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Antibiotic Use in Farm Animals: Supporting Behavioural Change of Veterinarians and Farmers

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Antibiotic Use in Farm Animals: Supporting Behavioural Change of Veterinarians and Farmers Antibiotic use in farm animals: supporting behavioural change of veterinarians and farmers David Speksnijder Antibiotic use in farm animals: supporting behavioural change of veterinarians and farmers © 2017, D.C. Speksnijder, Beuningen, the Netherlands Thesis, University of Utrecht, the Netherlands. All rights reserved. No part of this thesis may be reproduced, stored in a retrieval system or transmitted in any form or by any means without the permission of the author, or when appropriate, of the publishers of the publication. ISBN 978-94-6182-786-9 Printing Offpage, Amsterdam Lay out David Speksnijder Cover illustration & design Jedidja Speksnijder - Jung, Elianne Speksnijder Address for correspondence: D.C. Speksnijder, Department of Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht University. PO Box 80.165, 3508 TD Utrecht, the Netherlands. Phone: (31)30 253 4330, e-mail: [email protected] Antibiotic use in farm animals: supporting behavioural change of veterinarians and farmers Antibioticagebruik in landbouwhuisdieren; induceren van gedragsveranderingen van dierenartsen en veehouders (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof. dr. G.J. van der Zwaan, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op dinsdag 25 april 2017 des middags te 4.15 uur door David Christiaan Speksnijder geboren op 31 maart 1983 te Bergambacht Promotoren: Prof. dr. J.A. Wagenaar Prof. dr. Th.J.M. Verheij The studies in this thesis were financially supported by: ZonMW (Netherlands Organization for Health Research and Development), project no. 205100009. The printing of this thesis was financially supported by: Dpt. of Infectious Diseases & Immunology, Faculty of Veterinary Medicine, Utrecht AUV Veterinary Services, Cuijck St. Anna Advies, Nijmegen Dierenartsenpraktijk Tweestromenland, Wijchen Infection and Immunity Center Utrecht Contents Page Chapter 1 General introduction. Reduction of veterinary 7 antimicrobial use in the Netherlands. Chapter 2 Determinants associated with veterinary antimicrobial 19 prescribing in farm animals in the Netherlands: a qualitative study. Chapter 3 Attitudes and perceptions of Dutch veterinarians on their 39 role in the reduction of antimicrobial use in farm animals. Chapter 4 Opinions of veterinarians on antimicrobial use in farm 55 animals in Flanders and the Netherlands. Chapter 5 Impact of structural animal health planning on 71 antimicrobial use and animal health variables in conventional dairy farming in the Netherlands. Chapter 6 Structural animal health planning in dairy farming in the 91 Netherlands; short- and long-term effects on animal health and antibiotic use. Chapter 7 General discussion 105 Reference list 127 Summary 141 Nederlandse samenvatting 146 Dankwoord 151 About the author 154 Chapter 1 General Introduction This general introduction is an adaptation of the following manuscript: Reduction of veterinary antimicrobial use in the Netherlands. The Dutch success model. D.C. Speksnijder D.J. Mevius C.J.M. Bruschke J.A. Wagenaar Zoonoses and public health 2015, 62(s1), 79-87. General Introduction Abbreviations AHP: Animal Health Plan ATP: Animal Treatment Plan AGP: Antimicrobial Growth Promoter ESBLs: Extended Spectrum Beta-Lactamase producing bacteria HC: Dutch Health Council IKB: Integrated Chain Control; private quality assurance systems in the livestock sector KNMvD: Royal Dutch Veterinary Association LA-MRSA: Livestock Associated methicillin-resistant Staphylococcus aureus MoU: Memorandum of Understanding, signed between all stakeholders in 2008 PVE: Product Boards for Livestock, Meat and Eggs; public-private organization with legislative powers for the whole livestock sector SDa: Netherlands Veterinary Medicines Authority UDD: Administration by veterinarians only WVAB: Veterinary Antibiotic Policy Working Group Historical developments of veterinary antibiotic use The introduction of antibiotics in the second half of the 20th century has been of major importance in human and veterinary medicine. Veterinary antibiotic use increased from the 1950s onwards in the fast-developing modern livestock production systems (Manten 1963, EMEA 1999). In addition to therapeutic and preventive use, they were also applied as antimicrobial growth promotors (AGP) to increase the efficiency of animal production (McEwen, Fedorka-Cray 2002, van den Bogaard, Stobberingh 1999, McEwen 2006). The Swann Committee in 1969 was the first international body to raise serious concerns about extensive veterinary antibiotic use and increasing antibiotic resistance with related risks for human health