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

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'Nature strikes back', by Mr. Wim de Wit. VIV Animal Health Summit Conference, MARCH 14, VIV Asia 2013

'Nature strikes back', by Mr. Wim de Wit. VIV Animal Health Summit Conference, MARCH 14, VIV Asia 2013


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  • 1. NATURE STRIKES BACK A Global Problem Bangkok March 2013 CEO Summit Animal Health deWitAgroAdvies Bangkok 2013
  • 2. What is Resistance?It means that microbes have becomeimmune against the drugs used totreatisinfections. What resistance?This occurs as a result of the use ofantibiotics. deWitAgroAdvies Bangkok 2013
  • 3. The Human Health We have a situation deWitAgroAdvies Bangkok 2013
  • 4. History antibiotics1928 Fleming1938 Chain and Florey make penicillin useful inhumans1942 First life saving treatment1944 D-day; enough penicillin for all soldiers1946-1960 Wonder drug era; discovery oftetracycline, chloramphenicol, many others
  • 5. Early sixties: First signs of resistanceLate sixties – early seventies: analogsEighties and nineties: Resistance crisisreduction of agricultural use, restrictive usein humans20?? Postantibiotic ??
  • 6. deWitAgroAdvies Bangkok 2013
  • 7. Use of antibiotics outside the hospital in Europe deWitAgroAdvies Bangkok 2013
  • 8. European Antimicrobial Resistance Surveillance Network (EARS-Net)The report reflects the state of submissions in TESSy as of 2013-02-19 at 11:30 deWitAgroAdvies Bangkok 2013
  • 9. Meticillin Resistant Staphylococcus aureus (MRSA) deWitAgroAdvies Bangkok 2013
  • 10. Fluoroquinolones Resistant (R) Escherichia coli deWitAgroAdvies Bangkok 2013
  • 11. 3rd gen. cephalosporins Resistant (R) Klebsiella pneumoniae Isolates deWitAgroAdvies Bangkok 2013
  • 12. deWitAgroAdvies Bangkok 2013
  • 13. Emerging Risks an example Dissertation Liny Keessen 2013 Man and Pigs:Sharing the same C. difficile deWitAgroAdvies Bangkok 2013
  • 14. 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 deWitAgroAdvies Bangkok 2013
  • 15. 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. deWitAgroAdvies Bangkok 2013
  • 16. • 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. deWitAgroAdvies Bangkok 2013
  • 17. deWitAgroAdvies Bangkok 2013
  • 18. Totally Drug-ResistantTuberculosis in India Oxford journals The most recent version of this article [] was published on 2012-01-31 deWitAgroAdvies Bangkok 2013
  • 19. Resistance• More infections• Higher costs• Higher mortality• Higher risks in human health• Lower Food Safety• Higer Risks in Labour circumstances deWitAgroAdvies Bangkok 2013
  • 20. The environment deWitAgroAdvies Bangkok 2013
  • 21. Increase antibiotic resistence in archived soilsEnviron Sci.Techn. 2010;44;580-7 deWitAgroAdvies Bangkok 2013
  • 22. Relation Human Health and AgricultureOf the strains ( ESBL Coli)causing urinairytract infections in humans in 2009, 13 % wasidentical to “chicken” strains. Trend showsincrease of transfer. deWitAgroAdvies Bangkok 2013
  • 23. Belgium 2011 deWitAgroAdvies Bangkok 2013
  • 24. ESBL source •Poultry 88%•Beef/Porc meat 20% deWitAgroAdvies Bangkok 2013
  • 25. The security of our food supply is at risk in ways more noxious than anyone had feared. deWitAgroAdvies Bangkok 2013
  • 26. Use of antibiotica deWitAgroAdvies Bangkok 2013
  • 27. EHEC2005, South Korea, meat2011 Germany, fenugreek 2012 Germany, ? 2013 Sweden, meat deWitAgroAdvies Bangkok 2013
  • 28. Special strain of Methicillin ResistantStaphylococcus aureus (MRSA) found in pigsis also found in pig farmers and, less often,their familiesAll evidence taken together suggests thatresistance is transfered from agricultural to thehuman sector. How much it contributes to totalresistance in human pathogens is unclear.
  • 29. deWitAgroAdvies Bangkok 2013
  • 30. Seagulls may be spreading superbugs‘By Michelle Roberts, Health reporter, BBCNewsScientists fear migratory birds may be spreadinghard-to-treat infections after discovering seagullscan carry antibiotic-resistant bacteria.
  • 31. Diverse and abundant antibioticresistance genes in Chinese swine farmsPublished online before printFebruary 11, 2013,doi:10.1073/pnas.1222743110PNAS February 11, 2013 201222743 deWitAgroAdvies Bangkok 2013
  • 32. 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%
  • 33. Food Supply ChainSource: RABOBANK
  • 34. deWitAgroAdvies Bangkok 2013
  • 35. Strong increase of resistant strains1994: strains isolated that are resistantto all drugs available at that timeCause: (over)useUSA,1951: 580 tons medical use, 110 tonsgrowth promotor1978: 6080 tons medical use; 5580 tonsgrowth promotor
  • 36. Intensive animal husbandry is believed to be amajor contributor to the increased environmental burden of AR deWitAgroAdvies Bangkok 2013
  • 37. Antimicrobial resistance (AMR) is agrowing problem worldwide there is an urgent need for : • Reluctant use of antibiotics • Reserve the better ones for man • New medicines to treat resistant infections deWitAgroAdvies Bangkok 2013
