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Resistance (AMR)
Dr Ali Ahmed Yahaya, WHO-Regional Office for Africa-AFRO
What is AMR?
AMR is a natural phenomenon accelerated by use of
antimicrobial medicines.
Medicines for treating infections lose effect because
the microbes change
Acquire genetic information from other microbes to develop
Types of AMR
1. Antibacterial resistance (e.g. to antibiotics)
2. Antiviral resistance (e.g. to anti-HIV medicines)
3. Antiparasitic resistance (e.g. to anti-malaria medicines)
resistance (e.g. to medicines for Candidiasis)
AMR in the 4.
Benefits of antimicrobial medicines have been
Penicillin increased survival from 10% to 90%
among patients with pneumonia & bacteria in
their blood
AMR in the African region
Resistance was foreseen early
Alexander Fleming, Nobel Lecture, December 1945
AMR in the African region
“The time may come when penicillin
can be bought by anyone in the
shops. Then there is the danger that
the ignorant man may easily under
dose himself and by exposing his
microbes to non-lethal quantities of
the drug make them resistant”
2014 WHO report “Antimicrobial resistance: global report
on surveillance”
Survey of 114 countries
in all regions
23 countries in AFR
Data limitations
Surveillance gaps in many countries
No standard methodology
But best available global & regional pictures
In all regions, very high AMR levels in common
bacteria to major antibiotics
E coli, K pneumoniae, S aureus, S pneumoniae,
N gonorrhea
3rd generation cephalosporins, fluoroquinolones,
Available National Data* on Resistance for Nine Selected
Bacteria/Antibacterial Drug Combinations, 2013
Data is Patchy
High reported proportions of
resistance means that treatment for
severe infections, for which E. coli &
k. pneumoniae are a likely cause, may
need to be initiated with expensive
AMR in the African region
Resistance was foreseen early
Extensively drug-resistant TB (XDR-TB) had been reported
in the African region
by 92AMRcountries
by the end of 2012
AMR – Why is it increasing?
Circulation of substandard
counterfeit antimicrobials
Antibiotics fed to animals to
promote growth in some
Weak IPC : spread of MDR health care associated
infections in health care facilities
Spread and contamination of the environment
(hospital wastewaters, un-completely treated
urban wastewaters, untreated effluents from
livestock farms or aquaculture)
Antibiotic resistance is a complex problem with many drivers combating
AMR in the African region
it requires a multifaceted approach
Consequences Implications Projections
AMR in the African region
AMR Global Action Plan (GAP)
Adopted by World Health Assembly in May
Technical blueprint on what to do
Consolidates global scientific consensus
& draws upon countries, FAO, OIE, civil
society & others
Reflects stepwise approach recognizing
countries have different starting points,
AMR in the African region
Five strategic objectives
Improve awareness and understanding
Strengthen knowledge through surveillance &
Reduce incidence of infection (IPC\Sanitation)
Optimize use of antimicrobial medicines
Ensure sustainable investment
Next step to translate into National Action Plans
AMR in the African region
Implementation GAP: Guiding Principles
Realistic & achievable objectives
Take into account different capacities of Member States
Involve FAO and OIE, where appropriate
All-inclusive approach (HIV, TB and malaria)
Joint ownership between HQ and Regions
AMR in the African region
Implementation GAP: 10 work streams (HQ & AFRO)
1. Global communications campaign
2. Support National Action Plans of MS
3. Global Antimicrobial Resistance Surv System
4. Support measures to improve IPC
5. Monitor use & enhance stewardship of antibiotic use
6. Encourage R and D and explore new business models
7. Improve Point of Care diagnostics
8. Address the Environmental Drivers
9. Vaccines to prevent AMR
10.One Health Liaison
AFRO inter-clusters/programms Workforce.
AMR in the African region
AFRO major achievements
9 countries trained on the development of AMR-National Action
Plan using “One Health Approach”.
Epidemiologists and laboratory scientists from national institutions
representing food, animal and human health sectors from the
13 countries participated in the Global Antimicrobial Resistance
Surveillance System (GLASS) training.
12 countries participated in the training workshop on methodology
for monitoring antimicrobial consumption.
AMR in the African region
Major issues and challenges
Lack of a national comprehensive policy and plan (NAP) to address AMR
Lack of inter-sectorial approach to fight AMR
Weak medicines regulatory capacity and circulation of
substandard/counterfeit antimicrobials
Medicines supply and distribution systems in most countries of the
Region are fragmented and weak
Weak Infection Prevention and Control (IPC)
AMR in the African region
AMR now an urgent, global, Large problems, societal threat– e.g., climate change —
require whole-of-society engagement & strategies & solution commensurate with
Adopting & acting upon a broader concept of AMR is essential to achieving such an
approach & sustainably reversing AMR
Opportunities for existing and new initiatives: IDSR, IHR JEE, One Health approach,
Key developments are underway but world is in a race against time
Each major aspect is solvable
Did we start on time? No
Are we responding too late? Not if action is taken
AMR in the African region