good more good morning everybody everybody's awake now as you can see antimicrobial resistance can affect anyone at any age in any country it's not said by me but it's said by the World Health Organization the leading organization in the world looking after public health and who's listed already several years ago antimicrobial resistance as one of the most important risk for human health just to tell you that that is indeed an important topic my name is Yoon de Villefort's Philippe already introduced you are working at I'm working at Ghent University and we've been looking at the issue of antimicrobial use and resistance and for farm animals for many years we've been looking at the problems related to that but we also have tried to find some solutions and that's also the the way I gonna build up my presentation at this morning for you first they're gonna try to explain a little bit what the problem is where it is and how large it could become at a certain point but then secondly I'm probably more interesting I'll also point your heart what possible solutions are so antimicrobial resistance has been looked at as one as I said before as one of the most dangerous risks for human for mankind and in a rather recent study in the UK the O'Neill report for some of you may know it it was it was predicted that if we do not stop the epidemic of antimicrobial resistance I would call it then it would become a huge problem it would become an a human health problem which is larger than the problem of cancer because it can emerge so fast and it can become such a big an issue all over the world the predictions are and and just be careful these are predictions is for sure not yet the reality today but if we would not change the ways we are using antibiotics boat in animal medicine and in human medicine then the predictions are that by 2040 we would have by 2050 we would have 10 million people dying from and from bacterial infections that are untreated that had become untreatable every year so it is indeed a scary foresight if you want to see where that would happen then then immediately we see that we are at exactly the right place to talk about this topic and here in Asia because it is indeed in Asia that the biggest casualties are predicted them and why is that well there is one simple reason and that's of course that the majority of the human population lives and on the continent of Asia so it's not so difficult to get the most casualties there but take it Lee it's also because the the problem of antimicrobial resistance is already today in Asia substantially larger than it is in other continents such as as Europe or northern Latin America and so it is a certainly here but also in Africa a very pressing issue it's not by coincidence also that those two continents are the ones where the use of antimicrobials is water less lesser regulated than in other parts of the world so the more anterior bus you use and the lesser regulated you do that the more problems you see boat in animals and in humans I'll come back to that it is a one health issue and I know if some of you may agree with me that one health is a buzzword these days and you have to call everything one health if you want to find research money and at least that's in our world a little bit the case when I think altima Koval is this is is truly a one health issue it is one of those topics where really animal medicine of veterinary medicine human medicine and also the environment come together we are using antimicrobials and humans don't forget we using an tobacco birds and humans the problem of antimicrobial resistance in human medicine is largely caused by the fact that we are using a lot of antivirals in humans but we're also using a lot of antimicrobials and in animals boat and food animals and in companion animals often we forget about those companion animals but also in companion animals anti mokuba's are used and and very often that the same types of antimicrobials as are used in and Yuma medicine so in all those fields we are using antimicrob us and these fields are not independent from each other it is an illusion to think that what you do here does not infect this in the other way around it's exactly the same what you do in humans does in impact on what you see in animals and then of course we have the environment in between and we have the wildlife which is often making a link between an between produced animals and human medicine or humans we have the environment where we grow crops where we grow fruit and and we have of course the consumption of animal products so there's plenty of transmission routes through which we can transmit a resistance from one animal or from from one ecosystem to another ecosystem and notice that that the Iowas go in both both directions so often we think about a unilateral or unidirectional process and we often think that resistance goes from animals at least of the otter world is thinking about that the resistance goes from animals to humans and not the other way around and that's not true where we go we know that it goes in both directions in biology at the human species is just another animal species so there wouldn't be any reason and not to understand of not not the thing that it would go in two directions another thing also important and in in Asia and probably more in Asia than in the rest of the world is the production of antimicrobial so also the production of antimicrobial causes a lot of waste which gets into the environment that can get into the water can get into the in the soil and also these wastes I can then to this environment can get into the animals until the humans and select for resistance so it is really at the animal the environment and the human be playing together with all in this whole story if we want to