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
Control of 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
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for 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
Control of An*microbial Resistance WHO Regional Office for Europe
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.
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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/
Control of An*microbial Resistance WHO Regional Office for Europe
Copenhagen, Denmark
Framework for action http://www.who.int/drugresistance/global_action_plan/en/
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
Copenhagen, Denmark
GLASS – specimens and pathogens
Control of An*microbial Resistance WHO Regional Office for Europe
Copenhagen, Denmark
GLASS
Information flow
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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
Control of An*microbial Resistance WHO Regional Office for Europe
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