High levels of antibiotic resistance found worldwide, new data shows

WHO’s first release of surveillance data on antibiotic resistance reveals high levels of resistance to a number of serious bacterial infections in both high- and low-income countries.

WHO’s new Global Antimicrobial Surveillance System (GLASS) reveals widespread occurrence of antibiotic resistance among 500,000 people with suspected bacterial infections across 22 countries.

The most commonly reported resistant bacteria were Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Streptococcus pneumoniae, followed by Salmonella spp. The system does not include data on resistance of Mycobacterium tuberculosis, which causes tuberculosis (TB), as WHO has been tracking it since 1994 and providing annual updates in the Global tuberculosis report.

Among patients with suspected bloodstream infection, the proportion that had bacteria resistant to at least one of the most commonly used antibiotics ranged tremendously between different countries – from zero to 82%. Resistance to penicillin ranged from zero to 51% among reporting countries. And between 8% to 65% of E. coli associated with urinary tract infections presented resistance to ciprofloxacin, an antibiotic commonly used to treat this condition.

“The report confirms the serious situation of antibiotic resistance worldwide,” says Dr Marc Sprenger, director of WHO’s Antimicrobial Resistance Secretariat. “Some of the world’s most common – and potentially most dangerous – infections are proving drug-resistant,” adds Sprenger. “And most worrying of all, pathogens don’t respect national borders. That’s why WHO is encouraging all countries to set up good surveillance systems for detecting drug resistance that can provide data to this global system.”

To date, 52 countries (25 high-income, 20 middle-income and 7 low-income countries) are enrolled in WHO’s Global Antimicrobial Surveillance System. For the first report, 40 countries provided information about their national surveillance systems and 22 countries also provided data on levels of antibiotic resistance.

“The report is a vital first step towards improving our understanding of the extent of antimicrobial resistance. Surveillance is in its infancy, but it is vital to develop it if we are to anticipate and tackle one of the biggest threats to global public health,” says Dr Carmem Pessoa-Silva, who coordinates the new surveillance system at WHO.

Data presented in this first GLASS report vary widely in quality and completeness. Some countries face major challenges in building their national surveillance systems, including a lack of personnel, funds and infrastructure.

However, WHO is supporting more countries to set up national antimicrobial resistance surveillance systems that can produce reliable, meaningful data. GLASS is helping to standardize the way that countries collect data and enable a more complete picture about antimicrobial resistance patterns and trends.

Solid drug resistance surveillance programmes in TB, HIV and malaria have been functioning for many years and have helped estimate disease burden, plan diagnostic and treatment services, monitor the effectiveness of control interventions, and design effective treatment regimens worldwide monitor to address and prevent future resistance. GLASS is expected to perform a similar function for common bacterial pathogens.

The rollout of GLASS is already making a difference in many countries. For example, Kenya has enhanced the development of its national antimicrobial resistance system; Tunisia started to aggregate data on antimicrobial resistance at national level; the Republic of Korea completely revised its national surveillance system to align with the GLASS methodology, providing data of very high quality and completeness; and countries such as Afghanistan or Cambodia that face major structural challenges have enrolled in the system and are using the GLASS framework as an opportunity for strengthening their AMR surveillance capacities. In general, national participation in GLASS is seen as a sign of growing political commitment to support global efforts to control antimicrobial resistance.

Any country, at any stage of the development of its national antimicrobial resistance surveillance system, can enrol in GLASS. Countries are encouraged to implement the surveillance standards and indicators gradually, based on their national priorities and available resources.

GLASS will eventually incorporate information from other surveillance systems related to antimicrobial resistance in humans, such as in the food chain, monitoring of antimicrobial consumption, targeted surveillance projects, and other related data.

All data produced by GLASS is available free online and will be updated regularly.

 

 


Philips spearheads Circular Economy – will take back old medical equipment

At this year’s World Economic Forum Annual Meeting in Davos, Switzerland, Frans van Houten, CEO Philips, cemented the company’s 2020 commitment to the Circular Economy by pledging to take back and repurpose all the large medical systems that its customers are prepared to return to it. This means that Philips will actively pursue the trade-in of equipment such as MRI, CT and Interventional X-ray systems and take full control to ensure thatall traded-in materials are repurposed in a responsible way.

Such actions are necessary because the United Nations Resource Panel predicts that globally the manufacturing sector will need to extract 180 billion tons of the Earth’s natural resources every year by 2050, almost double what it does today, which is not sustainable.

