Global Health Security; where are we now? -seminaari 1.2.2016

1. Finnish Food Safety Authority
Antimicrobial resistance – a global
threat
Pia Mäkelä

2. Content
Why antimicrobial resistance is a global
problem?
What is the resistance situation in EU and
Finland?
What should we do?

3. 3
Antimicrobial resistance – a
global threat
 Antimicrobial resistance = the ability of micro-
organisms (bacteria) to withstand antimicrobial
treatments
 Both WHO and EU have recognised antimicrobial
resistance as a global threat
 Antimicrobial resistance is increasing in the world,
particularly because of overuse and missuse of
antibiotics in humans and in animals

4. The threat for public health
Due to antimicrobial resistance (AMR):
 Many modern medicines (antimicrobials) may loose their
effectiveness, leading to prolonged diseases and additional
deaths even in case of common infections
 It has been estimated that the yearly number of deaths
caused by AMR is 25 000 in EU and in USA 23 000
 AMR also increases the costs of health care and animal
husbandry
Resistant bacteria can spread through many routes within and
between countries
 E.g. travel, tourism, movement of patients, trade of animals
and food
4

5. 5
ECDC/EFSA/EMA first joint report on the integrated analysis of the consumption of antimicrobial agents
and occurrence of antimicrobial resistance in bacteria from humans and food-producing animals, 2015.
EFSA Journal
Antimicrobial resistance is zoonotic
– One Health concept needed

6. Actions taken at global level
 WHO: Global action plan on antimicrobial resistance, 2015
 OIE, FAO, ….
EU: Parliament, Council, Commission, ECDC, EMA, EFSA:
 Commission action plan 2011-16; legislation changes,
recommendations, guidelines
 EU monitoring systems for resistance and usage of
antimicrobials in humans, animals and food
 Scientific opinions, research funding
 European antibiotic awareness day
6

7. Agreed upon measures to combat
antimicrobial resistance
 Prudent use of antimicrobials in treatment of humans and
animals (e.g. better prescribing practices, respect of
dosages, use of microbiological diagnosis and susceptibility
testing, avoidance of herd treatments)
 Better prevention of infectious diseases and infections (e.g.
in healthcare settings, animal husbundry )
 Increase public awareness
 Development of new antimicrobials and alternative
treatments
 One Health concept
 Need for implementation of these measures !
7

8. 13.1.2016 Jari Jalava, National Institute for Health and Welfare 8
http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx
Resistance situation in
humans, EU, 2014
Finland among the
best countries

9. E. coli, invasive infections in humans, EU:
Antimicrobial resistance situation getting worse
13.1.2016
http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx
Jari Jalava, National Institute for Health and Welfare 9
2009 2014

10. 13.1.2016
2010 MRSA 2014 MRSA
http://www.ecdc.europa.eu/en/activities/surveillance/EARS-Net/Pages/index.aspx
Jari Jalava, National Institute for Health and Welfare 10
MRSA in humans, EU: Antimicrobial resistance
situation mostly getting better

11. Ciprofloxacin resistance among Campylobacter jejuni from broilers, 2013 ,
EFSA
14.4.2015EFSA and ECDC. EU Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food
2013. EFSA Journal 2015; 13 (2): 4036, 178 pp., doi:10.2903/j.efsa.2015.4036
Resistance situation
in animals, EU
Finland among the
best countries

12. 14.4.2015
Tetracyclin resistance among commensal E. coli – isolates from pig, 2013,
EFSA
EFSA and ECDC. EU Summary Report on antimicrobial resistance in zoonotic and indicator bacteria from humans, animals and food 2013.
EFSA Journal 2015; 13 (2): 4036, 178 pp., doi:10.2903/j.efsa.2015.4036
Resistance situation
in animals, EU
Finland among the
best countries

13. 13
Figure 3. Biomass-corrected consumption
of antimicrobials (mg/kg) in humans and
food-producing animals , 2012, Joint
report of ECDC, EFSA, EMA
ECDC/EFSA/EMA first joint report on the integrated analysis of the
consumption of antimicrobial agents and occurrence of antimicrobial
resistance in bacteria from humans and food-producing animals, 2015. EFSA
Journal
Usage of all
antimicrobials

14. 14
Finnish antimicrobial resistance
(AMR) situation
 AMR situation in Finland is better than in most European
countries
 Measures against AMR started early, from 1950 →
 Collaboration between human and veterinary sectors
established already in 1997
 A long tradition for combating infectious animal diseases;
→ good animal health situation – use of antimicrobials ↓
 Imported AMR a risk (e.g. travel, animal trade, etc)

15. K. pneumoniae KPC
K. pneumoniae VIM
K. pneumoniae NDM E. coli OXA-48
K. pneumoniae OXA-48
2009 – 2014
E. coli NDM
K. pneumoniae GES-14
E. cloacae IMI-1
E. coli OXA-181
K. pneumoniae OXA-181
R. planticola OXA-48
E. cloacae NMC-A
E. cloacae KPC
72% of human
infections with
multiresistant (CPE)
enterobacters in
Finland imported
from other countries
13.1.2016 Jari Jalava, National Institute for Health and Welfare 15

16. Introduction of ESBL E. coli to Finnish broiler
population from imported grandparent chicks
ESBL prevalence 80% (4/5); Imported
grandparents from UK, 2010-12
35% (7/20) Parent flocks in production in
Finland, 2011-12
17% (18/107) Slaughter broiler flocks in
Finland, 2011-12
Finnish broiler meat
18 % (8/45) 2012
13 % (7/53) 2013

17. On-going legal changes: The draft
EU Regulation on veterinary
medicinal products – Finnish views
 Measures to combat AMR are welcomed in the
Regulation
 In Finland we would need a possibility to use
additional national restrictions as regards the
use of antimicrobials for animals in order to
maintain the favourable situation of AMR in the
country
17

18. Conlusions
 Since antimicrobial resistance is a global problem, all
countries, including Finland, need to take actions - also the
developing countries
Important :
 Implementation of the given recommendations and
guidelines regarding prudent use and infection control
 Raising awareness among the general public and the
professionals
 International collaboration
18

19. Acknowledgements:
Jari Jalava
National Institute for Health and Welfare
Liisa Kaartinen, Anna-Liisa Myllyniemi and
Sinikka Pelkonen
Finnish Food Safety Authority