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U.S. Department of Health and Human Services

Animal & Veterinary

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Session II Questions and Answers

DR. SMITH-DeWAAL: Pat, I have a question that I would like the speakers this morning to address. Do you --

DR. GREEN: --- (Off microphone) -- identify yourself.

DR. SMITH-DeWAAL: Certainly. Caroline Smith-DeWaal, Center for Science in the Public Interest. Do you want to hold questions for after the break?

DR. McDERMOTT: Well, the --

DR. SMITH-DeWAAL: I just don’t want to loose the opportunity --

DR. McDERMOTT: No, go ahead, go ahead. Please carry on.

DR. SMITH-DeWAAL: Okay. The question I have has to do with whether the US maintains a common platform for the gathering of this data? You mention, the speakers mentioned that there were three separate reports from the different agencies but they’re combined in an Executive Summary.

I am asking the question in part because of the AGISAR work where we’re actually looking at a common platform for gathering this information. But also because of the experience with the state outbreak information coming into CDC really benefitting from them developing a common electronic platform for reporting that data to CDC.

So, I think there is really a benefit. And I want to know what the status is for the US. Thank you.

DR. McDERMOTT: I can take a stab at that, Caroline. I mean as far as how CDC can make best use of outbreak information, maybe Ezra or Rob can address that specific part of it. But as far as a maintaining a common platform for a monitoring that is our goal -- our goal is to make it more integrated in these discussions and through our work, you know, in trying to improve process.

So generally the goal is yes, we wish to sustain NARMS as an integrated platform, an inter-sectorial platform if you will for monitoring and to make it more integrated so that the data are more comparable. And we have some work to do in that area and we recognize that. The Science Board recognized it. But as far as dedication to that as a mission for this program, that is certainly our intention.

DR. KATHARIOU: Sophia Kathariou from North Carolina State. I have a quick question to perhaps Doctor Fedorka-Cray, is there a plan to include aquiculture and also wildlife or domestic animals in antimicrobial resistance monitoring?

DR. FEDORKA-CRAY: Okay. This is Paula Cray, and the answer to that right now is no.

DR. KATHARIOU: And would you elaborate as to the major reasons for aquiculture especially since aquiculture is a major user of antimicrobials.

DR. FEDORKA-CRAY: Well, I think primarily a lack of access to isolates and we’re looking at limited funding and prioritized human health impacts, so that’s where we’re at right now.

DR. McDERMOTT: Any other questions, please?

DR. LYNFIELD: Ruth Lynfield, Minnesota Department of Health. Couple of questions. One is for Ezra, when you look at the Campylobacter isolates from people, do -- are there any data on whether they have acquired their infection abroad? And then I also have another question. I don’t know if he’s here.

DR. McDERMOTT: He’s here.

DR. BARZILAY: I’m right here. Just getting out of the way. This is Ezra Barzilay responding. That is a very good question. In fact we’re working very closely linking with FoodNet, the food platforms, as you may know, looks very -- looks as much in depth, not only demographics, which we capture for NARMS for all of the pathogens, but also respects to exposures.

The question of travel which is the most often question asked about Campylobacter resistance is something that we’re looking in prospectively. And also trying to look back for those that exist retrospectively as well. And I think there is currently a pilot -- not a pilot, there is a study currently undertaking by one of the FoodNet partners -- one of the FoodNet states to collect this information.

We’re getting to the point where we begin to gather some of the information, it’s not ready yet, unfortunately. But we will, and it’s something that is much anticipated.

DR. LYNFIELD: Thank you. And then another question, just in general, do you look at the data geographically, you know, what is striking, looking at the retail meat data, that certainly some of the multi-drug resistant pulse field types seemed to be associated with certain states. And I’m just wondering if on the USDA end as well as the CDC end, if there are some regional analysis that are done.

DR. McDERMOTT: Paula, would you like to address that?

DR. FEDORKA-CRAY: This is Doctor Cray, and the answer is yes. There is just not enough time to show everything. We do have interactive graphs that I could bring down, they’re on my computer. But they will actually show you the distribution of serotypes by region and then we can link the PFGE to that and then we can link the resistance to that, too.

I think it’s really important for everybody to understand how few people have driven this entire program. And while it’s not a criticism or anything, but there is just an inordinate amount of information then. We have yet to develop a way to put all of it out in a manner that enables a rapid access and to look at it in all ways possible. That’s something that I think we’re really trying to address in the future.

DR. LYNFIELD: Thank you. And then one final comment, Paula, I’m really excited to hear that you are expanding, collecting isolates from the farm --


DR. LYNFIELD: -- collecting samples from the farm.


DR. LYNFIELD: Yes, I mean that is just so important. And again I know it is clinical sensitive and you require on the cooperation of the farms to be able to do the collection, but it would be wonderful to have good geographic representation, once that project gets off the ground as well.

DR. FEDORKA-CRAY: Thank you.

DR. KRUEGER: Just in response, I’m Amy Krueger, NARMS, CDC, I had abstracted --- in 2009 looking at spacial distribution of non-typhi Salmonella, and working on a manuscript right now.

DR. McDERMOTT: Thank you, Amy. Maybe one more question if anyone has another question. Please step to the microphone.

MR. ROACH: Yes, this is Steve Roach with Food Animal Concerns Trust and also Keeping Antibiotics Working. And one of the questions we’ve had, I saw some information on their relationship between outbreak data and antimicrobial resistance.

