Characterization of virulence factors in the newly described <i>Salmonella enterica</i> serotype Keurmassar emerging in Senegal (sub-Saharan Africa)

From 2000 to 2001, nine strains of Salmonella enterica belonging to the new serotype Keurmassar have been isolated from human and poultry samples at the Senegalese National Salmonella and Shigella Reference Laboratory at the Pasteur Institute, in Dakar. All strains carried virulence factors including Salmonella Pathogenicity Islands (SPI)-1, -2, -3 and -5 encoded genes. Strains did not harbour virulence plasmid. Ribotyping analysis revealed a single clone identical to Salmonella Decatur isolated in Zimbabwe. These data suggest that strains are closely related, and may have been spread clonally. In this new serotype, insertion sequence IS200 is not present

Proficiency of WHO Global Foodborne Infections Network External Quality Assurance System participants in the identification and susceptibility testing of thermo-tolerant Campylobacter spp. from 2003-2012

Campylobacter spp. are foodborne and waterborne pathogens. While rather accurate estimates for these pathogens are available in industrialized countries, a lack of diagnostic capacity in developing countries limits accurate assessments of prevalence in many regions. Proficiency in the identification and susceptibility testing of these organisms is critical for surveillance and control efforts. The aim of the study was to assess performance for identification and susceptibility testing of thermotolerant Campylobacter spp. among laboratories participating in the World Health Organization (WHO) Global Foodborne Infections Network (GFN) External Quality Assurance System (EQAS) over a 9-year period. Participants (primarily national-level laboratories) were encouraged to self-evaluate their performance as part of continuous quality improvement. The ability to correctly identify Campylobacter spp. varied by year and ranged from 61.9% (2008) to 90.7% (2012), and the ability to correctly perform antimicrobial susceptibility testing (AST) for Campylobacter spp. appeared to steadily increase from 91.4% to 93.6% in the test period (2009 to 2012). The poorest performance (60.0% correct identification and 86.8% correct AST results) was observed in African laboratories. Overall, approximately 10% of laboratories reported either an incorrect identification or antibiogram. As most participants were supranational reference laboratories, these data raise significant concerns regarding capacity and proficiency at the local clinical level. Addressing these diagnostic challenges is critical for both patient-level management and broader surveillance and control efforts.</p

Exploring the evidence base for national and regional policy interventions to combat resistance

The effectiveness of existing policies to control antimicrobial resistance is not yet fully understood. A strengthened evidence base is needed to inform effective policy interventions across countries with different income levels and the human health and animal sectors. We examine three policy domains—responsible use, surveillance, and infection prevention and control—and consider which will be the most effective at national and regional levels. Many complexities exist in the implementation of such policies across sectors and in varying political and regulatory environments. Therefore, we make recommendations for policy action, calling for comprehensive policy assessments, using standardised frameworks, of cost-effectiveness and generalisability. Such assessments are especially important in low-income and middle-income countries, and in the animal and environmental sectors. We also advocate a One Health approach that will enable the development of sensitive policies, accommodating the needs of each sector involved, and addressing concerns of specific countries and regions

WHO's essential medicines and AWaRe: recommendations on first- and second-choice antibiotics for empiric treatment of clinical infections.

The WHO Model List of Essential Medicines (EML) prioritizes medicines that have significant global public health value. The EML can also deliver important messages on appropriate medicine use. Since 2017, in response to the growing challenge of antimicrobial resistance, antibiotics on the EML were reviewed and categorized into three groups: Access, Watch and Reserve, leading to a new categorization called AWaRe. These categories were developed taking into account the impact of different antibiotics and classes on antimicrobial resistance, and the implications for their appropriate use. The 2023 AWaRe classification provides empiric guidance on 41 essential antibiotics for over 30 clinical infections targeting both the primary health care and hospital facility setting. A further 257 antibiotics not included on the EML have been allocated an AWaRe group for stewardship and monitoring purposes. This article describes the development of AWaRe focussing on the clinical evidence base that guided the selection of Access, Watch or Reserve antibiotics as first and second choices for each infection. The overarching objective was to offer a tool for optimising the quality of global antibiotic prescribing and reduce inappropriate use by encouraging the use of Access antibiotics (or no antibiotics) where appropriate. This clinical evidence evaluation and subsequent EML recommendations are the basis for the AWaRe antibiotic book and related smartphone applications. By providing guidance on antibiotic prioritization, AWaRe aims to facilitate the revision of national lists of essential medicines, update of national prescribing guidelines and surveillance of antibiotic use. Adherence to AWaRe would extend the effectiveness of current antibiotics while helping countries to expand access to these life-saving medicines for the benefit of current and future patients, health professionals, and the environment

