Monitoring antimicrobial usage in companion animals: exploring the use of the Danish VetStat database.

BACKGROUND: In the Danish Veterinary Statistics Program, VetStat, sales data on medicinal products prescribed for veterinary consumption is collected. The Danish Food and Veterinary Administration (DVFA) manages the database and each purchase contains detailed product-specific information linked with a species-specific ID. National surveillance systems are also implemented or being developed in the other European Union Member States. By 2029, all Member States are required to report data on antimicrobial usage for companion animals to the European Medicines Agency. This study aimed to assess the challenges encountered when using the VetStat database to quantify antimicrobial use in Danish companion animals. Raw VetStat data were propagated by the DVFA and originated from veterinary practitioners and Danish pharmacies. RESULTS: Comprehensive estimates of antimicrobial use in Danish companion animals were not readily available due to database construct. Antimicrobials sold for use in companion animals (linked to a companion animal ID) comprised a large number of products licensed solely for horses or livestock, while data assigned a replacement code encompassed both topical and peroral antimicrobials licensed for companion animals. Additionally, antimicrobials sold from pharmacies to veterinary practitioners presented the biggest challenge in data retrieval and validation. Treatment data are only transferred to VetStat through the billing systems when Danish veterinarians are treating livestock, but not companion animals. Information on products sold for in-house use in companion animals is only available from pharmacy records without a species-specific ID. As a result, parenteral antimicrobials with multi-species authorization utilized by small animal veterinary practitioners are not accounted for in the overall estimate for companion animals. CONCLUSIONS: Owing to the database structure and requirements for data entry, antimicrobial use in companion animals is an approximation. The actual consumption may be significantly higher than what is currently calculated from the database, as the majority of parenteral products are not included. Consumption data can be measured more accurately provided treatment data from veterinary practitioners in small or mixed practices are transferred to the database through the billing system. This would equal the legal requirements for Danish veterinary practitioners treating livestock.

Herd typologies based on multivariate analysis of biosecurity, productivity, antimicrobial and vaccine use data from Danish sow herds.

The use of antimicrobials in livestock constitutes an increasing global concern, and many countries pursue approaches to reduce the amount used, particularly in the pig production industry. The EU Commission has decided, due to environmental concerns, to phase out use of zinc oxide in pigs by 2022. This poses an additional challenge to efforts to reduce antimicrobial use (AMU) in European pig production. The pig production sector needs further information about how to comply with official AMU requirements without losing competitiveness. The most efficient approaches are likely to involve a combination of multiple factors. Therefore, the objective of this study was to explore multidimensional associations between biosecurity, productivity, vaccination and AMU. A cross sectional study was conducted using data from 160 Danish sow herds in 2014-2015. Biosecurity data were collected through computer-assisted telephone interviews using a pre-developed questionnaire (Biocheck.UGent®) supplemented with additional country-specific questions and translated into Danish. Herd-specific data, consisting of antimicrobial prescriptions, purchase of vaccines against five endemic infections, herd health status and one productivity measure (i.e. number of weaned piglets per sow per year) were extracted from various databases. Factor analysis was conducted on a subset of the data from 152 herds with sufficiently complete data. The identified factors were explained by evaluating data from herds with extreme loadings on the respective factor. The results were further discussed based on plots combining herd factor loadings on two factors at a time. Four factors were selected based on the break-point in the scree-plot. Factor 1 included herd type, herd size, and age of farm buildings. Factor 2 covered general biosecurity, including several internal and external biosecurity measures. Factor 3 represented preventive measures implying specific focus on avoiding introduction of ASF by foreign employees. Lastly, Factor 4 covered vaccination status, specifically regarding vaccination against Mycoplasma hyopneumoniae and Porcine Reproductive and Respiratory Syndrome virus. These factors were used to group the 152 sow herds into herd typologies. Feasible strategies aimed at improving health by reducing AMU without hampering animal welfare were identified and discussed for each typology. AMU and productivity correlated only weakly with other variables. This is probably due to limited variability in both these variables in study herds, which might be attributed to official restrictions on AMU, and a general high level of health and biosecurity in Danish sow herds.

