Chairwoman Slaughter's Statement On Agriculture Subcommittee Hearing on Animal Health, Antibiotics
Slaughter: "Antibiotic resistant infections are a growing public health menace demanding a high priority response"
Washington, DC - Congresswoman Louise M. Slaughter (D-NY-28), Chairwoman of the House Committee on Rules, today released the following testimony regarding the House Committee on Agriculture's Subcommittee on Livestock, Dairy, and Poultry's hearing on advances in animal health within the livestock industry. Rep. Slaughter submitted testimony in support of her bill, H.R. 962, the Preservation of Antibiotics for Medical Treatment Act, to help keep antibiotics working for people by ensuring that the meat we eat isn't full of superbugs.
Rep. Slaughter submitted the following testimony for the record:
Thank you Chairman Boswell and Ranking Member Hayes for allowing me to submit testimony on this important public health topic. With antibiotic resistance growing at an alarming rate, it is becoming harder and more expensive to treat common bacterial infections. The problem has become so significant that it has been labeled a "top concern" by the Centers for Disease Control and Prevention (CDC), and the World Health Organization has called it a "crisis." Therefore, it is critically important that we act now to protect our current stocks of antibiotics.
Two million Americans acquire bacterial infections during their hospital stay every year, and 70 percent of their infections will be resistant to the drugs commonly used to treat them. As a result, every day thirty-eight patients in our hospitals will die of those infections.
Sadly, children and infants are particularly susceptible to infections caused by antibiotic resistant bacteria. For example, Salmonella causes 1.4 million illnesses every year. Over one-third of all diagnoses occur in children under the age of 10. Infants under the age of one are 10 times more likely than the general population to acquire a Salmonella infection. In 1995, 19 percent of Salmonella strains were found to be multi-drug resistant. That means that our children are left to undergo multiple treatments for otherwise simple infections because we have allowed traditional treatments to become ineffective.
And the cost to our already strained health care system is astronomical. In fact, resistant bacterial infections increase health care costs by $4 billion to $5 billion each year.
We cannot in good conscience stand by while our life-saving antibiotics become obsolete. While overuse of antibiotics among humans is certainly a major cause for increasing resistance, there is evidence that the widespread nontherapeutic use of antibiotics in animal feed is another cause of heightened resistance. A National Academy of Sciences report states that, "a decrease in antimicrobial use in human medicine alone will have little effect on the current situation. Substantial efforts must be made to decrease inappropriate overuse in animals and agriculture as well."
Currently, seven classes of antibiotics certified by the Food and Drug Administration (FDA) as "highly" or "critically" important in human medicine are used in agriculture as animal feed additives. Among them are penicillin, tetracyclines, macrolides, lincosamides, streptogramins, aminoglycosides, and sulfonamides These classes of antibiotics are among the most critically important in our arsenal of defense against potentially fatal human diseases.
Penincillins, for example, are used to treat infections ranging from strep throat to meningitis. Macrolides and Sulfonamides are used to prevent secondary infections in patients with AIDS and to treat pneumonia in HIV-infected patients. Tetracyclines are used to treat to people potentially exposed to anthrax.
Despite their importance in human medicine, these drugs are added to animal feed as growth promotants and for routine disease prevention. Approximately 70 percent of antibiotics and related drugs produced in the US are given to cattle, pigs, and chicken to promote growth and to compensate for crowded, unsanitary, stressful conditions. The nontherapeutic use of antibiotics in poultry skyrocketed from 2 million pounds in 1985 to 10.5 million pounds in the late 1990s.
This kind of habitual, nontherapuetic use of antibiotics has been conclusively linked to a growing number of incidents of antimicrobial-resistant infections in humans, and may be contaminating ground water with resistant bacteria in rural areas.
