antimicrobial usage and antimicrobial resistance in vietnam

Antimicrobial usage and Antimicrobial resistance

in Vietnam

Dr Nguyen Van Long, DVM, MSc, PhD. Email: [email protected]

Dr Dang Thi Lua, PhD. Email: [email protected]

Aquatic AMR Workshop 1: 10-11 April 2017, Mangalore, India

FMM/RAS/298: Strengthening capacities, policies and national action plans on

prudent and responsible use of antimicrobials in fisheries

PRESENTATION OUTLINE

I. Background

II. Antimicrobial usage and Antimicrobial

resistance

III. State management activities

IV.National Action Plan

I. General

background

Area: 332,000 km2

Population: 90 million

(70% practice farming)

Capital: Hanoi

Agricultural production

contributed about 18% of

national GDP

Aquaculture contributes

about 26 % of total

agricultural GDP

1.1. TOP FIVE AQUACULTURE SPECIES

TT Species Estimate

d areas

(ha)

Estimated

productivity

(cubic ton)

Main

production

area

1 Shrimp

White leg shrimp (Litopenaeus

vannamei)

100,000 230,000 MRD

Giant tiger prawn (Penaeus monodon) 600,000 370,000 MRD

Giant freshwater prawn (Macrobrachium

rosenbergii)

28,000 60,000 Northern

provinces

2 Pangasius catfish (Pangasius

hypophthalmus)

5.500 1,500,000 10 MRD

provinces

3 Tilapia (Oreochromis niloticus) 25 150,000

4 Mollusca 50,000 350,000

5 Traditional fish (such as carp,…) 350,000 850,000 Northern

provinces

Place Pond area

(ha)

Cage area

(m3)

Production

(tonnes)

Highlands in North 7.348 3,560 21.373

Red river Delta 10,660 195,597 72,303

North Central 2,927 - 12,080

South Central 139 13,000 1,180

Highlands in South 1,578 - 5,750

South East 1,115 6,300 6,755

South West 1,648 904,008 62,641

Total 25,415 1,122, 465 182,082

Area and production of Tilapia (2014)

MAJOR AQUACULTURE AREAS

10 provinces

produce

pangasius

(5.500 ha)

29 provinces

produce brackish

shrimps (700.000

ha)

A total of 1,3

million ha

Intensive shrimp production farm without using antibiotics

The map of farming areas in

Building the traceability process

for pangasius products

www.pangasiusmap.com

Developing e-commerce to expand market share:

www. mekongfishmarket.com

Pangasius Processing Establishments

Bien Dong Seafood Co., Ltd

Sao Mai fish oil processing factory

Vam Cong IZ for fish processing

factories

Cantho Import-Export Seafood JSC.

(CASEAMEX)

Pangasius products

Total production of farmed Pangasius by

country (FAO statistics, 2008).

Shrimp: Market and Trade

Vietnam exports shrimp to over 95 countries and territories

Main markets: America, EU, Japan,China, Korea, Australia,

Canada, ASEAN, Taiwan.

Shrimp exports brought home about US$ 3.15 billion in

2016.

Total production of farmed Pangasius by country (FAO statistics, 2008).

Pangasius: Market and Trade

Vietnam is the world’s largest producer of Pangasius:

o Producing > 1.1 million tons per year

o Exporting to over 161 countries and territories

Pangasius accounted for over

25% of total seafood export

turnover of Vietnam

2016: Production was 1.2 million

tons and exports brought home

US$ 1.67 billion.

Total production of farmed Pangasius by

country (FAO statistics, 2008).

Tilapia: Market and Trade

Vietnam is one of five largest producer of tilapia in Asia:

o Producing 95.000 tonnes (2013) and 187.000 tons (2015)

o Exporting to over 60 countries and territories

Tilapia exports brought home more than US$ 34 million in 2015.

Tilapia still is mainly used for domestic consumption.

1.2. DISEASE SITUATION

Major disease concerned

• In shrimp

• WSSD

• AHPND

• IHHNV

• MBV

• EHP

• Taura?

• In Pangasius

• Edwardsiella ictalura

• Aeromonas hydrophila

• In mollusca

• Environmental change

• VLPs in Otter clam

• Perkinsus?