Additive Bayesian Network analysis of associations between antimicrobial consumption, biosecurity, vaccination and productivity in Danish sow herds.

In modern livestock farming, there is an increasing understanding that antimicrobial (AM) consumption must be kept low - preferably without compromising animal welfare or productivity. This requires an understanding of the relationship between AM use, productivity, biosecurity, vaccination and herd demographics. To obtain this, we undertook an Additive Bayesian Network analysis using data from 2014 to 2015, covering 157 Danish sow herds with weaners. In general, productivity and biosecurity were high, and AM consumption low. No association was found between prescribed AM and productivity. Other variables, such as biosecurity and enrolment in the Danish Specific Pathogen Free (SPF) system, had stronger associations with sow productivity than AM consumption. In the weaner unit, an association between AM consumption and certain vaccination practices was found, suggesting that vaccines might be used to control preexisting problems. The results reveal that most Danish sow producers are able to maintain productivity while using low amounts of AMs. This conclusion must be interpreted within the context of Danish pig farming i.e. generally high biosecurity and many years of official restrictions aiming at reducing AM consumption.

Antimicrobial prescription data in Danish national database validated against treatment records in organic pig farms and analysed for associations with lesions found at slaughter.

BACKGROUND: Antimicrobial use (AMU) in livestock is a debated topic, mainly due to the risk of associated development of antimicrobial resistance. There is focus on reducing AMU in the Danish pig production, which accounts for the largest proportion of AMU for animals in Denmark. Due to special restriction on AMU in organic pig production, the AMU in organic pig production is lower than in conventional pig production. There is concern that reduced AMU could jeopardize animal health and welfare, if it reflects insufficient treatment of sick animals, which might be reflected by the prevalence and types of lesions found at meat inspection. However, little is known about the associations between AMU and meat inspection findings in pigs from organic farms. Furthermore, excess amount of antimicrobial product after a treatment cannot be re-prescribed in organic pig herds. The initial prescription is recorded in the national database VetStat, but the unused amount is not deducted leading to uncertainty when reporting AMU. The objectives of this study were to 1) describe AMU patterns based on prescription data for organic pig production and compare with those of the conventional pig production for year 2016, 2) study the associations between herd-level AMU prescription data and meat inspection data for organic pig herds and 3) validate herd-level AMU prescription data in VetStat against treatment records collected on-farm in organic Danish pig herds. RESULTS AND CONCLUSIONS: Gastrointestinal indications account for the largest proportion of AMU in both organic pig herds (65 and 54% of treatment doses for weaners and finishers, respectively) and conventional pig herds (80 and 68% of doses for weaners and finishers, respectively). A larger proportion is prescribed for respiratory indications in organic than conventional weaners and arthropathic indications in finishers. No associations between AMU and meat inspection data were found. This needs further investigation as the prevalence of lesions at slaughter was slightly (non-significantly) higher in herds with no registered AMU than with AMU prescriptions. Only 8 out of 31 herds had recorded their AMU sufficiently detailed to compare, and using VetStat as a proxy for AMU led to 9-88% overestimation of the actual use in 7 out of these 8 herds and 120% underestimation in one herd.

A register-based study on associations between vaccination, antimicrobial use and productivity in conventional Danish finisher pig herds during 2011 to 2014.

