Medical Center Utrecht,
The Netherlands
Professor Marc J M Bonten
Project coordinator
Scott White
GlaxoSmithKline Research and Development
Ltd


Combatting Bacterial Resistance in
Europe
• Start Date01/01/2013
• Duration84 months
• Contribution €
• IMI Funding 83 033 010
• EFPIA 104 398 189
• Other 7 129 184
• Total cost 194 560 383


FOOD and AGRICULTURAL
ORGANIZATION

guidelines ??


Food and Feed Industries
• Hygienic processing methods
• Adapted (slaughter) machineries
• Cleaning methods
• Sustainable production
• Avoid cross contamination


Agriculture
• Improve Animal Health
• Lower growth rate
• Lower production rate
• Smaller flocks


INNOVATIONS
• Options in controlling
antibiotic resistance in
agriculture


Natural Enemies

BACTERIOPHAGES


Bacteriophages are strain specific
natural ennemies

110 times smaller than bacteria
Each 2 days 50% of all bacteria are killed
No influence on man, animal or plant
None effect on food or feed


• Listex is on the market,
used in the food industry
• Salmonelex in testing
phase


Competitive Inhibition
• Promote an healthy flora in the contestinal
tract by
• Selecting specific gut profiles by
metagenomics
• Producing feed able to stimulate healthy flora


NO ACTION TODAY NO
CURE TOMORROW


NO ACTION ?

No consumer trust
Upcoming social pressure
Loss of markets


Big Question

What can YOU do ?

For further reading
• 1.Foodborne antimicrobial resistance as a biological hazard1 Scientific Opinion of
the Panel on Biological Hazards (Question No EFSA-Q-2007-089)
• 2.Arias CA, Murray BE (2009) Antibiotic-resistant bugs in the 21st century—A
clinical super-challenge. N Engl J Med 360(5):439–443
• 3.Udwadia ZF, Amale RA, Ajbani KK, Rodrigues C (2012) Totally drug-resistant
tuberculosis in India. Clin Infect Dis 54(4):579–581.
• 4. Knapp CW, Dolﬁng J, Ehlert PAI, Graham DW (2010) Evidence of increasing
antibiotic resistance gene abundances in archived soils since 1940. Environ Sci
Technol 44(2):580–587.
• 5. Marshall BM, Levy SB (2011) Food animals and antimicrobials: Impacts on
human health. Clin Microbiol Rev 24(4):718–733.
• 6. Forsberg KJ, et al. (2012) The shared antibiotic resistome of soil bacteria and
human pathogens. Science 337(6098):1107–1111.


�ݺ�ߣ

VIV Animal Health Summit Closing CEO-level Conference, Mr. Wim de Wit, VIV Asia 2013

Recommended

More Related Content

Viewers also liked (8)

More from VIV Corporate (12)

VIV Animal Health Summit Closing CEO-level Conference, Mr. Wim de Wit, VIV Asia 2013