Week of August 1, 2016
By: Matthew Trail
“Although we do need science to provide solutions, the problems are fundamentally political.” — Andrew F. Read, Director, Center For Infectious Disease Dynamics, Penn State University, The Philadelphia Inquirer, 8/4/16
Welcome to In The Media: Antimicrobial Resistance, a recurring media compilation focusing on the rise of antimicrobial resistance and scientific discovery in advanced diseases.
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Rio Plagued With AMR Concerns
In response to reportedly high viral loads in Rio de Janeiro’s waterways, a University of Southern Florida professor offered this advice to Rio visitors: “Don’t put your head under water.”
The Center for Disease Control and Prevention (CDC) announced $67 million in grants to state and local health departments combating antimicrobial resistance, amid news that a new U.S./U.K. antibiotics and rapid diagnostics pipeline accelerator, CARB-X, has been launched.
An editorial published by the World Health Organization (WHO) calls for a global response to the AMR threat.
Researchers unveiled new findings on the prevalence of multidrug-resistant, mcr-1-positive E. coli in cattle.
McDonald’s announced that it has made good on its pledge to eliminate chicken raised with antibiotics from its menu.
Chart: Bearing The Burden Of C. difficile Infections
“The Centers for Disease Control and Prevention (CDC) is contributing $67 million to the nationwide effort to fight antibiotic resistance, according to a statement made by the CDC last week. These funds will be distributed to all 50 state health departments, six local health departments (Chicago, the District of Columbia, Houston, Los Angeles, New York City, and Philadelphia) and Puerto Rico. This funding will also support seven new regional laboratories that will specialize in rapid detection, identification, and response of emerging resistant pathogens.
“These funds will support activities outlined in the CDC’s Antibiotic Resistance Solutions Initiative, which was created in order to fully implement the activities defined in the National Action Plan for Combating Antibiotic-Resistant Bacteria. The main focuses of the Antibiotic Resistance Solutions Initiative involve tracking, rapid detection of and response to outbreaks, improved prescribing, providing better patient care, increasing susceptibility testing, providing insights for research innovation, implementing CDC’s Core Elements of Hospital Antibiotic Stewardship nationwide, and establishing global partnerships dedicated to prevention and detection, as outlined by the CDC.” (Kristi Rosa, 8/4/16)
“Bacteria resistant to one of the antibiotics of ‘last resort’ and a ‘substantial public health risk’ have been discovered in Scotland. Medical researchers detected the mcr-1 gene in a salmonella patient who had recently returned from south-east Asia. The gene was discovered in China last year, leading scientists to warn of a ‘post-antibiotic’ era. It is the first time that the bug, which is resistant to the antibiotic colistin, has been found in Scotland.
“The discovery was revealed in a Health Protection Scotland (HPS) report. HPS said the traveller was recovering and had not required antibiotic treatment.” (8/3/16)
“Two new studies in Emerging Infectious Diseases provide more evidence of the spread of MCR-1, the gene that confers resistance to the last-resort antibiotic colistin, in both animals and humans, including an isolate that was resistant to multiple antibiotics.
“In the first study, an international group of researchers reported that, out of 150 strains of Escherichia coli cultured from the fecal samples of European cattle from 2004 through 2010, 45 were classified as multidrug-resistant. Three of those multidrug-resistant strains showed elevated levels of resistance to colistin. Further analysis identified one isolate — an E coli 29957 strain — as MCR-1 positive.” (Chris Dall, 8/2/16)
“McDonald’s is no longer serving chicken raised on antibiotics that are important to human medicine. The company made the pledge last year, and now reports that it has completed its transition to the new antibiotic policy ahead of schedule.
“As we’ve reported, many scientists are concerned that the more an antibiotic is given to food animals, the more quickly bacteria could adapt and become resistant to it. And the FDA has urged farmers and ranchers who raise livestock to reduce antibiotic use.” (Allison Aubrey, 8/2/16)
“Just days ahead of the Olympic Games the waterways of Rio de Janeiro are as filthy as ever, contaminated with raw human sewage teeming with dangerous viruses and bacteria, according to a 16-month-long study commissioned by The Associated Press.
“Not only are some 1,400 athletes at risk of getting violently ill in water competitions, but the AP’s tests indicate that tourists also face potentially serious health risks on the golden beaches of Ipanema and Copacabana.” (Jenny Barchfield, 8/1/16)
Just For Fun
Leading AMR Thinking
“Without diagnostics, medicine is blind. And yet,diagnostics receive much less attention than vaccines and drugs. Imagine a sick infant with bacterial sepsis in sub-Saharan Africa. Without diagnostics, they will likely get incorrectly treated for malaria. Every year, 1 million patients with TB in India are either not diagnosed or not reported. Pregnant women with anemia, syphilis and diabetes are often missed in low-income countries where laboratory capacity is severely lacking. And where there is testing, it is often of low quality.
