CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour

CIPARSCIPARS Canadian Integrated Program for Antimicrobial Resistance Canadian Integrated Program for Antimicrobial Resistance SurveillanceSurveillance

Programme Canadien Intégré de Résistance aux AntimicrobiensProgramme Canadien Intégré de Résistance aux Antimicrobiens

PICRAPICRA... pour la préservation

d'antimicrob

iens efficaces p

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... pour la préservation d'antim

icrobiens e

fficaces pour l'hom

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et l'anim

al... pour la préservation

d'antimicrob

iens efficaces p

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icrobiens e

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... working towards the preservation of effective antimicrobials in humans and animals... working towards the preservation of effective antimicrobials in humans and animals... working towards the preservation of effective antimicrobials in humans and animals... working towards the preservation of effective antimicrobials in humans and animals

CIPARS On Farm Surveillance

ADED ROUNDSMay 22, 2007

Dave Léger, Sheryl Gow

Anne Deckert, Brent Avery

Laboratory for Foodborne Zoonoses,Laboratory for Foodborne Zoonoses,

Public Health Agency of Canada,Public Health Agency of Canada,

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CIPARS ObjectivesCIPARS Objectives• Unified approach to monitor trendsmonitor trends in

antimicrobial resistance and antimicrobial use in humans and animals

• Generate timely reportstimely reports

• Generate data to facilitate the assessment of the public health impactpublic health impact of antimicrobials used in human and agricultural sectors

• Allow accurate international comparisonsinternational comparisons with other countries that use similar surveillance systems (e.g. U.S. (NARMS) & Denmark (DANMAP)

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On – FarmAB, SK, MB, ON, QC

swine

HumanAntimicrobial Use

IMS Health

HumanNational

salmonellosis

AbattoirNational

beef/pork/chicken

VeterinaryLaboratories

salmonellosis

CIPARS Annual Reporthttp://www.phac-aspc.gc.ca/cipars-picra/index.html

RetailATL, ON, QC, SK, BC

beef/pork/chicken

VeterinaryAntimicrobial UseDistribution data

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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 ObjectivesOn-Farm Surveillance Objectives

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Background5 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

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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 2007Refined On-Farm Surveillance Framework 2007

Collaborating Veterinarians

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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

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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

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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

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Laboratory• Organisms of interest

– Salmonella• 1 isolate/sample• Typing performed

– E. coli• 5 isolates/sample (2006)• Generic E. coli

– Enterococcus• 3 isolates/sample• speciation

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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

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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

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268

155

123

277

286

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

• PHAC-LFZ Lab

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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

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Schematic: Sampling & Data Collection

WINTER SUMMER FALL

Pig #sRationsAM use

A1

B1A2

B2

Pig #sRationsAM use

Pig #sRationsAM use

Pig #sRationsAM use

Site InfoPig #sRationsAM use


Cohort Herds

Regular Herds

COHORT Arrival & CTM* Sampling Cohort sampling is conducted only once/year in any one of the three sampling seasons

A1

B1

A2

B2


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 #sRationsAM use

Composite faecal samples from CTM* Cohort pens. Collected & submitted by the VET. *CTM = Close-To-Market, pigs > 175 Lbs

Sampling Seasons

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0

10

20

30

40

50

60

70

80

90

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

2006

Nu

mb

er

of

Sa

mp

les

Su

bm

itte

d

Cohort Arrival Cohort Close-To-MarketRegular Close-To-Market

Sample Submissions by Sample Type

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Samples & Isolates - 2006Sampling Actual/Planned (%)

Number of herd visits completed / Planned 287/324 (89%)

Annual Questionnaires returned 65/108 (60%)

Sampling Day Questionnaires returned 89/432 (21%)

Cohort Arrival Samples 93/126 (74%)

Cohort Close-To-Market (CTM) Samples 92/126 (74%)

Regular Close-To-Market Samples 257/306 (84%)

Total Samples Received (% Planned) 442/558 (79%)

Positive Samples

E.coli recovery 442/442 (100%)

Salmonella recovery 92/442 ( 21%)

Enterococcus recovery 363/442 ( 82%)

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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

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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

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Schematic: Reporting & Analysis

***2007 Questionnaire Data Entry - Ongoing

WINTER / SPRING SUMMER FALL

Herd specific reports• Vets & ProducersSummary• Provincial MAF• Pork Boards• Advisory Committee

ReceivedIsolation

& AMR DatafromLabs

QuestionnaireDatabase

development & Data entry

AMU dataManipulation& Analysis

Receive Isolation& AMR Data forJan – Jun 2007

Herd specific reports• Vets & ProducersSummary• Provincial MAF• Pork Boards• Advisory Committee

AMRData

Manipulation & Analysis

AMRData

Manipulation & Analysis

AMU dataManipulation& Analysis

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HerdLevelHerdLevel

PenLevelPen

Level

Antimicrobial Use

Active Surveillance on Sentinel Farms

Sampling: Faecal

SiteInformation

SiteInformation

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 inon-farm food safety HACCP

Clinical Practice Guidelines

On-Farm AMU Protocols

Public health AMR recognized as a hazard inon-farm food safety HACCP

CompositePen Samples

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Future plans

• Sustainable funding

• Expansion into other commodities– Current research projects

• Feedlot beef cattle• Dairy cattle

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Laboratory for Foodborne ZoonosesPublic Health Agency of Canada

[email protected] Tel: (519) 826-2275

[email protected]: (306) 966-2232

[email protected] Tel: (519) 826-2354

[email protected]: (519) 826-2160

Contact InformationContact Information

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•CIPARS 2005 - Preliminary Results-CIPARS 2005 - Preliminary Results-• http://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.htmlhttp://www.phac-aspc.gc.ca/cipars-picra/2005_pr_e.html

• CIPARS 2005- Additional data CIPARS 2005- Additional data (Recovery (Recovery rates)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 WebInformation on the Web

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Documents

CIPARS Canadian Integrated Program for Antimicrobial Resistance Surveillance Programme Canadien Intégré de Résistance aux Antimicrobiens PICRA... pour