danmap-years-perspective-9.html
DANMAP 2015 3D
10 / 144
danmap 2015 10 danmap - 20 years 2. introduction danmap ? the danish
antimicrobial
resistance
monitoring and research programme ? was a reaction to concerns about how
antimicrobial
s were used in food animal production in denmark in the mid-1990s and what the consequences might be for human and animal
health
. it came in the wake of a national food crisis caused by a steep increase in human salmonellosis incidence that could be traced back to domestic food animal production. at the same time europe was struggling with the bse crisis that originated in the uk. based on an idea of a one
health
perspective ? the purpose of which is to unite methods and knowledge and share surveil- lance data between sectors for a better
health
for humans and animals - the first samples for danmap were collected in 1995 and published in an interim report in 1996. the one
health
paradigm was a pioneer concept and the specific design used in the danmap programme was state-of-the art at the time. the design has only changed slightly over the past 20 years. it is, however, becoming quite clear that
antimicrobial
resistance
is no longer an issue that can be handled adequately at the local regional or national level. today, the world faces a global
antimicrobial
resistance
pandemic that might exert devastat- ing effects on both human and animal
health
. a british report on
antimicrobial
resistance
estimates that the costs due to increased illness and deaths and a subsequent fall in produc- tivity amount to 100 trillion dollars by 2050 (o?neill, 2016). so, while local measures to control
antimicrobial
resistance
are indispensable, they are not sufficient in the face of a pan- demic. as danmap celebrates 20 years of existence, we describe some highlights and key elements from the programme and present a perspective on where to go from here.
antimicrobial
growth promoters
antimicrobial
agents were included in feed for food animals as early as the late 1940s in order to improve growth and reduce production costs. in these early days the positive ef- fects observed ? initially when feeding waste from production of tetracyclines to chickens - may partly have been due to the improvement of low quality feed in general, but the procedure of including sub-therapeutic concentrations of
antimicrobial
s in animal feed was soon integrated as an established practice in several countries [ moore, 1946; dibner, 2005 ] . following the introduction of the first
antimicrobial
agents for human clinical treatment,
resistance
very rapidly emerged. however, as several new
antimicrobial
classes were discovered in the late 1940s and early 1950s, this was not considered a major problem. during the 1960s, bacteria resistant to several
antimicrobial
classes were discovered, while emerging treat- ment failures in humans gave the first warnings that resis- tance might outrace the discovery of new
antimicrobial
s. in food animals high levels of
resistance
were observed, to some extent related to the use of
antimicrobial
growth promot- ers (agps). in 1969, the swann committee in the united king- dom considered the available evidence and clearly concluded that the use of agps selected for
resistance
that was transfer- able between bacterial species and could cause problems for human
health
[swann et al, 1969]. the report recommended that
antimicrobial
agents used for therapy should not be used for growth promotion. following this, a number of
antimicrobial
agents were banned for use as agps in the uk. after the uk entered the european union (eu) the ban was implemented in the other european union member states. in other countries, including the usa, similar recommendations were issued by the authorities, but restrictions were never implemented. one important thing, however, appears to have been over- looked, namely that different
antimicrobial
agents belonging to the same drug class will select for the same
antimicrobial
resistance
mechanisms. furthermore, it was not considered that other
antimicrobial
classes already being used as agps might become important for human treatment as new resis- tance mechanisms emerge. consequently, a number of new
antimicrobial
agents were approved and used as agps in the eu and other countries in the 1970s and 1980s. discussions of potential problems associated with this contin- ued use surfaced from time to time, but it was not until the mid-1990s, when new studies found new evidence, that larger scale interventions occurred. 2. danmap ? a 20 year perspective frank møller aarestrup, professor, national food institute, technical university of denmark, kgs. lyngby niels frimodt-møller, professor, dmsc, rigshospitalet, copenhagen kåre mølbak, state epidemiologist, dmsc, statens serum institut, copenhagen maja laursen, midwife, phd, the register of medicinal product statistics, the danish
health
data authority; copenhagen flemming bager, head of division, dvm phd, national food institute, technical university of denmark, kgs. lyngby
coli-food-use-11.html