look a little bit closer into this transmission from animals to humans we we see that there is different ways of transmitting resistance from one side to the other of course we using antimicrobials in animals and we're using antimicrobials in humans as I said before at both sides we select her resistance if we use them to be antibiotics we select for resistance whether we want it or not it is unavoidable if you use antimicrobials you will select for resistance you can do it a little bit more a little bit less I'll come back to that but it is unavoidable that you select your resistance one very obvious link between the animal world and the human world of course though notic bacteria those zoonosis you know you all know about I've been talking about them already at this conference as salmonella Campylobacter some some species of e.coli and others of course if they get resistant in the animal and they are cells then next they are transmitted to humans they will not lose their resistance genes during this transmission process if there became resistant of a Salmonella became resistant in poultry due to the use of antibiotics in poultry poultry one this Salmonella gets into a human it will will just carry on its resistance genes to the human and it will become more difficult to to treat that the the patient with antibiotics that's a very very obvious link it's also language has been exhaustively described in literature there's plenty of studies plenty of papers showing that indeed if you if you find those zoonotic bacteria and humans that you will find the same type same types of resistance as you will find them in the animal source however it's not the only link sometimes people if they think about transmission from resistance from animals to humans they only think about the zoonoses and that's where it stops but it's certainly not the only link and it's likely also not the most important link and there are others but before I go into that maybe first I just emphasize that within the animal body within the human body and I remember from Phillips introduction at a yesterday morning and there's one of 100 billion I don't know a very big number actually hundred billion bacteria in the gut in every gram of the guts so this huge amount of bacteria in that gut and these bacteria do exchange genetic information among each other and that's what's happening here there's plenty of commensals in there and they exchange genetic material with the zoonosis that can be there as well and by exchanging genetic material we'll also include the exchange of resistance genes they will do that to the pathogens as well I generally refer to these commensals as actually a reservoir of genetic information especially a reservoir of resistant genes and whenever the pathogen gets into the and gets into the animal it can just go and shop in the reservoir to find the resistant genes that are useful in the circumstances this pathogen is living in and especially if you then put the selection pressure on it if you treat the animals with antibiotics either as a growth promoter or as as a treatment then then of course at the the bacteria the pathogen has a good reason to go and shop in the commensal bacteria to find resistance genes to put itself from the selection pressure and so this this exchange of genetic information between these different components and different types of bacteria it's very important this happens in animals and of course it also happens in humans as again as I said before a human is just another animal species and then of course these commensals are also transmitted and they are transmitted much more than we transmit zoonosis if we produce animals in a perfect situation we can even avoid to have zoonoses so we can produce them without Salmonella it's not so easy to do that without Campylobacter but at least we can try to control the levels of Campylobacter you'll never produce a bird without ecoli it's always going to be there and it's going to be there in a massive amount and it also going to be transmitted upon to the meter and that's at least at the outside and so during the slaughter process you will so if you eat a piece or if you're in contact with a piece of Borla meat you will be in contact with with bacteria with commensal bacteria originating from those animals and in those commensal bacteria you will find two resistance genes so that is probably a much more important transmission route at least in terms of frequency of occurrence than this zoonotic transmission so that's probably where the focus should be on this transmitting of the commensalism they can also be transmission of pathogens but that would be rather lesser frequent just because pathogens are generally more species specific they would not so easily survive in a different good but but it could happen as well and then there is the issue of the residues where is it users very interesting if we treat the animals with antibiotics and then shortly after that we would slaughter the animals or we would consume the eggs or then it's there is a possibility or it's likely that we'll find residues in the me so in the eggs or in the milk if we talk about dairy and this these residues that can then get into the humans and there again a selector resistance if I give this talk in Europe I generally say that this is of no relevance because the fact for the reason that we are controlling very strongly on these residues it's a rather easy way easy thing to control it's just a chemical analysis and and the methods are very readily available to check for these residues in the meat our farmers or veterinarians are very much aware of this that we drove all time it's an extremely important issue if you use the antibiotics respect your withdrawal time make sure that there is