Measuring antibiotics use for pigs in Denmark, including pro
and cons of risk management and relation to other MS
measures
Annette Cleveland Nielsen
Chief Veterinary Advisor
Epidemiologist, DVM, Ph.D.
Danish Veterinary and Food Administration
Political target : 10% reduction from 2009 to 2013
in antibiotic usage for production animal herds
( 70 % usage=swine)
12000
11000
10000
10 %
Kg aktiv stof
9000
2009 -10%
Rullende 9. mdr
8000
7000
6000
Like going on a fast acting diet
without making the long lasting life-style changes……..
It does not last and you gain again !
5000
4000
2
Titel
Measuring AB in DK
The National Threshold Values for antibiotics used for Yellow card etc.
9 months rolling avg.
ADD/100 animals/day
Finishers
Weaners
Sows
National mean, 2010
4
14
2,6
Threshold value 2010
8
28
5,2
Threshold value 2013
7
25
5
Threshold value 2014
5,9
22,9
4,3
Amount of AM Used
Consumption =
Number of Pig Days
Yellow card in the appr. 5 % top AM using swine herds in Denmark
Political goal: 10% reduction 2013 compared to 2009 – difficult to reach
So new threshold values and diagnostics when flock medication and more vet visits
Measuring AB in Denmark
Distribution of herd and agegroup specific antibiotic consumption
Finishers
Used for definition of threshold values and calculation of numbers of affected herds in the
political process
Besætninger
Threshold value 2014 : 5,9 ADD/100 animals/day calculated in new ADD
Close to delivery, many low users – learn from them
Kilde: ACLN, FVST
Measuring AB in Denmark
Distribution of herd and agegroup specific antibiotic
consumption
Sows and piglets
Used for definition of threshold values and calculation of numbers of affected herds in
the political process
Besætninger
Threshold value 2014 : 4,3 calculated in new ADD
More normal distribution – older animals, non-growers –’normal’ treatment
Kilde: ACLN, FVST
Measuring AB in Denmark
Distribution of herd and age-group specific antibiotic consumption
Weaners
Used for definition of threshold values and calculation of numbers of affected herds in the
political process
Besætninger
Threshold value 2014 : 22,9 calculated in new ADD
High using age-group
a mean and median > 4.5 times higher than sows and finishers
Long lasting ‘’life-style’’ = production changes might be needed
Kilde: ACLN, FVST
Calculations on the increase in usage in swine in 2012
Which herds are responsible for the increase in AM usage seen in 2012 ?
The lowest using herds have increased – no worries for the yellow card
The highest using herds have reduced - they are still worried of the yellow card
One of two conclusions can be drawn:
1) It still works, as the higest using herds are reducing
OR
2) No, it does not work, as the farmers now use up to the limit
Either way: the AM selection pressure is increasing together with the AM usage !
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7
Danish Risk management (RM) –
country level 1994 - 2004
Country level strategies
• No sales profit
• No prophylaxis
• Monthly herd health
contracts
Legislation and courageous politicians
• Strengthening vets position
• Income = preventing disease, no sale drugs
• Securing vets income – monthly herd visits
• Pharmacie discount to farmers not vets
• Farmer pay vets for monthly visits and gets
AM for a longer period
• No AGP
• No fluoroquinolones
• One Health monitoring
and research on AM usage
and resistance
• AGP research – followed by EU bans
• Strategic use of fluoroquinolones
• DANMAP and VetStat established - research
Vets the targit for RM and RC from 2005
Vet level strategy
• Supervision team DVFA
Databased risk management / communication
• Focus on prescribers contribution
• Treatment guidelines
• Epidemiological calculations of vet usage
• Treatment patterns
• Injectables or oral treatments
• Focus on diagnostic work/
• Usage per swine
justified treatment
• Graphical displays on vet level
• Audit and supervision
every vet
• Compliance with
treatment guidelines
• Inspection and
enforcement - evaluation of
compliance with legislation
• Comparisons to other vets and country level
• Evaluation of records/documents kept –
treatment instructions, health consultancy
reports, lab results, prescriptions,
invoices…..etc.
