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Written by Ekta Patel                    Bacteriophage (Photo credit: Flickr/Kevin Gill) In the early 1920s, William Twort and Felix d’Herelle co-discovered bacteriophages, also known as phages. These are viruses that can infect and kill bacteria and can be found everywhere bacteria exist such as inside plants, animals, the soil and oceans. The concept of using phages to treat disease-causing bacterial infections was used to fight the bubonic plague outbreak on a Caribbean island. Now almost 100 years later, this idea of using viruses is making a comeback to treat life-threatening infectious bacterial disease in humans and more importantly for exploring its use in the fight against bacteria that are resistant to antibiotics and to reduce the risk of developing and spreading antibiotic-resistant bacteria. This issue is a global public health concern that falls under the broader umbrella of what is termed as antimicrobial resistance (AMR). Scientists at the International Livestock Research Institute (ILRI) are looking at using phages to kill strains of bacteria that are known to cause disease in poultry farms in Kenya. In Kenya,  agriculture contributes towards 26% of the gross domestic product (GDP), and poultry farming represents 30% of the total agricultural GDP. Kenya has an estimated poultry population of 31 million birds, of this 75 % are indigenous chickens, 22% of broilers and layers and 1% of breeding stock. Several diseases affect poultry farming and pose a risk to the health of the farmers and consumers, such as salmonellosis, caused by Salmonella bacteria which are responsible for foodborne infections. Antibiotics are widely used in the poultry farms in Kenya to treat or prevent Salmonella infection, improve growth rates and feed efficiency of chickens. However, this is contributing to the emergence of antibiotic resistance and is a growing concern in Salmonella. Alternatives to antibiotics are urgently needed for the control of these bacteria. A collaborative project between the Laval University in Canada, and ILRI, funded through Canada’s International Development Research Centre (IDRC) and the UK government’s Global AMR Innovation Fund managed by the Department of Health and Social Care (DHSC), hope to find alternatives to antibiotics by using phages. The lead scientist, a Canadian virologist, Nicholas Svitek says “it will be very critical to identify and use the best phages that will target the correct bacterial population. We are very excited to be working on such a project and grateful for donors and partners to be able to facilitate such research’. The research team aims to develop a mixture of different phages to improve protection against the Salmonella strains affecting poultry in Kenya with a view that such new alternative therapies to antibiotics will be adopted by the Kenyan poultry industry.   For more information on the project and application of phage in the news see below: IDRC announcement on the funding Scientists have found an alternative to antibiotics for treating bacterial infections in green sea turtles Scientists are killing superbugs with viruses #AMR #AMRhub #phage #bacteriophage  

Written by Ekta Patel and Jerome Delamare-Deboutteville Rapid risk assessment being conducted by women in a sub-district of Dhaka, Bangladesh. Photo credit: Michelle Stone/Cefas   Disease-causing bacteria, viruses, and parasites can develop resistance to antimicrobial (AM) agents (like antibiotics, antivirals and antiparasitics) to which they were originally sensitive. This is known as antimicrobial resistance, or AMR, when treatments fail, infections persevere and spread to others. AMR is a “one-health” problem where the health of people, animals, plants and the environment are closely interconnected. In order to meet the global demand for aquatic animal proteins, the overall aquaculture production needs to double in the next 30 years. Intensification of the aquaculture sector will inevitably come with some diseases challenges and a risk to see an increase in antimicrobial use (AMU) to combat them making the sector a potential key site for the emergence and transmission of AMR. Bangladesh is the world’s third largest inland producer of fish and shellfish that contributes to the country’s economic success. In recent years, the aquaculture sector has experienced a high disease burden often associated with an increase in antimicrobial use. In this context, one of the key challenges for Bangladesh Aquaculture is to maintain sustainable production without medicalization. As one of the Fleming Fund listed countries, Bangladesh receives financial support to tackle AMR with a specific focus on surveillance of antimicrobial use, resistant bacteria, and AMR risks.  