July 17, 2023
A special issue of PLOS Medicine elucidates the complexity of AMR and the need for One Health solutions.
The One Health Trust’s Dr. Ramanan Laxminarayan co-edited a special issue of PLOS Medicine dedicated to antimicrobial resistance (AMR) in low- and middle-income countries (LMICs). In an editorial written by Dr. Laxminarayan and his co-editors, they examined the literature in the special issue highlighting the multifaceted and complex nature of AMR, requiring engagement across human, agricultural, and environmental sectors. Some critical aspects of the current state of AMR include the increased vulnerability of neonates and infants to resistant infections; inadequate water, sanitation, and hygiene (WASH) services in LMICs; and prolonged antibiotic treatment courses in high-income countries. The authors call for standardized data collection and reporting on resistant infections and antibiotic use, as well as improved diagnostics to inform and improve antimicrobial stewardship programs and antibiotic use guidelines on a global level. [PLOS Medicine]
The EAT-Lancet Commission 2.0 will assess the relationship between planetary health and human diets with a focus on equity and justice.
In 2019, the EAT– Lancet Commission called for a “Great Food Transformation.” The changes needed have not been realized and inequitable distribution of healthy and sustainable diets remains, contributing to conflict, biodiversity loss, and the unrealized potential of people who are disadvantaged by inaccessible or unaffordable nutritious foods. To address these crises, a new EAT–Lancet Commission 2.0 (which includes OHT’s Dr. Ramanan Laxminarayan) will review the latest evidence on how to define and quantify a healthy reference diet and assess whether and how diets globally contribute to our health while making nutritious food accessible to all—produced, processed, distributed, and consumed fairly around the world. [The Lancet]
The Phage Directory provides a bridge between phage labs and infectious disease physicians.
Phage therapy, which leverages viruses that specifically target bacteria, is a growing infectious disease treatment approach in the face of rising rates of drug resistance. First proposed in the late 1910s, phage therapy is now being explored experimentally. Approaches including CRISPR modification and phage cocktails are possible strategies for the therapeutic use of phages for human health. The specificity and limited availability of phages pose barriers to the development and implementation of phage therapy. The creators of the Phage Directory aim to support physicians looking for phages as possible treatments for patients by bridging the gap between labs working with phages and physicians. [Nature]
Prior repeated antibiotic exposure worsened health outcomes in COVID-19 patients in England.
Researchers performed a case-control study using COVID-19 case and mortality data from England collected between February 2020 and December 2021 to investigate the association between repeated antibiotic exposure and health outcomes in COVID-19 patients. They observed a positive dose-response relationship between the frequency and diversity of prior antibiotic exposure and severe COVID-19 outcomes. One possible explanation of this association is the direct effect of antibiotics on the gut microbiota, thereby impeding the immune system’s capacity to fight infections. Antibiotic stewardship efforts are critical to reduce antibiotic overprescribing and mitigate severe clinical outcomes following infection. [eClinicalMedicine]
Children with low-severity illnesses were more likely to receive non-prescription medications in Zambia.
Researchers assessed illness characteristics associated with informal sector and non-prescription medication use in infants up to the age of 15 months in Zambia. Over the 14-month-long study period, 20 percent of medications to treat an illness episode were acquired from the informal sector in facilities like local retail stores and some pharmacies. This behavior was more closely associated with illnesses characterized by symptoms like malaise, fever, and headache (40.5 percent) in comparison to other, more severe illness characteristics (7.3-20.6 percent). Distance from formal sector health units was another driver of informal sector use; the farther an infant resided from a clinic, the more likely they were to receive medication from the informal sector. The use of non-prescription medications from the informal sector, a practice prevalent in LMICs, can lead to inappropriate antibiotic use. [PLOS Global Public Health]
Extensively-resistant microbes were found in a wounded Ukrainian soldier.
A Ukrainian soldier who suffered traumatic injuries in a vehicle fire, including full-thickness burns over 60 percent of his body, was treated at two hospitals in Ukraine before transferring to a U.S. military hospital in Germany. There, blood, urine, respiratory, and peri-rectal cultures grew six bacterial strains that were resistant to most antibiotics and carried multiple genes for antibiotic resistance. The continued war in Ukraine has disrupted supply chains and reduced resources and personnel in the area, placing substantial strain on regional health systems and impacting infection control efforts. Healthcare professionals treating Ukrainian citizens must consider the increased risk of transmission of multidrug-resistant organisms and utilize appropriate infection control measures in order to mitigate their spread. [Emerging Infectious Diseases]
HIV infection and malnutrition are linked to an increased risk of death from tuberculosis for children in Ethiopia.
The percentage of tuberculosis (TB) related mortality among children globally increased from 4.6 percent to 14 percent from 2011 to 2021, with Ethiopia ranking seventh in TB disease burden. A retrospective cohort study of children under 16 years who were treated for TB in Ethiopia between 2014 and 2022 discovered that children under 2 years made up 25 percent of all TB deaths. HIV-positive children and malnourished children were each four times more likely to die from TB compared to HIV-negative children with TB and well-nourished children with TB. Additionally, community transmission was found to be more prevalent than household transmission for children of all ages. [BMC Public Health]
Stray dogs and high human population density challenge rabies control in Beijing.
Rabies is estimated to kill 59,000 people and cost US$8.6 billion worldwide each year, with dog bites responsible for 99 percent of human rabies cases. With effective vaccines available for dogs and humans, the World Health Organization has set a goal for the eradication of dog-to-human rabies transmission by 2030. However, rabies is still a concern in densely populated urban environments where humans and stray dogs interact, such as Beijing, China. Despite rabies vaccination being mandatory since 2014 in China, rabies continues circulating in the environment, primarily in stray dogs. A collaborative One Health approach that aims to vaccinate stray dogs, decrease pet abandonment, and increase the availability of post-exposure prophylaxis will help eliminate rabies in Beijing. [One Health Advances]
Image from Canva