• In tilapia

• Streptococcus spp

• TiLV?

• In marine fish

• VNN

• Vibrio spp.

• In traditional fish

• Aeromonas infection

• Pseudomonas infection

1.2.1. Situation of shrimp diseases

Year Areas (ha) of giant tiger

prawn (Penaeus

monodon) with disease

Areas (ha) of white leg

shrimp (Litopenaeus

vannamei) with disease

Total

infected

areas (ha)

2014 27.859 14.287 42.146

2015 10.698 7.007 17.705

2016 5.470 5.845 11.315

Year WSSD (ha) AHPND

(ha)

IHHND

(ha)

Local endemic

diseases (ha)

Total

(ha)

2014 23,872 5,552 1,211 11,511 42,146

2015 5,337 9,420 41 2,906 17,704

2016 3,892 6,342 27 1,052 11,313

By infected species

By disease

SPATIAL DISTRIBUTION OF AREAS WITH DISEASED SHRIMP

IN 2014 - 2016

In 2014 In 2015 In 2016

TT DiseaseYear

2014

Year

2015

Year

2016

1Disease caused by Edwardsiella

ictalura (ha)729 77 79

2Disease caused by Aeromonas

hydrophila (ha)1 353 313

3 Local endemic diseases (ha) 970 151 101

Total 1,513 551 356

1.2.2. Situation of pangasius diseases

Some pangasius ponds infected with more than one disease, so if we sum-up

by disease, total infected areas slightly higher than the total mentioned above

table

SPATIAL DISTRIBUTION OF AREAS WITH DISEASED PANGASIUS

IN 2014 - 2016

In 2014 In 2015 In 2016

Situation of Tilapia disease

Steptococosis disease caused by Streptococcus iniae, S. agalactiae

The first outbreak was reported in Vietnam in 2009

Occur every year during the summer (high temperature)

Susceptible at marketable size with high mortalities (60%-100%)

Can be treated by antibiotics, start

using vaccination


I. Background


resistance



2.1. Summary of veterinary

products are licensed in Vietnam

• Total: 814 products produced by 51 domestic

manufactures and 53 importers

– 609 products produced by 51 domestic

manufactures

– 105 produced from 53 importers

• We also have a list of chemicals and antibiotics

banded for production, trading and using in

aquaculture

2.1. THE LIST OF CHEMICALS, ANTIBIOTICS

BANNED FOR PRODUCTION, TRADING IN AQUACULTURE

(Circular No. 10/2016/TT-BNNPTNT)

No Chemicals, antibiotics Applied for

1 Aristolochia spp and by products

Animal feed, veterinary

medicines, chemicals,

environmental treatment

substances, disinfectants,

substances for maintain, hand

cream in all breeding facilities,

aqua culture, processing and

storage for fishery services.

2 Chloramphenicol

3 Chloroform

4 Chlorpromazine

5 Colchicine

6 Dapsone

7 Dimetridazole

8 Metronidazole

9 Nitrofuran (bao gồm cả Furazolidone)

10 Ronidazole

11 Green Malachite (Xanh Malachite)

12 Ipronidazole

13 Các Nitroimidazole khác

14 Clenbuterol

15 Diethylstilbestrol (DES)

16 Glycopeptides

17 Trichlorfon (Dipterex)

18 Gentian Violet (Crystal violet)

19 Trifluralin

20 Cypermethrin

21 Deltamethrin

22 Enrofloxacin

23 Ciprofloxacin

24 Fluoroquinolones

2.2. AMU

Beside many good aspects for management of AMU, some issues to

be discussed as follows:

In 2015 and 2016, DAH carried out three surveys of AMU 714

aquaculture farming households in 3 pangasius production provinces

(Ben Tre, Dong Thap, An Giang) and 2 shrimp production provinces

(Soc Trang and Bac Lieu)

