May 07, 2011
As you may recall, a study on the environmental dissemination of NDM-1 in India in last month’s Lancet Infectious Diseases caused a storm of controversy. NDM-1, first documented in 2008, is a gene that confers resistance to our most powerful class of antibiotics carbapenems. The tremendous challenge in treating infections caused by bacteria containing the NDM-1 gene is naturally a cause for concern in the global health community.
April’s Lancet study appropriately released on World Health Day sampled seepage water and tap water in New Delhi for the presence of NDM-1. And the research team found it in 51 of 171 seepage samples and in two of 50 tap water samples. For the authors, the results pointed not only to the public health implications of resistance gene dissemination, but also to the need for robust surveillance of resistance to inform public health policy going forward.
While the study’s findings may not have been terribly surprising, they nevertheless spurred a initial reaction from Indian health officials reminiscent of the response to the first Lancet study on NDM-1 back in August 2010. Some decried the study for unfairly maligning New Delhi and India in the global effort against antimicrobial resistance. Others attacked the methodology, or even suggested that the water samples had been taken illegally. And there was debate over the public health implications, with prominent Indian health officials, such as VM Katoch of the Indian Council of Medical Research (ICMR) declaring that the environmental presence of NDM-1 gene carrying bacteria is not a significant finding since there is no clinical or epidemiological linkage of this finding in the study area.
But in the month following the study’s release, reactions have tempered and the sustained response has been a timely and renewed attention to an important global health issue.
Following last month’s controversial edition, Lancet Infectious Diseases editor John McConnell talked about how this month’s journal came together on the topic of drug resistance (check out the website for pieces on antibiotic stewardship efforts in the EU, multidrug-resistant tuberculosis, selective decontamination in ICUs, among others subscription required).
And, since the initial firestorm over the study, the ICMR has begun inviting research proposals on NDM-1 an important step forward in beginning to understand and address NDM-1, a resistance mechanism that of course is not bound by national territory lines. India has taken other significant actions on antibiotic resistance in the past year, including launching a task force to come up with a national plan for antibiotic use.
Perhaps ironically, the controversy around the study has left us with something more akin to the goals of World Health Day a sustained effort to make progress on a global health challenge. After all, the World Health Organization describes the WHD as a launch, rather than as an end unto itself. The 1st Global Forum on Bacterial Infections this coming fall in New Delhi will be a timely opportunity to check up on our momentum.
Image credit: Flickr: MiyagiDK
