1. No category

Denmarks National Scheme
To Cut Antibiotic Use in
Livestock
Jan Dahl, DVM
Chief Advisor, DVM
Danish Agriculture and Food Council
Development over time
Some reflections on relevance
Denmarks National Scheme To
Cut Antibiotic Use in Livestock
Not a new thing – started 20 years ago
Legislation and industry initiatives
•  Laws
•  Voluntary bans
Focus on animal health many years before that
•  Pigs
—  SPF-system for pigs – 1968
Focus on pigs
•  Low use in cattle
•  Normally more than 95 % of broilers are not treated
Legislation
1994
Separation of sales and veterinary advice
Stop for use of generic tetracycline
2000
Vetstat
Stop for AGP’s
2000
Ban on fluoroquinolones
2010
Yellow card
Voluntary ban on 3. and 4. gen. cephalosporins
Industry initiatives
AGP’s
•  Voluntary stop finishers 1998
•  Voluntary total stop 2000
Cephalosporins
•  2010 voluntary stop for 3. and 4. generation cephalosporins
in the pig production
•  Not used for Danish broilers
•  Reduced use cattle
Separation of advise from sale of
antibiotics
Stop for use of generic tetracycline
Vet not allowed to sell antibiotics (except for 5 days
emergency treatment)
Health advisory contract between producer and vet
•  Vet writes prescription to producer
•  Pharmacy delivers the product
•  Producer can keep antibiotics for 35 days
Tetracycline became more expensive
Separation of sales
and advice
Stop for generics
Benefits
Removes incentive for overuse
Transparent pricing of advise and medicine
Farmers organisations and veterinary organisation
supported the change
Separation of sales
and advice
Stop for generics
Stop for AGP’s
Vetstat
Vet
Pharmacy
Producer
Data
Vetstat
Veterinary and Food
Adminstration
Effect of Vetstat
Statistics on antibiotics (and all other medicines)
• 
• 
• 
• 
On country level
On type of production-level
On farm level
On vet-level
No direct effect on usage
•  But necessary for the yellow card initiative
2010 Yellow card initiative
Herds with more than double the average
consumption
ADD – Animal daily doses
Placed under extra supervision
If not successful in reduction
•  Second opinion visit
•  Other restrictions can be inforced – reduction of production
level
Yellow card limits
Boars and sows
Weaners
Finishers
Doses per 100
animals per day
until May 2013​
5.2​
28.0​
8.0​
Doses per 100
animals per day
from June 2013
5.0
25.0
7.0
​Doses per 100
animals per day
from Dec 2014
​ 4.3
22.9
5.9
​
​
​
​
Yellow card
Yellow card
Doses of vaccines (x1,000)
Vaccine sales
6000
5000
4000
3000
2000
1000
0
3_2009
4_2009
1_2010
2_2010
3_2010
4_2010
1_2011
Year and quarter of year
Respiratory
Gastro-intestinal
PCV2-related
Critically important antibiotics
Restrictions on fluoroquinolones
•  Only for very specific indications
Voluntary ban on cephalosporins for pigs
•  Only for very specific indications
Other initiatives
Treatment guide made by the Veterinary and Food
Administration, universities, veterinary association
and industry
Increased tax on broad spectrum antibiotics
Probably limited effect
Animal health initiatives
•  Pigs
—  SPF-system for pigs – 1968
SPF-system
Managed and owned by the pig production
Declaration of all herds in the system
Control of all transport trucks
Visual control
Microbiological control
SPF
Declaration system
Close to 4000 herds declared
73 % the pigs born in the SPF-system
• 
• 
• 
• 
45 % PRRS positive
16 % AP2 positive
0.5 % swine dysentery positive
2 % Atrophic Rhinitis positive
Open declaration of all
participating herds
www.spf.dk/sus
Open to the public
Potential buyers
Neighbours
Information on SPF-status, Salmonella, PRRS
Effects on productivity and
health
Limited to no effect on productivity
But we may be at the limit
OBSERVATIONS AND
REFLECTIONS
Are we really focusing on the correct things?
Some thoughts based on Scandinavian data
European resistance issues
Staph. aureus bacteremia
Denmark (23 % mortality)
2500
2000
1500
1000
500
0
2007
2008
Staf-bakteriæmi
2009
2010
2011
MRSA-bakteriæmi
2012
2013
MRSA CC398 bakteriæmi
2014
MRSA CC 398 in Europe
Based on Dutch, Danish, Italian, Spanish, German
papers
Approximately 3 % of MRSA across Europe is CC398
Less than 1 % of staph-bacteremias
European resistance issues
Vancomycin-resistant
enterococci
No VRE in Danish meat or animals for years
European resistance issues
ESBL - Scandinavia
Danish, Norwegian and Swedish results
•  Not the same clones in humans and animals
•  Not the same genes in humans and animals
Conclusion
Use as much as needed and as little as possible
Today I am more worried about treatment effect on animals
But focus on what is more important than how much
Focus on animal health
•  Healthy animals do not need antibiotics
•  Research on solutions and not on