• In 3 pangasius production provinces: 216/272 (79,4%) households

used at least one antibiotic

• In 2 shrimp production provinces: 256/436 (67,9%) households


This means that antibiotics have been used widely and frequently in

aquacultre. Antibiotics are used without any prescription; farmers

used for both prevention and treatment of diseases. Reasons, because

they invested a lot of money and they dont want to lose their products

USE OF OXYTETRACYCLINE

Before 2016, antibiotics were very commonly used in aquaculture

USE OF OXYTETRACYCLINE

Farmers just bought some kg of Oxytetracycline and kept them for their daily use Antibiotic without label was used in

aquaculture

And many other antibiotics are used

Even a farm has a list of antibiotics t be used at their farm

2.3. AMR• WHO warns that Vietnam is one of the top country where have

high rate of AMR

• In aquaculture (pangasisu production): AMR for disease caused by

Edwardsiella ictalura

Number of resistances Number of sensitivities

2.3. AMR• In aquaculture (pangasisu production): AMR for disease caused by

Aeromonas hydrophila

Number of resistances Number of sensitivities

PILOTING SURVEILLANCE FOR ANTIMICROBIAL RESISTANCE IN AQUACULTURE SECTOR IN VIETNAM sponsored by WHO

One of major objective:Study prevalence of enteric bacteria (E. coli and Salmonella) and

aquatic bacteria (Aeromonas spp and Vibrio spp) in catfish aquaculture in Can Tho province.

In 2014

TTAntimicrobi

als

Aeromonas spp.

Water Sediment Fish

S I R S I R S I R

1 FFC 148/167 2/167 17/167 164/182 6/182 12/182 130/169 6/169 33/169

2 OXT 118/167 0/167 49/167 154/182 2/182 26/182 89/169 6/169 74/169

3 ENR 45/167 77/167 45/167 113/182 55/182 24/182 87/169 55/169 27/169

4 AMP 1/167 0/167 166/167 5/182 0/182 177/182 1/169 0/169 168/169

5 AMO 1/167 0/167 166/167 5/182 2/182 175/182 1/169 0/169 168/169

6 NOR 150/167 6/167 11/167 175/182 0/182 7/182 162/169 3/169 4/169

7 SXT 154/167 2/167 11/167 169/182 0/182 13/182 158/169 2/169 9/169

8 GN 135/167 11/167 21/167 145/182 8/182 29/182 100/169 2/169 67/169

9 SDM 0/167 0/167 167/167 0/182 0/182 182/182 0/169 0/169 169/169

Antimicrobial resistance test for Aeromonas spp.

S – Susceptible I- Intermediate R- Resistance

536 isolates of Aeromonas spp.

Resistance rate among Aeromonas isolates

TT Antimicrobials Water Sediment Fish

S I R S I R S I R

1 FFC 103/117 5/117 9/117 117/134 11/134 6/134 62/77 4/77 11/77

2 OXT 81/117 0/117 36/117 74/134 22/134 38/134 57/77 2/77 18/77

3 ENR 62/117 19/117 36/117 91/134 18/134 25/134 42/77 22/77 13/77

4 AMP 75/117 17/117 25/117 107/134 17/134 10/134 52/77 4/77 21/77

5 AMO 74/117 27/117 16/117 107/134 20/134 7/134 44/77 15/77 18/77

6 NOR 101/117 5/117 11/117 99/134 11/134 24/134 57/77 8/77 12/77

7 SXT 66/117 5/117 46/117 60/134 3/134 71/134 25/77 6/77 46/77

8 GN 72/117 5/117 40/117 89/134 17/134 28/134 56/77 0/77 21/77

9 SDM 0/117 0/117 117/117 0/134 0/134 134/134 0/77 0/77 77/77

Antimicrobial resistance test for Vibrio spp.

S – Susceptible I- Intermediate R- Resistance

346 isolates of Vibrio spp.

Resistance rate among Vibrio spp. isolates


I. Background


resistance

III.State management activities


3.1. National aquatic animal health strategy

• In 2012 – 2013: FAO Project TCP/VIE/3304

– FAO supported Vietnam to identify pathogens of AHPND (Dr

Melba Reantaso and other international experts)

– And the National Aquatic Animal Health Strategy:

1. Policy legislations and institutional framework

2. Epidemiology (surveillance, monitoring), Emergency preparedness

and reporting

3. Diagnostics and laboratory systems

4. Quarantine, inspection and health certification

5. Veterinary drugs/chemicals and vaccine management

6. Capacity building

7. Research and Development

8. Communication and international collaboration

9. Resources and funding



3.2. Policy legislations and institutional framework

• New Veterinary Law has been effective since 01 July 2017

• Degree 35/2016/ND-CP dated 15/5/2016.