no residues in the meat and and but but if at some stage it would happen then still it is likely that are very very low concentrations in the into the meat the concentrations that are not sufficient to really select for resistance in the human and the human body so if you control this part well it's of no importance if you're living in a part of the world where the control of residues in the meat it's much lesser well developed then this can be an additional selection pressure because indeed if you are consuming meat or eggs that are containing high levels of high concentrations of residues of antibiotics this can give you an additional selection pressure to select a for resistance so it depends a little bit on where you are and what is the level of of control on this but it is relatively easily to control in the past this has been more or less the focus this has been at least in Europe and the US we made our legislations about this and very often legislation is about things you can measure and that's why we've we've put the focus on the residues whereas actually the danger is much more here in the resistance and there is a lot of confusion between residues and resistance and people think that if they can't control the problem of residues that they've also controlled the problem of resistance which is absolutely not the case so it's two different things and you should put you should control both sides of course you have to reduce these residues levels but you once you've done that you're not yet there you don't not have solve the problem because I'm still there is this problem of transmission of resistance and again it can also go in the other way around as I said before just to give you a small example of how easily this transmission to commensals can happen and this is a study we've conducted a couple of years ago in our research group where we have a system which is mimicking the gut flora of a human being and in this in this in the system we have introduced a human ecoli here at the beginning of our twhirl which then continues to stay there but more importantly one day later we have inoculated our model or two days later we have inoculated our model with an poultry donor eco light donor which was containing the ESBL resistance gene so extended spectrum beta lactam aza you probably are familiar with this ESBL resistance gene which is a broad spectrum a type of resistance so we've introduced that into a model and most interesting is to see that already one day later a daydream we had a new bacterium and that was what we call the trans conjugant that is the new eco lie which is a human Ecola but which has acquired this gene from this poultry source so it's a human Ecoline fully adapted to the human gut flora it can survive in the human good flora perfectly because that is its natural in a habitats but it has a quiet this new resistant gene remember my story about going and shopping in the commensals and try to see what what is useful and this is my new bacterium it stays there as a rather low prevalence but only if you for a few search very well you will see it but a couple of days later we selected this we implicated a selection pressure so which it's as if we treated our patients with antibiotics so we introduced antibiotics into the model and immediately you see that this too and Koenig and actually becomes our dominant as trained and that's the one which is again perfectly adapted to the human floor but which has acquired a resistance gene from animals so if you think about transmission of resistance from animals to humans you should rather think about transmission of genes and not so much so much about transmission of bacteria the bacteria are only the carriers of the genes and the genes are the ones that are causing the problems are the ones that are spreading and are the ones that are transmitted very easily from one type of bacteria to another type of bacteria and are causing the problem often do you get this discussion is this really a problem is there wheelie transmission or it does use of antibiotics and animals does that really add to the problem of our typical resistance in humans well there's plenty of literature on it and these days I would say every month more or less a new review paper comes out that has looked into this into this and almost always you come to the same conclusion and it's highlighted here overall there is evidence that the proportion of human extra intestinal extended spectrum resistance ecoli infections originate from food producing animals and then I've added of highlighted this especially for today we'll treat it particularly is probably a source so if you look into all the literature available and you add everything of you bring everything together the conclusion is and that's not the only paper saying this as plenty of papers coming to the same conclusion to conclusion is that there is an attribution of what we do in animals to the problem in human medicine does that mean that if we would solve the problem in an animal production in veterinary medicine if we would assume we would stop using antibiotics tomorrow in veterinary medicine would then immediately the problem in human medicine been solved of course not as I said there already in my in my introduction the problem of antiquaries essence and human medicine is largely due to the use of antibiotics in human medicine but there is also an attribution from veterinary medicine there is no attribution from animal production and so we do contribute to the problem how much that's a very difficult question nobody today is able to put a number on that is that five percent is a ten percent is a twenty percent likely it's gonna depend very much of what type of resistance you're looking at some types of resistance or 400% link