An AMR workshop funded by the UK Economic and Social Research Council (ESRC) under the cross UK Research Council “Tacking Antimicrobial Resistance” program was held on the 12-13 of February 2019 in Dhaka, Bangladesh. The workshop followed on from two UK-funded research projects on the microbial dynamics of disease within Bangladeshi aquaculture and on the disease management practices on farms and in hatcheries. Over sixty participants attended the workshop representing the Department of Fisheries, the Government of Bangladesh, the UK Government, non-government, intra-government, commercial, academic researchers and practitioner communities from over 20 organizations (e.g. the University of Exeter, local universities, Cefas, WorldFish, FAO, WHO) from the human, livestock and aquaculture health sectors.  The workshop was co-organized and supported by the CGIAR Research Program on Fish Agri-Food Systems (FISH) led by WorldFish with contributions by the CGIAR Trust Fund. The final report of the workshop written by Professor Stephen Hinchliffe from the University of Exeter can be found here. Below is a summary with some of the highlights from the report. The workshop had four aims that were to 1) gain a better understanding of key aquaculture practices in Bangladesh, diseases issues and drivers of resistance risks within the aquaculture industry 2) define a one health approach to tackle AMR in Bangladesh through new initiatives 3) discuss the utilization of this knowledge to raise AMR awareness in any public or farmer campaigns 4) identify data needs and approaches for future characterization of AMR issues in Bangladeshi aquaculture.  In order to obtain some tangible solutions to the challenges faced in Bangladeshi’s aquaculture, workshop’s participants were divided into three focus groups, namely, shrimp, finfish and integrated livestock and each group was invited to discuss and identify key messages on four broader themes: Theme 1: Main uses of AM   and sources of resistance risk in Bangladeshi aquaculture. While AM is used sparingly in Bangladeshi aquaculture to prevent or treat diseases. AMU is comparatively rare in sectors such as shrimp, and more common for finfish which is minor to the use in livestock (poultry). Medicines are becoming more common and freely available over the counter and shopkeepers are under pressure to stock treatments and advise farmers to use them, with no or little veterinary supervision. There is usually no record keeping. The quality of treatment available is variable as counterfeit medicines are common and rarely designed specifically for aquaculture use. In some cases locally made feeds have been reported to contain antimicrobials. Theme 2: Generating AMR awareness. There was a consensus that there is a need to establish a process for farmers to report diseases/abnormal mortalities and seek diagnostic support. Based on the diagnosis, farmers should seek professional advice if antibiotic treatment is required and which appropriate treatment to use. It was also recognized that farmers should only buy medicines from reliable sources that have been approved for aquaculture. It was recognized that the misuse and overuse of AM can have serious health impacts on producers, consumers and the environment. The overall discussion emphasized the need for a national campaign to highlight the importance of pond health environment and how to improve it. Theme 3: Data needs and surveillance of AMU and AMR risks. There is a need for a surveillance program of production, diseases and resistant pathogens. For this, a significant effort must be made on developing laboratory capacity, training of personnel, and the use of recognized and effective testing methods. Strong suggestions were made for investment in health management practices (prevention and control) and for greater regulation of medicines and policy enforcement. Funded by the Department of Environment Food and Rural Affairs (Defra) and the Fleming Fund, a joint program between the Department of Fisheries (DoF, Bangladesh), the Food and Agriculture Organization of the United Nations (FAO; Poultry, Bangladesh), WorldFish, the Centre for Environment Fisheries and Aquaculture Science (CEFAS), the Animal and Plant Health Agency (APHA) and the Veterinary Medicines Directorate (VMD) is in place to support coordination of training/education, capacity development, and to facilitate implementation of National Action Plans to enable international engagement to support action on AMR in Bangladesh. Theme 4: Identifying key interventions. Since this area requires several partners to come together, DoF should be encouraged to develop a specific unit dedicated to the regulation of medicines use and the enforcement for compliance. Bangladesh Directorate General of Drug Administration (DGDA) can train fish health inspectors to act on their behalf to regulate and monitor AM uses at district levels. A similar initiative to the training of trainers (ToT) approach adopted by FAO with the Bangladesh Antimicrobial Resistance Alliance (BARA), can be applied in the aquaculture sector to raise awareness and inform the wider public around the issue of AMR in remote regions, stimulating the sharing and uptake of good practices for a one health alliance and foster AMU compliance at national level.   