• Degree 39/2017/ND-CP dated 04/4/2017 on animal feeds with addition of

antibiotics which will be totally eliminated from animal feeds in2020.

• 11 Circulars of MARD on disease control, AMU and AMRD

• MARD established National Steering Committees for Prevention and Control of

Aquatic Animal Diseases; for AMU and AMR

• Ministry of Health (MoH) initiated national activities to tackle AMR with the

publication of the National Action Plan on Combatting Drug Resistance from

2013 to 2020. MoH also established National Steering Committee for

controlling AMU and AMR, including representatives rom 31 relevant agencies

• Three ministries, MoH, MARD and MONRE signed the ‘Multi-stakeholder

Engagement to combat AMR in Vietnam’

• MARD issued more than 20 official letters to direct and enforce controlling

AMU &AMR

III. State management activities3.3. National programmes

• National Programme for Prevention and Control of Diseases in Pangasisus

Animals between 2015 and 2020 (Decision 4995/QĐ-BNN-TY dated

20/11/2014)

• National Programme for Establishment of Disease Free Compartments and

Zones for Shrimp Production (Decision 4088/QD-BNN-TY dated 07/10/2016)

• National Programme for Active Surveillance of Diseases in Shrimp and

Pangasius Animals and Products to be exported between 2017 – 2020 (Decision

1038/QD-BNN-TY dated 29/3/2017)

• Annually, both National and Local Government issues the National and Local

Action Plans for Disease Control

• Objectives:

• Early warning

• More effective and timely detection, response to aquatic animal diseases

• Disease free compartments and zones

• Meet requirements from importers (currently 161 countries import aquatic animals

and aquatic animal products from Vietnam)

3.4. Aquaculture management system in Vietnam

Animal Health System of Viet Nam

Professional Centers

The National Center

for Vet. Diagnosis

The National Center

for Vet. Bio-products

Inspection 1, 2

The National Center

for Hygiene

Inspection 1, 2

DEPARTMENT OF ANIMAL HEALTH

(Divisions)

1. Epidemiology

2. Aquatic Animal Health

3. Animal Quarantine

4. Drug & Vaccine Management

5. Veterinary Public Health

6. Legislation & Inspection

7. Plan (Inter. Cooperation & Science)

8. Finance

9. Personnel and Administration

10. International Cooperation and Com.

MINISTRY OF AGRICULTURAL

AND RURAL DEVELOPMENT

Regional Animal

Health Offices

(RAHOs)

No. 1

No. 2

No. 3

No. 4

No. 5

No. 6

No. 7

Regional Sub

Departments of Animal

Quarantine and

Inspection in Lang Son,

Lao Cai and Quang Ninh

Provincial Sub-Department of Animal Health

District Veterinary

Station

Domestic Animal

Quarantine Station

Communal

Veterinary Team

NAFIQADDirectorateof Fishery; RIA1,2,3;

Universities

Direct state management (Technical + personnel

+ financial approval)

Only technical supervision and/or collaboration

Animal health staff

Institution Number of staff

Qualification (%)

Post.Grad Graduate Technicians Basic training

DAH and RAHOs

643 20 54 9 17

ProvincialSDAH

7,457 5 49 37 7

Communevets

25,227 0 5 38 57

Private vets 30,653 0 2 29 69

National Committee for Controlling Diseases

in Aquatic Animals in Vietnam:

30 members come from various national and local agencies

involve in aquaculture management and veterinary services

National Committee for AMU and AMR

• Lead by Deputy Prime Minister

• 32 Members come from all relevant ministries: MoH, MARD,

Ministry of Trade, Ministry of Police, Custom, etc.

