Antimicrobial resistance and antimicrobial use initiatives in agricultural food system in Vietnam
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1) Livestock and aquaculture production in Vietnam has grown significantly in recent decades. Research on antimicrobial resistance (AMR) and antimicrobial use (AMU) in Vietnam has focused on understanding drivers of AMU, surveillance of AMR and AMU, and transmission of AMR between animals, humans and the environment. 2) Intervention initiatives to promote rational antimicrobial use and reduce AMR have included alternatives to antibiotic use in aquaculture, on-farm trials of improved health management practices, and development of a national action plan. However, understanding of AMR transmission dynamics remains limited. 3) While regulatory frameworks and policies have been established in Vietnam to manage veterinary drug use and AMR
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Antimicrobial resistance and antimicrobial use initiatives in agricultural food system in Vietnam
- 1. Antimicrobial resistance (AMR) and antimicrobial use (AMU) initiatives in agricultural food system in Vietnam Trang Le, Sinh Dang, Son Dang, Tran Minh Phu, Pham Duc Phuc, Hung Nguyen-Viet International Livestock Research Institute (ILRI), Hanoi University of Public Health, National Institute of Veterinary Research and Can Tho University One Health AMR research coordination meeting Hanoi, 7-9 October 2019
- 2. Outline Livestock and aquaculture situation in Vietnam AMR and AMU researches Policy environment
- 3. Livestock production in Vietnam (2010-2017) Annual growth 2010-2017: 5-6% per year 0 500 1000 1500 2000 2500 3000 3500 4000 Y2010 Y2012 Y2013 Y2014 Y2015 Y2016 Y2017 Pork (1000 ton) Poultry (1000 ton) Buffalo & cattle (1000 ton) DLP/ MARD (2018)
- 4. Aquaculture production and export of Vietnam (1998-2018) Source: D-Fish 0 1000 2000 3000 4000 5000 199819992000200120022003200420052006200720082009201020112012201320142015201620172018 AQUACULTURE PRODUCTION ('000 TON) - 2,000 4,000 6,000 8,000 10,000 199819992000200120022003200420052006200720082009201020112012201320142015201620172018 EXPORT VALUE (MIL. USD)
- 5. Key areas of AMR/AMU research in Vietnam 1. Understand AMU drivers, AMR and AMU surveillance 2. AMR transmission animal – human – environment 3. Intervention initiatives
- 6. 1. Understand AMU drivers, AMR and AMU surveillance • 77.4 mg and 286.6 mg of in-feed antimicrobials were used to raise 1 kg of live chicken and pig, respectively. • 1023.5 tons: 42.2 and 981.3 tons for Vietnamese chicken and pig production per year, respectively. Nguyen Van Cuong et al. 2016. EcoHealth AMU consumption for chicken and pig medicated feeds
- 8. KAP of AMU and AMR control in livestock and aquaculture production in Vietnam - FAO The first response of producers (%) when their livestock fall sick. Pham Duc Phuc et al, 2019 Primary reason for antibiotic use reported by producers
- 9. A systems approach to livelihood-sensitive veterinary AM stewardship in Thai Nguyen Tarni L. Cooper Understand of how AM were used in the livelihood strategies of smallholder farmers and their animal health networks. Mixed-methods Revealed complex livelihoods interacting with decisions around AMU Cross-sectional and longitudinal surveys Understand of the system in which AMS decisions were made Identify leverage points for livelihood- sensitive intervention Tarni L. Cooper
- 10. Rational use of AM, reduced AMR, safer food Improve understanding of drug use and strengthen capacity in AMR /AMU surveillance Pig health and health management practices 1 Antibiotic resistance in pigs and antibiotic residues in pork products Effective interventions for improving pig health management 3 Veterinary drug use among pig farmers 2 4 VIDA-PIG 4 work packages One Heath Pig farms, feed mills, abattoirs, veterinarians, etc. Hung Nguyen et al. 2018Health and Antibiotics in Vietnamese Pig Production
- 11. Since 2013, monitoring of residues of antibiotics in shrimp products at 199 main aquaculture areas of 37 provinces 0.38% 1.18% 0.46% 0.30% 0.00% 0.20% 0.40% 0.60% 0.80% 1.00% 1.20% 1.40% Year 2013 Year 2014 Year 2015 Year 2016 (9/2365) (25/2104) (8/1751) (6/1692) Monitor AMR, AMU and antimicrobial residues
- 12. AMR in Vietnam: moving forward a OH surveillance system Marion Bordier et al.