Conclusion The workshop was concluded with some recommendations that were broken down into three broad areas, namely, Capacity, Surveillance and Awareness. These included developing a sustainable approach to training key personnel and training the trainers to deliver services needed within the laboratory and agricultural extension services. A coordinated surveillance program is needed to monitor antimicrobial sales, antimicrobial uses and antimicrobial resistance with an emphasis on aquaculture in order to provide good baseline data to inform interventions. Last but not least, it was recommended to develop tailored strategic awareness campaigns and approaches targeting farmers, shopkeepers, value chain holders and end users so as to have dual benefits of increasing reporting and to reduce overuse and misuse of antimicrobial treatments. What’s next? Support the Fleming Fund’s grant program by developing a protocol and guidelines for AMR surveillance in Aquaculture. WorldFish will lead this activity and will convene a workshop with main technical experts (WorldFish, Cefas, FAO, OIE, ILRI, etc.) to develop the protocol and having it peer reviewed. This will be followed by a pilot phase in four Fleming Fund countries (two in Africa and two in Asia). The National Fish Health Management Strategy of Bangladesh (NFHMSB) recommends the “development of a national aquatic animal reference laboratory for diseases diagnosis, AMR, and aquaculture medicinal product (AMP)”. The UK International AMR Reference centre (IAMRC) for aquaculture led by Cefas in collaboration with the DoF Bangladesh and WorldFish are planning to support laboratory capacity building to undertake AMR surveillance in aquaculture. This will be done in Bangladesh via training in aquatic animal health bacteriology diagnostics, and antimicrobial sensitivity testing of bacteria of aquatic origin. One of the aims is to pilot AMR projects to fully embed and validate, the principles established during the training, as well as to provide pilot data on AMR in Bangladesh culture systems.   Below are links for additional information on the topic Peer-reviewed articles Hinchliffe S., Butcher A. & Rahman M.M. (2018). – The AMR problem: demanding economies, biological margins, and co-producing alternative strategies. Palgrave Communications, 4 (1), 142. doi:10.1057/s41599-018-0195-4 – Link here Henriksson P.J.G., Rico A., Troell M., Klinger D.H., Buschmann A.H., Saksida S., Chadag M.V. & Zhang W. (2018). – Unpacking factors influencing antimicrobial use in global aquaculture and their implication for management: a review from a systems perspective. Sustain Sci, 13 (4), 1105–1120. doi:10.1007/s11625-017-0511-8. – Link here   YouTube videos and animation Tackling AMR in Bangladesh – a One Health approach (developed by the Food and Agriculture Organization of the United Nations) – Link here AMR in the Matrix -- An Irresponsible, Irresistible Parody (developed by BARA) – Link here AMR animation to increase awareness on antibiotic usage in fish culture lead by the University of Exeter in collaboration with WorldFish and FAO – Link here   Facebook page: The Bangladesh Antimicrobial Resistance Alliance (BARA) – Link here Blog story: Can Bangladesh’s aquaculture be sustainable without antibiotic use and what is required to achieve this?– Link here    

  Written by Ekta Patel    Kibera slum alleyway (Photo: Flickr/Ninara) As reported this week by Andrew Jacobs and Matt Richtel in the New York Times, ‘Kibera residents are prodigious consumers of antibiotics’.    Kibera area, one of Africa’s largest urban slums, is located in Nairobi, Kenya, with a population of around one million. Most people in the slum lack access to running water, electricity and medical care. Diseases caused by poor hygiene are prevalent.   Antibiotic resistance isn’t just a rich-country problem; it’s a global threat to us all. And the overuse and misuse of antibiotics that is helping to fuel resistance to antibiotic treatments is also not just a rich-country problem.    