1. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals CIPARS On Farm Surveillance ADED ROUNDS May 22, 2007 Dave Léger, Sheryl Gow Anne Deckert, Brent Avery Laboratory for Foodborne Zoonoses, Public Health Agency of Canada,

2. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 2 CIPARS Objectives monitor trendsUnified approach to monitor trends in antimicrobial resistance and antimicrobial use in humans and animals timely reportsGenerate timely reports public health impactGenerate data to facilitate the assessment of the public health impact of antimicrobials used in human and agricultural sectors international comparisonsAllow accurate international comparisons with other countries that use similar surveillance systems (e.g. U.S. (NARMS) & Denmark (DANMAP)

3. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 3 On – Farm AB, SK, MB, ON, QC swine Human Antimicrobial Use IMS Health Human National salmonellosis Abattoir National beef/pork/chicken Veterinary Laboratories salmonellosis CIPARS Annual Report http://www.phac-aspc.gc.ca/cipars-picra/index.html Retail ATL, ON, QC, SK, BC beef/pork/chicken Veterinary Antimicrobial Use Distribution data

4. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 4 Primary Objectives Establish infrastructure to support a national on-farm surveillance program Provide on-farm data on antimicrobial use and resistance Secondary Objective Investigate associations between antimicrobial use and resistance Long-term Objective Provide sound data for human health risk assessments On-Farm Surveillance Objectives

5. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 5 Background 5 yr Agricultural Policy Framework Funding Year 1 (2003-04) –Consultations: Provinces, pork/beef/poultry industry –Supported On-Farm AM use & resistance research Year 2 (2004-05) –Selected swine industry to pilot CIPARS On-Farm –Surveillance Framework Design Process initiated Year 3 (2005-06) & Year 4 (2006-07) –Implement and refine the On-Farm swine program –Data analysis and reporting

6. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 6 CIPARS On-Farm Working Group On-Farm Swine Advisory Committee DRAFT On-Farm Surveillance Framework Document Expert Review Panel Surveillance Framework Design Process On-Farm Surveillance Implementation Framework Document Producer/Vet Sub-Committee Refined On-Farm Surveillance Framework 2007 Collaborating Veterinarians

7. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 7 Inclusion / Exclusion criteria Inclusion criteria –CQA ® validated operations –Operations marketing >2000 hogs/year –Operations representative of the veterinary practice Exclusion criteria –Organic herds –Edible residual material herds –Pasture raised herds

8. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 8 108 Sentinel Sites across 5 Provinces Swine farms with grower/finisher units Major pork provinces: Québec, Ontario, Manitoba, Saskatchewan and Alberta 29 Swine Veterinarians Protect biosecurity and confidentiality Collect antimicrobial use data and faecal samples 2 Supervisory Veterinarians Protect confidentiality of corporate farms Operational Support PHAC Guelph & Saskatoon General Infrastructure

9. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 9 4 Laboratories PHAC-LFZ Labs –Saint-Hyacinthe QC –Guelph ON  Salmonella typing (PHAC-LFZ, Guelph) AF Lab, Edmonton AB Prairie Diagnostics Services, Regina SK Primary Isolation & Antimicrobial susceptibility testing (Sensititre ®, Trek Diagnostic Systems, Cleveland, OH, USA) Laboratory Infrastructure

10. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 10 Laboratory Organisms of interest –Salmonella 1 isolate/sample Typing performed –E. coli 5 isolates/sample (2006) Generic E. coli –Enterococcus 3 isolates/sample speciation

11. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 11 Compensation Veterinarians –Data and sample collection $200/visit –Travel $45/visit –To be incorporated with regular herd health visits Producers –Data preparation $200/visit ~40% of total operating dollars goes to compensation

12. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 12 Veterinary Model Why did we go with veterinarian? –Biosecurity –Knowledge of farm practices –Producer confidentiality –Producer trust/confidence Sustainability of this model –Uncertain –Alternatives to the veterinarian

13. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 13 26 8 15 5 12 3 27 7 28 6 Nationally: 108 Herds 29 Vets Distribution of Sentinel Herds & Vets Allocation of herds per province is proportional to the number of Grower/Finisher Units in each province 10 additional herds in AB & SK – Provincial APF funding AF Lab PDS Lab PHAC-LFZ Lab 5151

14. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 14 Data & Information Generated Sentinel herd data Demographic –Operation characteristics –Pig Inventory –Disease Antimicrobial Use –Qualitative: active ingredient, route –Quantitative: active ingredient, route, amount Antimicrobial Resistance –E.coli, Enterococcus and Salmonella –NARMS Panels - 15 antimicrobials

15. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 15 Schematic: Sampling & Data Collection WINTERSUMMERFALL Pig #s Rations AM use A1A1 B1B1 A2A2 B2B2 Pig #s Rations AM use Pig #s Rations AM use Pig #s Rations AM use Site Info Pig #s Rations AM use Site Info Pig #s Rations AM use Cohort Herds Regular Herds COHORT Arrival & CTM* Sampling Cohort sampling is conducted only once/year in any one of the three sampling seasons A1A1 B1B1 A2A2 B2B2 Site Info Pig #s Rations AM use Composite faecal samples from Regular CTM* pens; Collected & submitted by the VET. Composite faecal samples from Cohort pens on arrival. Collected & submitted by the PRODUCER. CTM Sampling Day Questionnaires: Herd & Site Info. (winter only) Sampling Day Information All-In-All-Out & Cont. Flow versions Pig #s Rations AM use Composite faecal samples from CTM* Cohort pens. Collected & submitted by the VET. *CTM = Close-To-Market, pigs > 175 Lbs Sampling Seasons

16. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 16 Sample Submissions by Sample Type

17. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 17 Samples & Isolates - 2006 Sampling Actual/Planned (%) Number of herd visits completed / Planned287/324 (89%) Annual Questionnaires returned65/108 (60%) Sampling Day Questionnaires returned89/432 (21%) Cohort Arrival Samples93/126 (74%) Cohort Close-To-Market (CTM) Samples92/126 (74%) Regular Close-To-Market Samples257/306 (84%) Total Samples Received (% Planned)442/558 (79%) Positive Samples E.coli recovery442/442 (100%) Salmonella recovery92/442 ( 21%) Enterococcus recovery363/442 ( 82%)

18. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 18 2006 isolate yield generic E. coli isolates (5/sample): 2,095 Salmonella isolates (1/sample): 85 Enterococcus isolates (3/sample): 1,043 2007 Projected isolate yield 732 samples generic E. coli isolates (3/sample): 2,196 Salmonella isolates (1/sample): 293 Enterococcus isolates (3/sample): 1,757 Samples & Isolates

19. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 19 Refinements for 2007 Modified data collection instruments –Simplified Questionnaires –Minimal use of CQA records –Sampling Day specific checklists –Tracking system –Data management tools developed – DEXA – DB – SA Modifications to sampling –Reduced number of cohort herds to 25% (PQ 100% Cohort herds – Provincially funded) –Reduced number of E. coli isolates per sample to 3 isolates

20. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 20 Schematic: Reporting & Analysis ***2007 Questionnaire Data Entry - Ongoing WINTER / SPRINGSUMMERFALL Herd specific reports Vets & Producers Summary Provincial MAF Pork Boards Advisory Committee Received Isolation & AMR Data from Labs Questionnaire Database development & Data entry AMU data Manipulation & Analysis Receive Isolation & AMR Data for Jan – Jun 2007 Herd specific reports Vets & Producers Summary Provincial MAF Pork Boards Advisory Committee AMR Data Manipulation & Analysis AMR Data Manipulation & Analysis AMU data Manipulation & Analysis

21. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 21 Herd Level Herd Level Pen Level Antimicrobial Use Active Surveillance on Sentinel Farms Sampling: Faecal Site Information Lab Analysis Salmonella E. coli Enterococcus Antimicrobial Resistance Patterns MDR strains Human Imp. Qualitative & Quantitative Kgs Active Ingred. Animal Daily Dose /Animal-time Operation & Management Characteristics Data Analysis & Reporting Risk-Based Policy Clinical Practice Guidelines On-Farm AMU Protocols Public health AMR recognized as a hazard in on-farm food safety HACCP Clinical Practice Guidelines On-Farm AMU Protocols Public health AMR recognized as a hazard in on-farm food safety HACCP Composite Pen Samples

22. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 22 Future plans Sustainable funding Expansion into other commodities –Current research projects Feedlot beef cattle Dairy cattle

23. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 23 Laboratory for Foodborne Zoonoses Public Health Agency of Canada David_Leger@phac-aspc.gc.ca Tel: (519) 826-2275 Sheryl_Gow@phac-aspc.gc.ca Tel: (306) 966-2232 Brent_Avery@phac-aspc.gc.ca Tel: (519) 826-2354 Anne_Deckert@phac-aspc.gc.ca Tel: (519) 826-2160 Contact Information

24. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 24 CIPARS 2005 - Preliminary Results-CIPARS 2005 - Preliminary Results- http://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.html http://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.html CIPARS 2005- Additional data (Recovery rates) CIPARS 2005- Additional data (Recovery rates) http://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.htmlhttp://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.html Information on the Web

25. CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour la préservation d'antimicrobiens efficaces pour l'homme et l'animal... working towards the preservation of effective antimicrobials in humans and animals 25