to use in human medicine other types of resistance for instance the ESBL typically but also the college teen resistance I'll come back to it later or probably for much larger part with this linked to what we do in veterinary medicine but again I'm not capable of putting a number on it but the fact that that it is an attribution and it has been proven over and over and over again should be sufficient motivation to work on it again it's a one health issue and this is a nice study done in the Netherlands where they looked into a review study rather looked into all the literature searching for residues and and and resistance genes into the environment and I'm not going to read it out for you but if you look at here and it says that actually wherever you search into the environment Edo in water or in vegetable produced or in the soil you have a pretty big likelihood to find resistant genes and so it is really also in the environment that we should never ignore this environment as an as a very important source of resistance and lost a one more recent publication on this colistin resistance this is a South American study of a study of conducted in South America where again it was concluded that this MCR warned that this new colistin transmittable colistin resistant gene and found in humans and actually for the first time described in china but since then it has been described all over the world of has been found all over the world and it says here that what you find in humans is linked to what is present and again in in broilers so the problem is pretty important we know that animal medicine and medicine animal production has a part in it we cannot ignore that so we shouldn't say that it has nothing to do with us another question is where does this problem come from and to explain this briefly I always put that in a separator than in four steps the first step is the emergence of resistance and actually anterior Coble resistance is a very old phenomenon and it's very nicely described in this nature paper and where they've made dwellings into the age of glaciers and into this I said they note that this layer of ice was frozen 30,000 years ago more or less and until in this ice they find bacterium and in this bacteria they find resistant genes proving that already 30,000 years ago there was antimicrobial resistance present so long before we ever found back antibiotics and and certainly long before we ever start using antibiotics there was already antibiotic resistance present in nature is that a surprise no of course not because antibiotics are natural products so the answer to the antibiotics in nature is also likely to be present there antibiotics are national natural products and so the resistance is also a natural phenomenon of bacteria to respond to these antibiotics however they are present these resistant genes are present and very very very low prevalences you know you need to search very careful to find them the majority of the bacteria 30,000 years ago you would find would be fully susceptible and only a very small minority would would carry some resistant genes there's also a very abundant type of resistant genes that plenty of resistant genes out a huge variety this also means that if ever which is pretty unlikely we would find a new antibiotic to be used in human and veterinary medicine then probably already the answer to that new antibiotic is already available in nature it's already out there so the the solution to the problem of antibiotic resistance is not finding new antibiotics and continue doing the way we've done it in the last 50 years the solution will be to do other things bacteria interact with each other as I told it before this this exchange of resistant genes which you can see here in the other picture where here does this conjugation and where genetic material will go from one bacteria to another and this is a very important in the epidemiology of resistances is very important because it means that your resistance will not only go from the mother bacteria to the daughter bacterias just to the multiplication of the splitting of the bacteria but it will also spread in a horizontal way from one type of bacteria to another so once you've selected for resistance in one group of bacteria then subsequently it can spread to other groups of bacteria pretty easily as I shown before and so this this this exchange and the spread goes and very rapidly until now I have not talked about use of antibiotics so the emergence of resistance is a natural phenomenon if ever you get into the discussion this politically discussion between veterinarians and human doctors who is causing the problem of resistance or where is the resistance coming from the easy answer out the discussion is it comes from nature and and it's actually right as well because originally resistant genes that come out of the out of nature out of the environment but the next step is the most important one is the step way select for resistance where you it will increase the level of resistance and that is of course where an term of antibiotic use and will come into the plate this is a study we've conducted also in our in our group where we looked at and it's way too small to read but where we looked at antibiotic use in the x-axis and levels of resistance in the y-axis and we've done that for different types of antibiotics and you might be able to read that these are the flu or keen alerts third-generation cephalosporins I mean openness islands and so on but for every type of antibiotic you see you find that the more antibiotics you use the higher your levels of resistance will be and in this graph every dot is a country so this is very highly aggregated data this is data coming from seven European countries where we had sufficient data on use