Resistant bacteria can be transferred from animals to humans in several ways. Antibiotic resistant bacteria can be found in the meat and poultry that we purchase in the grocery store. In fact, a New England Journal of Medicine study conducted in Washington, DC found that 20 percent of the meat sampled was contaminated with Salmonella and 84 percent of those bacteria were resistant to antibiotics used in human medicine and animal agriculture. Bacteria can also be transferred from animals to humans via workers in the livestock industry who handle animals, feed, and manure. Farmers may then transfer the bacteria on to their family. A third method is via the environment. Nearly 2 trillion pounds of manure generated in the USannually contaminate our groundwater, surface water, and soil. Because this manure contains resistant bacteria, the resistant bacteria can then be passed on to humans that come in contact with the water sources or soil.
And the problem has been well documented.
A 2002 analysis of more than 500 scientific articles and published in the journal Clinical Infectious Diseases found that "many lines of evidence link antimicrobial resistant human infections to foodborne pathogens of animal origin."
The Institute of Medicine's 2003 report on Microbial Threats to Health concluded "Clearly, a decrease in the inappropriate use of antimicrobials in human medicine alone is not enough. Substantial efforts must be made to decrease inappropriate overuse in animals and agriculture as well."
As recently as last November, in FDA Week, the article below entitled "Study Fuels Call for FDA to Phase Out Antibiotics In Animal Feed" highlighted how methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in Canadian pig farms and pig farmers.
STUDY FUELS CALL FOR FDA TO PHASE OUT ANTIBIOTICS IN ANIMAL FEED
9 November 2007
Vol. 13, No. 45
A new study has found that methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in Canadian pig farms and pig farmers, pointing to animals as a source of the deadly bacteria and raising new questions about the use of human antibiotics in animal feed. Health advocates are using the study's results to drum up support for the Preservation of Antibiotics for Medical Treatment Act, which would phase out the use of antibiotics important in human medicine as animal feed additives within two years.
The Veterinary Microbiology study (Khanna et al. 2007) is the first to show that North American pig farms and farmers have carried MRSA. The study looked for MRSA in 285 pigs in 20 Ontario farms. It found MRSA at 45 percent of farms (9 of 20) and in nearly one in four pigs (71 of 285). One in five pig farmers studied (5 of 25) also were found to carry MRSA, a much higher rate than in the general North American population, according to the study. The strains of MRSA bacteria found in Ontario pigs and pig farmers included a strain common to human MRSA infections in Canada.
The study stated MRSA colonization in pigs was first reported in the Netherlands and has also been found in pigs in France, Denmark, and Singapore. In all of these countries, farm and pig workers were found to have been infected with MRSA by pigs.
The study was published in October.
Also in October, the Journal of the American Medical Association (Klevens et al. 2007) published a study that estimated almost 100,000 MRSA infections in 2005, and nearly 19,000 deaths in the United States. In comparison, HIV/AIDS killed 17,000 people that year, according to the study.
A pending bill, The Preservation of Antibiotics for Medical Treatment Act, would phase out the use of antibiotics as animal feed additives within two years. The Senate version of the legislation is sponsored by health committee Chair Edward Kennedy (D-MA) and Sens. Olympia Snowe (R-ME), Susan Collins (R-ME), Sherrod Brown (D-OH) and Jack Reed (D-RI). The House version is sponsored by Rep. Louise Slaughter (D-NY), the only microbiologist in Congress, and 34 other House members.
The American Medical Association, the Infectious Diseases Society of America and theAmerican Academy of Pediatrics are among the more than 350 advocacy groups nationwide that have endorsed this bill.
Until recently, scientists believed MRSA was an infection occurring mainly in hospitals. The JAMA study found that even healthy people are developing MRSA infections. The Veterinary Microbiology study points to pig farms as a possible source of these resistant infections, as have earlier European studies.
A recent study in the Netherlands found MRSA transmission among pigs, pig farmers and their families.
Members of the Keep Antibiotics Working coalition, including medical, agriculture and environmental experts, are calling for Congress to compel FDA to study whether the use of human antibiotics in animal agriculture is contributing to the reported surge in MRSA infections and deaths in the United States.
"Identifying and controlling community sources of MRSA is a public health priority of the first order," said Richard Wood, executive director of Food Animal Concerns Trust and Steering Committee Chair of Keep Antibiotics Working. "Are livestock farmers and farms in the United States also sources? We don't know for sure, because the U.S.government is not systematically testing U.S. livestock for MRSA."