“A recent NEJM article proposes a simple way to improve access to critical diagnostics: make a list. In 1977, the World Health Organization started (and has since maintained) a Model List of Essential Medicines (EML). The EML, a global health success, has improved access to medicines. Sadly, there is no equivalent Model List of Essential Diagnostics (EDL).” (Lee Schroeder et. al., 8/4/16)
“The doctor tried antibiotic after antibiotic, but the bacteria in the woman’s body continued to proliferate. With only two drugs left, the doctor asked for my advice. An evolutionary biologist collaborating with the physician to study antibiotic resistance, I suggested he use both drugs simultaneously. I reasoned that since the two drugs had different modes of action, more mutations would be required for the bacteria to generate resistance to both drugs.
“In truth, we had no idea what to do, and there wasn’t enough justification to go with my theory. We know simultaneous drugs can stop resistance with HIV, but we have no idea about chronic bacterial infections.” (Andrew Read, 8/4/16)
“…So what does antimicrobial resistance have to do with trade? Interestingly, the overuse and misuse of antibiotics in livestock is a key contributor to the spread of AMR germs, according to the WHO. The majority of antimicrobials are used in agriculture, rather than in the pharmaceutical industry. Therefore, global trade regulations and individual country standards/tariffs can have a significant influence on the spread of AMR. In the past few years, two agreements have dominated trade discussions: the TPP (Trans-Pacific Partnership, between 12 Pacific Rim countries and Canada, signed by Minister Freeland, but yet to be ratified) and the proposed TTIP (Transatlantic Trade Investment Partnership, between the EU and the US). The European Commission projects TTIP to boost the US economy by €90B.
“The White House has insisted that the TPP is an agreement with high standards. However, there are some who argue the TPP has negative consequences because it does not mention AMR anywhere, not even in the Sanitary and Phytosanitary chapter (SPS chapter). The TTIP text will be publicly disclosed after negotiations conclude, and before being signed and ratified. In the meantime, some public health advocates are concerned that harmonization will result in a race to the bottom: in other words, the adoption of lowest common denominator sanitary standards. Developed countries do not use tariffs to compete with one another — instead, they rely on a maze of rules and differing compliance standards. Therefore, these sanitary standards have the ability to dictate the flow of trade. Currently, the EU’s standards on meat are higher than those in the US. The American meat and agriculture industries are pushing for the EU to relax its restrictions. For example, the EU has banned poultry from the US since 1997. The US National Chicken Council claims the EU’s justifications are not based in science, and that the non-tariff barriers are overly trade restrictive. And if the EU potentially adopts lower standards in the TTIP, US poultry exports can increase $500M.” (Julia Peng, 8/3/16)
“Given the magnitude and severity of the threat of antimicrobial resistance, it is a sign of progress that Member States of the World Health Organization (WHO) are now developing national action plans in response to WHO’s Global action plan on antimicrobial resistance.1 To accelerate these efforts, in April 2016 the Wellcome Trust held an interdisciplinary international summit, bringing together policy-makers and scientists from more than 30 countries to review and debate a set of 25 policy options.
“The summit’s discussions reflected the multidimensional challenge posed by antimicrobial resistance. There are social, economic and environmental dimensions that encompass food production systems as well as human and animal health.2Public attitudes and behaviours have a major impact on antibiotic use in health care.3In many countries, agricultural use of antibiotics exceeds medical use.4 The solutions to antimicrobial resistance must be similarly broad in scope. The ‘One Health’ concept captures this scope, by recognizing the interdependence of human health, agriculture and animal health and the environment.” (Tim Jinks et. al., 8/1/16)
“Olympics is more than a competition among athletes with exceptional strength, skills and abilities. As previous Olympics have shown, there are other trials at play. For example, the Beijing Olympics was a test of resilience against airborne pollutants, other Olympics overcame logistical hurdles like making sure all the sporting venues and other infrastructure were built on time and all modern Olympics have faced security challenges. Now, the 2016 Rio Olympics might present a new test: the threat posed by antimicrobial resistance (AMR).
“The potential for bacteria and other “bad bugs” to survive despite treatment with drugs intended to stop or kill them is likely to be one of the greatest global threats to public health and the economy in our lifetime. This threat was highlighted by an independent UK Review on AMR — the ‘O’Neill Review’ — which was published in May 2016. RAND Europe’s analysis for the O’Neill Review found that the potential costs of AMR globally could reach $3 trillion and cause a population decline of up to 10 million people per year if it is not addressed.” (Jirka Taylor and Elta Smith, 7/29/16)
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