Dr. David Leger - The Canadian Integrated Program for Antimicrobial Resistance Surveillance: Building a Voluntary Farm Surveillance Framework
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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-stewardship
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Dr. David Leger - The Canadian Integrated Program for Antimicrobial Resistance Surveillance: Building a Voluntary Farm Surveillance Framework
- 1. 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
- 2. 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
- 3. Background: Calls for surveillance of AMR and AMU Recommendation To establish a national surveillance system to monitor antimicrobial resistance and use in the agri-food and aquaculture sectors… 3
- 4. 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.php http://www.phac-aspc.gc.4 ca/cipars-picra/pubs-fra.php
- 5. CIPARS: Active and Passive Surveillance Components 5
- 7. 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 7
- 8. CIPARS Farm Surveillance: Framework development National Farm Surveillance System Mandate For Farm Surveillance $Funded Contentious Issue Obstacles • Challenging existing management practices • “Not on our radar!” Anxiety... Fear... Mistrust to • Data confidentiality • Farm biosecurity • Time investment • Findings... Communication • Big Government Volunteer Data Providers to Collaboration Mandate For Farm Surveillance $Funded 8
- 9. 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 9 Multi-CCoommmmooddiittyy CCoonnssuullttaattiioonnss DRAFT CCIIPPAARRSS FFaarrmm WWoorrkkiinngg GGrroouupp 1
- 10. CIPARS Farm Surveillance: Framework development DRAFT CCIIPPAARRSS FFaarrmm WWoorrkkiinngg GGrroouupp 1 EExxppeerrtt RReevviieeww PPaanneell –– RRoouunndd 11 EExxppeerrtt RReevviieeww PPaanneell –– RRoouunndd 22 SSwwiinnee//PPoouullttrryy WWoorrkkiinngg GGrroouupp PPrroodduucceerr//VVeetteerriinnaarriiaann SSuubb--CCoommmmiitttteeee DRAFT 3: Implementation Framework (2006) DRAFT 3 DRAFT 2 10 • Operational logistics • Sampling kits and protocols • Questionnaires development
- 11. 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 11
- 12. Sample & Data Collection - Implementation WINTER SUMMER FALL A1 A2 Cohort Herds B1 B2 Regular Herds COHORT Arrival and Close-to-market (CTM)* Sampling A1 B1 A2 B2 Site Info Pig #s AM use Composite samples: Regular CTM* pens Composite samples: Cohort pens on arrival CTM* Sampling Day Questionnaires: • Herd & Site Info. (winter only) • Sample Information Pig #s AM use • AMU, pig inventory and health Composite samples: Cohort CTM* pens * CTM = Close-To-Market, pigs > 80 Kgs (175 Lbs) Sampling Seasons Site Info Pig #s AMU Pig #s AM use Pig #s AM use Site Info Pig #s AMU Pig #s AM use Pig #s AM use Approximately 30% of enrolled herds in 2006- 08 12
- 13. 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 26 8 15 5 12 3 27 7 28 6 Nationally: 108 Herds 29 Vets • AF Lab • PDS Lab • PHAC-LFZ Lab • PHAC-LFZ Lab 13
- 14. CIPARS Farm Surveillance: Framework development DRAFT CCIIPPAARRSS FFaarrmm WWoorrkkiinngg GGrroouupp 1 EExxppeerrtt RReevviieeww PPaanneell –– RRoouunndd 11 EExxppeerrtt RReevviieeww PPaanneell –– RRoouunndd 22 SSwwiinnee//PPoouullttrryy WWoorrkkiinngg GGrroouupp PPrroodduucceerr//VVeetteerriinnaarriiaann SSuubb--CCoommmmiitttteeee SSwwiinnee//PPoouullttrryy WWoorrkkiinngg GGrroouupp CCoollllaabboorraattiinngg VVeetteerriinnaarriiaannss CCIIPPAARRSS FFaarrmm WWoorrkkiinngg GGrroouupp DRAFT 3: Implementation Framework (2006) DRAFT 3 DRAFT 2 CCIIPPAARRSS DDaattaa AAnnaallyyssiiss 14
- 15. Sample & Data Collection - Refined Herd data Pig #s AM use Pig Health WINTER SUMMER FALL • One sampling/data collection visit per herd per year • Veterinarians distribute sampling of herds over the calendar year Herd data Pig #s AM use Health Sampling Seasons 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) 15
- 16. Broiler Poultry Surveillance: Methods Hatchery Stage Broiler Barn AT PLACEMENT 21 1 >30 Characterization of : 1)Vertically-transmitted E. coli and Salmonella spp 2)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 in-ovo Subcut Broiler Barn PRE-HARVEST 1 AGE TO MARKET Feed & Water AMU 18 Placement Pre-harvest Stage (Days) Antimicrobial Use Sampling points Significance 16
- 17. Poultry: Distribution of sentinel flocks and veterinarians •At least 30 flocks in major poultry producing provinces or in FoodNet Canada Sentinel Sites (chicks sourced from major hatcheries=16 hatcheries) 15 30 1 3 30 4 30 4 Nationally: 105 flocks 12 Vets • AF Lab • PHAC-LFZ Lab • PHAC-LFZ Lab In 2014 – 30 flocks in AB; 9 flocks in SK 17
- 18. CIPARS Farm Surveillance: Framework development National Farm Surveillance System Mandate For Farm Surveillance $Funded Contentious Issue Obstacles • Challenging existing management practices • “Not on our radar!” Anxiety... Fear... Mistrust to • Data confidentiality • Farm biosecurity • Time investment • Findings... Communication • Big Government Volunteer Data Providers to Collaboration Mandate For Farm Surveillance $Funded 18