and on resistance in animals and so it's aggregated at a very at the very high level so the dots behind every dot there is a huge amount of data individual country data and you see that for every country we find the same Association at the higher your use the higher your levels of resistance are that was published in 2014 one year later ECDC AFSA and EEMA published their first Jerrica report and so this these are the european research institutes are looking at human health animal health and medicines use and they found very very comparable associations that this is again for fluoroquinolones and for Campylobacter irrelevant bacteria for poultry production and here again you find this positive slope the more anthemic robust you use the higher your levels of resistance are and again every dot as a country there's more countries in this and they study similar patterns were found for tetracycline resistance microlight resistance and whenever you have enough data you will find this type of associations going back to our first study if you want to know which are the countries well there they are up there and this is my country I'm absolutely not proud of that we are at that moment we are we were of those seven countries where we had enough data we were the one using the highest amount of antimicrobials and that was translated also in the highest level of resistance and we have a very remarkable good fit here it's really fitting very well the more you use the higher your level of resistance is countries that have a long-standing tradition of very moderate use a very low use of antibiotics they have also a very moderate level of resistance in animals so it's really mirroring each other pretty well just afford to be politically correct again these were the countries at that time where we had enough data if I would add some other countries here I think and maybe here is silent and and China and I don't know but probably we would go away up so just don't think that after this slide that Belgium is the worst country in the world at least not for you for an typical usage I mean there is others where the uses is even much higher this is new data it's not in the in the slides in your book because it's only recently added and it's not it's not published yet and this is data coming from the EU effort project is a very large project and from the European Commission where we looking at that typical usage in nine European countries and this is use in poultry production in nine upian countries where we measure to usage in exactly the same methodology because that's often a tricky thing if you're using if you're measuring usage there's plenty of different methodologies available and everybody does it a little bit different to avoid that you can compare one country with another here we've done it exactly the same in all the countries and you see that there are some countries that have very very low low use in the broiler productions and there's other countries that have much higher levels of use what is this number saying well if if you have I'll take Belgium here if you have a treatment incidence of around hundreds this is the median around hundred it means that if you have thousand animals daily hundred would be used with you would be treated with antibiotics of course that's not the way it works so you'll treat the whole group always every that means that if a broiler would live four thousand days it would be treated 100 days out of those thousand ten percent in other words of its lifetime it would be treated with antibiotics so in some European countries it's ten percent some countries it's one or two percent and some countries it's twenty percent and and in some exceptional cases it even goes much higher it goes up to a hundred and even above 100 percent and so and that's when you apply two or three treatments at the same time it would add up and it would be as if you would treat your animals more than the total lifetime again this is in a circumstance where we do not use any growth promoters if you would do this study in countries where they still use growth promoters you would be all up here around as a thousand around one hundred percent because then you'd then you almost continuously are applying a selection pressure and using antibiotics so even for those countries in Europe that are not doing so well it's not it can still be much worse than this also from this study and there's a lot of numbers here but I'm gonna help go to this together this is the types of antimicrobials used in an embroiderer production and the different European countries and just look at this these are the fluoroquinolones and the polymyxin sao paulo mixing this is exclusive exclusively kala Steen well and then you see both both are CIA so what are the CIA's those are the critically important antimicrobials by the list of the w-h-o they rank the importance of antimicrobials and the most critically important or the third and fourth generation cephalosporins of fluoroquinolones and recently due to this colistin resistance problem a college teen has been added to this Lester has been promoted if you want to the most important most critical and then you see that a lot of the Interior Cobras were using in boiler production are actually belonging to this most critically important but even more interestingly you see if we take polymyxin some countries are using a lot of them a for instance Italy half of the antimicrob was used in Italy or Paulo mix-ins whereas other countries the Netherlands Belgium don't use Paulo mixings at all do we see totally different types of pathology in those countries no we see very very very comparable type of pathology but we're using totally different types of antibiotics and totally different levels of antibiotics for instance