The challenge, which was highlighted at Davos in the Circle Economy ‘Circularity Gap Report’, is to shift from today’s linear ‘take-make-dispose’ model, in which less than 10% of the raw material is recycled, to a circular ‘make-use-return’ paradigm – the so-called Circular Economy. Widely regarded as essential to meeting the United Nations Sustainable Development Goals, the Circular Economy aims to keep products, components and materials at their highest utility and value at all times throughout the make-use-return and repurposing cycle.

Through his co-chairmanship of the PACE (Platform for Accelerating the Circular Economy) initiative, van Houten is championing the necessary change, spearheading its implementation, and assembling a coalition of like-minded companies to make similar capital equipment pledges. Philips will continue to expand its own pledge until it includes all its professional equipment.

“We firmly expect the circular economy to replace the traditional ‘take-makedispose’ scheme,” said van Houten. “So, at Philips we aim to take back all capital equipment from our hospital clients. What’s more, we expect this to become a win-win business model, because there is much residual value to recover. We continuously endeavour to ‘disrupt ourselves’ by rethinking and redesigning the way we do business to contribute to a better world.”

Innovative service models, smart upgrade paths, and product take-back and remanufacturing programs are not only good for the planet and improving people’s lives, they also make good business sense. As part of its ‘Healthy people, Sustainable planet’ strategy, Philips aims to deliver 15% of total revenues from circular solutions by 2020. Over the last decade, it has returned some 7000 tons of refurbished medical imaging equipment to the market and incorporated 6000 tons of recycled plastics into its new consumer products.

Van Houten’s commitment to promoting sustainability and the Circular Economy has won him a Fortune Award for Circular Economy leadership, which was presented to him at WEF 2018.


Working towards zero tolerance for female genital mutilation

Nine years ago, one community in Sudan decided to follow WHO recommendations and abandon the practice of female genital mutilation (FGM).

Since then, Tuti Island, a community of 21,000 residents located at the juncture where the White Nile and Blue Nile rivers merge, has been held up as a trailblazer in a growing movement to end FGM.

To date, more than 1000 communities in Sudan have abandoned the practice which has no health benefits and continues to violate the human rights of 200 million women and girls in Africa, the Middle East and Asia.

“Tuti Island is a shining example of how a community can initiate and sustain an effort to end FGM,” said Dr Wisal Ahmed, team leader in WHO Sudan’s Women’s Health Unit. “We hope the other communities who have declared abandonment in the past four years can also sustain progress.”

Sudan has one of the highest rates of FGM in the world, with most girls undergoing the practice between 5–9 years of age. Eighty-seven percent of women aged 15-49 years have been cut, and the majority have undergone the severest form – infibulation – where the genitals are stitched up after cutting, leaving only a small opening for urine to pass.

However, there are indications that the practice is decreasing among younger girls, explained Dr Ahmed. “Only a third of girls aged 0-14 years undergo FGM compared to 9 out of 10 girls aged 15-49 years.”

Five years ago, WHO, joined the UNICEF and UNFPA programme supporting the Government of Sudan, called “Sudan Free From Female Genital Cutting”. As part of the programme, WHO has been working to strengthen the health sector’s response to FGM by halting “medicalization” – the practice of FGM performed by midwives and other healthcare providers.

“FGM is a human rights violation breaching the health profession’s code of ethics to ‘do no harm’. WHO and partner UN agencies are opposed to the medicalization of FGM,” said Dr Naeema Al-Gaseer, WHO Country Representative for Sudan.

Working with the Sudan Ministry of Health, midwifery schools, and health professional associations and regulatory bodies, WHO is ensuring health professionals adhere to the recommendations laid out in its Global strategy to stop healthcare providers from performing female genital mutilation.

As part of pre-licence training, all paramedical and midwives in the country now receive information about the harms of FGM. To date, nearly 1000 health professionals have undergone the training. And, more than 2700 medical professionals in Sudan have pledged to abandon FGM and its medicalization.

Using WHO recommendations on the management of health complications from FGM, the country is also working to ensure women who have undergone FGM receive the care, treatment and counselling they need, and are not repeatedly harmed when seeking care, especially after childbirth.

Educating young girls about the dangers of FGM is another component of the multisector programme. Since more than 70% of girls in Sudan attend primary school, WHO, in partnership with the Ministry of Education and Ministry of Health, developed and integrated FGM content within the school curriculum. Now girls learn that FGM is not a religious rite and has significant short- and long-term negative health consequences.

 


Rapid spread of multidrug-resistant malaria in southeast Asia demands urgent action

The current spread of multidrug-resistant malaria in southeast Asia is likely to be the result of two mutations combining in 2008, according to a retrospective genetic study published in The Lancet Infectious Diseases journal. The study shows how the multidrug-resistant parasite gained increased biological fitness, spreading rapidly through the region unnoticed for 5 years until the outbreak became apparent in 2013. The authors warn that malaria programmes should closely monitor genetic mutations to mitigate the possibility of the parasite becoming untreatable.

