WHO initiatives to build global AMR surveillance...

Control of An*microbial Resistance WHO Regional Office for Europe

Copenhagen, Denmark

WHO initiatives to build global AMR surveillance

capacity

Dr Danilo Lo Fo Wong Programme Manager An*microbial Resistance

WHO Regional Office for Europe


Copenhagen, Denmark

AMR Surveillance Local – National – Regional – Global •  Needed to:

–  Guide patient treatment

–  Inform local, national and regional action

–  Monitor effectiveness of interventions

–  Understand resistance development and spread

–  Detect newly emerged resistance

•  Major objective of European (2011) and Global (2015) AMR action plans


Copenhagen, Denmark

Central Asian and Eastern European Surveillance of

Antimicrobial Resistance (CAESAR)

European Centre for Disease Prevention and Control World Health Organization Regional Office for Europe

Countries submitting data to CAESAR Countries visited for CAESAR participation Countries to be visited for CAESAR participation Countries participating in EARS-Net

European Antimicrobial Resistance Surveillance Network

(EARS-Net)

Expanding AMR surveillance throughout Europe


Copenhagen, Denmark

CAESAR Network

•  Network of networks

–  Strengthen national AMR surveillance

–  Member States, not part of EARS-Net of EU

•  Joined initiative –  European Society of Clinical Microbiology

and Infectious Diseases (ESCMID)

–  National Institute of Public Health in the Netherlands (RIVM)

•  Close collaboration ECDC –  Use methodology compatible to EARS-Net

@ WHO/Europe

Central Asian and Eastern European Surveillance of An2microbial Resistance


Copenhagen, Denmark

CAESAR Methodology

•  Pathogens under surveillance –  S. aureus (MRSA)

–  S. pneumoniae (Pen R)

–  E. coli (ESBL, Carbapenemases)

–  K. pneumoniae (ESBL, Carbapenemases)

–  E. faecium and E. faecalis (VRE)

–  P. aeruginosa (MDR)

–  Acinetobacter spp.


Copenhagen, Denmark

CAESAR Methodology

•  Routinely collected blood or CSF isolates

•  MIC/Zone diameter/Etest and SIR interpretations

•  International guidelines (EUCAST/ CLSI)

•  Patient characteristics –  Gender, Age, ICU

•  Denominator information –  Patient days to calculate incidences


Copenhagen, Denmark

CAESAR collaboration – country support

WHO EURO – Political expertise

ESCMID – Laboratory expertise RIVM – IT/EPI expertise

Country support process

Country situation analysis

Follow up ac*vi*es

National workshops Multi country workshops

Consultancy / Mentorships

Observerships / Twinning

Focus

- Laboratory capacity building; Reference labs; QA, ID & AST, EUCAST - CAESAR methodology; Standardized data collection - Diagnostic and antibiotic stewardship


Copenhagen, Denmark

CAESAR External Quality Assessment

•  15 countries have participated in 2015 (250 labs)

•  Laboratories providing/planning to provide data to CAESAR

•  Joint initiative with UK-NEQAS (PHE) and ECDC

•  Six strains sent to each laboratory

•  Results reported via secured website

•  Instant feedback on performance


Copenhagen, Denmark

CAESAR Annual Report 2014 –  Data of 5 countries (Turkey, The former

Yugoslav Republic of Macedonia, Serbia, Belarus, Switzerland)

–  EQA results 2013 (9 countries)

–  Levels of data quality described

–  Guidance of data interpretation

–  Provide AMR data to support policy decisions

–  Encourage implementation, maintenance and improvement of national AMR surveillance programs


Copenhagen, Denmark

Global AMR Action Plan - Strategic Objectives

1.  Improve awareness and understanding

2.  Strengthen knowledge and evidence base

3.  Reduce incidence of infection

4.  Optimize use of antimicrobial medicines

5.  Develop economic case for sustainable investment

http://www.who.int/drugresistance/global_action_plan/en/


Copenhagen, Denmark

Framework for action http://www.who.int/drugresistance/global_action_plan/en/


Copenhagen, Denmark

•  Foster national surveillance and global standards

•  Estimate extent and burden of AMR globally

•  Analyse and report global AMR data

•  Detect emerging resistance and its international spread

•  Inform implementation of targeted prevention and control programmes

•  Assess the impact of interventions

GLASS objectives


Copenhagen, Denmark

GLASS – specimens and pathogens


Copenhagen, Denmark

GLASS

Information flow


Copenhagen, Denmark

GLASS and CAESAR

Aggregated global data

Countries

CAESAR / EARS-‐Net

Relavra (PAHO)

Other AMR networks

Animal / food

networks

An*microbial consump*on

Virtual platform - GLASS


Copenhagen, Denmark

WHO support for surveillance

•  Access to web-based platform for data sharing, management and reporting

•  Support package, incl implementation tools, software

•  Capacity-building activities and assistance in M&E

•  Exchange and peer support between countries

•  Provide technical support for implementation of GLASS –  International collaboration among WHO CCs, national and regional

networks and other institutions


Copenhagen, Denmark

Acknowledgments •  Division of Communicable Disease,

Health Security & Environment –  Nedret Emiroglu –  Cristiana Salvi –  Siff Malue Nielsen

•  AMR Coordination –  Danilo Lo Fo Wong –  Nienke van de Sande-Bruinsma –  Saskia Nahrgang

•  Food Safety –  Hilde Kruse

•  Health Systems and Public Health –  Hans Kluge

•  Health Technologies and Pharmaceuticals

–  Hanne Bak Pedersen –  Guillaume Dedet

•  Influenza & other Respiratory Pathogens –  Caroline Brown –  Pamela Hepple

•  Vaccine Preventable Diseases & Immunization

–  Robb Butler –  Catharina de Kat-Reynen

•  Alert and Response Operations –  Ana Paula Coutinho


Copenhagen, Denmark

Thank you for your aOen*on

WHO initiatives to build global AMR surveillance...

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