Ms. Susan Vaughn Grooters - Consumer Perceptions-Superbugs In Our Food Supply

Consumer Perception- Superbugs in the Food Supply

National Institute for Animal AgricultureSusan Vaughn Grooters, MPHResearch and Policy Associate

Kansas City, MO November 13th 2013

Center for Science in the Public Interest - CSPICSPI is a bi-national consumer advocacy organization founded in 1971 by Michael Jacobson, Ph.D.

Focuses on nutrition, health, and food safety

Publishes the award-winning Nutrition Action Healthletter

Approaching 1 million subscribers in the United States and Canada

Accepts no government or industry funding

CSPI Reports and Research

CSPI Activities

Strong Food Safety Laws

• FSMA

Petitions for Government Action

• USDA – Salmonella

Comments on Food Regulations

Collaborative work

• Safe Food Coalition• Make Our Food Safe• Keep Antibiotics Working

CSPI’s ResearchPolicyAdvocacy

Antibiotic Resistance in Foodborne Outbreaks -CSPI Report

Study of 55 Outbreaks in the U. S. 1973-2011

does not include the two Foster Farms assoc. outbreaks

Analyzes: Food Vehicle Etiology WHO categories Multi-drug resistance

Outlier – 1985 Samonella Typhimurium outbreak in pasteurized milk in which 16,659 were sickened, 2,777 were hospitalized, and 18 died

World Health Organization’s List of Critically Important Antibiotics

Aminoglycosides Streptomycin

Carbapenems

Cephalosporins (3rd and 4th generation Ceftriaxone

Macrolides

Fluoro- and other Quinolones Ciprofloxacin Nalidixic acid

Glycopeptides Vancomycin

Penicillins (natural aminopenicillins and antipseudomonals)

Amocicillin/claulanic acid Ampicillin Carbenicillin Penicillin

Source: http://apps.who.int

World Health Organization’s List of Highly Important Antibiotics

Amphenicols Chloramphenicol

Cephalosporins (1st and 2nd generation) and Cephamycins

Cephalothin Cefoxitin

Lincosamides

Streptogramins

Sulfonamides, et al. Sulfamethoxazole Sulfisoxazole

Tetracyclines

Source: http://apps.who.int

Antibiotic Resistant Bacteria and Foodborne Outbreaks St

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40

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Drug Resistance Profiles by WHO categories

Critically Important Highly Important Not classified on WHO's list

# o

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reaks

ABR Foodborne Outbreaks1970s

Year Location Bacteria Food/Source Cases Hosp Death Resistances Drug Family WHO Status

1973 ME S. Typhimurium Eggs 32 NR NR unknown

streptomycin aminoglycosides critically important

sulfamethoxazole sulfonamides highly important

tetracycline tetracycline highly important

1977 KY S. Typhimurium Raw milk 3 NR NR ampicillin penicillin critically important

carbenicillin penicillin critically important

kanamycin aminoglycosides highly important

penicillin penicillin critically important



1979 CA, OR S. Dublin Raw milk 39 NR NR unknown

NR27 NRGround beefMD, FL, CO

1975 S. Newport

ABR Foodborne Outbreaks 1980s


1980 MT S. Typhimurium Raw milk NR NR unknown

1983 AZ S. Typhimurium Raw milk 12 NR 1 ampicillin penicillin critically important

chloramphenicol amphenicol highly important



sulfonamide* sulfonamides highly important


1983 MN, SD, NE, IA S. Newport Ground beef 18 11 1 ampicillin penicillin critically important

carbenicillin penicillin critically important


1984 OR S. Typhimurium Salad bar 715 45 0 tetracycline tetracycline highly important


1985 CA S. Newport Ground beef 298 22 2 ampicillin penicillin critically important






1985 IL S. Typhimurium Pasteurized milk 16659 2777 18 ampicillin penicillin critically important





1987 GA S. Havana Chicken 73 36 1 tetracycline tetracycline highly important



1994 WI E. coli O153:H45 (ETEC)

Unknown, banquet food

205 NR NR ampicillin penicillin critically important


sulfisoxazole sulfonamides highly important


1995 AZ S. Stanley Alfalfa sprouts 19 5 NR kanamycin aminoglycosides highly important


trimethoprim-sulfamethoxazole

sulfonamides *

1996 NE S. Typhimurium DT104

Unknown, chocolate milk suspected

19 0 0 ampicillin penicillin critically important





1997 WA S. Typhimurium DT104

Mexican-style soft cheese (queso fresco) (raw milk)

89 5 0 amoxicillin/clavulanate

penicillin critically important

ampicillin penicillin critically important





1997 CA S. Typhimurium DT104

Mexican-style cheese (raw milk)

79 13 NR ampicillin penicillin critically important





ABR Foodborne Outbreaks 1990s cont.

