Foodborne Pathogens and Antibiotic Resistance: Consequences and Possible Solutions

1. Foodborne Pathogens and Antibiotic Resistance: Consequences and Possible Solutions Stacy Holzbauer, DVM, MPH Foodborne and Diarrheal Diseases Branch National Center for Infectious Diseases Centers for Disease Control and Prevention

2. Overview • Trends in Foodborne Diseases and Antimicrobial Resistance • National and State Antimicrobial Resistance Programs • Ways to work together

3. Important Declines in Foodborne Pathogens • FoodNet reported important declines in the major foodborne diseases in 2004 compared to 1996 • E. coli O157:H7, Campylobacter, Salmonella have declined from 8-42% • MMWR April 2005

4. 2 Campylobacter E. coli O157 Listeria Salmonella 1 Relative Rate 0.8 0.7 0.6 0.5 1996-1998 2005 1999 2000 2001 2002 2003 2004 Year Trends in Selected Pathogens, 1996-98 to 2004

5. Reasons for E. coli 0157 declines • Important changes by major cattle slaughter plants • Prevent contamination when remove hide • Steam pasteurization after process • Test and hold meat

6. Relative Incidence baseline - 2004: Top 5 Salmonella Serotypes Pathogen Change 95% Conf. Interval Declined S Typhimurium -41% -48% to -34% No Change S Enteritidis 0% -21% to +25% S Heidelberg +3% -16% to +26% Increased S Newport +41% +5% to +89% S Javiana +167% +75% to +306%

7. Antimicrobial Resistance Trends • Increase in multi-drug resistance • Salmonella Typhimurium DT104 • MDR-AmpC Salmonella Newport • Increase in resistance to clinically important antimicrobial agents • Third generation cephalosporins – Salmonella • Fluoroquinolones – Campylobacter, Salmonella including S. Typhi, Shigella

8. Percentage of S. Newport with at least ACSSuT and MDR-AmpC resistance pattern, 1996-2003* Newport MDR-AmpC % ACSSuT *2003 preliminary data

9. MDR Salmonella Newport in Animals • 2004 Salmonella outbreak in horses in Pennsylvania • Highly resistant Newport strain • Significant mortality associated with infection

10. Bridging the Gap • Can public health and animal health work together? • Is there really a gap??

11. Public Health’s Mission • CDC's MissionTo promote health and quality of life by preventing and controlling disease, injury, and disability. • APHL’s Mission The Association of Public Health Laboratories (APHL) works to safeguard the public's health by strengthening public health laboratories in the United States and across the world.

12. Veterinary Oath • Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for thebenefit of society through theprotection of animal health, the relief of animal suffering, the conservation of livestock resources,thepromotion of public health,and the advancement of medical knowledge.

13. Common Theme • Society • Prevent Disease • Control Disease • Public Health

14. Is There A Gap? • On paper…. • NO! • Ability to communicate… • YES!

15. 12 Step Program, DHQP GET SMART, DBMD Reduce the Spread of Antimicrobial Resistance NARMS-EB, DBMD

16. Get Smart: Know When Antibiotics Work • Established in 1998 • 115 Partners • $17.5 million in-kind support • Over 1300 people working on the campaign around the country

17. Get Smart Sites - 2004 Program Funded

18. GET SMART: Know When Antibiotics Work on the Farm Educational Activities to Promote Appropriate Use of Antimicrobial Agents in Animals Sister program of GET SMART: Know When Antibiotics Work

19. Antimicrobial Resistance: A Complex Problem In Veterinary Medicine • Companion animals • Farm animals, including food animals • Individual patients, herd health, human health • Antimicrobial agent use without direct veterinary supervision • Over the counter sales • Client education • Pet owners like parents • Food animal producers

20. Get Smart on the FarmEducational Activities to Promote Appropriate Use of Antimicrobial Agents in Animal Health • Veterinary Curriculum • State-based Interventions

21. Veterinary Curriculum • Enhance veterinary education in antimicrobial resistance • Promote appropriate use of antimicrobial agentsin veterinary medicine • Web-based with background, species specific sections • Microbiology, pharmacology, public health

22. State-based InterventionsFoster Collaboration between state public health and veterinary communities • Establish local surveillance of antimicrobial resistance among enteric bacteria from humans and animals • Develop community-based programs on appropriate use of antimicrobial agents in animals

23. Animal Health Practices on Washington Dairy Farms A Tacoma-Pierce County Health Department Antibiotic Resistance Task Force Project Primary Investigator: Monica Raymond, MPH, MS, RN Project Coordinator: Ron Wohrle, DVM Advisory Board Chairman: Robert Whitney, DVM

24. Background • Focus on dairy industry • Collect real-world data on use of antibiotics and biosecurity practices on farm • Establish relationships with dairy producers, dairy organizations, and veterinarians

25. Project Methods • Initiate dialogue with veterinarians, producer organizations, local health departments, other constituencies • Survey producers on knowledge, attitudes, and practices related to antibiotic use and biosecurity

26. ProjectApproach • Voluntary • Supportive • Focus on benefits to producers • COLLABORATIVE

27. Survey of Animal Health Practices on Washington Dairy Farms July 2003 Endorsed by the Washington State Dairy Federation This is a collaborative effort between professional veterinary, animal agricultural, human health, and public health communities in Washington State

28. “FARM SOCIOLOGY 101" WE “MANAGE’ ORGANISMS--- PRODUCERS “MANAGE” ANIMALS WE VALUE “INFORMATION”---PRODUCERS VALUE “A WAY OF LIFE” WE STRIVE FOR “FREEDOM FROM DISEASE”---PRODUCERS STRIVE FOR “THE OPTIMUM LEVEL OF DISEASE THEY CAN LIVE WITH AND SURVIVE”

29. Needs Assessment Survey • Producer knowledge • Attitudes and practices • Biosecurity and antibiotic use • Four major areas • Herd characteristics • Colostrum & calf management • Animal health management practices • Producer background information

30. Needs Assessment Survey • 15 page (65 questions) self-administered mail questionnaire with $5 incentive • Pre-notice letter of endorsement by Washington State Dairy Federation • Representatives from partners aided in question and survey design

31. Summary • Approximately 600 dairy operations in WA State • Major uses of antibiotics in dairy cattle: • Calf milk replacer • Dry-off lactating cows • Treatment of mastitis, calf diarrhea, respiratory illness • Major biosecurity issues • calf immunity • introduction of newly purchased animals • calving and sick pens

34. Washington Conclusions • Given openness on both “sides” - public health and industry, a collaborative approach can be an effective method for addressing antibiotic use in agriculture • There is willingness in the DAIRY industry to examine antibiotic use and take steps to use antibiotics more judiciously

35. Important Points • There are many silos • Lack of communication • Lack of understanding other disciplines • A need to share commonalities

36. Bridge Building • The gap is not that large • Communication is a must • Positive examples to follow • Silos still need to be broken down • Many potential collaborations/sources of information