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Foodborne Pathogens and Antibiotic Resistance:

Consequences and Possible Solutions

Stacy Holzbauer, DVM, MPHFoodborne and Diarrheal Diseases Branch

National Center for Infectious DiseasesCenters for Disease Control and Prevention

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Overview

• Trends in Foodborne Diseases and Antimicrobial Resistance

• National and State Antimicrobial Resistance Programs

• Ways to work together

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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

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1

0.8

0.7

0.6

0.5

2

1996-1998 1999 2000 2001 2002 2003 2004

Year

Campylobacter E. coli O157 Listeria Salmonella

Rel

ativ

e R

ate

2005

Trends in Selected Pathogens, 1996-98 to 2004

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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

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Relative Incidence baseline - 2004: Top 5 Salmonella Serotypes

Pathogen Change 95% Conf. IntervalDeclinedS Typhimurium -41% -48% to -34%

No ChangeS Enteritidis 0% -21% to +25% S Heidelberg +3% -16% to +26%

IncreasedS Newport +41% +5% to +89%S Javiana +167% +75% to +306%

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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

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1

17

22

0

10

20

30

40

50

1996 1997 1998 1999 2000 2001 2002 2003

Year

Percentage of S. Newport with at least ACSSuT and MDR-AmpC resistance pattern,

1996-2003*

* 2003 preliminary data

Newport MDR-AmpC

% A

CS

SuT

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MDR Salmonella Newport in Animals

• 2004 Salmonella outbreak in horses in Pennsylvania

• Highly resistant Newport strain

• Significant mortality associated with infection

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Bridging the Gap

• Can public health and animal health work together?

• Is there really a gap??

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Public Health’s Mission

• CDC's MissionTo promote health and quality of life by preventing and controlling disease, injury, and disability.

• APHL’s MissionThe Association of Public Health Laboratories(APHL) works to safeguard the public's health bystrengthening public health laboratories in the United States and across the world.

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Veterinary Oath

• Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society through the protection of animal health, the relief of animal suffering, the conservation of livestock resources, the promotion of public health, and the advancement of medical knowledge.

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Common Theme

• Society

• Prevent Disease

• Control Disease

• Public Health

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Is There A Gap?

• On paper….– NO!

• Ability to communicate…– YES!

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Reduce the Spread of

Antimicrobial Resistance

NARMS-EB, DBMD

12 Step Program, DHQP

GET SMART, DBMD

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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

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Program Funded

Get Smart Sites - 2004

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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

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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

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Get Smart on the FarmEducational Activities to Promote Appropriate Use

of Antimicrobial Agents in Animal Health

• Veterinary Curriculum

• State-based Interventions

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• Enhance veterinary education in antimicrobial resistance

• Promote appropriate use of antimicrobial agentsin veterinary medicine

Veterinary Curriculum

• Web-based with background, species specific sections

• Microbiology, pharmacology, public health

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State-based Interventions Foster 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

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Animal Health Practices on

Washington Dairy Farms

A Tacoma-Pierce County Health Department

Antibiotic Resistance Task Force Project

Primary Investigator: Monica Raymond, MPH, MS, RNProject Coordinator: Ron Wohrle, DVMAdvisory Board Chairman: Robert Whitney, DVM

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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

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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

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Project Approach

• Voluntary

• Supportive

• Focus on benefits to producers

• COLLABORATIVE

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Survey of Animal Health Practices on

WashingtonDairy Farms

July 2003

Endorsed by theWashington StateDairy Federation

This is a collaborative effort between professional veterinary, animal agricultural, human health, and public health

communities in Washington State

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“FARM SOCIOLOGY 101"

WE “MANAGE’ ORGANISMS--- PRODUCERS “MANAGE”ANIMALS

WE VALUE “INFORMATION”---PRODUCERS VALUE “A WAYOF LIFE”

WE STRIVE FOR “FREEDOM FROM DISEASE”---PRODUCERS STRIVE FOR “THE OPTIMUM LEVEL OF DISEASE THEY

CAN LIVE WITH AND SURVIVE”

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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

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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

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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

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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

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Important Points

• There are many silos– Lack of communication– Lack of understanding other disciplines

• A need to share commonalities

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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