1997 CA S.Typhimurium var Copenhagen DT104b

Mexican-style cheese (raw milk)

31 14 NR ampicillin penicillin critically important





1997 MD S. Heidelberg Pork 706 NR 2 kanamycin aminoglycosides highly important



1997 VT S. Typhimurium Raw milk 9 1 NR ampicillin penicillin critically important





1998 NY S. I 4,[5],12:i- Unknown, dinner reception multiple foods suspected






sulfonamides *

1998 KS Campylobacter jejuni

Unknown, gravy, potato, pineapple suspected

128 2 0 ciprofloxacin fluoroquinolone critically important

tetracycline tetracycline highly Important



2000 TN Staphylococcus aureus (MRSA)

Pork, barbeque, vegetable salad, cole slaw

3 0 0 methecillin penicillin *

2000 PA, NJ S. Typhimurium Pasteurized milk






2001 CT S. Newport Italian-style soft cheese (raw milk)

27 12 0 amoxicillin/clavulanate penicillin critically important


cefoxitin cephamycin highly important

ceftiofur cephalosporin (3G) *

cephalothin cephalosporin (1G) highly important





2001 WI E. coli O169:H41/ST (ETEC)

Quesadilla, fajitas, nacho chips, beans

21 0 0 tetracycline tetracycline highly important

2002 NY, MI, PA, OH, CT

S. Newport Ground beef 47 17 1 amoxicillin/clavulanate penicillin critically important



ceftiofur cephalosporin *






kanamycin (2/3 resistant)

aminoglycosides highly important

ceftriaxone (2) cephalosporin (3G) critically important


2002 OR E. coli O27:H7/ST (ETEC)

Chicken lasagna

49 0 0 streptomycin aminoglycosides critically important



2003 TN E. coli O169:H49 (ETEC)

Catfish, coleslaw

41 2 0 tetracycline tetracycline highly important

2003 9 states S. Typhimurium DT104

Ground beef 56 11 0 ampicillin penicillin critically important





2004 NV E. coli O6:H16 (ETEC)

Shrimp 130 0 0 ampicillin penicillin critically important


nalidixic acid quinolone critically important


sulfisoxazole sulfonamides highly important


sulfonamides *

2004 CA S. Newport Pasteurized milk

100 5 0 amoxicillin/clavulanate




ceftiofur cephalosporin (3G)

*

ceftriaxone cephalosporin highly important






2004 IL S. Newport Unknown 2 NR NR amoxicillin/clavulanate




ceftiofur cephalosporin (3G)

*







2004 MN S. Agona Sandwich, turkey

24 6 0 sulfonamide* sulfonamides highly important


2004 NY S. Istanbul Chicken 42 14 0 tetracycline tetracycline highly important

2005 MN S. Heidelberg Chicken 4 1 0 gentamicin streptomycin sulfonamide*

aminoglycosides aminoglycosides sulfonamides

critically important critically important highly important

2005 TN S. Heidelberg Unknown 19 2 0 gentamicin aminoglycosides critically important

nalidixic acid quinolone critically important



2005 IN, MI, MO, OH

S. Braenderup Tomato 84 8 0 ampicillin


gentamicin aminoglycosides critically important




2005 CO S. Typhimurium S. Newport

Unknown 100 1 0 amoxicillin/clavulanate penicillin critically important









2005 CO S. Typhimurium Sushi 25 0 0 amoxicillin/clavulanate penicillin critically important






sulfonamides *


2006 AR S. I 4,[5],12:i- Unknown 14 4 0 nalidixic acid quinolone critically important

2006 PA S. Typhimurium Queso fresco, unpasteurized; raw milk









2006 UT S. Typhimurium Root vegetable 3 NR NR amoxicillin/clavulanate penicillin critically important







2006 PA S. Schwarzengrund Unknown 6 0 0 amoxicillin/clavulanate penicillin critically important





2006 CA S. Newport Multiple foods 24 NR NR amoxicillin/clavulanate penicillin critically important


cefoxitin cephamycin highly importantceftiofur cephalosporin (3G) *






2006 IL S. Newport Unknown 9 3 0 amoxicillin/clavulanate penicillin critically important









2006 IL S. Newport S. Meleagridis

Mexican-style cheese (cotija), (raw milk)









