Animal drug shortages limit veterinary therapeutic options and introduce artifacts in antimicrobial sales reporting.

Supply chain issues disrupt veterinary care and cause downstream consequences that alter the practice of veterinary medicine. Antimicrobials are just 1 class of pharmaceuticals that have been impacted by supply chain issues over the last couple of years. Since February 2021, 2 sponsors/manufacturers of penicillin products have reported shortages in the active pharmaceutical ingredient. With the release of the 2021 Summary Report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals by the FDA, a key finding was a 19% decrease in penicillin sales and distribution from 2020 to 2021. Herein, we provide our clinicians' professional perspective regarding how drug shortages, specifically that of penicillin, might contribute to misconstrued patterns in antimicrobial use and what can be done by veterinarians and the FDA to minimize the impact of an antimicrobial drug shortage on animal health and well-being.

Antibiograms as one-health tools for antimicrobial stewardship: California's experience with livestock antibiogram development.

Antibiograms are collections of antimicrobial susceptibility data for a particular bacterial organism and host species. Antibiograms are important tools for antimicrobial stewardship, as they may be used to guide empiric antimicrobial therapy and assess trends in antimicrobial resistance, maximizing treatment success and preserving the efficacy of currently available pharmaceuticals. Targeted use of antimicrobials is critically important to minimize the spread of antimicrobial resistance, which may be conveyed between animals and humans directly but may also be spread through the environment and ecological niches, such as soil, water, and wildlife reservoirs. To effectively utilize antibiograms as part of a comprehensive antimicrobial stewardship plan, veterinarians need to know data characteristics, including the source population, body site (when possible), and number of isolates included, in addition to the animal species and bacterial organisms for which each breakpoint was developed. Although widely used in human health systems, antibiograms are not often available in veterinary medicine. This paper describes antibiogram creation and use, discusses antibiogram development by US veterinary diagnostic laboratories, and shares California's process to create and promote livestock antibiograms. The companion Currents in One Health article by Burbick et al, AJVR, September 2023, addresses the benefits and challenges associated with developing veterinary antibiograms.

Benefits and challenges of creating veterinary antibiograms for empiric antimicrobial selection in support of antimicrobial stewardship and advancement of one-health goals.

Antibiograms are important tools for antimicrobial stewardship that are often underutilized in veterinary medicine. Antibiograms summarize cumulative antimicrobial susceptibility testing (AST) data for specific pathogens over a defined time period; in veterinary medicine, they are often stratified by host species and site of infection. They can aid practitioners with empiric therapy choices and assessment of antimicrobial resistance trends within a population in support of one-health goals for antimicrobial stewardship. For optimal application, consideration must be given to the number of isolates used, the timeframe of sample collection, laboratory analytical methodology, and the patient population contributing to the data (eg, treatment history, geographic region, and production type). There are several limitations to veterinary antibiograms, including a lack of breakpoint availability for bacterial species, a lack of standardization of laboratory methodology and technology for culture and AST, and a lack of funding to staff veterinary diagnostic laboratories at a level that supports antibiogram development and education. It is vital that veterinarians who use antibiograms understand how to apply them in practice and receive relevant information pertaining to the data to utilize the most appropriate antibiogram for their patients. This paper explores the benefits and challenges of developing and using veterinary antibiograms and proposes strategies to enhance their applicability and accuracy. Further detail regarding the application of veterinary antibiograms by privately practicing clinicians is addressed in the companion Currents in One Health article by Lorenz et al (JAVMA, September 2023).

2018 Survey of antimicrobial drug use and stewardship practices in adult cows on California dairies: post-Senate Bill 27.

