Foodborne Pathogens and
Antibiotic Resistance:
Consequences and Possible
Solutions
Stacy Holzbauer, DVM, MPH
Foodborne and Diarrheal Diseases Branch
National Center for Infectious Diseases
Centers 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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Trends in Selected Pathogens, 1996-98 to 2004
2
Relative Rate
Campylobacter
E. coli O157
Listeria
Salmonella
1
0.8
0.7
0.6
0.5
1996-1998
1999
2000
2001
2002
Year
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2003
2004
2005
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
Declined
Change
95% Conf. Interval
S Typhimurium
-41%
-48% to -34%
0%
+3%
-21% to +25%
-16% to +26%
+41%
+167%
+5% to +89%
+75% to +306%
No Change
S Enteritidis
S Heidelberg
Increased
S Newport
S Javiana
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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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Percentage of S. Newport with at least
ACSSuT and MDR-AmpC resistance pattern,
1996-2003*
50
% ACSSuT
Newport MDR-AmpC
40
30
20
22
25
22
21
17
10
1
0
1996
1997
1998
1999
2000
Year
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2001
2002
2003
* 2003 preliminary data
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 Mission
To promote health and quality of life by preventing
and controlling disease, injury, and disability.
• APHL’s Mission
The Association of Public Health Laboratories
(APHL) works to safeguard the public's health by
strengthening 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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12 Step Program, DHQP
GET SMART, DBMD
Reduce the Spread of
Antimicrobial Resistance
NARMS-EB, 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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Get Smart Sites - 2004
Program Funded
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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 Farm
Educational Activities to Promote Appropriate Use
of Antimicrobial Agents in Animal Health
• Veterinary Curriculum
• State-based
Interventions
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Veterinary Curriculum
• Enhance veterinary education in
antimicrobial resistance
• Promote appropriate use of antimicrobial agents
in veterinary medicine
• 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, RN
Project Coordinator:
Ron Wohrle, DVM
Advisory 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
Washington
Dairy Farms
July 2003
Endorsed by the
Washington State
Dairy 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 WAY
OF 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) selfadministered 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
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