And we had requested some data -- because there was some multi-drug resistance Salmonella outbreaks last year associated with ground beef. And we were just trying to get the basic information on what were the drugs -- what were the outbreaks, what types of resistance was associated with the outbreaks.

And we really had problems -- nobody has been willing to actually give us that data either from FSIS looking at meat samples or CDC. And I just would like to get a little bit more clarity on -- we realize that the state submits samples to CDC. And then well it was said well, we can’t provide the data back to you all, you have to go through the states. But it seems like a lot of data from the states actually is provided to the public but just not the resistance data. So eventually I’m assuming all of that outbreak data, what information we have will be made public.
So, I would just like to get more information about what actually is done with outbreak data with respect to resistance and what are the barriers, actual barriers to making that data available. Because we think it is a big important public health issue. A year after outbreak, we should be able to know what drugs the outbreak isolates were resistant to.

DR. McDERMOTT: Ezra, do you want to answer that and then maybe one more question or -- okay, turn that on --

DR. ZHAO: You know in the past --

DR. McDERMOTT: Identify yourself, Shaohua.

DR. ZHAO: Oh, Shaohua Zhao, from FDA. In the past they actually we tried to you know to compare the MDR outbreak strains to the CDC. But in many cases they did not just -- available to -- the positive databases. So actually we would love to have the other breakout strains sent to us to -- to do the AST data and to share with the public.

And the company, whenever we have an opportunity to get isolates, we will contact the AST and share with the --- and the CDC.

DR. BARZILAY: This is Ezra Barzilay, at CDC. I would like to add just to what Shaohua was saying.

There are a couple of, I want to say more soft barriers to it, part of it is that the outbreaks -- our outbreak surveillance is an incredibly complex one because trying to link, at least within CDC, three different systems and then track down which isolates come from where, which -- where they have been submitted across our continuum and collect data from the system.

The more practical aspect is that we are really bound by the ownership if you will of these isolates submitted by the state. We have to get exclusive permission to release that information. And usually the easiest way is basically to say for the request, is you really need to call up the state to do that. The state says it’s fine. And it’s their data to release. And we actually give them -- we give the states back the information.

The final part of this, and this is a little trickier as well, is that the NARMS data for human isolates are not meant to guide treatment at the isolate level because our testing is not geared towards a clear certified human clinical testing.

We are trying very hard to avoid sending back isolates and saying, look, these isolates are resistant to ampicillin, and suddenly getting, which has happened, getting out a note from physicians, saying do not use ampicillin in this outbreak, it is resistant. That’s not the driving force behind this. And which is also why we’re partnered very closely with states to allow for them to guide the data, the flow of information, once isolates are tested.

I recognize there are definitely some hindrances, we’ve been working on for several months, if not a year, some cleaning out the outbreak isolates databases as far as understanding what has happened in resistance strains within our outbreaks isolates.

But I, you and I have spoken about this at length, but this really is a state CDC communication -- not an issue but situation and one that I think is best handled by the states itself, that runs the outbreak. We can talk more about it at the break.

MR. McDERMOTT: Do you have a quick question? Could you, then we’ll break.

DR. M’IKANATHA: Actually my question is --

MR. McDERMOTT: Please identify yourself.

DR. M’IKANATHA: Njuchia M’ikanatha, with the Pennsylvania Department of Health. I want to comment Doctor Cray, she has asked me to collaborating with our lab. But I have a question for her that relates to the resistant patterns that they identify that showed a big difference between the isolates tested by VetNet and the human isolates. And what one for the DT-104 she showed three percent but for the human isolates was about like 10 percent.

And my question is, is there effort to pull up the data and actually show, explain and not just simply show the trends, but explain why there is a disparity and also what are the research gaps in our understanding.

The last question is relates to actually if you want to link outbreak better we need a system of labeling commodities, food product, the meats that are not prepackaged is very difficult to actually know where they came from. And I wonder whether there is an effort to do that and an effort to collaborate more with the states that are interested in doing more sampling during an outbreak for resistance testing. Thank you.

DR. FEDORKA-CRAY: Thank you. This Paula Cray again. I would just like to acknowledge that we have had a collaboration with the Department of Health at Pennsylvania now with VetNet isolates. And we provided a lot of information to them and particularly for their state isolates in an attempt to sort out what might be going on between some of the VetNet patterns and what they see in Pennsylvania.
As far as -- in answer to your question about DT-104, I think that NARMS, the three arms of NARMS, particularly over the last two years has spent a significant amount of time looking at additional collaborations and how we can parse the data out between the three systems to make a comprehensive story.

And I think that you will see that in publications coming out. Maria Carlson has one coming out on SIP resistance. We’ve had a number of posters, Regan Rickert had one at the ICEID, we have one coming out at ISAAC and I think that there will be a number of papers coming out in the next year so that -- that try to merge all of the data together in some way.

The other thing is, is that I think you will notice in the Executive Report, if I’m not mistaken, that will be coming out in 2008, there will be more verbiage in some of that, that tries to identify these trends over time, too.

With regard to outbreak investigations, that’s really not our purview, that’s something that CDC, you know, undertakes, but whatever we can do as far as our data goes and helping you better understand what might be going on, per state, we’ve made that offer that we’re do, all you have to do is call us, and we will in fact respond eventually. Thank you.

DR. McDERMOTT: All right. Thank you, Paula. Let’s take a break. And I want to announce that if you got presentations after the break, make sure they’re loaded on the computer. Thank you, everybody.

(Whereupon, a break was taken.)