BACKGROUND: A survey of California (CA) dairies was performed in spring 2018 to characterize antimicrobial stewardship practices, antimicrobial drug (AMD) use, and health management of adult cows on CA dairies since the implementation of the Veterinary Feed Directive (VFD) and the CA Senate Bill 27 (SB 27). Effective January 1, 2017, the U.S. Food and Drug Administration (FDA) implemented regulatory changes requiring veterinary oversight for therapeutic uses of medically-important antimicrobial drugs (MIADs) administered in feed (VFD) and water (veterinary prescription). Similarly, effective January 1, 2018, the CA legislature enacted California Food and Agricultural Code (FAC) 14400-14408, formerly known as Senate Bill 27 (SB 27) requiring veterinary prescriptions for all other dosage forms of MIADs. METHODS: The questionnaire consisted of 43 questions partitioned into three sections to assess herd information, management practices, and AMD use and perspectives. The questionnaire was mailed to 1,282 grade A licensed dairies in CA and 149 responses (11.6%) were collected from 19 counties across the three defined regions of CA: Northern CA (NCA), Northern San Joaquin Valley (NSJV), and Greater Southern CA (GSCA). RESULTS: Most dairies reported treating all dry cows with intramammary AMD and/or teat sealant at the end of a lactation (87.2%). In 92.3% of dairies, producers relied on the veterinarian for information about AMD used to treat cows. Treatment duration for cows treated with AMD was based on the drug manufacturer's label and veterinarian's instructions in most dairies (98.6%). Most respondents to the survey confirmed having a valid veterinarian-client-patient-relationship (VCPR) for their dairies (91.7%), participated in animal welfare audit programs (81.8%) and dairy quality assurance programs (52.9%). Approximately 98.6% respondents were aware that all uses of MIADs in livestock required a veterinary feed directive (VFD) or prescription and are no longer sold over-the-counter (OTC) in CA since January 1, 2018. Multiple factor analysis (MFA) was performed and identified seven components composed of 21 variables (questions) that explained 99.7% of the total variance in the data. Hierarchical cluster analysis on the principal coordinates of the MFA based on conventional dairy survey responses identified two clusters characterized as large conventional dairies (median herd size: 1,265 cows) and mid-sized conventional dairies (median herd size: 715 cows) mostly in GSCA and NSJV. The organic dairies grouped into a single cluster of median herd size of 325 cows mostly in NCA. CONCLUSIONS: The survey results contribute to the knowledge of AMD use and antimicrobial stewardship practices on CA dairies since the implementation of the SB 27 and VFD laws and provide useful information for future evaluation of resistance-related risk in adult cows.

2019 Survey of Antimicrobial Drug Use and Stewardship Practices in Adult Cows on California Dairies: Post Senate Bill 27.

Antimicrobial resistance (AMR) is a global issue for both human and animal health. Antimicrobial drug (AMD) use in animals can contribute to the emergence of AMR. In January 2018, California (CA) implemented legislation (Senate Bill 27; SB 27) requiring veterinary prescriptions for medically important AMD use in food animals. The objective of our survey was to characterize AMD use, health management, and AMD stewardship practices of adult cows on CA dairies since the implementation of SB 27. In 2019, we mailed a questionnaire to 1282 California dairies. We received a total of 131 (10.2%) survey responses from 19 counties in CA. Our results showed that 45.6% of respondents included a veterinarian in their decision on which injectable AMD to purchase. Additionally, 48.8% of dairy producers included a veterinarian in their decision on which AMDs were used to treat sick cows. The majority (96.8%) of dairy producers were aware that all uses of medically important AMDs require a prescription. Approximately 49% of respondents agreed or strongly agreed that AMD use in livestock does not cause problems in humans. The survey documents antimicrobial use and stewardship practices in CA's dairy industry and focus areas for future research and education.

Results of a survey to estimate cattle movements and contact rates among beef herds in California, with reference to the potential spread and control of foot-and-mouth disease.

OBJECTIVE: To estimate contact rates and movement variables for shipments of beef cattle to and from producer premises in California. DESIGN: Cross-sectional survey. SAMPLE POPULATION: 583 beef producers in California. PROCEDURES: Questionnaires were developed and distributed to beef cattle producers in California. The study period was from April 20, 2005, through September 7, 2006. Data from completed questionnaires were entered manually into an electronic format. Descriptive statistical analyses were performed. RESULTS: Median number of interstate animal movements (movement of cattle into or out of California) was 0.17/mo; on the basis of this median, beef cattle were moved interstate > 2 times/y. Respondents kept beef cattle at up to 5 locations throughout the year. More than 40% of the movements from the respondents' premises were to a sale yard or auction facility. CONCLUSIONS AND CLINICAL RELEVANCE: Frequency of animal movements in this statewide study differed from values in another study of monthly shipments of animals to and from beef operations in 3 counties of California. The survey reported here revealed more frequent movements of animals to and from beef operations of all sizes. In addition, there were more high-risk indirect contacts on beef operations than has been reported previously. However, the number of low-risk indirect contacts was similar for small beef operations but less for large beef operations than has been reported elsewhere. Epidemic simulation models for California based on data in earlier studies likely underpredicted disease transmission involving beef herds.

