Cambodia AGISAR/WHO and FAO project,2012 Dr Kruy Sun Lay, Head of - PowerPoint PPT Presentation

Implementation of AMR research in Cambodia AGISAR/WHO and FAO project,2012 Dr Kruy Sun Lay, Head of Food microbiology Lab

Plan  Project titles  Overall project aims  Chronology of events  Poultry production in Cambodia  Project approach FAO/WHO  Sample site and design  Poultry sample collection  Poultry slauther chain continuum  Sample size for FAO/WHO  Project outputs  Preliminary results Thailand Workshop 17-19/09/2012 2

AGISAR/WHO and FAO project I- WHO/“An Integrated surveillance study of antimicrobial resistance in Salmonella subspecies, Campylobacter spp, Escherichia coli and Enterococcus spp from poultry carcasses and Salmonella subspecies, Campylobacter spp from inpatients of National Pediatric Hospital, Phnom Penh, Cambodia” II- FAO/“the control of microbial and antimicrobial resistance hazards along the poultry chain continuum, in Cambodia” Thailand Workshop 17-19/09/2012 3

Overall project aims  Understand the role of poultry in transmitting bacteria creating a risk for consumers as a cause of foodborne illness and of resistance to antibiotic treatment  Map the pathways of contamination from production to consumption  Identify approaches to control contamination of poultry meat with bacteria causing foodborne illness and carrying antimicrobial resistance  Identify points of contamination and practices to prevent/ control it  Identify measures to control antibiotic use in poultry production and human medicine Thailand Workshop 17-19/09/2012 4

Specific aims Human illness:  Investigate the incidence of human enteric illness caused by pathogens that could be transmitted by chicken consumption when they are resistant to antimicrobials  Investigate the practices used in medical clinics for antimicrobial treatment among sick children Thailand Workshop 17-19/09/2012 5

Specific aims continued Poultry meat production:  Describe the poultry value chain and the pathway from farm to retail markets  Determine the level of chicken contamination and AMR  Indentify key points where contamination is reduced, increased or remains the same and factors that could cause these changes Thailand Workshop 17-19/09/2012 6

Chronology of events  Submission of document to 3 rd expert groups meeting : Oslo, Norway, June 2011  Decision made on implementation of AGISAR/WHO project in Cambodia/end June 2011  FAO/ early 2012, an integration manner, the AMR assessment risks along the poultry chain continuum  30/01/2012, seminar to launch the study, with stakeholders Thailand Workshop 17-19/09/2012 7

Poultry production  Cambodia, poultry production is important by its contribution ( 26,000 T/year, source OIE, Cambodia)  Household food security  Income  Human health risks associated to poultry consumption are mostly, associated with pathogens ( Salmonella subspecies, Campylobacter spp, E coli pathogen…)  As well as the increasing presence of antimicrobial resistance in pathogenic and commensal bacteria ( E coli , Enterococcus ) isolated in poultry products Thailand Workshop 17-19/09/2012 8

Project approach WHO/FAO Type of sample ( FAO) No. sample Sample type Site Lab test to be carried out Analysis Live bird fresh faecal 20x2x2 (2 type of Pooled sample Kien Svay district - Campylobacter Quali. for Salmonella and production Kandal province - Salmonella Campylobacter droppings at production -Large scale production And AMR site - Poultry backyard villager Cecae of birds at slaughter 20x2x2 cecae Deum Kor or - Campylobacter Quali. for Salmonella site/market O Russey market - Salmonella Quantitative for - E. coli Campylobacter and E. coli And AMR Carcass after slaughter - neck 20x2x2 Fresh Deum Kor or - Campylobacter Quali. Salmonella and skin (WHO) Unchilled Orussey market - Salmonella Quantitative for neck skin - E. coli Campylobacter , E Coli and - VRE Entercoccus VRE And AMR Rinse/wash water (if common 20x2x2 100mL Deum Kor or O Russey - Campylobacter Qualitative for Salmonella for birds) to determine market - Salmonella Quantitative for - potential for cross- E. coli Campylobacter and E coli contamination of carcasses And AMR e.g. in bucket or basins Surface of chopping boards 20x2x2 swab 10cm 2 area Deum Kor or O Russey - Campylobacter Qualitative for Salmonella that could result in significant market - Salmonella and quantitative for cross-contamination between - E. coli Campylobacter and E coli birds; sample at the end of the And AMR day or after multiple birds in contact Total FAO 400 WHO Samples No. samples Sample type site Lab test to be carried out Analysis Carcasses after slaughter - 200 during FAO sampling Fresh unchilled Deum Kor or O Russey - Campylobacter Quali. Salmonella , neck skin ( 80 included within FAO Neck skin market - Salmonella Campylobacter , E Coli and sample) - E. coli Entercoccus VRE And 160 other s samples - V RE after finishing FAO project And AMR Total WHO 200 for total 360 9 AGISAR samples

