Antibiotic use in farm animals: supporting behavioural change of veterinarians and farmers

155 Pages·2017·2.73 MB·English

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: [phone],
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 Agriculture1 (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).
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