One Health with Special Reference to Antimicrobial Resistance

Antimicrobial Resistance and Global HealthCanadian Coalition for Global Health Research and McMaster University

April 9th, 2014

Mohamed A. Karmali, MB ChB, FRCP (C)

Public Health Agency of Canada

Emerging Pathogens and Zoonoses(Woolhouse and Gowtage-Sequerias, EID 11:1842-1846, 2005)

Of 1,407 known human pathogenic

species 816 (58%) are zoonotic

Of 177 emerging or re-emerging

pathogens 130 (73%) are zoonotic

Emerging and Re-emerging Pathogens

• Ebola• SARS• West Nile Virus• HPAI• Nipah• Mers CoV• STEC/VTEC• Borellia burgdorferi• Etc.

The Concept of the Interdependence of Human Health, Animal Health and Environmental Health is Ancient

(Wikepedia – One Health)

Hippocrates (c 460 BC to c 370) – “On Airs, Waters, and Places”

Lancisi, 17th C, Italy – integrated study of human and animal health

Villerme and Parent-Duchâtelet, early 19th C – French Public Health movement (LaBerge, 1992)

Virchow coined the term zoonosis (19th C, Germany)

Sir William Osler(19th C) held joint Faculty positions in Medicine at McGill University and Veterinary Medicine (U of Montréal)

Calvin Schwabe, 19th C – “One Medicine”

James Steele, 1947 established field of Veterinary Public Health at CDC

W. Karesh 2004, Wildlife Conservation Society, “One World-One HealthTM”

American Veterinary Medical Association, 2008, “One Health”

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JOINT STRATEGIC FRAMEWORK ON “One World, One Health”

(Sharm el-Sheikh, Oct. 2008)

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Objectives of the Framework (2008)● Develop surveillance capacity (national, regional, global)

● Strengthen public and animal health capacity to prevent, detect and respond to disease outbreaks at national, regional and international levels

● Strengthen national emergency response capability, including a global rapid response support capacity

● Promote inter-agency and cross-sectoral collaboration and partnership

● Control HPAI and other existing/re-emerging infectious diseases

● Conduct strategic research to aid in mitigating EIDs

Pressures for current and future Emergence/Re-emergence of Zoonoses

• Exponential growth in human and livestock populations• Overcrowding• International travel• Rapid urbanization• Close contact between humans and animals• Environmental degradation• Closer integration between livestock and wildlife• Rapidly changing farming systems• Forest encroachment and habitat disruption• Climate and ecosystem change• Globalization of trade in animals and animal products• Conflict, mass population migration, poverty

Climate Change’s Impact on Infectious Diseases

– Vector-borne diseases– Water-borne diseases– Agriculture Production– Migration of Animals– Changing ecosystems for wildlife and animals– Built environment– Human-Animal Interface– Ecologies and a new research portfolio– Evidence-based public health impact

Pathogen circulation in

the animal host

Transmission from animal to

human

(Emergence)

Infection and Clinical impact

in human population

Manage infection and outbreaks in

human populations

Shifting the paradigmupstream

Prevent transmission and Predict emergence

Control in animal population where

feasible

Heyman, D: Policies and Strategies to Meet the Challenge of Emerging Disease Threat through Prevention, Preparedness and Response. 2nd

International One Health Congress Conference, Bangkok 2013

Riots, Rage and Resistance: A Brief History of How Antibiotics Arrived on the Farm

Maureen Ogle, Scientific American, September 2013 (Guest Blog)

Early 20th Century saw food shortages in the US

1910, millions of Americans joined a national meat boycott to protest prices

US government pours money into research to stimulate production of affordable meat

In the 1940s, with of antibiotics, a discovery was made serendipitously that sub-therapeutic doses of antibiotics greatly stimulated animal growth

This led to a veritable food revolution which saw the production of affordable meat in the US

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Changes in Intestinal Flora of Farm Personnel after Introduction of Tetracycline-supplemented

Feed on a FarmS.B. Levy NEJM 295:583-588, 1976

• Within 5 months after chickens on a farm were fed Tet-supplemented feed, 31.3% of weekly fecal samples from farm dwellers contained > 80% TetR bacteria

• In contrast only 6.8% samples from 24 neighbours contained TetR bacteria (p<0.001)

• The resistant bacteria contained transferable plasmids that encoded for multiple antibiotic resistance

• Isolated from a variety of animals: dogs, cats, rabbits, horses, cattle, pigs, poultry, and exotic species (e.g., elk, cheetah, monkey, polar bears)

• Ubiquitous in the environment • Food animals

• Disease causing in some e.g., suckling pigs, horses• Ribotype 027/ NAP 1 (occurs in dogs, cattle, pigs but

relatively uncommon)• Ribotype 078 more common in animals but the role of

animals in dissemination remains unclear

• Food • Recovered from pork, beef, chicken, fish, raw veg• Importance? Role in dissemination?

Clostridium difficile in Animals

• Isolated from a variety of animals: dogs, cats, rabbits, horses, cattle, pigs, poultry, and exotic species including whales, alpacas, rats.

• Companion animals reflect prevalence of local community-acquired MRSA; can be household reservoirs esp. dogs.

• Horses – some strains of CMRSA-5 are well adapted to horses. • Food animals – some community-acquired strains but main issue is

“livestock associated” MRSA - ST398• Common in pigs in Europe, US, Canada, etc.• Also occurs less frequent in cattle (dairy, beef, veal); few reports for poultry• High proportion of human community cases in parts of Europe (Netherlands,

Denmark etc.) but very rare among human cases in Canada

• Food – pork (~5-10%), beef (~5%), chicken (<1%)• Importance? Role in dissemination?

• Occupational risk – vets (~10-15% colonization), farmers (~20%), slaughterplant workers etc.

MRSA in AnimalsJS Weese. MRSA in Animals. ILA J 2010

Emerging Infectious Dis. 16: 587-594, 2010

• Use of cephalosporins and beta-lactams in food animals in Canada• in ovo use of ceftiofur in broiler hatching eggs (extra-label use to be

voluntarily stopped by Canadian poultry industry May 2014)• Bla (cmy-2) relatively common in the food chain in Canada, US, Europe;

especially in poultry Salmonella and E. coli – linked to ceftiofur use in hatching eggs

• ESBLs (TEM, SHV etc.) rare in Canada in the foodchain Pouget et al. AEM 2013 Jun;79(12):3864-6. Characterization of bla(SHV) genes on plasmids

from scherichia coli and Salmonella enterica isolates from Canadian food animals (2006-2007).

• CTX-M – the most significant cause of resistance to beta-lactam antibiotics in E. coli , reported worldwide• Movement into the food chain also a worldwide issue; some reports in North

America but so far uncommon 2012.Wittum et al. Detection of Salmonella enterica isolates producing CTX-M Cephalosporinase in

U.S. livestock populations. AEM 2012;78(20):7487-91.

ESBLs (and ESCs) in Animals

PLoS One, 7: 1-6, May 2012; e37152

Appl. Environ. Microbiol. 78:7487-91, 2012

Annual number of human Salmonella enterica serotype Kentucky isolates per country (France, England and Wales, and Denmark), 2000–2008, and the

proportion of isolates resistant to ciprofloxacin.

Le Hello S et al. J Infect Dis. 2011;204:675-684

© The Author 2011. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Poultry identified as a major reservoir

Figure 1. Sources and distribution of pharmaceuticals in the environment1 (STP: sewage treatment plant).

Kümmerer K J. Antimicrob. Chemother. 2003;52:5-7

©2003 by Oxford University Press

Acknowledgements

Richard Reid-Smith

Nick Previsich and Linda Williams