As antimicrobial resistance (AMR) increasingly threatens global health, the alarming rise in pertussis cases (commonly known as whooping cough) and mounting evidence of macrolide-resistant strains of Bordetella pertussis highlight the imperative need to enhance surveillance and treatment efforts for this vaccine-preventable illness. With such an urgent call to action, the health community must mobilize resources and strategies to address these challenges effectively.
However, despite advancements achieved in regions like Asia, Europe, and North America, critical gaps in surveillance coverage are still evident, particularly in Latin America and the Caribbean. For instance, Brazil and Mexico, prior to 2022, faced significant limitations in their ability to conduct macrolide resistance surveillance for B. pertussis. This lack of capacity created a substantial void in understanding the prevalence of resistant strains in these countries. Recent developments have seen collaborations catalyzed by ASM’s Global Public Health Programs (GPHP) and international partners, sparking efforts to introduce standardized methodologies for assessing macrolide susceptibility at national and select state reference laboratories. This collaborative approach marks a pivotal step toward bridging regional gaps in monitoring AMR related to pertussis.
The Pertussis Project
ASM’s GPHP employs a multi-pillar framework for strengthening laboratory capacity, facilitating extensive enhancements in workforce development, technology integration, and data management systems crucial for tracking antimicrobial resistance effectively.
Why International Partnerships Are Crucial for AMR Surveillance
In light of the cross-border nature of dangerous pathogens such as B. pertussis, and the inequities in health systems infrastructure worldwide, the formation of international partnerships becomes indispensable in combatting AMR. Such alliances provide robust platforms for the exchange of knowledge, data, and resources, enabling countries to fortify their surveillance systems and formulate rapid responses to AMR threats.
Global initiatives, including the Global Antimicrobial Resistance and Use Surveillance System (GLASS) , championed by the World Health Organization (WHO), exemplify the immense benefits of international cooperation. Similarly, the Global Health Security Agenda harnesses a collaborative strategy, uniting countries, international organizations, and governmental and non-governmental entities to enhance countries’ capabilities to prevent, detect, and respond to infectious disease threats, including those posed by AMR. Such collaborative undertakings underscore the reality that no nation can effectively tackle AMR alone; international partnerships ensure that resource-constrained environments gain access to essential technical assistance, training, and funding, while simultaneously allowing all involved nations to benefit from a more profound dataset and early alerts about emerging resistant strains, thereby protecting worldwide public health.
Given these dynamics, ASM’s GPHP has consistently adopted a collaborative methodology to build laboratory and health system capacities since 2005, focusing on low- and middle-income countries (LMICs). In conjunction with funders and local stakeholders, GPHP implements a spectrum of initiatives designed to enhance and expand the capabilities of existing health and laboratory sectors to meet local demands efficiently. These deliberate efforts prioritize strengthening health security frameworks, refining laboratory data reporting, and advancing the detection and responsiveness to AMR. GPHP champions the development of resilient laboratory infrastructures, enhances technical capabilities, and cultivates a culture of data-driven decision-making, ensuring that these improvements are seamlessly integrated into each nation’s financial, programmatic, and policy architectures.
Case Studies: Successes and Challenges
The compelling case studies from Mexico and Brazil illustrate both the triumphs and difficulties encountered while strengthening B. pertussis surveillance and response initiatives through ASM’s partnerships. These experiences illuminate the tangible impact of capacity-building efforts and emphasize the critical nature of coordinated approaches to AMR surveillance.
The Mexico Case
In Mexico, ASM collaborates closely with the Institute of Epidemiological Diagnosis and Reference (InDRE) to bolster quality assurance practices at InDRE’s national reference laboratory (NRL) and select state laboratories, optimizing diagnostics for B. pertussis and screening for macrolide resistance. ASM has particularly enhanced the culturing methodologies at the NRL, significantly improving the isolation rates of B. pertussis. These advancements have been encapsulated in updated national guidelines, leading to the standardization of diagnostic practices across the public health laboratory network. Furthermore, through dynamic train-the-trainer workshops, ASM has elevated clinician awareness of B. pertussis, fostering improved communication between clinicians and laboratory technicians, resulting in enhanced collection of pertussis samples. This vital collaboration culminated in the identification of the first macrolide-resistant pertussis case in Mexico in early 2024.
“During the COVID-19 pandemic, some macrolide antibiotics were used indiscriminately,” observed Irma López Martínez, M.S., Diagnosis and Reference Director at InDRE. “Now, it is crucial to assess their impact. The diagnostic methodologies introduced by ASM in our institution have significantly bolstered our capacity to detect B. pertussis infections and conduct surveillance for AMR.”
The Brazil Case
Since 2021, ASM’s fruitful partnership with the Adolfo Lutz Institute (IAL) and the Ministry of Health’s General Coordination of Public Health Laboratories (CGLAB) in Brazil has led to groundbreaking results, including the recent identification of the first seven macrolide-resistant B. pertussis cases in the country. Under CGLAB’s direction, productive collaborations between private laboratories and IAL in the São Paulo region have significantly optimized testing capabilities for detecting positive DNA samples, thereby enhancing responses to recent outbreaks of B. pertussis in the area. Additionally, ASM’s comprehensive training and mentorship for the NRL have cultivated a proficient team of laboratory personnel adept at supporting reference testing. The NRL has evolved into a training hub for laboratories within the national public health laboratory network, enhancing the timeliness and reliability of test outcomes while supporting clinical management of B. pertussis and AMR surveillance efforts.