Strengthening Foodborne Diseases Surveillance In The Who African Region: An Essential Need For Disease Control And Food Safety Assurance

Several devastating outbreaks of foodborne diseases have been reported in the African region including acute aflatoxicosis in Kenya in 2004 and bromide poisoning in Angola in 2007. There are concerns about transmission of multiple antibiotic resistant bacteria and pesticide residues in foods. The globalization of the food trade which could increase the spread of food contaminants internationally is an emerging issue. The new International Health Regulations (IHR) (2005) cover events of international importance including contaminated food and outbreaks of foodborne disease. The IHR (2005) and other international as well as regional agreements require Member States to strengthen surveillance systems including surveillance for foodborne diseases. WHO has been supporting countries to strengthen foodborne disease surveillance since 2003. This paper reports on the work of WHO and partners in the area of foodborne disease surveillance, the challenges and opportunities and provides perspectives for the area of its work. The paper shows that laboratory-based surveillance is the preferred system for foodborne disease surveillance since it allows early detection of outbreak strains and identification of risk factors with laboratory services as the cornerstone. Foodborne disease surveillance has been included in the revised Integrated Disease Surveillance and Response (IDSR) Strategy and there are guidelines for use by countries. WHO in collaboration with partners, especially the Global Food Infections Network (GFN), has been supporting countries to strengthen national analytical capacity for foodborne disease surveillance and research. Training for countries to detect, control and prevent foodborne and other enteric infections from farm to table has been conducted. The training for microbiologists and epidemiologists from public health, veterinary and food sectors involved in isolation, identification and typing of Salmonella sp, Campylobacter sp., Vibrio cholerae , Vibrio sp. and Shigella from human and food samples have been carried out. Research into specific topics in microbiology and chemical contaminants has been conducted. Three institutions in Cameroun, Mali and Nigeria have been designated as centres of excellence for chemical contaminants. Despite these significant achievements, a number of challenges remain. Most food safety programmes and food safety systems remain fragmented resulting in duplication of efforts and inefficient use of resources; and most laboratories in the African Region are poorly resourced. In countries where facilities exist, there is underutilization and lack of synergy among laboratories. Countries should, therefore, conduct audits of existing laboratories to determine their strengths and weaknesses and strategize as appropriate. It is also imperative to continue to strengthen partnerships and forge new ones and increase resources for food safety, in general, and for foodborne disease surveillance, in particular, and continue capacity building, both human and institutional

Correspondence: Reply to Cohen and Denning

To the Editor — We agree with Cohen and Denning [1] that the large-scale use of antifungals in agriculture on crops is a potential threat to human populations, because resistant fungi that develop can be transmitted to humans [2]. We also agree that the issue of antimicrobial resistance should not be confined solely to the large-scale use of antibiotics. Overuse of antifungals (especially azole use) is an important issue. We also need to be concerned about possible large-scale use of antivirals in agriculture—for example, reports of amantidine and other anti-influenza antiviral use in poultry in China because of H5N1 outbreaks in fowl flocks [3, 4]—and then with the resultant risk of influenza strains developing resistance to antivirals if acquired by swine and/or humans.J. M. C. has received grants from Alberta Innovates-Health Solutions, personal fees and nonfinancial support from Pfizer, nonfinancial support from bioMérieux, and other support from the National Collaborating Centre for Infectious Diseases (Canada). A. A. has received personal fees from the Davoltera company (within the frame of the French law for innovation and research) and Cepheid and has received grants from the Agence Nationale pour le Recherche and from the European Union FP7 program. S. A. M. has been granted contracts from Health Canada and the Ontario Ministry of Agriculture, Food and Rural Affairs