Combating AMR: How Kerala reduced antibiotic misuse in animals

 

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The importance of antibiotics in human and animal health cannot be understated, which is why antimicrobial resistance (AMR) is such a global threat.

As bacteria develop resistance to antibiotics, we risk returning to a time when animals and people fell ill and died from simple, treatable infections. So, antibiotics are a cornerstone of modern medicine and public health.

Antibiotics are the tools to manage animal disease in animal health as well. Reducing antibiotic use without first tackling disease rates would mean sick animals go untreated, causing unnecessary suffering and mortality while increasing risk of transfer to other animals and people.

By better protecting animals from the threat of disease, identifying health issues earlier and treating them quickly and responsibly, we can decrease disease levels and the need for antibiotics.

This requires exploiting the long-term and preventative health benefits of tools such as vaccination, nutrition, biosecurity, disease surveillance, diagnostics, husbandry including housing and other animal health technologies. But antibiotics are the only way to treat a bacterial disease and there is currently no alternative.

In addressing issues such as AMR, it must recognised that such complex issues can only be resolved through intersectoral National Action Plans, which are cornerstone for action by any state.

Such action plans are the starting point for implementation of control strategies. They help identify relevant stakeholders, followed by mapping of available infrastructure and capabilities of stakeholders to arrive at a ‘One Health’ action plan for control.

Health is a state subject in India and individual states can formulate decisive actions. Only a very few states have developed a strategic action plan based on a national action plan. Kerala was the first state to ramp up efforts to control AMR, which was guided by WHO.

AMR can only be addressed by working across disciplines. The state, therefore, launched such a plan called Kerala AMR Strategic Action Plan (KARSAP) for the same.

Kerala has operationalised the plan in animal health by the conceptualisation in-KARSAP: A ‘One-Health’ response to AMR containment. It took action on each of the six strategic priorities as detailed below:

Strategic priority 1: Awareness & Understanding

The extension and training wing of the animal husbandry department is the livestock management training centers (LMTCs) located across various districts of Kerala. Each centre trains around 200 farmers every month.

A one-day training programme was conducted for veterinarians of LMTCs titled Train the trainers on AMR so that this message could be given to farmers. Kerala State Veterinary Council, the statutory registration body controlling veterinary practice, is now conducting Continuing Veterinary Education (CVE) programme for veterinarians on AMR.

The Veterinary University has AMR in its curriculum, with an aim to improve the understanding on AMR and promote prudent use of antibiotics.

Strategic priority 2: Knowledge & evidence

• Laboratories: ISO 17025: NABL accreditation for Labs as well as that of all four apex labs of the Veterinary Department to the International Standard has been completed. Staff training to the lab personnel of microbiology divisions on WHO-NET has also been completed. These trainings were conducted by Govt Medical College, Trivandrum, the State nodal Centre for AMR.

Surveillance: Residue monitoring for antibiotics in broiler chicken by govt of Kerala to cover farms from various districts of Kerala.

• AMR in food and food animals: An integrated veterinary surveillance programme for Kerala (meat, milk, poultry) and molecular identification and resistance study of bacterial isolates from animal products
• Detection of common antibiotic residues of oxytetracycline & penicillins in milk in select pilot districts including study of AMR patterns for staphylococcus in milk and MRSA isolation
• AST for bacterial avian diseases is an ongoing activity.

Strategic priority 3: Infection prevention & control

To optimise the use of antibiotics, the AMR working group has developed a standard operating procedure (SOP) for IPC in veterinary hospitals and plans to distribute it initially among district vet hospitals in Kerala.

An SOP for biosecurity for livestock and poultry farms has been developed by the AMR working group and the same would be given to departmental farms in the first phase.

Strategic priority 4: Optimise use of antibiotics

• Regulations: Kerala Livestock and Poultry feed (Regulation of manufacture and sale Act 2018) is now in draft stage and the work is underway.
• Surveillance of antimicrobial use: Restricting veterinary antibiotic use by making them prescription only medicines by RVP and conducted a survey on prescription practice with respect to antimicrobials among veterinary doctors in select districts.

Strategic priority 5: Research & innovations

• The state livelihood mission’s “Kerala Chicken” tested for antibiotic residues

distribution of field level rapid antibiotic sensitivity kits to veterinary institutions throughout Kerala

• Mapping and geo tagging of all animal farms in Kerala along with individual animal identification for disease control and animal traceability (BHUMIKA app)

Strategic priority 6: Collaborations

• ReAct Asia Pacific conducted a one-day workshop at Ernakulam on biosecurity and antibiotic issues in poultry industry and on antibiotic smart communities
• Training programme for veterinarians on AMR are being organised by Indian Veterinary Association, Kerala
• Training programme for government veterinarians from other states and sharing of Kerala model on AMR action plans facilitated by the think-tank Centre for Science and Environment, New Delhi, was held at Thiruvanthapuram. Nine different states participated.

Disease control programmes

The department of animal husbandry had two major diseases control programmes for control of major diseases in animals and poultry. Better animal health management is very important as healthy animals and birds, just like healthy humans do not require any antibiotics.

As with the human health, the animal health aspect of AMR is a complex issue that requires concerted, coordinated action.

The lack of detailed antimicrobial usage (AMU), epidemiological, molecular data (antibiotic resistant genes) impacts our ability to interpret prevalence / surveillance data on AMR and to design efficient interventions. Therefore, monitoring systems on use and residue monitoring in animal products is essential to fill this knowledge gap. 

Finally, the ecology of AMR should be addressed with a holistic, one-health approach combining expertise from different disciplines, such as medical doctors, veterinary clinicians, fisheries professionals, public health scientists, microbiologists, wildlife specialists, environmental scientists (ecologists) and epidemiologists.

The KARSAP for AMR is a first such endeavour for Kerala.

The author works with the state veterinary department of Kerala. Views expressed are the author's own and don't necessarily reflect those of Down To Earth

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