Antimicrobial Resistance

Key facts 

          

•  Infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death.
• About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths.
•  Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries.
• A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
• Inappropriate and irrational use of antimicrobial medicines provides favourable conditions for resistant microorganisms to emerge, spread and persist.

What drives antimicrobial resistance (AMR)?

Inappropriate and irrational use of medicines provides favourable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread.

Underlying factors that drive AMR include:

• inadequate national commitment to a comprehensive and coordinated response, ill-defined accountability and insufficient engagement of communities;
• weak or absent surveillance and monitoring systems;
• inadequate systems to ensure quality and uninterrupted supply of medicines
• inappropriate and irrational use of medicines, including in animal husbandry:
• poor infection prevention and control practices;
• depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products.

Combat drug resistance - No action today, no cure tomorrow

The emergence of AMR is a complex problem driven by many interconnected factors; single, isolated interventions have little impact. A global and national multi-sectoral response is urgently needed to combat the growing threat of AMR.

WHO has selected combating antimicrobial resistance as the theme for World Health Day 2011. On this day, WHO issues an international call for concerted action to halt the spread of antimicrobial resistance and recommends a six-point policy package for governments.

WHO calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance.

Source: WHO Fact sheet N°194, February 2011, WHO Media center

Inputs: Prof. Sudhi Ranjan Garg

A glaring example of working without borders on health issues

Asian Biomedicine Vol. 4 No.4 August 2010; 671

World Rabies Day (September 28, 2010): the continuing effort to 'make rabies history'

Peter Costa, Deborah J Briggs, Robert Dedmon

Alliance for Rabies Control, Edinburgh, UK and Global Alliance for Rabies Control Manhattan, Kansas 66506; Kansas State University College of Veterinary Medicine, Manhattan, Kansas 66506, Medical College of Wisconsin, Milwaukee, Wisconsin 53226, USA

In spite of a number of advances in rabies research and education, rabies remains a serious global threat and causes 55,000 deaths annually. About half of these deaths occur in children under 15 years of age, and in areas where awareness, public and private support, and rabies vaccines and immunoglobulin (RJG) are unavailable or too expensive. Until rabies biologics become more readily available, public and professional education remain of critical importance toward efforts to eliminate this dreadful scourge. In North America, bats remain the principal cause of rabies deaths although the epizootic in wildlife remains a serious challenge. In much of the developing world, dogs are the principal transmitter of rabies to humans. More than half the rabies deaths globally occur in Asia, where adequate preventive care is often unavailable. In addition, the ongoing rabies outbreak in Bali reminds us of the dire consequences of ill-informed and ineffective animal culling without adequate vaccination of at least 70% of all dogs to control spread of rabies.

This year marks the fourth World Rabies Day (WRD) effort under the sponsorship of the Global Alliance for Rabies Control (GARC)/Alliance for Rabies Control (ARC), WHO, The U.S. CDC, FAO (Food and Agricultural Organization), OlE (World Organization for Animal Health), a number of veterinary organizations and schools, and several national ministries of agriculture, animal health, and public health. The number of countries participating in WRD efforts has grown from 75 in 2007 to 105 in 2009, and in Asia from 13 in 2007 to 24 in 2009. Currently, the Alliance (GARC/ARC) is communicating prevention messages to 200 countries and territories through partnerships with a variety of private and public organizations.

In its first three years, WRD efforts have resulted in educating nearly 100 million people, providing almost three million animal vaccinations, and in 2009, receiving over 205,000 visitors to its web site (www.worldrabiesday.org). Much of this work has been done by dedicated volunteers, as well as through donations from individuals and various foundations. However, much more work remains. WRD4 is another opportunity to 'Make Rabies History' and 'Save the Children'. The authors encourage all health and government leaders to observe and support this effort, remembering that rabies is 100% preventable.

Inputs

Peter J Costa

MPH CHES (Health Educator)

Director, Global Communications

Global Alliance for Rabies Control

World Rabies Day Campaign

World Rabies Day Campaign: Evaluating a Global Initiative

P. Orlosky², C. Williams¹, J. Blanton², D. Briggs³, R. Dedmon⁴, A. Tumpey², P. Costa¹

 ¹Global Alliance for Rabies Control, Manhattan, KS/US, ²U.S. Centers for Disease Control and Prevention, Atlanta, GA/US, ³Kansas State College of Veterinary Medicine, Pathobiology, Manhattan, KS/US, ⁴Medical College of Wisconsin, Population Health, Milwaukee, WI/US

Rabies, one of the oldest known zoonotic diseases, is a 100% preventable yet results in approximately 55,000 deaths each year, almost one person every 10 minutes. Community education has proven to be effective in raising awareness and adoption of prevention behaviors. The World Rabies Day initiative aims to bring together all of the important stakeholders towards the common objective of human rabies prevention and animal rabies control. World Rabies Day (WRD) is the only worldwide event of its kind, advocating for the improved health of the total population, both human and animal, through a One Medicine approach.

The success of World Rabies Day is promising. In just three years, the Campaign has helped to educate nearly 100 million people and vaccinate approximately 3 million animals. 

Inputs from: 

Peter J Costa, MPH CHES (Health Educator), Director, Global Communications, Global Alliance for Rabies Control, Manhattan, USA 

Educational campaign for rabies awareness, responsible pet ownership and dog vaccination

Rabies is a fatal disease affecting man and animals. It is mainly transmitted through dog bites. A special campaign against rabies was organised by the College of Veterinary Sciences, Hisar on the World Rabies Day 2010.  The effective control of rabies will only be possible when there is complete interdepartmental coordination among public health department, local civic bodies, animal husbandry department, wildlife department and NGOs. 

Sudhi Ranjan Garg
Professor & Head 
Department of Veterinary Public Health & Epidemiology,
College of Veterinary Sciences, Hisar-125004, India

Multidisciplinary approach and intersectoral coordination in health issues

A Symposium "Interdisciplinary Approach for Tuberculosis Control" at Hisar

The modern world has changed into a global village, the disease agents do not respect geographical borders, but unfortunately, the health issues concerning humans and animals remain largely compartmentalized and bordered. Though, public health and animal health issues generally overlap because a large number of infectious diseases of animal origin are transmissible to humans from animals or animal products; public health specialists and veterinary specialists mostly continue to work in complete isolation within their narrow domains. With the One Health initiative gaining momentum worldwide, the relationship between medical and veterinary sciences is, however, being increasingly recognized now.

It is also important to understand that health, though an individual’s possession, is not always in its own control. The environment has great influence on it. An individual cannot remain healthy in an unhealthy environment. However, despite the fact that microbiologists, immunologists, epidemiologists, biotechnologists, parasitologists, entomologists, biologists, wildlife specialists, chemists, pharmacologists, environmentalists, food scientists, nutritionists, engineers, technologists, health educators and many others contribute significantly in health risk mitigation, their role does not find due attention while health programmes are being planned. We should not forget that human, livestock, wildlife, and environmental health are integrally linked, so multidisciplinary approach and intersectoral coordination are absolutely essential to sort out the health issues.

Sudhi Ranjan Garg

Professor & Head

Department of Veterinary Public Health & Epidemiology,

College of Veterinary Sciences, Hisar-125004, India