One Health Office

The OIE PVS Tool

Evaluation of the Performance ofVeterinary Services

- First PVS evaluation of aquatic animal health system in the world in 2009. Level 2 (the best level 5)

- First follow-up PSV evaluation of aquatic animal health system in the world in 2015: level 3 (the best level 5)

III. State management activities3.5. Diagnostics and laboratory systems

• A total of 32 national and local laboraties for aquatic animal

diseases. Of which 19 laboratories are accreditaed with ISO 17025

• All 12 National laboratories are at the level 2+ for biosecurity will

all advanced facilities such as PCR, Real-time PCR, isolation and

sequencing

• All 12 National laboratories are assigned for monitoring residues

in aquatic animals and aquatic animal products

• Have participated the proficiency tests with the OIE/NACA

reference labroratories, Arizonal, Australian Animal Health

Laboratory

• Invited many international recognised experts came to Vietnam to

support establishment of laboratories, training course; and send ky

laboratory staff to the references for trainings on advanced

techniques

Proficiency test with National laboratory and

International reference laboratories

NoCausative

agentMethod

of

developin

g protocol

Arizona AAHL CSIRO – ANQAP – NACA

Number of

samples

Equivalenc

y rate (%)

Number of

samples

Equivalency

rate (%)

Number of

samples

Equivalency

rate (%)

1 WSSV qPCR 2011 2011: 10 100% 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

2 TSV qRT-PCR 2011 2011: 10 100% 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

3 YHV qRT-PCR 2011 2011: 10 100% 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

4 IMNV qRT-PCR 2011 2011: 10 100% 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

5 IHHNVqPCR,

PCR2011 2011: 10 100%

2013: 36

2014: 36

2013: 100%

2014: 100%

7 MrNV RT-PCR 2012 2012: 12 100%2013: 36

2014: 36

2013: 92%

2014: 100%

8 SVCVqRT-PCR,

RT-PCR2012 2012: 12 100%

2013: 36

2014: 36

2013: 92%

2014: 100%

9 KHV qPCR 2012 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

10 VNN qRT-PCR 20112013: 36

2014: 36

2013: 100%

2014: 100%

11 RSIV qPCR 2012 2012: 12 100%2013: 36

2014: 36

2013: 100%

2014: 100%

12 EHN PCR 2014 2014: 12 100%

13 IHHNV RT-PCR 2014 2014: 12 100%

14 VHS qRT-PCR 2014 2014: 12 100%

II. NĂNG LỰC CHẨN ĐOÁN BỆNH THỦY SẢNINTER-COMPARISON LABORATORY - Arizona University (PCR technique - 2011)

II. NĂNG LỰC CHẨN ĐOÁN BỆNH THỦY SẢNINTER-COMPARISON LABORATORY - Arizona University (Histopathology technique-2012)

NACA project, Asian Regional Laboratory Proficiency Testing Program for Aquatic animal Diseases

from 2013 to 2014

No Diseases TechniqueReport results

01 White Spot Disease (WSSV) Real-time PCR Pass

02 Taura Syndrome (TSV) Real-time PCRPass

03 Yellow Head Disease (YHV) Real-time PCRPass

04 Infectious Myonecrosis (IMNV) Real-time PCRPass

05Infectious Hypodermal and

Haematopoetic Necrosis (IHHNV)Real-time PCR

Pass

06 White Tail Disease (MrNV) Conventional PCR Pass

07 Viral Nervous Necrosis (VNN) Real-time PCR Pass

08 Spring Viraemia of Carp (SVCV) Conventional PCR Pass

09 Koi Herpes virus (KHV) Real-time PCR Pass

10 Red Sea Bream Iridovirus (RSIV) Real-time PCR Pass

PROFICIENCY TESTING(Conventional PCR and Real-time PCR technique)

Aquatic Animal

Health Laboratory

Prof. Lightner, Arizona

Uni came to Vietnam

many times to help

establishment of

laboratories and training

courses

(

Drs. Tim & Lightner have visited and worked at RAHO6 several times

4/11/2017 56

a) DAH manage

import/export all animal

and animal products,

including aquatic

animals

b) SDAH manage local

transportation of animal

and animals products

3.6. Quarantine of animals, products of animal origin, including aquatic products



I. Background


resistance



IV. National Action Plan for the Reduction of

Antibiotic Use and Resistance in Livestock

Production and Aquaculture,

2016-2020• FAO supported Vietnam to develop the NAP since 2016

• Major activities:

