Public Health




World Health Day
– Call to combat drug resistance
 



April 7 is World Health Day, a day celebrated around the world each year to mark the founding of the World Health Organisation, more than 60 years ago. Each year the WHO chooses an issue on which to focus – and this year it is “Combat Drug Resistance”.


The WHO warns that drug resistance is becoming more severe and many infections are no longer easily cured, leading to prolonged and expensive treatment and greater risk of death. The WHO calls for urgent and concerted action by governments, health professionals, industry and civil society and patients to slow down the spread of drug resistance, limit its impact and preserve medical advances for future generations.

“The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures,” said WHO Director-General Dr Margaret Chan. “In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated.”

In his message mark the occasion, Dr Hussein Gezairy, regional director WHO Eastern Mediterranean Region reiterated Dr Chan’s remarks: “We are seeing now a decline in the cure rates of diseases due to the development by all kinds of microorganisms – bacteria, viruses and parasites – of resistance against drugs, which results in a weakening of the response of antimicrobials and, consequently, reduction in their effect. This threatens to return the world to the era before the discovery of the medicines that are so essential in controlling infectious diseases, the heavy burden of which needs to be addressed urgently.”

The discovery and use of antimicrobial drugs to treat diseases such as leprosy, tuberculosis, gonorrhoea and syphilis changed the course of medical and human history. Now, those discoveries and the generations of drugs that followed them are at risk, as high levels of drug resistance threaten their effectiveness.

Last year, at least 440,000 new cases of multidrug resistant-tuberculosis were detected and extensively drug-resistant tuberculosis has been reported in 69 countries to date. The malaria parasite is acquiring resistance to even the latest generation of medicines, and resistant strains causing gonorrhoea and shigella are limiting treatment options. Serious infections acquired in hospitals can become fatal because they are so difficult to treat and drug-resistant strains of microorganism are spread from one geographical location to another in today's interconnected and globalized world. Resistance is also emerging to the antiretroviral medicines used to treat people living with HIV.

WHO has published a policy package that sets out the measures governments and their national partners need to combat drug resistance. The policy steps recommended by WHO include:
- develop and implement a comprehensive, financed national plan
- strengthen surveillance and laboratory capacity
- ensure uninterrupted access to essential medicines of assured quality
- regulate and promote rational use of medicines
- enhance infection prevention and control
- foster innovation and research and development for new tools.

“WHO has established many initiatives to understand and address drug resistance over the last decade, particularly in relation to some of the world's most deadly infectious diseases,” said Dr Mario Raviglione, Director of WHO Stop TB Department, who has been leading the preparations for World Health Day 2011. “Those measures must now be further strengthened and implemented urgently across many diseases and across many sectors. New collaborations, led by governments working alongside civil society and health professionals, if accountable, can halt the public health threat of drug resistance.”


WHO EMR World Health Day 2011
http://www.emro.who.int/whd2011/index.htm
Disease specific drug resistance http://www.who.int/drugresistance/diseases/en/index.html
 

Super super-bug NDM-1 gene found in New Delhi water supply

A report from ProMed Mail via Reuters (6 April 2011) says that a gene that makes bugs highly resistant to almost all known antibiotics has been found in bacteria in water supplies in New Delhi used by local people for drinking, washing, and cooking. The NDM 1 gene, which creates what some experts describe as “super superbugs,” has spread to germs that cause cholera and dysentery, and is circulating freely in other bacteria in the Indian capital of 14 million people.

“The inhabitants of New Delhi are continually being exposed to multidrugresistant and NDM 1-positive bacteria,” said Mark Toleman of Britain’s Cardiff University School of Medicine, who published the findings in a study on 7 April 2011.

A “substantial number” of them are consuming such bacteria on a daily basis, he told a briefing in London. “We believe we have discovered a very significant underlying source of NDM 1 in the capital city of India,” he said.

NDM 1, or New Delhi metallo-betalactamase 1, makes bacteria resistant to almost all antibiotics, including the most powerful class, called carbapenems.

It first emerged in India three years ago and has now spread across the world. It has been found in a wide variety of bugs, including familiar pathogens like E. coli.

No new drugs are on the horizon for at least 5-6 years to tackle it and experts are concerned that only a few major drug companies, such as GlaxoSmithKline and AstraZeneca, still have strong antibiotic development programmes.

Experts say the spread of superbugs threatens whole swathes of modern medicine, which cannot be practiced if doctors have no effective antibiotics to ward off infections during surgery, intensive care, or cancer treatments like chemotherapy.

The WHO has designated 7 April as World Health Day and under the slogan “No action today, no cure tomorrow” it is campaigning about the risks of life-saving antibiotics losing their healing power.

“We are at a critical point in time where antibiotic resistance is reaching unprecedented levels,” said Zsuzsanna Jakab, the WHO’s regional director for Europe.

“Given the growth of travel and trade in Europe and across the world, people should be aware that until all countries tackle this, no country alone can be safe.”

Source: http://tinyurl.com/3q7qxnt

Comment from ProMed moderator

Referring to research by Yong D, et al a ProMed Mail <www.promedmail.org> moderator comments: The plasmid carrying NDM-1 also carries several other resistance genes and appears to easily transmit itself to other organisms. The authors state “the dissemination of this plasmid among clinical bacteria would be a nightmare scenario.” Clearly, inadequate sanitary systems make spread of enteric bacteria of any sort quite easy.

This gene cassette of wide-spectrum antimicrobial resistance appears to have developed in the Indian subcontinent where the use of antimicrobial agents is quite poorly controlled. Organisms carrying this resistance combination have already been introduced into Western Europe, the USA, and Canada. The best methods of control are rapid recognition by standard microbiologic methodology in patients having the appropriate medical/travel history and aggressive handwashing techniques.

The amazing overuse of our current antimicrobial armamentarium that I am currently observing in my clinical practice in the USA will no doubt serve as an efficient multiplier of these isolates just as intravenous drug abuse and sexual promiscuity facilitated the explosion of HIV 30 years ago. This misuse, in my opinion, is directly related to the lack of control of antimicrobial usage in intensive care units and emergency care settings by intensivists and ER physicians who often react without wisdom and “cookbook” protocols instead of using common sense and rational prescribing patterns. Once the patient moves out of the ICU or ER, these physicians do not even see the products of their unwise labours.

Reference:
Yong D, Toleman MA, Giske CG, et al: Characterization of a new metallo-betalactamase gene, bla(NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53(12): 5046-54. Source: http://tinyurl.com/6z49apa
 


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ate of upload: 10th Jul 2011

 

                                  
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