Malaria is caused by Plasmodium parasites, which are transmitted by mosquitoes. Typically, treatment for malaria involves a combination of drugs including artemisinin – a potent and fast-acting antimalarial drug – and a longer-acting partner drug to ensure that all parasites are killed and to prevent the emergence of resistance.

In 2008, Plasmodium falciparum started to become resistant to artemisinin in western Cambodia. Since then, resistance has been observed in other parts of Cambodia, Thailand, Vietnam, Myanmar, and Laos.

From 2013, the frequency of complete treatment failure in patients receiving a drug combination of dihydroartemisinin and piperaquine increased rapidly in Cambodia, northeast Thailand, and Vietnam.

“Malaria policy makers now face a dilemma. On one hand, malaria remains treatable and its prevalence has been reduced to low enough levels to aim to eliminate the disease in Cambodia and neighbouring countries. However, the situation is fragile, and it is unclear how the parasite population will evolve in response to new interventions,” says Roberto Amato, Wellcome Sanger Institute, UK. “While it would be catastrophic if resistance developed in the same way for the last remaining anti-malarial drugs, it is now possible to conduct genetic surveillance of malaria cases, allowing researchers to respond as soon as possible to changes in the parasite population. It is important that we embrace these technologies so that major outbreaks of resistance do not go unnoticed in the future, and to reduce the risk of a global health emergency.”

In the study, the authors analysed the genomes of 1492 P falciparum samples from 11 locations across southeast Asia between 2007-2013, including 464 samples collected in western Cambodia, to determine how resistance developed.

Resistance to artemisinin is caused by mutations in a gene called kelch13, while amplifications of the genes plasmepsin 2 and plasmepsin 3 are linked to resistance to piperaquine.

The rapid spread of the mutation pair suggests that artemisinin-resistant parasites are acquiring increased biological fitness, and it is unclear how much this increases the risk of resistance to other drugs and trans-continental spread.

The authors also note that the mutation pair seems to have displaced other artemisinin-resistant parasite lineages, including those that cause resistance to the anti-malarial drug mefloquine.

Writing in a linked Comment, Dr Didier Ménard, Pasteur Institute, France, says: “The results of this study are reminiscent of the evolution of chloroquine resistance, wherein multiple P falciparum chloroquine resistance transporter (Pfcrt) alleles emerged in southeast Asia before one allele (the CVIET allele) eventually spread to Africa, leading to millions of deaths. Obviously, this scenario should be avoided for artemisinin combination therapy. For chloroquine, the molecular signatures of resistance were only detected in early 2000, long after resistant parasites had spread outside their original focus. The spread of strains resistant to artemisinin combination therapy in western Cambodia is underway; however, it is reassuring to learn from this study that genomic tools are available to monitor the onset of this spread and, by contrast with chloroquine resistance, to track resistant parasites in real time. We must take advantage of this situation. One way is to improve understanding of the causes of emergence and selection of resistance to artemisinin combination therapy by progressing analyses of parasite population genetics.”


GE, Roche partner to develop digital diagnostics platform

GE Healthcare has entered into a strategic, long-term partnership with Roche to jointly develop and co-market digital clinical decision support solutions. The partnership will initially focus on products that accelerate and improve individualized treatment options for cancer and critical care patients.

The two companies aim to develop an industry-first digital platform, using advanced analytics to provide workflow solutions and apps that support clinical decisions. This will allow the seamless integration and analysis of in-vivo and invitro data, patient records, medical best practice, real time monitoring and the latest research outcomes. Clinicians will then have the comprehensive decision support for providing the right treatment and quality of care for their patients.

“This is the first time that two major players in healthcare have combined advanced analytics with in-vivo and in-vitro diagnostics to this degree. We believe this alliance will help accelerate the delivery of data-driven precision health for customers, patients and the healthcare industry,” said Kieran Murphy, President & CEO of GE Healthcare.

For example, oncology care teams with multiple specialists will have a comprehensive data dashboard to review, collaborate and align on treatment decisions for cancer patients at each stage of their disease. In the critical care setting, data from a patient’s hospital monitoring equipment will be integrated with their biomarker, tissue pathology, genomic and sequencing data, helping physicians to identify, or even predict severe complications before they strike.


US NIH to launch genome editing research programme

The US National Institutes of Health will launch an effort aimed at removing barriers that slow the adoption of genome editing for treating patients. This program, Somatic Cell Genome Editing, plans to award researchers approximately US$190 million over six years beginning this year, pending availability of funds. These researchers willcollaborate to improve the delivery mechanisms for targeting gene editing tools in patients, develop new and improved genome editors, develop assays for testing the safety and efficacy of the genome editing tools in animal and human cells, and assemble a genome editing toolkit containing the resulting knowledge, methods, and tools to be shared with the scientific community.

