1. 1 December 2014 Working across sectors: a public health approach to to antimicrobial resistance

2. 2 December 2014 Antibiotic use: use in plants, fish and animals Washington,11 Oct. (IPS) – More than half of the antibiotics used in the United States are estimated to be used in animal feed for poultry, hogs, and cattle. In 80 percent of cases, the drugs are used to fatten the animals faster. Between 40,000 and 50,000 pounds of tetracycline and streptomycin - both used to treat infections in humans - are sprayed to control bacterial disease among fruit trees. In the United States nearly 150 pounds of antibiotic are applied per acre of salmon US: OVER-USE OF ANTIBIOTICS THREATENS HUMANS by Danielle Knight Source: Inter Press Service

3. 3 December 2014 Antibiotic consumption in animals, 2000 Source: Follet,G (2000) Agbioforum

4. 4 December 2014 Primary effects sought from antibiotic growth promoters increased growth improved feed efficiency lower incidence of certain diseases Source. Doyle E, Food Research Institute, University of Wisconsin

5. 5 December 2014 European ban on the use of antibiotic growth promoters, 1998 - 2006

6. 6 December 2014 Antibiotics: therapeutic use and growth promotion, pigs, Denmark 1992 - 2008 Mg/kg Source: Aarestrup F. Danish Government

7. 7 December 2014 Annual antibiotic use for human and veterinary practice in Denmark

8. 8 December 2014 Success factors, Danish ban on growth promoters

9. 9 December 2014 Estimated antimicrobial use to produce on kilogram of meat Source: Grave K, Torren-Edo J, Mackay D. Comparison of the sales of veterinary antibacterial agents between 10 European countries. Journal of Antimicrobial Chemotherapy, 2010, 65(9):2037-40.

10. 10 December 2014 Antibiotic use in animal husbandry Source: New England Journal of Medicine, 1999

11. 11 March 2013 Antimicrobial resistance at animal/human interface: US awareness campaign

12. 12 December 2014 Macrolide use and enterococcal resistance in pigs, Denmark Source: Statens Serum Institut, Danish Veterinary and Food Administration, Danish Medicines Agency, NationalVeterinary Institute and National Food Institute, Technical University of Denmark.

13. 13 December 2014 Cephalosporin resistance after stopping use in poultry, Quebec, Canada Source: Dutil L et al. Ceftiofur resistance in Salmonella enterica serovar Heidelberg from chicken meat and humans, Canada. Emerging Infectious Diseases, 2010, 16(1):48-54.

14. 14 December 2014 Fireblight (), fruit trees, USA 1994 Fireblight (Erwinia amylovora), fruit trees, USA 1994 Source: McManus L, American Phytological Society, 1994

15. 15 December 2014 Microbial-resistant plant agriculture

16. 16 December 2014 *Bacterial resistance, aquaculture sludge, Puget Sound, 1992 Aquaculture Puget Sound *pseudomonads, E.coli,enterobacter,enterococci, other

17. 17 December 2014 Vaccination in aquaculture, US and Norway

18. 18 December 2014 Antimicrobial use and salmon/trout production, Norway, after introduction of vaccination, 1994 Source: FAO/OIE/WHO Expert consultation on antimicrobial use in aquaculture and antimicrobial resistance, 2006

19. 19 December 2014 Complexity of the antimicrobial web Source:Cantas l.Front. Microbiol., 14 May 2013 |

20. 20 December 2014 Antimicrobial resistance: two independent mechanisms Selection pressure: over/under-use of antimicrobials Plasmid exchange: environmental exposure to other organisms

21. 21 December 2014 Principal transfer pathways, antibiotic resistance genes: humans, animals, food and the environment Source: DARC/ARHAI joint report, UKI Plants

22. 22 December 2014 Risks at animal/animal and animal/human interface

23. 23 December 2014 Reservoirs of bacteria causing human infections Source: WHO

24. 24 December 2014 Multidrug-resistant Definitive Type (DT) 104 Salmonella Typhimurium, Europe, 1982-1996 Salmonella Typhimurium isolates from both cattle and humans % 0 10 20 30 40 50 1982-851986-901991-941995-96 cattlehumans Source: WHO from published data

25. 25 December 2014 Clinician-perceived contribution(%) of individual bacteria species, EU 2000 Source: Bywater and Casewell: J Antimicrobial Chemotherapy, 2000

26. 26 December 2014 Possible alternatives to growth promoters Alternative husbandry practices leading to cleaner agriculture Probiotics (e.g. lactic acid bacteria) and competitive exclusion of other organisms Organic acids (Acidifers) to acidify feed and encourage growth of lactobacilli – PH monitoring/rumen chip technology Gastrointestinal enzymes to increase digestability of feed Immune modulators to enhance resistance to infection Feed supplements (vitamins, protein supplements and minerals) Nitric Oxide and respiratory disease - stressed animals Source. Doyle E. Food Research Institute, University of Wisconsin

27. December 2014 27 Putting it all together: antimicrobial resistance in animals, plants and fish Increased public awareness Clean agriculture Use existing vaccines Work across sectors Regulation with enforcement Monitoring effectiveness of above and other interventions Research and development - newer technologies, point of care diagnostics, vaccines Select/hybridise/engineer microbial-resistant plants Consider an international treaty Do the bottom line mathematics

28. 28 December 2014 The bottom line: do the maths Human + antibiotic = saved life Food animal, fish and plant + antibiotic = saved life + rapid growth, and equal or increased profit

29. 29 December 2014 Leading infectious causes of mortality, 2008 estimates, with smallpox 1967 Deaths (millions) < 5 years old > 5 years old 0 0.5 1.0 1.5 2.0 2.5 3.0 3.5 ARI AIDS Diarrhoea TBMalariaMeasles Smallpox 1967