2006 TN S. Hadar Unknown 9 1 0 streptomycin aminoglycosides critically important


2007 CA, AZ, ID, NV

S. Newport Ground beef 43 15 0 amoxicillin/clavulanate penicillin critically important




ceftriaxone cephalosporin critically important






2007 MN S. Newport Unknown 11 0 0 amoxicillin/clavulanate penicillin critically important









2009 7 states S. Typhimurium DT104

Ground beef 14 6 0 ampicillin penicillin critically important





2009 14 states S. Newport Ground beef 68 4 0 amoxicillin/clavulanate penicillin critically important









2009 AZ S. Newport Ground beef 2 NR NR amoxicillin/clavulanate penicillin critically important










2011 10 states S. Hadar Ground turkey (Jennie-O

12 3 0 ampicillin amoxicillin/clavulanate

penicillin penicillin cephalosporin

critically important critically important




gentamicin aminoglycosides critically important

2011 7 states S. Typhimurium Ground beef 20 8 0 amoxicillin/clavulanateampicillin

penicillin penicillin

critically important critically important

134 states2011 S. Heidelberg Ground turkey (Cargill)

136 37

Antibiotic Resistant Bacteria and Foodborne Outbreaks

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Outbreaks by Food Cat-egory

Num

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Antibiotic Resistant Bacteria and Foodborne Outbreaks

S. T

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OUTBREAKS BY ETIOLOGY

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* Multiple Salmonella serotypes implicated in two outbreaks

Antibiotic Resistant Bacteria and Foodborne Outbreaks O

ne

Two

Thre

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Five Six

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Individual Drug Resistances per Outbreak

Number of Ineffective Drugs

Nu

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Risk Management Concepts

Hazard resonably likely to occur (foundation of HACCP-based controls)

Known safety risk of a particular food (FDA FSMA)

Performance standards (contaminant specific and science-based); appropriate to reduce the risk of serious illness or death to humans or animals (FDA FSMA)

Prevention / Crisis Communication

What we are AIMING for :“An ounce of prevention is worth a pound of

cure”

What we too often HIT“Don’t let a good crisis go to waste”

Planning a response

Anticipating BSE’s emergence in North America started in 1996; emergence in the early 2000s

Result: Well researched risk communication

strategy and a clear statement of the risk in relation to other hazards in consumers’ diets resulted in only short term declines in consumer consumption of beef

The Alternative: Consumer Confidence in Freefall

Source: University of Minnesota Food Industry Center; Louisiana State University AgCenter

Risk Communication

The interactive exchange of information and opinions concerning risk and risk management among risk assessors, risk managers, consumers, and other interested parties

Transparency is a key objective and its importance can not be overemphasized

Involvement of stakeholders can contribute to issue identification and characterization, provide data and other inputs for risk assessment, provide alternatives for options assessment, develop consensus or provide an outlet for public concern

Relation of Data Gathering to Risk Management & Communication

The data collection function of AGISAR will generate information of interest to multiple parties, including risk managers, the food industry, retailers and consumers

Producers may be concerned about disclosure of information about practices that they are not prepared to address

Consumers may be concerned that the results demonstrate that their food is highly contaminated

Risk managers must be prepared to address concerns of stakeholders at any point during the data collection process

Risk Management: WHO/OIE even USDA

World Health Day Focus with WHO/ FAO/OIE Core actions for antimicrobial use in food producing

animals: Provide national leadership and collaboration Create and enforce regulatory framework Strengthen surveillance and monitoring Promote education and training on antimicrobial

use in food-producing animals Reduce the need for antimicrobials through better

animal husbandry

U.S. Department of Agriculture

“Animals, when exposed to antimicrobial agents, may serve as a significant reservoir of resistant bacteria that can transmit to humans through the food supply.”

“The economic impact of antimicrobial resistance is significant. Insufficient or failed treatment … is a huge human cost.”

June 10, 2011 Food Safety Research Information Office

Antibiotic Sales Data -Animal and Human by WHO Status

Table 1. Antimicrobial Drugs Approved for Domestic Use in Humans and Food-Producing Animals*. Sales and Distribution Data Reported to FDA by Drug Class.