Reduction of antimicrobial use (AMU) in pigs is a priority to counteract development of antimicrobial resistance in animal and human pathogens. However, there is concern that Danish pig producers complying with official AMU restrictions might experience reduced herd health and productivity in the future, if alternative strategies are not available. Vaccination has been suggested as a strategy to prevent disease and minimise the need for antimicrobial treatments. The aim of this register-based study was to assess the associations between data on vaccination, productivity and AMU in Danish finisher herds over a 4-year period following initiation of the Yellow Card, which is a restrictive AMU control scheme. For each of the years 2011 to 2014, sow herds were grouped according to purchase patterns regarding Porcine Circovirus Type 2 (PCV2) (use/no use). For the sow herds (N = 179-433), additional information of purchases of vaccines against Mycoplasma hyopneumoniae (MYC), Actinobacillus pleuropneumoniae (APP), Porcine Reproductive and Respiratory Syndrome virus (PRRS) and Lawsonia intracellularis (LAW) was included. By use of movement data, finisher herds receiving pigs from the sow herds were tracked and included in the analyses. Finisher herds (N = 40-62) with register data on productivity (i.e. average daily weight gain, feed conversion rate, mortality and lean meat percentage) and data on prescriptions of antimicrobials measured in Animal Daily Doses/100 finishers/day as well as the proportion of parenteral AMU treatments out of all treatments (AMU-ratio) were included. Univariable combinations were tested for statistically significant associations (P < 0.05) and included in multivariable linear mixed-effects model for each of the six outcome variables representing productivity (N=4) or AMU (N=2). Herd number was included as a random effect to account for the herds appearing more than once. The variables representing PCV2, enrolment in the Danish Specific Pathogen Free (SPF) system, year, herd type and herd size were included as potential confounders. Vaccination against PRRS and higher AMU for finishers were associated with increased lean meat percentage, potentially due to disease outbreaks resulting in reduced growth of the pigs and lower carcass weight at slaughter in herds with PRRS. None of the other types of vaccines was associated with any of the productivity outcomes. Vaccination against PCV2, PRRS and APP were associated with higher levels of AMU, and vaccination against LAW with a higher AMU-ratio. This may be explained as some farmers preferring to take action soon after observing disease problems. No association was found between vaccination against MYC and AMU. Herds enrolled in SPF had significantly higher average daily weight gain than non-SPF herds.

No Clear Effect of Initiating Vaccination against Common Endemic Infections on the Amounts of Prescribed Antimicrobials for Danish Weaner and Finishing Pigs during 2007-2013.

It is often stated that vaccines may help reduce antimicrobial use in swine production. However, limited evidence is available outside clinical trials. We studied the change in amounts of antimicrobials prescribed for weaners and finishers in herds following initiation of vaccination against five common endemic infections: Mycoplasma hyopneumoniae, Actinobacillus pleuropneumoniae, porcine circovirus type II, porcine reproductive and respiratory syndrome virus, and Lawsonia intracellularis. Comparison was made to the change after a randomly selected date in herds not vaccinating against each of the infections. Danish sow herds initiating vaccination during 2007-2013 were included (69-334 herds, depending on the analysis). Danish sow herds with no use of the vaccine in question were included as non-exposed herds (130-570 herds, depending on the analysis). Antimicrobial prescriptions for weaners in sow herds and for finishers in receiving herds were extracted from the VetStat database for a period of 12 months before and 6-18 months after the first purchase of vaccine, or random date and quantified as average animal daily doses (ADDs) per 100 animals per day. The herd-level difference between ADD in the period after and before vaccination was the outcome in linear regression models for weaner pigs, and linear mixed-effects models for finishing pigs, taking into account sow herds delivering pigs to two or more finisher herds. Three plausible risk factors (Baseline ADD, purchase of specific vaccine, purchase of other vaccines) and five confounders (herd size, export and herd health status, year and season) were initially considered in all 10 models. The main significant effect in all models was the Baseline ADD; the higher the Baseline ADD was for weaner and finishing pigs, the larger the decrease in ADD was following vaccination (or random date for non-vaccinating herds). Regardless of vaccination status, almost equal proportions of herds experienced a decrease and an increase in ADD resulting in no overall Change in ADD. Furthermore, only minor effects were found, when vaccinations were used in combination. In conclusion, this study provided little support for the hypothesis that vaccination against five common endemic diseases provides a plausible general strategy to reduce antimicrobial use in Danish pig herds.

Comparison of the antimicrobial consumption in weaning pigs in Danish sow herds with different vaccine purchase patterns during 2013.