“Genome editing technologies such as CRISPR/Cas9 are revolutionizing biomedical research,” said NIH Director Francis S. Collins, M.D., Ph.D. “The focus of the Somatic Cell Genome Editing program is to dramatically accelerate the translation of these technologies to the clinic for treatment of as many genetic diseases as possible.”

Advances in genome editing made over the past decade now make it possible to precisely change the DNA code inside living cells. Despite widespread interest and investment in this field, many challenges remain preventing broad adoption of this technology in the clinic.

Somatic cells are any of the non-reproductive cells of the body, i.e. the cells that do not pass DNA down to the next generation. By focusing on somatic cells, any changes to the DNA introduced by the genome editing therapeutics will not be inherited.


WHO prequalifies breakthrough vaccine for typhoid

At the end of December last year, WHO prequalified the first conjugate vaccine for typhoid, Bharat Biotech’s Typbar-TCV. Typhoid conjugate vaccines (TCVs) are innovative products that have longer-lasting immunity than older vaccines, require fewer doses, and can be given to young children through routine childhood immunization programmes. The fact that the vaccine has been prequalified by WHO means that it meets acceptable standards of quality, safety and efficacy. This makes the vaccine eligible for procurement by UN agencies, such as UNICEF, and Gavi, the Vaccine Alliance.

In October last year, the Strategic Advisory Group of Experts (SAGE) on immunization, which advises WHO, recommended TCV for routine use in children over 6 months of age in typhoid endemic countries. SAGE also called for the introduction of TCV to be prioritized for countries with the highest burden of typhoid disease or of antibiotic resistance to Salmonella Typhi, the bacterium that causes the disease. Use of the vaccine should also help to curb the frequent use of antibiotics for treatment of presumed typhoid fever, and thereby help to slow the alarming increase in antibiotic resistance in Salmonella Typhi.

Shortly after SAGE’s recommendation, Gavi Board approved US$85 million in funding for TCVs starting in 2019. Prequalification is therefore a crucial next step needed to make TCVs available to low-income countries where they are needed most. And even in non-Gavi-supported countries, prequalification can help expedite licensure.


UN Environment, WHO set up major collaboration on environmental health

UN Environment and WHO have agreed a new, wide-ranging collaboration to accelerate action to curb environmental health risks that cause an estimated 12.6 million deaths a year.

The new collaboration creates a more systematic framework for joint research, development of tools and guidance, capacity building, monitoring of Sustainable Development Goals, global and regional partnerships, and support to regional health and environment fora.

Mr Erik Solheim, head of UN Environment, and Dr Tedros Adhanom Ghebreyesus, Director- General of WHO, signed an agreement in Nairobi to step up joint actions to combat air pollution, climate change and antimicrobial resistance, as well as improve coordination on waste and chemicals management, water quality, and food and nutrition issues. The collaboration also includes joint management of the BreatheLife advocacy campaign to reduce air pollution for multiple climate, environment and health benefits. This represents the most significant formal agreement on joint action across the spectrum of environment and health issues in over 15 years.

“There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate – which are the foundations for life on this planet. This new agreement recognizes that sober reality,” said Solheim.

Tedros commented: “Our health is directly related to the health of the environment we live in. Together, air, water and chemical hazards kill more than 12.6 million people a year. This must not continue.”

He added: “Most of these deaths occur in developing countries in Asia, Africa and Latin America where environmental pollution takes its biggest health toll.”

The two agencies will develop a joint work programme and hold an annual high-level meeting to evaluate progress and make recommendations for continued collaboration.

Priority areas of cooperation between WHO and UN Environment

  • Air Quality - More effective air quality monitoring including guidance to countries on standard operating procedures; more accurate environment and health assessments, including economic assessment; and advocacy, including the BreatheLife campaign promoting air pollution reductions for climate and health benefits.
  • Climate - Tackling vector-borne disease and other climate-related health risks, including through improved assessment of health benefits from climate mitigation and adaptation strategies.
  • Water – Ensuring effective monitoring of data on water quality, including through data sharing and collaborative analysis of pollution risks to health.
  • Waste and chemicals – Promotion of more sustainable waste and chemicals management, particularly in the area of pesticides, fertilizers, use of antimicrobials . The collaboration aims to advance the goal of sound lifecycle chemicals management by 2020, a target set out at the 2012 United Nations Conference on Sustainable Development.

BreatheLife
breathelife2030.org

Date of upload: 24th Mar 2018

                                  
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