Results of a survey of owners of miniature swine to characterize husbandry practices affecting risks of foreign animal disease.

OBJECTIVE: To characterize husbandry practices that could affect the risks of foreign animal disease in miniature swine. DESIGN: Survey study. STUDY POPULATION: 106 owners of miniature swine. PROCEDURES: An online survey of owners of miniature swine was conducted to obtain information about miniature pig and owner demographics; pig husbandry; movements of pigs; and pig contacts with humans, other miniature swine, and livestock. RESULTS: 12 states, 106 premises, and 317 miniature swine were represented in the survey. More than a third (35%) of miniature swine owners also owned other livestock species. Regular contact with livestock species at other premises was reported by 13% of owners. More than a third of owners visited shows or fairs (39%) and club or association events (37%) where miniature swine were present. More than 40% of owners fed food waste to miniature swine. Approximately half (48%) of the veterinarians providing health care for miniature swine were in mixed-animal practice. CONCLUSIONS AND CLINICAL RELEVANCE: Results of this study indicated that miniature swine kept as pets can be exposed, directly and indirectly, to feed and other livestock, potentially introducing, establishing, or spreading a foreign animal disease such as foot-and-mouth disease. In addition, the veterinary services and carcass disposal methods used by miniature swine owners may reduce the likelihood of sick or dead pigs undergoing ante- or postmortem examination by a veterinarian.

Global veterinary opportunities and responsibilities: some recent graduates' perspectives.

The veterinary profession has critical global responsibilities. To help meet these responsibilities, it is critical that the training programs for veterinary graduates provide them with the skills, knowledge, understanding, and professional attributes pertinent to meeting these responsibilities. The programs at US veterinary schools, in the full range from admissions, to curriculum, to post-graduate opportunities, fall short in many critical arenas.

Risk-based surveillance for avian influenza control along poultry market chains in South China: The value of social network analysis.

Over the past two decades, the poultry sector in China went through a phase of tremendous growth as well as rapid intensification and concentration. Highly pathogenic avian influenza virus (HPAIV) subtype H5N1 was first detected in 1996 in Guangdong province, South China and started spreading throughout Asia in early 2004. Since then, control of the disease in China has relied heavily on wide-scale preventive vaccination combined with movement control, quarantine and stamping out. This strategy has been successful in drastically reducing the number of outbreaks during the past 5years. However, HPAIV H5N1 is still circulating and is regularly isolated in traditional live bird markets (LBMs) where viral infection can persist, which represent a public health hazard for people visiting them. The use of social network analysis in combination with epidemiological surveillance in South China has identified areas where the success of current strategies for HPAI control in the poultry production sector may benefit from better knowledge of poultry trading patterns and the LBM network configuration as well as their capacity for maintaining HPAIV H5N1 infection. We produced a set of LBM network maps and estimated the associated risk of HPAIV H5N1 within LBMs and along poultry market chains, providing new insights into how live poultry trade and infection are intertwined. More specifically, our study provides evidence that several biosecurity factors such as daily cage cleaning, daily cage disinfection or manure processing contribute to a reduction in HPAIV H5N1 presence in LBMs. Of significant importance is that the results of our study also show the association between social network indicators and the presence of HPAIV H5N1 in specific network configurations such as the one represented by the counties of origin of the birds traded in LBMs. This new information could be used to develop more targeted and effective control interventions.

Paraveterinary service use in Nepal's Himalaya.

The involvement of paraveterinarians in animal-health delivery can reduce costs and allow expanded service delivery. Our objectives were to describe use of public paraveterinary services offered by junior technicians (JT) in two regions of Nepal, to identify factors associated with JT service use, and to characterize factors that limit JT service use. We used a survey of livestock owners in the Khumbu and Lower Mustang regions of Nepal's Himalaya to examine JT service use. Of 118 questionnaires completed between May 30, 1997 and July 8, 1997, 81 were analyzed for use of JT services to treat livestock: bovids, equids, and small ruminants. Five factors were associated with owners' use of JT services: living <30 min walk from a JT post (OR=12.2); having a positive opinion about JT services (OR=23.6); animals not having disease events that either impaired mobility or affected production or reproduction (OR=5.6), animals died related to a reported disease event (OR=3.2), and the owners' sex (with women being more likely to report use of JT services than men; OR=5.3).