care. Despite increasing knowledge about the potential impact of veterinary antibiotic use on public health, veterinary antibiotic use still increased during the following decades (EMEA 1999, van den Bogaard, Breeuwsma et al. 1994, Endtz, Ruijs et al. 1991). It took until 1986 when, as precautionary measure, Sweden was the first country in the world to ban all AGP use in animals (Wierup 2001). It was only in 1997 that the European Union (EU) banned the use of avoparcin as AGP in response to the finding of vancomycin resistant enterococci (VRE) in avoparcin fed pigs and poultry. The recommendations of the World Health Organization (WHO) in 1997 and the Copenhagen recommendations in 1998 regarding the use of non-therapeutic antibiotics in animals further accelerated EU policymaking which resulted in the withdrawal of specific AGPs in 1999 and a complete ban on all AGP use in animals by 2006 (Barton 2000, Cogliani C., Goossens H. et al. 2011, Mevius, Sprenger et al. 1999, World Health Organization 1997, Aarestrup 2005). 8 Chapter 1 Notwithstanding these European interventions, in the Netherlands the total sales of antibiotics for therapeutic veterinary use increased from an estimated 275 tons in 1990 to almost 600 tons in 2007, with the most prominent increase during and after the withdrawal of AGPs (Figure 1) (MARAN 2009, Pijpers, Fink-Gremmels et al. 1998). In 2007, the Netherlands was ranked as the highest veterinary antibiotic consumer out of 10 EU countries from which data were available (Grave, Torren-Edo et al. 2010). Parallel to the increase in use, the Monitoring of Antibiotic Use and Resistance in Animals in the Netherlands (MARAN) reported increasing antibiotic resistance levels in commensal E. coli isolates from farm animals between 1998 and 2009 (MARAN 2010). Turn of the tide In 2005, Livestock Associated-methicillin-resistant Staphylococcus aureus (LA-MRSA) was reported to be widely spread in the Dutch pig population with occupational transmission to humans (farmers, veterinarians). Dutch hospitals had controlled MRSA very successfully by restricted antibiotic use and strict infection control measures in the last decades. The sudden discovery of this formerly unknown and large MRSA reservoir was followed by societal and political pressure to reduce antibiotic use in farm animals (Voss, Loeffen et al. 2005). Discussions on the future of antibiotic use in farm animals between government and stakeholders of the livestock industry resulted in 2008 in the set-up of the Taskforce Antibiotic Resistance in Animal Husbandry. This taskforce comprised representatives from all parties within the animal production chain, the Royal Dutch Veterinary Association (KNMvD), the Ministry of Agriculture 1 (MoA) and the Ministry of Health (MoH). This Taskforce developed action plans per animal production sector (cattle, veal calves, poultry, and pigs) as part of a Memorandum of Understanding (MoU) with the aim to control antibiotic resistance in livestock (Letter to the Parliament 2008). The action plans aimed at detailed monitoring of antibiotic use at herd level, the monitoring of antibiotic resistance, a clear description of responsibilities of veterinarians and farmers in antibiotic prescribing and use, and the introduction of Farm Treatment Plans and Farm Health Plans. However, no strict targets or regulations for antibiotic use were formulated yet. Although the MoU was the basis for further discussions, it did not have a direct effect on the total veterinary antibiotic use in the following year (MARAN, 2010). The discovery of ubiquitous presence of Extended Spectrum Beta-Lactamase producing bacteria (ESBLs) on Dutch poultry meat in 2009 and a possible relationship with a human casualty was widely disseminated in the media in 2010 and led to serious public concerns (Leverstein-van Hall, Dierikx et al. 2011). A debate in parliament 1 Agriculture was till 2010 part of the Ministry of Agriculture, Nature and Food Quality. From 2010-2012 it was part of the Ministry of Economic Affairs, Agriculture and Innovation. It is currently in the Ministry of Economic Affairs. Throughout this manuscript we use consequently ‘Ministry of Agriculture’. 9 General Introduction followed where the public health concerns of extensive use of antibiotics in farm animals were discussed. As a result, the government introduced a compulsory 20% and 50% reduction target in antibiotic use in farm animals in 2011 and 2013 respectively with 2009 as a baseline. These targets were supported by the livestock sectors (Figure 2) (Letter to the Parliament 2010). Sulfonamides growth (AGP) cephalosporins rs Antimicrobial promote Others Trimethoprim/ Fluoroquinolones Aminoglycosides Macrolides Tetracyclines Penicillins/ 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 Year 2005 2004 2003 2002 2001
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