NATURE STRIKES BACK     A Global Problem   Bangkok March 2013 CEO Summit Animal Health       deWitAgroAdvies Bangkok 2013
What is Resistance?It means that microbes have becomeimmune against the drugs used totreatisinfections.   What resistance?...
The Human Health We have a situation      deWitAgroAdvies Bangkok 2013
History antibiotics1928 Fleming1938 Chain and Florey make penicillin useful inhumans1942 First life saving treatment1944 D...
Early sixties: First signs of resistanceLate sixties – early seventies: analogsEighties and nineties: Resistance crisisred...
deWitAgroAdvies Bangkok 2013
Use of antibiotics outside the hospital              in Europe              deWitAgroAdvies Bangkok 2013
European Antimicrobial Resistance Surveillance Network (EARS-Net)The report reflects the state of submissions in  TESSy as...
Meticillin Resistant Staphylococcus           aureus (MRSA)            deWitAgroAdvies Bangkok 2013
Fluoroquinolones Resistant (R)       Escherichia coli          deWitAgroAdvies Bangkok 2013
3rd gen. cephalosporins Resistant (R) Klebsiella             pneumoniae Isolates                  deWitAgroAdvies Bangkok ...
deWitAgroAdvies Bangkok 2013
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 t...
Some figures• Antibiotic-resistant bacteria cause 25 000  deaths in EU every year and cost economy  €1.5 billion. (IMI/EFP...
• Oct. 16, 2007 -- It appears that more people in  the U.S. now die from the mostly hospital-  acquired staph infection MR...
deWitAgroAdvies Bangkok 2013
Totally Drug-ResistantTuberculosis in India  Oxford journals  The most recent version of this article [] was  published on...
Resistance•   More infections•   Higher costs•   Higher mortality•   Higher risks in human health•   Lower Food Safety•   ...
The environment      deWitAgroAdvies Bangkok 2013
Increase antibiotic resistence in archived soilsEnviron Sci.Techn. 2010;44;580-7                  deWitAgroAdvies Bangkok ...
Relation Human Health and            AgricultureOf the strains ( ESBL Coli)causing urinairytract infections in humans in 2...
Belgium 2011  deWitAgroAdvies Bangkok 2013
ESBL source •Poultry     88%•Beef/Porc meat 20%      deWitAgroAdvies Bangkok 2013
The security of our food supply is at risk in ways    more noxious than anyone had feared.                   deWitAgroAdvi...
Use of antibiotica    deWitAgroAdvies Bangkok 2013
EHEC2005, South Korea, meat2011 Germany, fenugreek    2012 Germany, ?  2013 Sweden, meat      deWitAgroAdvies Bangkok 2013
Special strain of Methicillin ResistantStaphylococcus aureus (MRSA) found in pigsis also found in pig farmers and, less of...
deWitAgroAdvies Bangkok 2013
Seagulls may be spreading superbugs‘By Michelle Roberts, Health reporter, BBCNewsScientists fear migratory birds may be sp...
Diverse and abundant antibioticresistance genes in Chinese swine              farmsPublished online before printFebruary 1...
Investigation University Linköping, Sweden              Effect of traveling• Of 231 persons 4% was carrier of ESBL   bacte...
Food Supply ChainSource: RABOBANK
deWitAgroAdvies Bangkok 2013
Strong increase of resistant strains1994: strains isolated that are resistantto all drugs available at that timeCause: (ov...
Intensive animal  husbandry is believed to be amajor contributor to the increased  environmental burden of AR            d...
Antimicrobial resistance (AMR) is agrowing problem worldwide there is        an urgent need for :     • Reluctant use of a...
The microbes strike back!        Resistance crisisThat which does not kill me, only      makes me stronger!!              ...
The system is overloaded. Can we lighten it?
What can we do?     deWitAgroAdvies Bangkok 2013
Limiting density of  Farm Animals      deWitAgroAdvies Bangkok 2013
140                                                                         Observed             Expected   Tolerance     ...
Concentration of Cleared Farms          deWitAgroAdvies Bangkok 2013
Wilfrid van Pelt,RIVM        May-June 2003Greatest reductionaround clearedchicken farms
Actions by  International bodies National governments   Pharma IndustriesFeed and Food Producers        Farmers          V...
The consumers role, WHO       deWitAgroAdvies Bangkok 2013
The Veterinarians     deWitAgroAdvies Bangkok 2013
PRUDENT USE GUIDELINES        Federation of Veterinarians of Europe1) Animals receiving antibiotics must be under the   ca...
Different antibiotics for human usage          and for agriculture  Resistance patterns change rapidlyHence reviews of the...
The Farmers deWitAgroAdvies Bangkok 2013
Eliminate improper incentives to      prescribe Antibiotics.     Good Agricultural Practice:         Cleaning carefully   ...
Exclusieve relationshipGoal: not to allow the farmer to shoparound for a vet who easily prescibes              antibiotics...