Farmer the targit for RM and RC from 2010
Farmer level strategies
• Help realize and lower
herd usage
• Improve motivation for
non-AM herd health
• Authorities go into herds
• Second opinion vets
• Control expenses for
herds with high usage
Swine industry :
• Ban of cephalosporins
• Best practice manual
Databased risk management / communication
• Focus on direct distributors contribution
• Evidence based treatment guidelines used by
vets
• Epidemiological calculations on agegroup level
in swine and cattle herds
• National threshold values of usage per
swine or cow
• Yellow card limits for swine calculated
from national threshold values
• AM graphs and tabels in VetStat
– Direct risk communication and
– Early alert to vets and farmers
New 2014 risk management strategies in DK
Differentiated taxes:
Taxes on CIA and broad spec. AM – none on vaccines:
• 0,8 % on simple penicillins,
• 5,5 % on other AM,
• 10,8% on CIA´s and
• 0 % vaccines
New AMR projects:
1) Research in measuring antimicrobial resistance on the herd level
- future resistance benchmarking linked to specific usage maybe
2) Research project in alternatives to antibiotics and
3) Research on reduced stocking densities in red card herds
New SundReg:
Order to do diagnostic tests when you flock medicate in swine herds
and more herd health visits if high antibiotic use or high mortality
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11
NEW:SundReg – internet based risk communication
directly to farmers on AB and mortality in their herds
Red, yellow, green warning when 70 % of threshold values - act in due time farmer and vet
Threshold values AM and mortality decides
- Frequency of herd health advice ( increases farmers expenses for vet advice)
- Frequency of diagnostic tests, if flockmedication is used
(increases farmers expenses for lab and vet)
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12
Data based Risk Communication (RC) using VetStat
Threshold values and Yellow card
•Good RC creates awareness of (over)treatment
•Improve motivation to non – AM strategies
- Vaccination
- Management reducing disease prevalence's
- Proper diagnostic testing
Effect of threshold values andYellow card
Large decrease in usage in 2010-2012 could be attributable to:
•
•
INCREASED AWARENESS ON VET AND FARMER LEVEL
GOOD RISK COMMUNICATION VIA GRAPHS IN VETSTAT
AND/OR
•
Poorly managed herds with low productivity and high usage of AM close business
(same as in the AGP stop situation)
AND/OR
•
•
•
•
Stop of previous over-treatment
Under-treatment when usage dropped 30 % – DVFA do inspections and a welfare index
Effect of new (treatment) guidelines in 2010
Improved motivation for non-antimicrobial strategies
– Increased use of vaccination strategies
– Increased diagnosis quality and testing frequency
– Improved management reducing disease prevalence etc.
Increasing usage 2012 - :
Herds below threshold values - no fear of Yellow card
– calculating the amount ‘’acceptable’’ – loss of awareness due to no direct RC
Prudent use and precautions?
Use of vaccines and antibiotics for swine
45.000
110000
Threshold values and Yellow card
105000
Vaccine - antal doser
100000
35.000
95000
90000
30.000
85000
25.000
80000
20.000
75000
2005
2006
2007
2008
2009
2010
2011
2012
Antibiotika - kg aktivt stof
40.000
Pros and cons in RM and RC in Denmark
•
Direct RM/RC by supervision of all vets:
costly, changes prescription patterns but no effect on usage
•
•
•
•
•
Database and direct RM/RC to farmer: Yellow card – 30% reduction in 2010-12
BUT the scaring effect wears out.
Costs of antibiotics – large reduction if expensive drug compared to other drug
Multi focus RM/RC – better results
Data based RC TOGETHER with direct RC works – talk with them
Let them know what we have on them – self recognition
Let them know how astray they are – compare to colleagues
Graphs and tables on Yellow card and vets prescription patterns
Tetracykliner
Vet´s collegues
5% 10%
7%
25%
15%
Makrolider
Vet
nr 1234
5%
20%
5%
Lincosamider
19%
12%
22% Sulf/Trim
55%
Comparing usage in the EU – no go
DK and NL are hardly comparable due to
- Different agegroups, weight of standard animals, ADD calculations, time-periode for usage
NL have 3 different statistics for use of AB:
- Sales (FIDIN) from pharmaceutical industry- 98 % recorded
- MARAN from a sample apprx. 110 swineherds stratified so representative
- SDa all herds from vets and owner, resemble DK – except not all NL pig farms in 2012
NL conclusions:
MARAN: 50% reduction from 2009 to 2012 and 26% from 2011 to 2012
SDa: 17%reduction in sows and 8% in slaughter pigs from 2011 to 2012 and 15 % for all prod.
SDa : The distribution between low, medium and high using farms are the same, so all types
have reduced. Likewise in DK in 2010, but in 2012 usage rose in lower using herd
BUT it works in NL as all herds are supervised and direct RC !!
‘System’
NL
Germany
DK
Herds and animals
Data collection
Most herds, # animals
Vets
All herds
Farmer
All herds, # animals
Pharmacies
Time-periode
12 months
6 months
9 months
Benchmark
Yes
Yes
Yes
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17
Comparing NL and DK - anyway
‘Most’ comparable are slaughter pigs :
newest measures DAPD: NL=23,4 DK=20 acc. to DANMAP2012 Fig. 4.4
so DK 14,5% lower usage in slaughter pigs compared to the NL
ADD
Mean
VetStat, DK
SDa, NL
Median
VetStat, DK
SDa, NL
Percentile 75
VetStat, DK
SDa, NL
Mean
MARAN, NL
Titel
Sows and piglets
DK=200 kg
NL=220 +5,5 x 12,5
kg ++
Weaners
DK=15 kg
NL= Na
Slaughter pigs
DK 50 kg
NL 70 kg
(‘’most’’
comparable)
1,8
16,9
9
Na
2
9,6
1,6
9,3
8,4
Na
1,5
3,0
2,4
20,8
19,3
Na
2,8
10,8
10
Benchmarking ADD,
signal and action level
2014
DK / NL
Sows
S/A
DK >3,01
DK > 4,3
NL 10-22
NL > 22
Slaughter
S/ A
DK > 4,13
DK > 5,9
NL 10-13
NL > 13
6
18
Idea for measuring comparable antibiotic
usage in MS without fancy databases
1) Calculate a sufficient and representative national sample
2) Use the same:
-
ADD calculations
Animal standard weights
Animal age-groups
3) Let the farmers fill in a simple spread sheet with pre-filled
names of antibiotics, ADD etc.
4) Farmer fill in:
- ml/kg of used antibiotics and
- number of animals in specific age-group
5) The spread sheet calculates ADD/100 animals /day and the
sheet is sent to a national database
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19
Thank you for your attention
[email protected]