- 13. 2. AMR transmission animal – human – environment Integrated Pig-Fish farm
- 14. Defining the burden of antibiotic resistance in Vietnam across different ecosystems Institute of Environmental Health and Sustainable Development (IEHSD)
- 15. An Ecohealth Approach to Develop a Strategy for the Prudent Use of AM (APEIR – AMR) To explore, develop, and assess the effectiveness of a strategy for the proper use of antimicrobials in humans and animals to control antimicrobial resistance
- 16. Engaging the food and agriculture sectors in sub‐Saharan Africa and South and South‐East Asia in the global efforts to combat antimicrobial resistance using a One Health approach (GCP/GLO/710/UK) 2018-2019
- 17. Flemming Fund in Vietnam
- 18. 3. Intervention initiatives Alternatives to AB: nano-silver in Vinh Phuc
- 19. Alternatives to AB: Bio-active plant product for aquaculture production 3. Intervention initiatives
- 20. An intervention controlled trial (ViParc) Dong Thap province Feb 2020 • Farmer Training • Farm Health Plan (level 1) • Diagnostic support • Farmer Training • Farm Health Plan (level 2) • Diagnostic support • No intervention Mar 2018 Oct 2016 Vietnamese Platform for Antimicrobial Reductions in Chicken production ViParc project
- 21. Enabling environment (legal basis) Regulatory framework NAP for AMR (2013 and 2017) Livestock Law (2018) Law on Veterinary No. 79/2015/QH13 (19 June 2015) Decree No 35/2016/ND-CP issued on 15/05/2006 of the Government which defined detailed implementation for several articles of Veterinary law; Circular No. 10/2016/TT-BNNPTNT (1 June 2016) (Ministry of Agriculture and Rural Development, issuing the List of approved and prohibited veterinary drugs in Viet Nam); Circular No. 13/2016/TT-BNNPTNT (2 June 2016) (MARD on Veterinary Drugs Management) .....
- 22. Conclusions Most of the projects focused on AMR and AMU surveillance including social aspect of AMU Limited number of initiatives on solutions and interventions Limited understanding on AMR transmission dynamics NAP for AMR in 2017 and legal enabling environment is available (drug and vaccine management) but reinforcement is needed
- 23. better lives through livestock ilri.org This presentation is licensed for use under the Creative Commons Attribution 4.0 International Licence. ILRI thanks all donors and organizations who globally supported its work through their contributions to the CGIAR system
Notas do Editor
- Thanks Dr. Hoang for the summary on human projects, I will continue with the agriculture part
- After coming with AMR and AMU researches part, I will talk a bit on the livestock and.... And finish with some points on policy environment
- According to DLP/ MARD (2018), the annual growth of LS production in Vietnam from 2010-2017 is 5-6%/year, pork is leading product
- The same picture was seen with aquaculture production that it has increased ~8 times from 500 thousand tons in 1998 to 4.5million in 2018, aligning with the rising of export value
- In the review of key areas of AMR/AMU research project in aquaculture, we divided them in 3 main categories base on main objectives and impact of the project, that include:
- AM is used frwquntly for chicken and pig medicated feeds Latest estimate showed that …… overall consumption of in-feed antimicrobials (for pigs and chicken) was 1,023.5 tons per year and it is believed that the actual use is much higher
- There are also many researches on AMU in aquaculture, e.g. a study on monitoring …. Showed a very high number of AB residue at 26.9%
- In that context, to explore knowledge, attitudes, and practices amongst livestock producers to identify their perspectives on antibiotic use and resistance, a project lead by FAO was implemented in pig, chicken and aquaculture producer Infection treatment and prevention were report as primary reasons for ABU by all chicken, pig and aqua producersin which, >60% indicated the reason of treatment And the study also indicated that more favorable attitude scores did not translate into better practices
- It was very good that some mixed method-projects was conduct to understand…. In other words, its to understand of the…. mixed-methods design + epidemiological and Communication for Development approaches Stakeholder workshop to interpreting data and co-constructing an Finally, stakeholders came together, to identify leverage points for livelihood-sensitive intervention.