  • 38. The microbes strike back! Resistance crisisThat which does not kill me, only makes me stronger!! Swammerdam Institute for Life Sciences
  • 39. The system is overloaded. Can we lighten it?
  • 40. What can we do? deWitAgroAdvies Bangkok 2013
  • 41. Limiting density of Farm Animals deWitAgroAdvies Bangkok 2013
  • 42. 140 Observed Expected Tolerance 120 CampylobacterWeekly 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
  • 43. Concentration of Cleared Farms deWitAgroAdvies Bangkok 2013
  • 44. Wilfrid van Pelt,RIVM May-June 2003Greatest reductionaround clearedchicken farms
  • 45. Actions by International bodies National governments Pharma IndustriesFeed and Food Producers Farmers Vets Retail Consumers deWitAgroAdvies Bangkok 2013
  • 46. The consumers role, WHO deWitAgroAdvies Bangkok 2013
  • 47. The Veterinarians deWitAgroAdvies Bangkok 2013
  • 48. PRUDENT USE GUIDELINES Federation of Veterinarians of Europe1) Animals receiving antibiotics must be under the care of the prescribing vet2) Good administration3) Species and indication approved, susceptible4) Dosage regimen based on pharmacodynamics5) Limit broad spectrum and multiple antibiotics6) Flock/herd treatment only to prevent spreading
  • 49. Different antibiotics for human usage and for agriculture Resistance patterns change rapidlyHence reviews of the exclusively human list every other year?
  • 50. The Farmers deWitAgroAdvies Bangkok 2013
  • 51. Eliminate improper incentives to prescribe Antibiotics. Good Agricultural Practice: Cleaning carefully Constant removal of refuse Reduce density Good quality feed
  • 52. Exclusieve relationshipGoal: not to allow the farmer to shoparound for a vet who easily prescibes antibiotics What kind of measures are implementable?
  • 53. BroilersGrowth/day 65 g> 50 gTime 40 days> 45 days deWitAgroAdvies Bangkok 2013
  • 54. THE RETAIL deWitAgroAdvies Bangkok 2013
  • 55. deWitAgroAdvies Bangkok 2013
  • 56. deWitAgroAdvies Bangkok 2013
  • 57. EUROPEdeWitAgroAdvies Bangkok 2013
  • 58. A new Animal Health Strategy for the European Union (2007-2013) where “Prevention is better than cure”
  • 59. Goal 1To ensure a high level of public health and food safety by minimising the incidence ofbiological and chemical risks to humans.
  • 60. Goal 2 To promote animal health by preventing/reducing the incidence of animal diseases, and in this way to supportfarming and the rural economy. deWitAgroAdvies Bangkok 2013
  • 61. Goal 3 To improve economic growth/cohesion/competitiveness assuring free circulation of goods and proportionate animal movements. deWitAgroAdvies Bangkok 2013
  • 62. Goal 4To promote farming practices and animal welfare whichprevent animal health related threats and minimise environmental impacts insupport of the EU Sustainable Development Strategy deWitAgroAdvies Bangkok 2013
  • 63. PHARMA INDUSTRY deWitAgroAdvies Bangkok 2013
  • 64. The search for new antibiotics• Innovative Medicines Initiative EU • Cooperation with European Federation of Pharmaceutical Industries and Associations deWitAgroAdvies Bangkok 2013
  • 65. 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. deWitAgroAdvies Bangkok 2013
  • 66. Participants• EFPIA companies• GlaxoSmithKline Research and Development Ltd, UK• AstraZeneca AB, Sweden• Janssen Infectious Diseases Diagnostics BVBA, Belgium deWitAgroAdvies Bangkok 2013
  • 67. 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 deWitAgroAdvies Bangkok 2013
  • 68. 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 deWitAgroAdvies Bangkok 2013
  • 69. FOOD and AGRICULTURAL ORGANIZATION guidelines ?? deWitAgroAdvies Bangkok 2013
  • 70. Food and Feed Industries • Hygienic processing methods• Adapted (slaughter) machineries • Cleaning methods • Sustainable production • Avoid cross contamination deWitAgroAdvies Bangkok 2013
  • 71. Agriculture• Improve Animal Health • Lower growth rate• Lower production rate • Smaller flocks deWitAgroAdvies Bangkok 2013
  • 72. INNOVATIONS• Options in controlling antibiotic resistance in agriculture deWitAgroAdvies Bangkok 2013
  • 73. Natural EnemiesBACTERIOPHAGES deWitAgroAdvies Bangkok 2013
  • 74. Bacteriophages are strain specific natural ennemies 110 times smaller than bacteriaEach 2 days 50% of all bacteria are killed No influence on man, animal or plant None effect on food or feed deWitAgroAdvies Bangkok 2013
  • 75. • Listex is on the market,used in the food industry • Salmonelex in testing phase deWitAgroAdvies Bangkok 2013
  • 76. Competitive Inhibition• Promote an healthy flora in the contestinal tract by• Selecting specific gut profiles by metagenomics• Producing feed able to stimulate healthy flora deWitAgroAdvies Bangkok 2013
  • 77. NO ACTION TODAY NO CURE TOMORROW deWitAgroAdvies Bangkok 2013
  • 78. NO ACTION ? No consumer trustUpcoming social pressure Loss of markets deWitAgroAdvies Bangkok 2013
  • 79. Big QuestionWhat can YOU do ? deWitAgroAdvies Bangkok 2013
  • 80. deWitAgroAdvies Bangkok 2013
  • 81. 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. deWitAgroAdvies Bangkok 2013

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