• Objective 1: Enforce policy and governance related to AMR and AMU in

livestock production and aquaculture

• Objective 2: Increase awareness on AMR and AMU among livestock and

aquaculture professionals and consumers

• Objective 3: Implement good treatment and husbandry practices in


• Objective 4: Monitor AMR, AMU and antibiotic residues in food and

agriculture

• Objective 5: Facilitate inter-sectoral collaboration in the management of the

risk of AMR

IV Nat onal Act on Plan…

4.1. Enforce policy and governance related to AMR and AMU in


• Training local staff to fully understand the legal regulation, action

plans

• Communicate to improve public awareness

• Force farmers, traders, exporters, importers to comply with the

regulations and technical guidelines

• Strictly handle administrative violations of the legal regulations

(new Degree applied)

• Review the current regulations, policies and programmes to ensure

that they cover well and more effective for AMU and AMR


4.2. Communication, workshops and meetings

• A large number of workshops and meetings between government

agencies, companies, associations on AMU and AMR have been

organized to identify current problems, gaps and difficulties in the

control of AMU and AMR.

• Many training courses for management of AMU in veterinary

services, animal production and aquaculture

• Mass media programmes on AMU and AMR

• At the national level, DAH established collaboration programme

with VTV1, VTC16, key Newspapers

4.3. Implement good treatment and husbandry practices in


- Improve aquaculture practices in shrimp, pangasius

- Disease free compartments and zones



4.4. Survey of AMU

In 2015 and 2016, DAH carried out three surveys of AMU 714

aquaculture farming households in 3 pangasius production provinces

(Ben Tre, Dong Thap, An Giang) and 2 shrimp production provinces

(Soc Trang and Bac Lieu)

• In 3 pangasius production provinces: 216/272 (79,4%) households


• In 2 shrimp production provinces: 256/436 (67,9%) households


• Common antibiotics were used: Amex, Amoxicillin, Ampi,

Colistin, Cephalosporin, Doxycycline, Cephalosporin,

Enrofloxacin, Flofenicol, Tremi, Sunfa, Tetracyclin


4.4. Survey of AMU

Since 2013, Vietnam also carried monitoring residue of antibiotic in

shrimp products at 199 main aquaculture areas of 37 provinces.

Number of positive samples are presented in following table.

Residue of antibiotic Year 2013 Year 2014 Year 2015 Year 2016

Chloramphenicol (CAP) 00 01 01 00

Enrofloxacin 01 02 01 00

Nitroimidazoles 00 07 01 03

Ivermectin 00 01 00 00

Trichlorfon 02 01 01 00

MG/LMG 00 04 01 01

Oxytetracycline 04 02 01 01

Doxycyline 00 04 00 01

Sulfonamides 02 03 02 00

Total 09 25 08 06

• Proportion (%) of shrimp products that were positive with

one of any listed antibiotics

0.38%

1.18%

0.46%

0.30%

0.00%

0.20%

0.40%

0.60%

0.80%

1.00%

1.20%

1.40%

Year 2013 Year 2014 Year 2015 Year 2016

Year Year 2013 Year 2014 Year 2015 Year 2016

Number of positive

/tested samples09/2365 25/2104 08/1751 06/1692


4.5. Facilitate inter-sectoral collaboration in the management of

the risk of AMR

• Inspection of all importers (28 companies) for veterinary medicine

products and raw material, especial for antibiotic raw materials to

identify how did they import, use and sell antibiotic products and

antibiotic raw materials.

• Local manufactures are now only allowed to import antibiotic raw

materials for their own production of antibiotic products.

• Inspection of veterinary drug shops to check whether they sell the

registered antibiotic products and all shops are not allowed to sell

antibiotic raw materials

• Implement the Aide Memoire on ‘Multi-stakeholder Engagement

to combat AMR in Vietnam’; leading by DAH (MARD) and Drug

Administration of Vietnam (MoH)

DEPARTMENT OF ANIMAL HEALTH OF VIETNAM –

RESEARCH INSTITUTE FOR AQUACULTURE NO.1

THANK YOU VERY MUCH

antimicrobial usage and antimicrobial resistance in vietnam

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