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Weekly Digest: FAO unveils Action Plan to reduce antimicrobial use in agriculture; Syrian refugee children at high risk for multidrug resistant infections


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

Antimicrobial resistance in India is threatening the survival of newborns. In a large multi-center study of neonatal sepsis in tertiary care hospitals in India, sepsis incidence and mortality was high and antimicrobial resistance increased the case fatality rates. CDDEP Director Ramanan Laxminarayan, in a Lancet comment, highlights the importance of sepsis prevention in newborns, as births in India and other low- and middle-income countries take place increasingly in health facilities, where the infection risk is high. The results of the Delhi Neonatal Infection Study (DeNIS) indicate the need to understand the pathogenesis of sepsis in newborns and infants, as well as the need to implement proven infection control interventions to prevent the illness in low-income and middle-income countries. [Lancet Global Health Study, Comment]

The Food and Agriculture Organization has unveiled an “Action Plan on Antimicrobial Resistance, 2016-2020,” to help countries develop strategies for addressing the spread of antimicrobial use and resistance in their food supply chains. The Action Plan addresses four focus areas: 1) improve awareness of AMR-related threats, 2) develop the capacity for surveillance and monitoring of AMR resistance and use in food and agriculture, 3) strengthen governance related to use and resistance, and 4) promote good practices and prudent use of antimicrobials in food and agricultural systems. According to the Action Plan, two-thirds of the estimated future growth of antimicrobial use is expected to occur in animal production, with use in pig and poultry production predicted to double. The Action Plan was released to coincide with the United Nations General Assembly High-Level Meeting on Antimicrobial Resistance, on September 21. [FAO release, FAO Action Plan]

Syrian refugee children are at high risk for multidrug resistant infections, according to research published in Emerging Infectious Diseases. For nearly three years, researchers collected demographic and clinical microbiology data for all Syrian children who were admitted to the Galilee Medical Center, a hospital where children who are ill or severely wounded from the civil war have been secretly transported for treatment. Most of the 128 children admitted to the hospital—89 of them—were infected with a multidrug resistant pathogen. Infections were more frequent among wounded (90 percent) than among sick (10 percent) children. The Syrian civil war has contributed to inadequate sanitation, the destruction of hospitals and infrastructure, and suboptimal infection control measures. [Emerging Infectious Diseases]

First case-control study reinforces microcephaly-Zika link; unanticipated Zika outbreak in Singapore. The first case-control study of the Zika-microcephaly link, ordered by Brazil’s health ministry, appeared in Lancet Infectious Diseases. All babies born with microcephaly in eight public hospitals in the Zika hot-spot of Recife, Brazil, between January 14 and May 2 constituted the cases. The first two infants without microcephaly born the morning after each case were taken as controls. Among 30 mothers of newborns with microcephaly, 24 (80 percent) had been infected with Zika and 13 of 32 (41 percent) babies with microcephaly had lab-confirmed Zika. The risk of microcephaly with laboratory-confirmed Zika in the neonates was 55 times the risk without infection, leaving little room for doubt that the association is real and is likely causal.

More than 369 cases of Zika have now been reported in Singapore, despite its well-known vector control programs. Infectious disease specialist Dr. Hoe Nam Leong said, “We suspect a significant mutation occurred that conferred [on the virus] an advantage in spreading from person to mosquito to person. Previously, reports of Zika are far and few in between.” [Lancet Infectious Diseases, CIDRAP, CIDRAP, Sept 16 Singapore Ministry of Health update]

WHO should modify its strategy and outsource duties, according to public health experts. In a comment published in the BMJ Global Health, global public health experts suggest that the WHO should adapt to the changing global health landscape with a new global health architecture, built to prevent future health crises and pandemics. The authors point to shortcomings in the Ebola response, as well as a series of what they term institutional failures in Sri Lanka in 2009, Haiti in 2010, South Sudan in 2013, and the MDR-TB response in Papua New Guinea at present. The rise and maturation of multilateral organizations and NGOs devoted to global health should allow the WHO to outsource many of its functions. The authors write, “The Constitution of the organisation emphasises coordination, collaboration with specialised agencies and other organisations, furnishing assistance, assisting in providing and promoting cooperation—all of which resonate with the idea of WHO providing leadership but outsourcing key activities.” [BMJ Global Health, The Guardian]