if you look at the Netherlands and Denmark two countries are doing very well in terms of reduce of limited antibiotic use there only the Denmark for instance they're only using linked expecting and the tetracyclines away worse than tetracyclines but the other countries are used much lesser what I want to bring as a message here is that antibiotic usage is not very much linked to the type of pathology you are work at you are encountering antibiotic usage is very much linked to tradition probably to marketing and other motivators to select one or the other antibiotic and and not necessarily really based on truly very truly veterinary investigation that tell you based on a on bacteriology and antibody grams that this or another antibiotic has exactly the right spectrum to be used there's plenty of other reasons probably the price the availability and things like that will have a big a much bigger influence than to veterinary reasoning if you look in literature there's a little bit of data on resistance in Asia it's not very abundant so those of you that have ambitions this is really a field where you can do a lot of research in in Asia because we don't have so much data both on the uses on the rhesus this insight but what is available is this this review paper on resistance and the red bars so this these are different types of antibiotics and the red bars the resistance levels in borders and chickens in different Asian countries so it's it's coming from Vietnam Thailand it's coming Thailand Vietnam Indonesia and some China Chinese data in there I think and so you see that of no surprise that the levels of resistance in Asia are very very hard this is substantially higher than what we would see in European data but and of course this is again linked to the usage okay once we've selected for resistance will it then if we stop using it what will happen well often what we see and this is an example of pigs but what we see that if we stop using a certain answer back over that your resistance will continue to be present this is the example of chloramphenicol we've stopped using that 30 years ago in europe and still the resistance against Clerkin for Nikolas is abundantly present and so you select for resistance very easily getting rid of resistance goes much slower and it's much more difficult can it never go away and from no one I'll start with the positive side of my talk it can it never go away well it can go away and the good example is for instance again Belgium we have been working in reducing our antibiotic use in the last year's substantially in the last five years we've reduce the total use of antibiotics and animals with 20% and positively we also see that this translates into a downward trend in levels of resistance since we've started to reducing our use we do see with some delay over one or two years of delay we see that our levels of resistance or also start to go down in our in our commensal bacteria so that's a very positive message for everybody it's not it's not the lost case if you if you can bent the curve if you can in start of a cause before it was all going up but if you can bend the curve and use you will also be able to bend the curve in your resistance so what can we do about it I think the message is pretty clear from now on it's all about using lesser and Tobaccoville so we should avoid to use antimicrobials and then we will result result in less resistance but obviously we cannot do that at the cost of a reduced production levels because if I would tell you just stop using antimicrobials and I don't mind if you have 20% mortality or if your if your birds will grow 10% less or fast nobody would ever listen and they would say well this is totally impossible end of the story so we need to find improvements that can help you without having a negative effect on a production and a lot has been said already at this conference about improved feet and especially about feet additives and I will not talk about that because it's not my field of expertise so I will talk about another a possibility not with the pretension to say that this is the best one I would rather see it as an addition it's not either walk either feet additives or biosecurity but it's much more the combination that you need better feet you need probably some feed additives and you also need improve biosecurity and that will be the focus on my of my story so what I if I talk about biosecurity I talk about the combination of measures taken to reduce the risk of introduction and spread of diseases into a hurt I will focus on the hurt level and so maybe just focus on the fact that it has two components it's the risk of introduction and the risk of spread and we translate that into the external biosecurity and internal biosecurity external biosecurity is everything you can do to avoid the risk of introduction and to seal your form from the outer world the internal biosecurity is everything you do to avoid the continued spread of bacteria of pathogens whatever viruses in your form that's their internal biosecurity and we look at biosecurity as the fundament the the basis of any disease preventive measures if you don't have good biosecurity if you're working in dirty stables if you're working with poor management you can add as much feed additives as you want you can add as much vaccines as you want they will have a poor effect if you do that and in very good conditions you will just increase your effector you will have a synergistic results of what we did when we start studying the biosecurity I think more than 10 years ago the first problem we encountered and that's a problem everybody encounters is that it's difficult to measure if you are an experienced fat if you go on many farms you will come into a farm and you will say this is a