- 19. CIPARS Farm Surveillance: Framework implementation National Farm Surveillance System Mandate For Farm Surveillance $Funded Contentious Issue • Challenging existing management practices • “Not on our radar!” Anxiety... Fear... Mistrust • Data confidentiality • Farm biosecurity • Time investment • Findings... Communication • Big Government Volunteer Data Providers Mandate For Farm Surveillance $Funded 19 SSuussttaaiinnaabbiilliittyy 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 Responsiveness • Data quality, findings and feedback • Builds trust and contributes to sustainability
- 20. Number of Farms Reporting Hogs 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Farms 2000 2005 2010 Canada Maritimes Quebec Ontario Manitoba Sask Alberta BC Source: Statistics Canada, Agriculture Division 20
- 21. CIPARS Farm Surveillance Summary 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 21
- 22. Percentage of pig farms with reported use of antimicrobials in feed, by weight category of pig (n=89). Farm-Swine Surveillance, 2013 22
- 23. Swine: Regional and temporal variation in feed AMU frequency (%Swine Farms) 23
- 24. Quantitative estimates of AMU in feed (median grams/1000-pig-days) by reason for use. Farm-Swine Surveillance, 2013 24
- 25. Poultry: Overview of antimicrobial use (n=99 flocks), 2013 25 Ceftiofur use (n=31 flocks)
- 26. Poultry: Temporal variation in ceftiofur resistant generic E. coli Farm level results parallel the retail and abattoir results in 2013 Farm level results parallel the retail and abattoir results in 2013 8 flocks using TIO 15 flocks using TIO 0 flocks using TIO 26
- 27. Differences in reported antimicrobial use by food animal sector Broiler G-F Swine: Feed* Poultry: Feed* 27 * Based on kg active ingredients (PCU); * Estimates include ionophores and chemical coccidiostats.
- 28. Primary reasons for antimicrobial use in feed Reasons for AMU in feed*, 2013 Broiler Poultry Swine: Feed 28 Swine: Trends in reasons for use in feed* * Ionophores & chemical coccidiostats excluded
- 29. Acknowledgements • 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 29
Editor's Notes
- Rebecca Refer to Chapt. 1 for more detailed component information
- Rebecca Refer to Chapt. 1 for more detailed component information
- Cohort herds were at 63, now at???
- Sampling can occur during any season Vets are asked to distribute their herds over calendar year Compensation Producer compensation Sampling period Questionnaire Veterinary compensation Sampling period Questionnaire Producer - $200 per sampling period – unchanged $200 per questionnaire – new Vet - $245 per sampling period – unchanged $445 per questionnaire – new Enough to make it worth the effort to participate for vets To address issue of vets spending considerably more time on questionnaire than producer
- Outlines the production sectors in Canada Do not sample the hatchery stage for logistical reasons – AMU at this level is captured in the questionnaires Placement sampling is important to CFC but may not be an ongoing component of the Broiler program With 2013 data we now have pre-/post-intervention information (Industry initiative to remove preventative use of Category I antimicrobials).
- Cohort herds were at 63, now at???
- From 2000 through 2010, the number of farms reporting hogs in Canada declined by 58%. The largest decline occurred in Saskatchewan, followed by Alberta and the Maritimes. The smallest decline occurred in Quebec followed by BC. Perhaps not surprisingly given the financial situation in recent years, the bulk of the decline in farm numbers occurred from 2005 through 2010. For Canada as a whole, the 2000-2005 decline was 26% compared to 43% from 2005 to 2010
- only antimicrobial classes used in 5 or more herds presented
- DAVE Context: difference in disease pressure (types and number of diseases present), farm density and farm size.
- Can we make summary statements when we see all the pie charts together? Can we highlight the tetracycline – as we will come back to this point a bit later….
- Antimicrobial Growth Promotion Broiler chickens 2013: Very few flocks (12%) reported the use of antimicrobials for production reasons (growth promotion) purposes, which involved four drugs (bacitracin, virginiamycin, bambermycin, and penicillin). However, some of the doses reported suggested that bacitracin and virginiamycin were used for disease prevention, rather than growth promotion. Grower-finisher pigs 2013: Antimicrobial growth promotants were administered on 2-26% of farms depending on the antimicrobial; which involved four drugs (tylosin, ionophores, lincomycin, and chlortetracycline). Disease Prevention Broiler chickens 2013: Antimicrobials were used in feed on 93% of farms and were mostly administered for the prevention of common bacterial diseases 1) necrotic enteritis (macrolides, penicillins, streptogramins, and bacitracin) and 2) coccidiosis (ionophores and chemical coccidiostats). Grower-finisher pigs 2013: Antimicrobials administered via feed for disease prevention were reported by 2-33% of sentinel farms, depending on the antimicrobial; which involved lincomycin and tylosin mainly for the prevention of enteric disease or chlortetracycline for the prevention of respiratory disease. The predominant antimicrobial administered through water for disease prevention (mainly respiratory disease) was penicillin.