The reemergence of the potentially fatal "swine flu" (H1N1 virus) cases in humans has caused concern over the ease with which the virus is able to spread. Last November, a guest editor for a special issue of Medical Clinics of North America wrote, "Mobility[horizontal ellipsis]is unprecedented in volume, reach, and speed. Movement involves people, plants, and animals and allows juxtaposition of species that have never been in contact before and novel opportunities for transmission across species, especially from animals to humans."1
This special journal issue was brought to my attention when a student selected an op-ed published in the New York Times for a media assignment. To verify the scientific merit of the information, the student went to the original citation, an article on pigs and resistant strains of methicillin-resistant Staphylococcus aureus (MRSA).2,3
Exposure factors
In the guest editorial, the author discusses how some pigs are raised in confined animal feeding operations (CAFOs). These old, small-scale family farms are almost nonexistent now in the United States. Animals are fed antimicrobials for three main reasons: to treat sick animals (therapeutic), to prevent the spread of disease among susceptible animals (prophylactic), and to promote faster growth (nontherapeutic). The waste from these animals, the disposal of which is not regulated, contaminates air, water, and soil. The end result is resistant bacteria detectable in the air in CAFOs and in ground and surface water near CAFOs. This contributes to community exposures and reservoirs of resistance through contact and consumption of food products, occupational exposures, and environmental contamination.
Antimicrobials and animals
The World Health Organization and others have recommended ending the practice of adding antimicrobials to animal feed. In the United States, only ciprofloxacin analogs have been banned; restrictions vary greatly by country. Surprisingly, there is little regulation in this area. One side says the problem is politics and not the pigs2; "agribusiness" interests generate strong resistance to legislation. The other claims that medical practitioners and the general public have paid little to no attention to current practices in agricultural use of antimicrobials.3
Representative Louise Slaughter (D-NY), a microbiologist, introduced H.R. 962, The Preservation of Antibiotics for Medical Treatment Act of 2007, "to preserve the effectiveness of medically important antibiotics used in the treatment of human and animal diseases."4 Though the bill died then, on March 17, 2009, she reintroduced it as H.R. 1549 in the House while Senator Edward Kennedy (D-MA) introduced it as S. 619 in the Senate. Both bills have gone to committee in the new 111th Congress.
Controlling the emergence and spread of superbugs that result from antimicrobial use in animal feed is a major problem. The FDA seems to have little power over the medications that animals are fed and their impact on public health and safety. Superbugs currently have access to unrestricted breeding grounds. Who ultimately suffers? This is another opportunity for political advocacy that NPs and all healthcare providers cannot afford to ignore. Follow the progress of these two bills. After all, pigs are at the mercy of humans.
Jamesetta Newland, RN, PhD, FNP-BC, FAANP, FNAP
Editor-in-Chief
[email protected]
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