Surveillance to link food-producing animals, the environment and human medicine as a progressive measure to limit future resistance problems

Sarah J O’Brien

ANTIMICROBIAL RESISTANCE

Added to the government's national

risk register of civil emergencies!

“APOCALYPSE NOW?”

DEATHS ATTRIBUTABLE TO ANTIMICROBIAL

RESISTANCE EVERY YEAR COMPARED WITH

OTHER MAJOR CAUSES OF DEATH

Source: Review on Antimicrobial Resistance 2014

Source: Review on Antimicrobial Resistance 2014

ANTIMICROBIAL RESISTANCE

Rising trend in

carbapenemase-producing

Enterobacteriaceae cases

referred to Public Health

England, 2003 to 2011

Source: Annual Report of the

Chief Medical Officer, 2011

ANTIMICROBIAL RESISTANCE

Source: EFSA Journal 2011;9(8):2322

Phylogeny of Scottish and global Salmonella

Typhimurium DT104, rooted on S. Typhimurium

SL1344

Source: Mather et al. Science. 2013;341:1514-17

Bayesian maximum clade credibility phylogenetic tree and most

probable ancestral state reconstruction of host population for

Salmonella Typhimurium DT104 in Scotland

Source: Mather et al. Science. 2013;341:1514-17

Venn diagrams demonstrating the degree of overlap in

antimicrobial resistance (AMR) between the human and animal

populations of S. Typhimurium DT104

Source: Mather et al. Science. 2013;341:1514-17

Good farm management, bio-security, and animal husbandry systems

underpin the health and welfare of food-producing animals.

When applied appropriately they minimise disease, reduce susceptibility

to bacterial disease and minimise the need for antibiotic use in animals.

Livestock, Food Retail and Veterinary Sectors

Seven key areas for future action:-

1. Improving infection prevention and control practices in human and animal health

2. Optimising prescribing practice

3. Improving professional education, training and public engagement

4. Developing new drugs, treatments and diagnostics

5. Better access to and use of surveillance data in human and animal sectors

6. Better identification and prioritisation of AMR research

7. Strengthened international collaboration

REVIEW ON ANTIMICROBIAL

RESISTANCE

ANIMAL DISEASE

SURVEILLANCE

Eavesdropping on

veterinary diagnostic services

(i.e. passive surveillance)

Notifiable disease

(i.e. active surveillance)

Outbreak

investigation

Heavy lines denote the main ‘planks’ of current ‘surveillance’. Dotted boxes denote information that is not being adequately captured. Dotted lines denote links that are not being adequately made.

Reference

Laboratories

Slide courtesy of Dominic Mellor,

University of Glasgow

HUMAN DISEASE

SUVEILLANCE

Eavesdropping on

medical diagnostic services

(i.e. passive surveillance)

Notifiable disease

(i.e. active surveillance)

Heavy lines denote the main ‘planks’ of current ‘surveillance’. Dotted boxes denote information that is not being adequately captured. Dotted lines denote links that are not being adequately made.

‘Spotter’ Practices; Calls to

NHS 24/111; Hospital

Admissions

(i.e. syndromic surveillance)

Outbreak

investigation

Reference

Laboratories

Slide courtesy of Dominic Mellor,

University of Glasgow

DISEASE

INTELLIGENCE

Eavesdropping on

veterinary diagnostic services

(i.e. passive surveillance)

Eavesdropping on

medical diagnostic services

(i.e. passive surveillance)

Notifiable disease

(i.e. active surveillance)

Notifiable disease

(i.e. active surveillance)

Outbreak

investigation

Heavy lines denote the main ‘planks’ of current ‘surveillance’. Dotted boxes denote information that is not being adequately captured. Dotted lines denote links that are not being adequately made.

‘Spotter’ Practices; Calls to

NHS 24/111; Hospital

Admissions

(i.e. syndromic surveillance)

Outbreak

investigation

Reference

Laboratories

Slide courtesy of Dominic Mellor,

University of Glasgow

THE BACKBONE OF THE INTERNATIONAL

AGRO-FOOD TRADE NETWORK (2007)

Ercsey-Ravasz et al. PLoS One. 2012;7(5):e37810.

DISEASE

INTELLIGENCE

Eavesdropping on

veterinary diagnostic services

(i.e. passive surveillance)

Eavesdropping on

medical diagnostic services

(i.e. passive surveillance)

Medical

epidemiological

research

Notifiable disease

(i.e. active surveillance)

Notifiable disease

(i.e. active surveillance)

Imported feed

Imported food

Animal demographics • Numbers

• Place and time

• Breeds/(pheno/geno)types

• Age/Sex

• Movements

Human demographics • Numbers

• Place and time

• Ethnicty

• Age/Sex

• Travel

• Socio-economic status

Outbreak

investigation

Veterinary

epidemiological

research

Slaughterhouse (i.e. syndromic surveillance):

Food Chain Information

Collection & Communication of Inspection Results

Heavy lines denote the main ‘planks’ of current ‘surveillance’. Dotted boxes denote information that is not being adequately captured. Dotted lines denote links that are not being adequately made.

Medical prescribing

Veterinary prescribing

‘Spotter’ Practices; Calls to

NHS 24/111; Hospital

Admissions

(i.e. syndromic surveillance) Outbreak

investigation

Fallen

Stock

Reference

Laboratories

Domestic feed

Domestic food

Slide courtesy of Dominic Mellor,

University of Glasgow

CHALLENGES: POLITICAL

• Multiple Government Departments/Agencies including in Devolved

Administrations

• Department of Health

• Department of Environment, Food and Rural Affairs

• Food Standards Agency

• Public Health England and equivalent bodies in Scotland, Wales and

Northern Ireland.

• Food Industry

• Commercial confidentiality

• Ownership!

CHALLENGES: SCIENTIFIC

• Samples sizes

• Laboratory methods

• Provenance data

• Statistical methods

• BIG DATA!