Since 1921, the National Veterinary Accreditation Program (NVAP) has leveraged private practice veterinarians’ medical expertise, as well as their relationships in the communities they serve, to deliver regulated animal health services. However, accredited veterinarians’ importance to Americans goes even further because of their expertise in zoonotic diseases and judicious antimicrobial use. With roughly 75% of newly recognized or emerging infectious diseases being zoonotic, accredited veterinarians’ role in the early diagnosis and management of zoonotic diseases is critical to the health of our population. Additionally, accredited veterinarians’ proper use of antimicrobial drugs in animals influences the emergence of antimicrobial resistant strains of microbes which can cause disease in humans.
All uses of antibiotics influence bacterial populations and potentially select for resistance. Although the development of antibiotic resistance is not new or unexpected, the use of antibiotics in any setting (human, animal, agriculture, etc.) is the single most important contribution to antibiotic resistance development. Antibiotic use creates a selection pressure that favors the survival and amplification of resistant strains.
Both natural causes (e.g., natural variation, selective pressure, mutation, and gene transfer) and societal pressures (e.g., inappropriate use, inadequate diagnostics, and hospital and agricultural use) drive bacteria to constantly adapt in an effort to evade the antibiotics developed to suppress them.
Since the introduction of NVAP Module 23: Use of Antibiotics in Animals in 2012 in Web, classroom, and printed training material formats, it has played a key role in VS’ AMR global education and outreach efforts. The module is the collective effort of subject matter experts from several subsets of the veterinary medical community (academic, livestock, and companion animal veterinarians), plus input of officials from FDA, CVC, DOD, and USDA-NIFA. The module has been completed over 20,000 times by accredited veterinarians. Like all NVAP training modules, however, Google Analytics reveals usage by a global audience equal in size and separate from accredited veterinarians. At the meeting of the Group of Seven (G7) meeting in Germany in 2015, Module 23 was one of only two “Best Practices of Combating Antimicrobial Resistance” from North America. Over the past year, Module 23 underwent major revisions to ensure its content is timely and reflective of the latest best practices, and NVAP recommends all APHIS employees explore and share the module with your veterinarians and physicians.
Released in 2017, NVAP Module 29: Veterinary Feed Directive has already been completed by over 2,100 accredited veterinarians, and is the most viewed module in NVAP’s training suite in 2017. Module 29 was created with the close collaboration of FDA’s Center for Veterinary Medicine to clarify FDA regulations which went into effect in January 2017. A veterinary feed directive (VFD) is a written (nonverbal) statement, also referred to as a VFD order, for a veterinarian to maintain oversight of medicated feed for use in food producing animals by authorizing the client to obtain and use feed containing antibiotics that are medically important in human medicine. All veterinarians, including accredited veterinarians, have been mandated by FDA regulations to use VFDs to direct the use of medicated feed by producers. However, accreditation is not required to write a VFD. Google Analytics data indicates that Module 29 provides a historic departure from past data with a new and yet undefined data set of “agriculturalist” users which exceeds our accredited veterinarian audience three-fold. Comments and questions from these “agriculturalists” indicate that they include, but are not limited to, feed manufacturers, feed mill owners/operators, feedlot personnel, and livestock producers. NVAP has also had an unexpected number of questions regarding the regulation of antibiotics used in beekeeping, perhaps a portent for a future module.
National Animal Health Monitoring System
APHIS Veterinary Services’ National Animal Health Monitoring System (NAHMS), in conjunction with the National Agricultural Statistics Service (NASS), will launch two studies in May 2017, in beef feedlots and swine farms, focusing on antimicrobial use and stewardship practices. These studies represent a new data collection and reporting effort for NAHMS and were first proposed in the USDA’s Antimicrobial Resistance Action Plan released in 2015. This plan specifically called for enhanced monitoring of antimicrobial use in food-producing animals. These activities will add to our understanding of antimicrobial use in veterinary medicine and animal agriculture, especially as they relate to judicious use and stewardship.
In May 2017, representatives from NASS will contact producers to inquire about their interest in participating in the study. NASS’ role will be to obtain producers’ consent for study participation. Beginning June 2017, producers who agreed to participate in the studies will be contacted to schedule an in-person interview conducted by a veterinarian.
NAHMS is a statistical unit under the Confidential Information Protection and Statistical Efficiency Act (CIPSEA). All information acquired during the antimicrobial use studies will be used for statistical purposes only and will be treated as confidential in accordance with CIPSEA guidelines. Only summary estimates based on the inference population will be reported. Data collected under CIPSEA are protected from Freedom of Information (FOIA) Requests.