“ASM has provided us with invaluable insights, especially through technical laboratory visits, training workshops, and the ASM Microbe conferences,” reflected Amanda Bertani, a laboratory technician at IAL’s NRL. “We believe in the importance of continuous learning and striving for excellence in our techniques. The knowledge gained from ASM has empowered us to continuously elevate laboratory practices and expand our expertise.”
Panama and Peru: What’s Next?
Building on the significant outcomes of the pertussis project in Brazil and Mexico, ASM is now extending its activities to two additional countries. As outbreaks of B. pertussis continue to surge in Latin America, and the emergence of macrolide-resistant cases prompts concern, enhancing technical capabilities to screen for AMR through standardized capacity and fortifying the readiness of the surveillance laboratory network is essential. Thus, the Pertussis Project is expanding its reach to Peru and Panama. By leveraging successes and lessons learned in Brazil and Mexico, ASM’s goal is to invigorate surveillance efforts and bolster laboratory capacities in these nations. Furthermore, ASM is committed to fostering regional collaboration to optimize resource utilization while facilitating knowledge sharing, thereby establishing a cohesive and effective approach to disease surveillance throughout Latin America.
A Call for Action
The surge of AMR in B. pertussis underscores an urgent call for global collaboration aimed at expanding surveillance efforts and creating sustainable capabilities across nations and regions. The accomplishments of ASM GPHP’s initiatives in Brazil and Mexico illustrate that through cooperative endeavors and strategic investments, it is indeed possible to redefine diagnostic capabilities, enhance data-sharing practices, and facilitate early detection of resistant strains. To capitalize on these successes, global health organizations, governments, and the scientific community must prioritize investments aimed at enhancing AMR surveillance not only in Latin America but across the globe. By securing long-term support and resources, we can build resilient laboratory systems, encourage regional collaboration, and ensure a more effective global response to the challenges posed by AMR.
How does the collaboration with the American Society for Microbiology enhance the management of antimicrobial resistance in public health?
**Title: Strengthening Surveillance Against Antimicrobial Resistance: An Interview with Irma López Martínez**
**Editor:** Today, we’re talking with Irma López Martínez, the Diagnosis and Reference Director at Mexico’s Institute of Epidemiological Diagnosis and Reference (InDRE). We’ll discuss the recent rise in pertussis cases and the efforts being undertaken to combat antimicrobial resistance (AMR) in collaboration with the American Society for Microbiology’s Global Public Health Programs. Thank you for joining us, Irma.
**Irma López Martínez:** Thank you for having me. It’s crucial to address these challenges as they pose significant threats to public health.
**Editor:** Recently, we’ve learned that macrolide-resistant strains of *Bordetella pertussis* are becoming increasingly prevalent. Can you explain why this is a concern for both Mexico and the wider global community?
**Irma López Martínez:** Absolutely. Macrolides are a cornerstone of antibiotics used to treat pertussis. The emergence of resistant strains complicates treatment protocols, making infections harder to manage and increasing the risk of outbreaks. In Mexico, the increased capacity for surveillance and resistance detection is vital, especially in light of our recent identification of the first macrolide-resistant case.
**Editor:** How has the partnership with ASM assisted in addressing these issues in Mexico?
**Irma López Martínez:** ASM’s collaboration has enhanced our diagnostic capabilities significantly. We’ve improved quality assurance practices at our national reference lab and state labs. Their training programs have equipped us to better screen for *B. pertussis* and identify resistant strains. The updated national guidelines developed with ASM’s help ensure standardized practices across our public health laboratories.
**Editor:** That sounds promising. Can you elaborate on the specific methodologies or practices that have been implemented?
**Irma López Martínez:** One key change has been in our culturing methodologies at the national reference lab, which has led to much higher isolation rates of *B. pertussis*. Additionally, our “train-the-trainer” workshops have bolstered clinician awareness, improving communication between clinicians and laboratory technicians, which is essential for effective sample collection. Increased awareness has greatly improved our surveillance capacity.
**Editor:** It’s clear that building local capacity is essential. How do international partnerships like the ones facilitated by ASM impact countries like Mexico?
**Irma López Martínez:** International partnerships are invaluable. They not only provide technical assistance and resources but also foster a culture of continuous learning and improvement. Countries with less robust health infrastructures gain access to essential tools and knowledge, enabling them to respond to AMR and enhance overall health security. The collaborative frameworks created through these partnerships are crucial for a coordinated global response to infectious diseases.
**Editor:** What are the next steps for ASM’s initiatives in Latin America?
**Irma López Martínez:** Following our successes in Mexico, ASM is expanding its efforts into Panama and Peru. The goal is to replicate our achievements in strengthening surveillance capabilities and addressing the threats posed by AMR. By working together, we can ensure that both the health systems and the communities are prepared for future challenges.
**Editor:** Thank you, Irma, for shedding light on this pressing issue. Clearly, collaboration and enhanced surveillance systems are vital to combat the rising challenge of AMR, particularly concerning diseases like pertussis.
**Irma López Martínez:** Thank you for highlighting the importance of this topic. It is through such discussions that we can raise awareness and mobilize resources for action.