"Last summer, when we raised the MRSA issue, the FDA told us that it had no plans to sample U.S. livestock to see if they carry MRSA," said David Wallinga, director of the Institute for Agriculture and Trade Policy's Food and Health Program. "Given the latest science that hog farms may generate MRSA, we need Congress to give FDA and other relevant agencies the necessary funding and a sense of urgency. Sampling needs to be done as soon as possible."--Inside OSHA
As the impact of MRSA continues to unfold, there is little doubt that antibiotic resistant diseases are a growing public health menace demanding a high priority response. Despite increased attention to the issue, the response has been inadequate. Part of the problem has been the FDA's failure to adequately address the effect of the misuse of animal antibiotics on the efficacy of human drugs.
Although the FDA could withdraw its approval for these antibiotics, its record of reviewing currently approved drugs under existing procedures indicate that it would take nearly a century to get these medically important antibiotics out of the feed given to food producing animals. In October 2000, for example, the FDA began consideration of a proposal to withdraw its approval for the therapeutic use of fluoroquinolones in poultry. The review, and eventual withdraw of approval, took five years to complete. Under its regulations, the FDA must review each class of antibiotics separately.
In 2003, the Center for Veterinary Medicine at FDA released Guidance 152 which provides safety guidelines on how antibiotics should be used in agriculture However, the guidance never established a timeframe for FDA to reevaluate existing antibiotics used in animal feed and so has rendered these recommendations useless.
During discussions involving the now-enacted Farm Bill, I supported language which would have provided the farm industry with sound, scientific information on production practices that could have helped them reduce their dependence on antibiotics and meet the growing consumer demand for meat produced without these drugs. The ability to grow food animals with fewer antibiotics would have also given US exporters an advantage in the international marketplace. This language would have also increased research on the movement of antibiotics and antibiotic-resistant traits in water to aid public health professionals in developing new tools and methods for reducing the spread of resistant diseases. Disappointingly, however, industry successfully lobbied to strip this language out of the Farm Bill.
I am also the sponsor of H.R. 962, the Preservation of Antibiotics for Medical Treatment Act (PAMTA). This bill requires three actions to accomplish the goal of reducing antibiotic resistance in humans. PAMTA would phase out the use of the seven classes of medically significant antibiotics that are currently approved for nontherapeutic use in animal agriculture. Because the bill defines nontherapeutic use as "in the absence of any clinical sign of disease in the animal for growth promotion, feed efficiency, weight gain, routine disease prevention, or other routine purpose," this bill would in no way infringe upon the use of these drugs to treat a sick animal.
In addition, PAMTA provides that if an antibiotic that is now used only in animals also becomes potentially important in human medicine, the drug would be automatically restricted from nontherapeutic use in agricultural animals unless FDA determines that such use will not contribute to development of resistance affecting humans.
Lastly, to assist public health officials in tracking implementation of the phase out of antibiotics in animal feed, PAMTA requires producers of agricultural antibiotics to report the quantity of drugs they sell, information on the claimed purpose, and the dosage form of those drugs.
The fundamental solution to the problem of antibiotic resistance is to reduce unnecessary use. Then when antibiotics are required, use them prudently. Most antibiotics in agriculture are used for growth promotion and routine disease prevention - uses that can be reduced, if not eliminated, in properly designed animal production systems. Drastic reduction of antibiotics uses in animal agriculture, as called for in PAMTA, will lessen the encouragement of resistant disease and prolong the longevity of vital human drugs.
As a mother, grandmother, and microbiologist, I cannot stress the urgency of this problem enough. When we go to the grocery store to pick up dinner, we should be able to buy our food without worrying that eating it will expose our family to potentially deadly bacteria that will no longer respond to our medial treatments. Unless we act now, we will unwittingly permit animals to serve as incubators for resistant bacteria.
It is time for Congress to stand with scientists, the World Health Organization, the American Medical Association, and the National Academy of Sciences and do something to address the spread of resistant bacteria. We cannot afford for our medicines to become obsolete.