AntimicrobialResistance:Aglobalpublichealththreat

DrMarkSchippAustralianChiefVeterinaryOfficer

Rotary–WAMay2019

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AveryquickintroductionWhatisAMR?-  Whenmicro-organismsevolveresistanceto

antimicrobialsubstances,likeantibiotics.WhyisAMRimportant?-  AMRthreatenstheeffectivepreventionand

treatmentofanever-increasingrangeofinfections.-  Anincreasinglyseriousthreattoglobalpublic

healththatrequiresactionacrossallgovernmentsectorsandsociety.

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Natureoftheproblem

•  AMRisanincreasinghealthconcerninAustraliaandaroundtheworld.

•  Ifnotaddressed,simpleinfectionscouldcausesignificantharm.

•  Itisestimatedthatby2050,tenmillionpeoplewilldieeveryyearasaresultofAMR.•  Eventoday,700,000peopledieof

resistantinfectionseveryyear.

Whydowehaveaproblem?

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Whyisavetspeakingtous?

•  Mostantibioticsareusedinanimalindustries

•  AMRmaybetransmittedthroughfood

•  AOneHealthissue•  OneHealthrecognisesthe

interconnectednessofhuman,animalandenvironmentalhealth. https://www.canada.ca/en/health-canada/services/

publications/drugs-health-products/tackling-antimicrobial-resistance-use-pan-canadian-framework-action.html

AntimicrobialuseinAustralia

Referenceadaptedfrom:http://amr-review.org/sites/default/files/Antimicrobials%20in%20agriculture%20and%20the%20environment%20-%20Reducing%20unnecessary%20use%20and%20waste.pdf

Reference:http://www.safetyandquality.gov.au/wp-content/uploads/2016/06/AURA-2016-First-Australian-Report-on-Antimicroibal-use-and-resistance-in-human-health.pdf

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AntibioticuseinAustralia

•  Australiansareover-usingantibioticsinhumanhealth.•  Australiaisthe11thhighestuserofantibioticsoutof31OECDcountries.

•  In2015,morethan30millionantibioticscriptswereprovidedthroughthePharmaceuticalBenefitsScheme.

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Whatisbeingdone?NationalAMRStrategyKeyobjectives:

1.  Communication,educationandtraining2.  AntimicrobialStewardship3.  Surveillance4.  Infectionpreventionandcontrol5.  Researchanddevelopment6.  Internationalengagement7.  Governance

Animalhealthkeyinitiatives§  Bestpracticeantibioticprescribingguidelines–pigs

§  Veterinaryantimicrobialstewardshiponlinetrainingprogram

§  Antimicrobialgrowthpromotants(AGPs)–nolabelclaims

§  OIEantimicrobialusage(AMU)annualquestionnaire

§  AntibioticAwarenessWeek

§  ASTAGAntibacteriallistworkinggroup

§  Compendiumreportonantimicrobialstewardshipefforts–livestockindustries

§  AntimicrobialStewardshipGuidelinesfortheAustralianCattleFeedlotIndustry

§  Factsheetsonresponsibleantibioticuse–companionanimals,livestockandhorses

§  Therearecurrentlyonlythreeantibioticsregisteredwithgrowthpromotantclaims,noneofwhicharecurrentlyimportantforhumanmedicine

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HowarethingsinAustralia?ü Anexcellentanimalhealthstatusü Abestpracticeanimalidentificationandtraceabilitysystem

ü Wehavegoodpartnershipsbetweenindustryandgovernment

ü Oursystemsareflexibleandresponsive

ü Wehavegoodagriculturalpracticesincludingon-farmhygieneandbiosecurity

ü ManyofourindustriesimplementbiosecuritymanualsandQAsystems

ü AustralianveterinarianshavebeenproactivelymitigatingAMRforsometime.

ü AustraliaalreadyhasaregulatorysystemworkingtominimiseAMRü Australiahasbeenveryconservativeinregisteringantibioticsforuseinfoodanimals.

ü NearlyallantimicrobialsusedinanimalsareSchedule4medicines.

ü Ourfeedlotindustryarethefirstanywhereintheworldtoimplementastewardshipprogram,andhowtouseantimicrobialsappropriately.

ü OpportunitiesforAustralia

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Isfoodarisk?

InAustraliawehavesurveyedanimals:ü  Cattle(2013)–(Note:beefcattle,dairycattleandvealcalf)ü  Pigs(2018)ü  Chickenmeat(2018)ü  ChickenEggs(2018)o  Salmono  Barramundio  ChickenEgg–furtherwork?  Others(Note:Thisrelatestosamplesfromhealthyanimals.)

Reference:https://www.spok.com/blog/swiss-cheese-model-patient-safety-errors-closing-holes-message-accountability

Whataboutimportedfood?SourcingCertificationTestingDiseasestatusCookedProcessedGeneticmaterialResiduetesting

FutureVision

Ø  Coordination–government/industry,OneHealth,internationally

Ø  Surveillance–human/animal/food/environment,use,resistance

Ø  Keydatasystems–Antimicrobialsused,laboratoryresults,standardised,integrated

Ø  Resourced–communityawareness,research,preventive

•  A time for action

•  Opportunities for the future

•  More work needed

Summary

Reference:http://www.oie.int/en/for-the-media/amr/waaw2015/

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