Market profile and poultry sellers  Two markets: Orussey (OR) and Deumkor (DK) in South PP area  OR market, 1,200 shops ( 25-30 shop poultry sellers)  Daily average weight sold/ 800-1200kg  Sometime, highest weight daily sold reached 2T  DK market, ~ 1000 shops ( 11 shops poultry sellers)  These two markets owned by the government. Thailand Workshop 17-19/09/2012 10

Phnom Penh markets Orussey market 11

Sampling design  Each poultry sellers in each market will be randomly selected  A total of 5 poultry neck skin samples and 2 on each of other poultry chains, minimum 11 samples per week from Phnom Penh OR and DK markets will be sampled Thailand Workshop 17-19/09/2012 12

Poultry farm 13

Poultry backyard villagers Thailand Workshop 17-19/09/2012 14

Poultry slaughtering in the market Thailand Workshop 17-19/09/2012 15

Poultry sample collection 2 3 Caecae Samples collect before bird is Feed slaughtered for Pool 10 caecae for one AGISAR sample Storage post- Farm Transport Slaughter Retail slaughter Faecal Fresh droppings unchilled Pool 5 carcasses 1 individual for retail sale droppings for Collect neck one sample skin 5 4 Water bath used Contact to clean surfaces carcasses Common contact surfaces that may result in cross- Water in tubs or buckets used to contamination such as chopping clean carcasses and the that may blocks/boards/tables, ground result in cross-contamination Swab 10cm 2 area  100mL water FAO specimen selected a long the poultry slaughter continuum 16

Poultry slaughter chain continuum Storage post- Transport Slaughter Retail slaughter Fresh Chilled frozen unchilled carcasses carcasses for retail sale Chopping Water bath board Thailand Workshop 17-19/09/2012 17

Sampling site along the poultry slaughter continuum( AGISAR + FAO) Fecal dropping at large scale farm Specimen and bacyard Caecae for poultry villagers before bird is AGISAR slaughter 1 2 Storage post- Transport Slaughter Retail slaughter Fresh Chilled frozen carcasses for carcasses- retail sale Collect neck skin  Collect neck skin 3 Chopping Washing board Water 5 4 Thailand Workshop 17-19/09/2012 FAO specimen selected a long the poultry slaughter process 18

Sampling process for Cambodia dry season (February-July, 2012) Thailand Workshop 17-19/09/2012 19

Sampling process during the Cambodia rainy season (September/2012 to January 2013) Thailand Workshop 17-19/09/2012 20

Sample for FAO and AGISAR  The sampling process for FAO start from February to July for 200 specimens and September 2012 to January 2013/ 2012 to obtain 400 specimens  Animal samples for AGISAR/WHO  1 st -160 th specimen for Salmonella,  1-237 th specimen for Campylobacter  and 1-360 th specimen for E. coli and Enterococcus  Human samples for AGISAR/WHO  1 st - 750 th diarrhea selected from Cambodia NP hospital Thailand Workshop 17-19/09/2012 21

Project outputs  Prevalence of Salmonella spp. and Campylobacter spp. in retail poultry and isolates of these pathogens from inpatient children with diarrhoea  Levels of contamination with faecal indicator bacteria, E. coli and Enterococcus spp. in retail chicken  AMR profile of the bacterial isolates Thailand Workshop 17-19/09/2012 22

Project outputs continued  Assessment of antimicrobial use in patients and poultry broiler production  Stakeholder meetings and recommendations on options for control of Salmonella and Campylobacter food safety risks and AMR transmission  Baseline for future policy developments 23

Preliminary results -76 Salmonella and 63 Campylobacter strains Thailand Workshop 17-19/09/2012 24

Preliminary results of human samples  February – Septembre/2012  83/750 fresh fecal samples from NPH  Two Salmonella were identified  One Salmonella Typhimurium with ESBL profile  No Campylobacter spp have been isolated in human samples yet Thailand Workshop 17-19/09/2012 25