2009 Animal Annual Totals (LBS)

2010 Animal Annual Totals (LBS)

2011 Animal Annual Totals(LBS) WHO Status

Aminoglycosides 748,862 442,675 473,762 Critically / highly

Cephalosporins 91,113 54,207 58,667 Critically / highly

Ionophores 8,246,671 8,424,167 9,090,230 Not ranked

Lincosamides 255,377 340,952 419,101 Important

Macrolides 1,900,352 1,219,661 1,284,933 Critically

Penicillins 1,345,953 1,920,112 1,940,427 Critically / highly

Sulfas 1,141,715 1,116,020 817,959 Highly

Tetracyclines 10,167,481 12,328,521 12,439,744 Highly

Other (Not Indepen- dently Reported (NIR))** 4,910,501 3,345,398 3,330,241

Total 28,808,024 29,191,712 29,855,066

2009 Human Annual Total (LBS)

2010 Human Annual Total (LBS)

2011 Human Annual Total (LBS) WHO Status

Aminoglycosides 20,682 15,413 14,297 Critically / highly

Cephalosporins 1,101,465 1,107,957 1,095,499 Critically / highly

Ionophores 0 0 0 Not ranked

Lincosamides 153,744 152,637 157,531 Important

Macrolides 388,626 362,239 361,620 Critically

Penicillins 3,217,027 3,174,502 3,219,677 Critically / highly

Sulfas 1,039,352 1,057,081 1,061,887 Highly

Tetracyclines 289,108 284,800 250,957 Highly

Other (Not Indepen-dently Reported (NIR))** 1,102,567 1,074,121 1,089,921

Total 7,312,570 7,228,750 7,251,390

* For all classes except aminoglycosides and ionophores, data includes antimicrobial drug products which are approved and labeled for use in both food- and non-food- producing animals.

** NIR is used for antimicrobial classes with fewer than three sponsors actively marketing products. This category includes fluoroquinolones and streptogramins. *** Human drug use data is based on data from the IMS Health, IMS National Sales Perspectives.

Government Monitoring& Reporting

What’s in the meat we eat?

NARMS Salmonella & Resistance



Petition

RegulationsADUFASec. 105

Guidance for

Industry - 209 & 213VFD

On April 11, FDA issued new guidelines intended to curb the non-therapeutic uses of antibiotics in food animal production.

This first step: Voluntarily seeks to ban the use of

antibiotics to grow animals faster. Moves all over the counter (OTC) uses

under veterinary supervision.

Concerns with the guidances:

Do not outline how FDA will monitor the effectiveness of the guidelines.

Do not clearly outline what uses are considered prevention

Litigation

PAMTA (Preservation of Antibiotics for Medical Treatment Act)HR 1150: Rep. SlaughterPARA (Prevention of Antibiotic Resistance Act)S. 1256:

Endorsed by:• American Medical Association• American Nurses Association• American Academy of Pediatrics• American Public Health Association• More than 400 other organizations!

Consumer advocates’ understandingAntibiotics are important in human medicine

Antibiotics treat infections

Antibiotics don’t work on the Flu, Colds – e.g. Viral infections

Consumer advocates’ understanding

People take antibiotics when they are sick.

Antibiotics are only available with medical consult from a clinician.

Antibiotics only available with a prescription.

Giving antibiotics to animals must mean they’re sick, too.

When consumers learn that antibiotics are given preventatively, for animals that aren’t sick – lack of understanding.

Lack of consistent veterinary oversight different from human medicine.

Consumer Logic

Consumer advocates’ understandingGiving antibiotics to healthy animals in low doses, helps speed along the emergence of antibiotic resistant bacteria.

People can get sick with antibiotic resistant infections when food is contaminated.

Consumers want alternatives

MediaMessaging

MediaMessaging

Danielle Wadsworth, Salmonella Typhimurium survivor

Antibiotic Resistant bacteria generate $16.6 billion - $26 billion annually in extra costs to the US Healthcare system

The Alliance for the Prudent Use of Antibiotics

Fighting Antibiotic Resistance

Antibiotic Resistance Antibiotics are losing their effectiveness

due in part to overuse in food animal production

Consumer Interest Preserving effective medicines for fighting

infections Resistant bacteria associated with

foodborne diseases Residue issues (allergens, side effects)

Recommendation Adopt EU policy banning non therapeutic

use Remove critically important human drugs

from animal food chain

THANK YOU!

Susan Vaughn Grooters, MPHResearch and Policy AssociateCenter for Science in the Public Interest1220 L St. NW, Suite 300Washington, DC 20005

Phone: 202.777.8377Email: [email protected] the Internet: www.cspinet.orgwww.FoodDay.org

http://www.cspinet.org/

http://www.foodday.org/

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Ms. Susan Vaughn Grooters - Consumer Perceptions-Superbugs In Our Food Supply

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