BroilersGrowth/day 65 g> 50 gTime 40 days> 45 days      deWitAgroAdvies Bangkok 2013
THE RETAIL deWitAgroAdvies Bangkok 2013
deWitAgroAdvies Bangkok 2013
deWitAgroAdvies Bangkok 2013
EUROPEdeWitAgroAdvies Bangkok 2013
A new Animal Health Strategy   for the European Union     (2007-2013) where  “Prevention is better than            cure”
Goal 1To ensure a high level of public   health and food safety by  minimising the incidence ofbiological and chemical ris...
Goal 2 To promote animal health by    preventing/reducing the incidence of animal diseases,   and in this way to supportfa...
Goal 3          To improve economic    growth/cohesion/competitiveness    assuring free circulation of goods        and pr...
Goal 4To promote farming practices  and animal welfare whichprevent animal health related    threats and minimise  environ...
PHARMA INDUSTRY    deWitAgroAdvies Bangkok 2013
The search for new antibiotics• Innovative Medicines Initiative EU    • Cooperation with European     Federation of Pharma...
Combacte  the IMI-funded COMBACTE project, aims to give antibiotic  drug development a much-needed boost by pioneering new...
Participants• EFPIA companies• GlaxoSmithKline Research and  Development Ltd, UK• AstraZeneca AB, Sweden• Janssen Infectio...
16 Universities, research organisations, public          bodies, non-profit groups            Management group :       Uni...
Combatting Bacterial Resistance in                Europe•   Start Date01/01/2013•   Duration84 months•   Contribution €•  ...
FOOD and AGRICULTURAL    ORGANIZATION    guidelines ??       deWitAgroAdvies Bangkok 2013
Food and Feed Industries  • Hygienic processing methods• Adapted (slaughter) machineries         • Cleaning methods      •...
Agriculture• Improve Animal Health   • Lower growth rate• Lower production rate      • Smaller flocks       deWitAgroAdvie...
INNOVATIONS• Options in controlling antibiotic resistance in       agriculture       deWitAgroAdvies Bangkok 2013
Natural EnemiesBACTERIOPHAGES    deWitAgroAdvies Bangkok 2013
Bacteriophages are strain specific        natural ennemies    110 times smaller than bacteriaEach 2 days 50% of all bacter...
• Listex is on the market,used in the food industry • Salmonelex in testing            phase          deWitAgroAdvies Bang...
Competitive Inhibition• Promote an healthy flora in the contestinal  tract by• Selecting specific gut profiles by  metagen...
NO ACTION TODAY NO CURE TOMORROW       deWitAgroAdvies Bangkok 2013
NO ACTION ?   No consumer trustUpcoming social pressure    Loss of markets        deWitAgroAdvies Bangkok 2013
Big QuestionWhat can YOU do ?      deWitAgroAdvies Bangkok 2013
deWitAgroAdvies Bangkok 2013
For further reading•   1.Foodborne antimicrobial resistance as a biological hazard1 Scientific Opinion of    the Panel on ...
VIV Animal Health Summit Closing CEO-level Conference, Mr. Wim de Wit, VIV Asia 2013
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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

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

  1. 1. NATURE STRIKES BACK A Global Problem Bangkok March 2013 CEO Summit Animal Health deWitAgroAdvies Bangkok 2013
  2. 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. 3. The Human Health We have a situation deWitAgroAdvies Bangkok 2013
  4. 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. 5. Early sixties: First signs of resistanceLate sixties – early seventies: analogsEighties and nineties: Resistance crisisreduction of agricultural use, restrictive usein humans20?? Postantibiotic ??
  6. 6. deWitAgroAdvies Bangkok 2013
  7. 7. Use of antibiotics outside the hospital in Europe deWitAgroAdvies Bangkok 2013
  8. 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. 9. Meticillin Resistant Staphylococcus aureus (MRSA) deWitAgroAdvies Bangkok 2013
  10. 10. Fluoroquinolones Resistant (R) Escherichia coli deWitAgroAdvies Bangkok 2013
  11. 11. 3rd gen. cephalosporins Resistant (R) Klebsiella pneumoniae Isolates deWitAgroAdvies Bangkok 2013
  12. 12. deWitAgroAdvies Bangkok 2013
  13. 13. Emerging Risks an example Dissertation Liny Keessen 2013 Man and Pigs:Sharing the same C. difficile deWitAgroAdvies Bangkok 2013
  14. 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. 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. 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. 17. deWitAgroAdvies Bangkok 2013
  18. 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. 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. 20. The environment deWitAgroAdvies Bangkok 2013
  21. 21. Increase antibiotic resistence in archived soilsEnviron Sci.Techn. 2010;44;580-7 deWitAgroAdvies Bangkok 2013
  22. 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. 23. Belgium 2011 deWitAgroAdvies Bangkok 2013
  24. 24. ESBL source •Poultry 88%•Beef/Porc meat 20% deWitAgroAdvies Bangkok 2013
  25. 25. The security of our food supply is at risk in ways more noxious than anyone had feared. deWitAgroAdvies Bangkok 2013
  26. 26. Use of antibiotica deWitAgroAdvies Bangkok 2013
  27. 27. EHEC2005, South Korea, meat2011 Germany, fenugreek 2012 Germany, ? 2013 Sweden, meat deWitAgroAdvies Bangkok 2013
  28. 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. 29. deWitAgroAdvies Bangkok 2013
  30. 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. 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. 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. 33. Food Supply ChainSource: RABOBANK
  34. 34. deWitAgroAdvies Bangkok 2013
  35. 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. 36. Intensive animal husbandry is believed to be amajor contributor to the increased environmental burden of AR deWitAgroAdvies Bangkok 2013
  37. 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. 38. The microbes strike back! Resistance crisisThat which does not kill me, only makes me stronger!! Swammerdam Institute for Life Sciences
  39. 39. The system is overloaded. Can we lighten it?
