Weekly Digest: HIV drug resistance is rising; One in ten infants received no vaccination last year

21 Jul 2017

A weekly roundup of news on drug resistance and other topics in global health. 

High prevalence of antibiotic resistance in Indian poultry farms raises global concerns about farming practices. A CDDEP study in Environmental Health Perspectives finds high levels of antibiotic-resistant pathogens in chickens raised for both meat and eggs on farms in India’s Punjab state. Samples from 530 birds on 18 poultry farms were tested for resistance to a range of antibiotics critical to human medicine. Two-thirds of the farms reported using antibiotics for growth promotion, and samples from these farms were three times more likely to be multidrug-resistant than samples from the other farms. Sixty percent of all E. coli isolates produced enzymes (extended-spectrum beta-lactamases) that confer resistance to antibiotics important in treating bacterial pneumonia and other infections. Use of antibiotics for growth promotion in farm animals has increased worldwide in response to rising demand for food animal products. In 2015, CDDEP, projected that antibiotic consumption in food animal production will rise globally by two-thirds by 2030, including more than a tripling of use in India. [Environmental Health Perspectives]

Lack of consensus on the latest public health verdict by ECJ. Public health experts have taken issue with a recent verdict by the European Court of Justice in a French vaccine compensation case. The ruling suggested that in the absence of scientific evidence, “circumstantial evidence’” be allowed to guide decisions. In a commentary in The Hindu, CDDEP Director Ramanan Laxminarayan and South Asia Head Jyoti Joshi explain that “Public health interventions must be guided by scientific panels, weighing the pros and cons for the larger public good.” The authors fear that the ruling could sow the seeds of doubt about proven vaccines and potentially put millions of lives at risk. [The Hindu]

MRSA gene predated the introduction of methicillin. Resistance to a specific antibiotic is thought to result from natural selection in bacteria exposed to that antibiotic. Resistance to methicillin—the next generation after penicillin—was found in 1960, less than a year after its introduction. A study in Genome Biology contends that methicillin-resistant Staphylococcus aureus (MRSA) was present before the drug was introduced, having emerged earlier in response to penicillin. Using whole genome sequencing and a reconstruction of the evolutionary history of 209 MRSA isolates from Europe in 1960 and 1989, they found that use of penicillin to treat S. aureus in the 1940s and 1950s had selected for strains carrying MRSA’s mecA gene, which also encodes penicillin resistance. According to author Matthew Holden, “Our study provides important lessons for future efforts to combat antibiotic resistance. It shows that new drugs which are introduced to circumvent known resistance mechanisms, as methicillin was in 1959, can be rendered ineffective by unrecognized, pre-existing adaptations in the bacterial population." [Genome Biology, CIDRAP]

WHO: HIV drug resistance is rising. Drug resistance could undermine global progress in treating and preventing HIV infection, according to the World Health Organization’s (WHO) HIV Drug Resistance Report 2017. In six of the11 countries surveyed in Africa, Asia, and Latin America, at least 10 percent of people starting antiretroviral therapy had a strain of HIV resistant to some first-line medicines. WHO uses a 10 percent threshold to signal that countries should shift to alternative regimens. If no action is taken, an additional 135,000 deaths and 105,000 new infections could follow in the next five years, and HIV treatment costs could increase by $650 million. CDC’s Shannon Hader observed that “Overall high rates of viral suppression across three recent national Population-based HIV Impact Assessments showed that present first-line regimens remain largely effective. However, special attention to populations at risk for higher resistance, such as pediatrics, adolescents, pregnant women and key populations, will be critical to target more urgent interventions.” [WHO report, press release]

One in ten infants received no vaccination last year. Ten percent of infants went unvaccinated in 2016, according to State of inequality: Childhood immunization, a joint UNICEF-WHO report. An additional 6.6 million infants who received one dose of diphtheria-tetanus-pertussis (DTP) vaccine did not complete the full, three dose series in 2016. According to Jean-Marie Okwo-Bele at WHO, “Most of the children that remain un-immunized are the same ones missed by health systems. These children most likely have also not received any of the other basic health services. If we are to raise the bar on global immunization coverage, health services must reach the unreached. Every contact with the health system must be seen as an opportunity to immunize." [WHO, CIDRAP]

U.K. Arts and Humanities Research Council to fund interdisciplinary projects tackling AMR. The U.K. Arts and Humanities Research Council (AHRC) has announced 11 awards for research projects targeting antimicrobial resistance (AMR) in indoor and built environments. Seven universities and a research nonprofit will share more than £2 million for the work. The AHRC launched its call for submissions in November 2016 as part of a wider AMR research initiative led by the Medical Research Council, noting that AMR “cannot be tackled purely by biomedical and clinical expertise, but through global and interdisciplinary approaches.” [UK AHRC]


Image courtesy of Charles Brower