- Health and Antibiotics in Vietnamese Pig Production (VIDAPIG) Include 4 packages … using OH approach include prople from pig farms… to understand identify factors that influence veterinary health management and veterinary drug use practices at pig farms in Bac Ninh province; review current guidelines for antimicrobial use; assess contextual dimensions and networks that influence pig health management and antibiotic use; establish quality and quantity of antibiotic drugs used in pig production; strengthen local capacity in surveillance of antibiotic use, prevalence of antibiotic resistance and antibiotic residues in pigs and pork products; strengthen local stakeholder interactions and communication channels to advance animal health, reduce the use of antibiotics and diminish the spread of antibiotic resistance and 4 residues related to pig production.
- Along with research to understand the use of AMU, there were also the project to monitor AMR,, AMU and AM residues
- And we are starting to move from monitor to an OH SS. Here we have a project by CIRAD to assess the role of key stakeholders in the strategy, as well as their abilities to comply with a OHSS within the national context This is the stakeholder mapping of the ABR surveillance strategy in Vietnam was developed, very beautiful, colourful, and compliceted comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may question the ability and willingness of surveillance stakeholders to implement the collaborations required.
- The 2nd group is the AMR trans… within AHE interaction From the impact of medicated feed on the development of AMR which focus on animal – environment of integrated Pig-Fish farm
- To a project of defining… Different ecosystems here include: environment: water, soil, from food (pork, chicken, veg) and human (patients with urinary tract infections (UTI). To determine ARB burden in Vietnam in different environmental reservoirs and in the human gut and link to the burden of ARB in community- and nosocomial-related infections as well as understand the impact of residual antibiotics, both in reservoirs and in patients, in maintenance of antibiotic selection pressure in the Community
- An Ecohealth Approach to Develop a Strategy for the Prudent Use of AM to Control AMR in Human, Animal, and Environmental Health in Asia (APEIR – AMR)
- New big project will be launched soon by FHI360 focus on strengthening capacity in human resources and laboratory and surveillance systems for antimicrobial use and resistance in humans and animals
- And, our researchers did not stop at only finding problems, but also base on those finding created many intervention initiatives, that’s bring us to the project belongs to the last 3rd category here As the fact that farmers using AB mainly as prevention and growth promoter, it is comes from the benefit for their livelihood. There was a trial to compare the effect of 2 groups using Amox and nano silver in pig feed found no significant between AD weight gain of 2 groups, indicated a potential replacement of antibiotic added to the feed but Evidence of efficacy, cost-benefit, acceptability to farmers, development of resistance, risk assessment for transfer to pork and an environmental impact assessment of nanosilver are needed before scaling up its use.
- Vietnamese Platform for Antimicrobial Reductions in Chicken production (ViParc) in Dong Thap Reduce AMU among chicken farmers by providing farmers with a locally-adapted veterinary support system Elucidate relationship between AMU, farming practices and AMR Provide recommendations to GoV on cost-effective measures that help reduce farmer’s reliance on antimicrobials
- Important to mention that in between there has been extensive development and issuance of legal documents and training materials to improve awareness of health officials in microbiology and management of antibiotic use. In 2013, Vietnam became the first country in the WHO’s Western Pacific Region to publish its National Action Plan on antimicrobial resistance (AMR). And established the National Steering Committee on AMR In 2017, with Fleming Fund support, the Vietnamese Ministry of Agriculture and Rural Development, adopted a National Action Plan for the management of antibiotic use and control of AMR in livestock production and aquaculture.
- Effective coordination is the key to success