Consider Sharon Mbone, the Kibera resident described in the New York Times article. With no money to see a doctor to help her 22-month-old son recover from a fever, diarrhea and vomiting, she did what most mothers would do in her circumstance—she visited a small shopkeeper near her who, without a pharmacist degree or medical training, sold her two antibiotics which cost her Kshs.1,500 (USD15).   ‘Antibiotic resistance is a global threat’, say the reporters, ‘but it is often viewed as a problem in rich countries, where comfortably insured patients rush to the doctor to demand prescriptions at the slightest hint of a cough or cold.’   That view is mistaken. As pointed out in the New York Time article: ‘Kibera residents are prodigious consumers of antibiotics. One study found that 90 percent of households in Kibera had used antibiotics in the previous year, compared with about 17 percent for the typical American family. . . .   ‘Sam Kariuki, a researcher at the Kenya Medical Research Institute who has been studying resistance for two decades, said nearly 70 percent of salmonella infections in Kenya had stopped responding to the most widely available antibiotics, up from 45 percent in the early 2000s. “Salmonella kills roughly 45,000 Kenyan children every year, or nearly one in three who fall severely ill with it,” he said. In the United States, the mortality rate is close to zero.   ‘We are quickly running out of treatment options and if we don’t get a handle on the problem, I fear for the future,’ said Professor Kariuki.     ‘. . . Ms. Mbone and her husband have become inured to the sight and smell of untreated sewage that flows in front of their one-room shack. With no other place to play, their son, Shane and his 3-year-old sister sometimes end up frolicking in the muck. “They are kids, they will always go outside to play,” said Ms. Mbone, 19. “How can you stop them?”’   Read the whole article by Andrew Jacobs and Matt Richtel, In a poor Kenyan community, cheap antibiotics fuel deadly drug-resistant infections, New York Times, 7 April 2019.  Watch Sam Kariuki, director of research and development at the Kenya Medical Research Institute (KEMRI), talk about the challenges of tackling AMR in Kenya and the importance of the CGIAR AMR hub, which was launched on the 21 Feb 2019 at ILRI in Nairobi.   

Written by Ekta Patel   Jimmy Smith (right) and Ochieng' Ogodo (SciDev.net) at a discussion on how the CGIAR AMR hub can help integrate and channel research and development efforts in tackling AMR. (photo credit: ILRI/Paul Karaimu) As reported this week by Jacqueline Ogada, a journalist at SciDevNet, the director general of the International Livestock Research Institute (ILRI) said recently that ‘reducing the use of antimicrobials in agriculture as well as medicine . . . can make a huge difference’ in protecting public health. ILRI Director General Jimmy Smith said this at a recent launch of a CGIAR Antimicrobial Resistance (AMR) Hub, which is based in ILRI’s Nairobi advanced biosciences laboratories. The new CGIAR AMR Hub, Smith said, will help accelerate the changes required to reduce antimicrobial use in the agriculture sectors of developing countries. The new Hub will do this, he said, by creating productive stakeholder partnerships and by placing research evidence at the very centre of policymaking in these countries. To meet the rising global challenges AMR presents, Smith argued that developing countries need to have in place appropriate and practical research solutions as well as effective partnerships across disciplines. Both he reported, are at the heart of the CGIAR AMR Hub. Journalist Ogada goes on to report the following. ‘About 28 million people could fall into extreme poverty by 2050 if high antimicrobial resistance is not addressed. ‘Antimicrobial resistance occurs when medicines for controlling infections caused by germs such as bacteria, fungi, viruses and parasites are no longer effective. According to the World Bank, antimicrobial resistance could cut annual global gross domestic product by about USD1 trillion by 2030 and reduce global livestock production by almost eight per cent. ‘According to Jonathan Wadsworth, lead agriculture specialist at the World Bank Group, antimicrobial resistance will negatively affect Sustainable Development Goals such as those that focus on poverty, good health and well-being.’ The CGIAR AMR Hub was launched 21–22 Feb 2019 in Nairobi, Kenya. It is hosted by ILRI and its Biosciences eastern and Central Africa-ILRI Hub and is supported by the CGIAR Research Program on Agriculture for Nutrition and Health, which is led by the International Food Policy Research Institute (IFPRI), and its donor and partner organizations. Read the whole article by Jacqueline Ogada, Drug resistance could make 28 million people poor, at SciDev.net, 7 Mar 2019.