good form it's harder this has a good biosecurity but if I ask you to translate that into a number from zero to ten or from zero to one hundred whatever type of number it's not easy is this is this a six out of ten or is it a 7 out of 10 of our 5 it's not so easy so that's what we try to do here it with this with this tool and where we try to quantify a biosecurity based on a questionnaire so and the good thing about once you've quantified you make it measurable and once something is measurable you can start to improve on it and the measure the fact that if you quantified by security you can compare scores between different hurts but you can also compare the score of one hurt over time if you look if you look over time and you do the scoring today you come back within six months within one year and see how the score has evolved them and you take different risks into account that's what we did in our scoring tool it's a weight at a risk base going to and so it's a lot of questions you have to fill in but it's not just a zero one it's not just well I mean the answers are yes no but behind the answer there is a calculating system there is an algorithm that will take in to account the importance of the different questions some things some measures are much more important than others so some will get high points and others will get lower points so that's what behind it and if you look into the bar security score for boilers which is a so we have it for pics and borders and we are currently developing it for for cattle it's almost ready but for boilers we have this external biosecurity with the different subcategories I'm not going to read them out for you one by one but you can easily see them and you see that these different subcategories they they get different weight factors as some are more important get higher weights than others and the same holds true for the internal biosecurity and in broilers 70% of the score goes to the external 30% of the score goes to the internal in pigs it's a 50/50 percent distribution and so that depends a little bit on on the on the production system so you you get the scores and at the end if you fill in this questionnaire you'll get a score from zero to hundred so what a previously asks you like can you give me a score for this farm well with this tool you can and you'll get something of your internal biosecurity has a score of 65 and me and then then we know relatively accurate what the level of biosecurity is and at least it's reproducible it's not a perfect measurement for every measurement you can you can say maybe I would put the score a little bit higher or lower but anyway it's a reproducible way of measuring at the biosecurity and from that point on what you can start working you also get your subcategories you will immediately see okay I score pretty high on purchases of animals but I score very low on vermin and birth control or I score very low on hygiene and cleaning and then immediately you can also see on this specific farm this is the topic we should advise upon this is the topic we have to work and we have to improve them this is our website how it looks currently the questionnaire has been filled in four thousand pics and more than thousand boiler forms already it's available in Dutch in English and recently also in Chinese effort so the Chinese among you we have translated their website fully also into Chinese and it's used as so the the bio check scoring system for Boris is already used in 40 different countries it means that we can also provide you with averages from your country so if you have and so if if we have enough data you your form will not be compared to the average of the world but it will be compared to the average of your specific country May which makes it even more irrelevant of course I'm not going discourse due to lack of time but you see a lot of variation some parts as going pretty high on average others are scoring relatively low it's always the case that there are things that can be improved even on the best forms there is still margin for improvement and this is a very easy tool to to help you which I haven't said yet is that this is totally free for use it's without any payment and it's accessible for everybody you just go to the website and you can start using it and and we don't charge you anything the only thing we charging you is that the data in an anonymous way we don't need to know that the name order of the farm or the address but in an anonymous way the data comes to us so for us this is an cheap way of collecting information and for you it's a cheap way of using the tool finally my last slide we've used this system to advise farms in that study done in Belgium to advise farms on improvement of biosecurity and you see that we've improved the biosecurity with a little bit some some improvements there's a change of five points for external four points for internal that's not massive that's not spectacular but it did change something in the farms and we had some changes and mortality in the first week went up a little bit but the total mortality went down the the feed conversion went down a little bit the performance index went up but most importantly and that's my talk about we were able to reduce the usage of antibiotics with almost 30 percent so 30% lower use and still a better performance of the flocks and this we are currently trying to repeat the study again in several countries and we've done this in pig production and a much bigger type of 12 and repeatedly again we found this type of results where we are by improving biosecurity we are capable of improving the production results and at the same time reducing the levels of antibiotic usage so that's the end of my presentation and I'll thank you for your attention [Music]