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A ONE HEALTH APPROACH TO ANTIBIOTIC STEWARDSHIP IN SOUTH AFRICA
PROF MORITZ VAN VUUREN, DIRECTOR: FOOD SAFETY AND FOOD SECURITY PORTFOLIO
AFMA Congress, March 2020
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INTRODUCTORY REMARKS
Veterinary and human medicine share the responsibility of preserving the efficacy of
antibiotics and preventing the spread of antimicrobial resistance (AMR)
The shared antibiotic classes, and the transfer of resistant bacteria between the animal,
environmental and human sectors, makes AMR a One Health issue requiring multi-
sector collaborations
To prevent the spread of AMR, antimicrobial stewardship should be collectively
developed in all settings where antimicrobials are used
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WHAT IS ONE HEALTH?A one health approach recognizes the relationships between the human,
animal, and environmental health, and applies interdisciplinary tools to solve
complex public health problems
TRADITIONAL PUBLIC HEALTH
MODEL
ONE HEALTH APPROACH
Human Animal
Environmental
One Health
Human Animal
Environmental
Source: Gael Lamielle
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TRADITIONAL PUBLIC HEALTH
MODEL
ONE HEALTH APPROACH
Human Animal
Environmental
One Health
Human Animal
Environmental
Source: Gael Lamielle
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THE FOUNDATION OF THE ONE HEALTH CONCEPT
In the 1960s, Dr. Calvin Schwabe coined the term “One Medicine”
It focused on opportunities that exist to protect public health through policies
aimed at preventing and controlling pathogens at the level of animal populations
The control of infectious diseases was central to One Medicine
Today One Health involves all health issues at interfaces between animals,
humans and the environment
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The need for antimicrobial stewardship
across a One Health platform
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Mendelson et al., S Afr Med J 2012;102(7):607-8
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9
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MAC on
AMR
Regulators and policy makers
Clinicians, family doctors,
pharmacists, microbiologists
and nurses
Veterinarians
Laboratories –NHLS/NICD, SASCM and
private
DTI ,DBE, DAFF
Military, DCS
HIV, TB representatives
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It was found in E. coli in 20.9% of pigs surveyed at slaughter, 22.3% of raw pork products, 28% of
chicken products and in 13/902 (1.4%) of patients being treated for E. coli infections and 3/420
(0.7%) with Klebsiella pneumoniae infections
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INCREASING COLISTIN RESISTANCE IN PATHOGENIC E. COLI IN SOUTH AFRICAN POULTRY OPERATIONS
V-Tech, 11th Jan 2016
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South African response to the threat of
losing colistin as an antibiotic for
human health
Implemented a programme to advance national stewardship of colistin across the
One Health platform
Stage 1: The formation of South Africa’s Colistin Working Group
Stage 2: Converting analysis to action
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Converting analysis to action
Short term interventions
Cancel registration of registered colistin medicines
Prohibit registration of colistin-containing farm feeds
Introduce Section 21 conditions of the Medicines Act for use of colistin in animals
Increase the schedule of colistin API to Schedule 6, and the medicine final product
to Schedule 4 for human or veterinary use
License all manufacturers, importers, and distributors of APIs
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One Health, is a strategic commitment
by the Tripartite
One Health, is a requirement of the
International Health Regulations
One Health, is a requirement of the
OIE’s Performance of Vterinary Services
(PVS) country evaluation programme
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GLOBAL DATABASE FOR ANTIMICROBIAL RESISTANCE COUNTRY SELF ASSESSMENT
Information captured in this database is a result of
the country self-assessment questionnaire
disseminated to countries by WHO, FAO and OIE
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COUNTRY PROGRESS WITH DEVELOPMENT OF A NAP ON AMR
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MULTI-SECTOR AND ONE HEALTH COLLABORATION/COORDINATION