BACKGROUND: There is growing concern about development of antimicrobial resistance due to use of antimicrobials (AMs) in livestock production. Identifying efficient alternatives, including vaccination, is a priority. The objective of this study was to compare the herd-level amount of AMs prescribed for weaner pigs, between Danish sow herds using varying combinations of vaccines against Porcine Circovirus Type 2 (PCV2), Mycoplasma hyopneumoniae (MYC) and Lawsonia intracellularis (LAW). It was hypothesised that herds purchasing vaccines, use these to prevent disease, and hence reduce their AM consumption, compared to herds purchasing fewer or no vaccines against these pathogens. Data summarised over year 2013 were obtained from the Danish Central Husbandry Register and the Danish VetStat database, in which prescriptions of medication are recorded. All one-site indoor pig herds with >50 sows and >200 weaners were selected. AMs prescribed for weaners was measured in animal daily doses (ADD) and divided according to three indication groups (gastro-intestinal, respiratory indication or total use). The analysis was based on three multivariable linear regression models of the herd-level ADD for each indication group. The eight vaccination combinations (2x2x2) were included as one explanatory variable, and herd size, measured as the number of weaner pen places was included in the models as a potential confounder. RESULTS: Out of the 1513 herds in the study, 1415 had AMs prescribed for gastro-intestinal disorders, and 836 for respiratory disorders. PCV2 vaccines were purchased in 880 herds, MYC vaccines in 787 and LAW vaccines in 115 herds. Herds purchasing PCV2 and MYC vaccines had significantly more AMs prescribed than herds not purchasing vaccines or only purchasing LAW vaccines. CONCLUSION: In the present study, using register data covering 1 year, we found an association between use of vaccination and increased amount of AMs prescribed for weaners. This does not exclude that the vaccines work, just that we were unable to detect this. The findings might be explained by some herds experiencing clinical problems associated with MYC or PCV2 despite use of vaccination. In other herds, it might reflect that vaccines applied to weaners are used for disease prevention in finishers rather than in the weaners. Information about vaccination protocols and herd health status was not available at the time of the study. Hence, further studies are required to investigate causality of the associations between use of AMs, vaccination practices and other confounding on-farm factors.

Assessment of human health risk associated with pyaemia in Danish finisher pigs when conducting visual-only inspection of the lungs.

The most important lesion to be overlooked when performing visual-only inspection of the lungs is embolic pneumonia. The aim of the present study was to assess the additional human health risk represented by overlooking cases of pyaemia represented by embolic pneumonia in finisher pigs, when conducting visual-only compared to palpation of the lungs, as is the traditional meat inspection procedure. An examination of bacteria isolated from 19 finisher pigs identified with embolic pneumonia at traditional meat inspection was undertaken. From each pig samples were taken from various organs (lungs, spleen, heart, liver and kidney), from the carpal joints (A. carpi) and flexor muscle (M. flexor digitorum superficialis) on the right foreleg. These data were included in a risk assessment following OIE guidelines. Bacteria were isolated from 78 out of 127 tissue and swap samples taken (61% positive samples). Staphylococcus aureus (N=37) was the most frequently isolated bacterium. The predominant site of S. aureus was the lung. S. aureus was detected although less frequently in low numbers in some organs (<100CFU/sample) and muscle samples (<10CFU/sample). Only one MRSA isolate was found. Staphylococcus warneri (N=24) was the second most commonly found bacterium. There was no predominant site and the number of S. warneri was less than 50CFU per sample. The risk of a food-borne intoxication from S. aureus in relation to pyaemia in pigs was considered very low due to the low quantitative numbers of S. aureus in muscle tissue samples. Implementing visual-only inspection will reduce the exposure of S. aureus due to less cross-contamination and handling of the plucks by the meat inspectors. The human health risk associated with S. warneri was considered very low, due to the limited zoonotic potential of this bacterium. In conclusion, the additional human health risk in relation to possibly overlooking pyaemia in Danish finisher pigs was considered negligible when conducting visual-only compared to traditional meat inspection.