  40. 40. What can we do? deWitAgroAdvies Bangkok 2013
  41. 41. Limiting density of Farm Animals deWitAgroAdvies Bangkok 2013
  42. 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. 43. Concentration of Cleared Farms deWitAgroAdvies Bangkok 2013
  44. 44. Wilfrid van Pelt,RIVM May-June 2003Greatest reductionaround clearedchicken farms
  45. 45. Actions by International bodies National governments Pharma IndustriesFeed and Food Producers Farmers Vets Retail Consumers deWitAgroAdvies Bangkok 2013
  46. 46. The consumers role, WHO deWitAgroAdvies Bangkok 2013
  47. 47. The Veterinarians deWitAgroAdvies Bangkok 2013
  48. 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. 49. Different antibiotics for human usage and for agriculture Resistance patterns change rapidlyHence reviews of the exclusively human list every other year?
  50. 50. The Farmers deWitAgroAdvies Bangkok 2013
  51. 51. Eliminate improper incentives to prescribe Antibiotics. Good Agricultural Practice: Cleaning carefully Constant removal of refuse Reduce density Good quality feed
  52. 52. Exclusieve relationshipGoal: not to allow the farmer to shoparound for a vet who easily prescibes antibiotics What kind of measures are implementable?
  53. 53. BroilersGrowth/day 65 g> 50 gTime 40 days> 45 days deWitAgroAdvies Bangkok 2013
  54. 54. THE RETAIL deWitAgroAdvies Bangkok 2013
  55. 55. deWitAgroAdvies Bangkok 2013
  56. 56. deWitAgroAdvies Bangkok 2013
  57. 57. EUROPEdeWitAgroAdvies Bangkok 2013
  58. 58. A new Animal Health Strategy for the European Union (2007-2013) where “Prevention is better than cure”
  59. 59. Goal 1To ensure a high level of public health and food safety by minimising the incidence ofbiological and chemical risks to humans.
  60. 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. 61. Goal 3 To improve economic growth/cohesion/competitiveness assuring free circulation of goods and proportionate animal movements. deWitAgroAdvies Bangkok 2013
  62. 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. 63. PHARMA INDUSTRY deWitAgroAdvies Bangkok 2013
  64. 64. The search for new antibiotics• Innovative Medicines Initiative EU • Cooperation with European Federation of Pharmaceutical Industries and Associations deWitAgroAdvies Bangkok 2013
  65. 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. 66. Participants• EFPIA companies• GlaxoSmithKline Research and Development Ltd, UK• AstraZeneca AB, Sweden• Janssen Infectious Diseases Diagnostics BVBA, Belgium deWitAgroAdvies Bangkok 2013
  67. 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. 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. 69. FOOD and AGRICULTURAL ORGANIZATION guidelines ?? deWitAgroAdvies Bangkok 2013
  70. 70. Food and Feed Industries • Hygienic processing methods• Adapted (slaughter) machineries • Cleaning methods • Sustainable production • Avoid cross contamination deWitAgroAdvies Bangkok 2013
  71. 71. Agriculture• Improve Animal Health • Lower growth rate• Lower production rate • Smaller flocks deWitAgroAdvies Bangkok 2013
  72. 72. INNOVATIONS• Options in controlling antibiotic resistance in agriculture deWitAgroAdvies Bangkok 2013
  73. 73. Natural EnemiesBACTERIOPHAGES deWitAgroAdvies Bangkok 2013
  74. 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. 75. • Listex is on the market,used in the food industry • Salmonelex in testing phase deWitAgroAdvies Bangkok 2013
  76. 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. 77. NO ACTION TODAY NO CURE TOMORROW deWitAgroAdvies Bangkok 2013
  78. 78. NO ACTION ? No consumer trustUpcoming social pressure Loss of markets deWitAgroAdvies Bangkok 2013
  79. 79. Big QuestionWhat can YOU do ? deWitAgroAdvies Bangkok 2013
  80. 80. deWitAgroAdvies Bangkok 2013
  81. 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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