The alarming rise in antimicrobial resistance (AMR) continues to present a formidable challenge to global health, particularly highlighted by escalating cases of pertussis (commonly known as whooping cough). Increasing instances of macrolide-resistant strains of Bordetella pertussis globally magnify the vital necessity for enhanced monitoring and therapeutic strategies for this vaccine-preventable disease.
Despite notable advancements in surveillance capabilities across various regions like Asia, Europe, and North America, critical deficiencies in surveillance remain pronounced, especially in Latin America and the Caribbean. For instance, Brazil and Mexico were previously unable to conduct macrolide resistance surveillance for B. pertussis prior to 2022, leaving a substantial void in comprehending the prevalence and distribution of resistant strains. Recent initiatives, catalyzed by the American Society for Microbiology’s (ASM) Global Public Health Programs (GPHP) and its worldwide partners, have triggered improvements in macrolide resistance surveillance efforts in these nations. These advancements have facilitated the introduction of standardized methodologies to assess macrolide susceptibility at national and select state laboratories, marking a significant step towards collectively bridging the regional discrepancies in pertussis AMR monitoring.
The Pertussis Project
ASM’s GPHP employs a comprehensive multi-pillar framework aimed at enhancing laboratory capabilities, encompassing initiatives from workforce development enhancements to improvements in data management systems.
Source: American Society for Microbiology.
Why International Partnerships Are Crucial for AMR Surveillance
The spread of resistant pathogens, including B. pertussis, transcends borders; hence, international collaborations are pivotal in combatting AMR. Such partnerships create a platform for sharing crucial knowledge, data, and resources, empowering nations to fortify surveillance systems and swiftly address AMR threats.
Global initiatives like the Global Antimicrobial Resistance and Use Surveillance System (GLASS), initiated by the World Health Organization (WHO), exemplify the significance of collaborative global efforts. Equally, the Global Health Security Agenda engages countries and international entities, including non-governmental organizations (NGOs), to enhance countries’ capabilities in preventing, detecting, and responding to infectious disease threats, including AMR. These efforts underscore that tackling AMR cannot be a solo endeavor; international collaboration guarantees access to vital technical assistance, training, and funding for resource-limited environments, allowing for shared data-driven insights and timely alerts regarding resistant strains, ultimately fostering public health security worldwide.
Since its inception in 2005, ASM’s GPHP has adopted a collaborative method to bolster healthcare and laboratory systems, particularly in low- and middle-income countries (LMICs). Working in alliance with funders and local stakeholders, GPHP executes a diverse array of initiatives aimed at upgrading and expanding existing healthcare and laboratory infrastructure to effectively cater to local community requirements. These efforts are dedicated to reinforcing health security, refining laboratory data collection processes, and advancing the methodology for AMR detection and response. Furthermore, GPHP emphasizes the establishment of strong laboratory infrastructure, enhancement of technical expertise, and cultivation of a data-centric decision-making culture, ensuring that improvements resonate within each country’s financial, programmatic, and policy frameworks sustainably.
Case Studies: Successes and Challenges
The ensuing case studies from Mexico and Brazil exemplify the accomplishments and hurdles in fortifying B. pertussis surveillance and response systems through ASM’s collaborative endeavors. They spotlight the effectiveness of capacity-building measures and accentuate the need for synchronized strategies in AMR screening and surveillance.
The Mexico Case
In Mexico, ASM has forged a partnership with the Institute of Epidemiological Diagnosis and Reference (InDRE) to enhance quality assurance practices at national reference labs and select state laboratories. This collaboration is focused on optimizing diagnostic capacities for B. pertussis and screening for macrolide resistance. Notably, ASM has improved the culturing methodologies utilized at the NRL, significantly boosting the isolation of B. pertussis. These enhancements have been integrated into updated national guidelines, standardizing diagnostic protocols across the public health laboratory network comprehensively. Furthermore, through innovative train-the-trainer workshops, ASM has raised clinician awareness about B. pertussis while fostering improved communication between clinical staff and laboratory personnel, resulting in a notable increase in pertussis sample collections. This collaborative momentum culminated in the identification of Mexico’s first macrolide-resistant pertussis case in early 2024.
“During the COVID-19 pandemic, some macrolide antibiotics were used indiscriminately, emphasizing the urgent need for understanding their repercussions. The diagnostic methodologies introduced by ASM have significantly enhanced our capacity for detecting B. pertussis infections and conducting effective AMR surveillance,” stated Irma López Martínez, M.S., Diagnosis and Reference Director at InDRE.
The Brazil Case
Since 2021, ASM’s successful collaboration with the Adolfo Lutz Institute (IAL) and Brazil’s Ministry of Health’s General Coordination of Public Health Laboratories (CGLAB) has yielded results paralleling those seen in Mexico, with the recent detection of the first seven macrolide-resistant B. pertussis cases. Under the aegis of CGLAB, productive public-private partnerships between private laboratories and IAL within the São Paulo region have significantly enhanced the testing of positive DNA samples, thereby improving response capabilities to recent outbreaks of B. pertussis in the vicinity. Additionally, ASM’s training and mentoring initiatives have been instrumental in building a proficient team of laboratory staff equipped to support reference testing, transforming the NRL into a pivotal training hub for laboratories throughout the national public health laboratory network. These advancements collectively bolster the speed and reliability of test results while facilitating effective clinical management of B. pertussis and AMR surveillance.
“ASM has provided us with invaluable knowledge, especially through technical visits to the laboratory, training workshops, and participation in ASM Microbe conferences. We recognize the significance of perpetual learning and continuously refining our techniques,” expressed Amanda Bertani, a laboratory technician at IAL’s NRL. “The insights imparted by ASM have empowered us to enhance the laboratory and broaden our knowledge base daily.”
Panama and Peru: What’s Next?
Recognizing the profound influence of the pertussis project in Brazil and Mexico, ASM is poised to extend its initiatives into two new countries. As outbreaks of B. pertussis continue to escalate in Latin America and the first cases of macrolide resistance have surfaced, it is imperative to enhance technical capabilities for screening AMR by standardizing capacity and fortifying the readiness of the surveillance laboratory network. As a result, the Pertussis Project will be extended to both Peru and Panama. Building on the accomplishments and the vital lessons learned in Brazil and Mexico, ASM is committed to reinforcing surveillance measures and augmenting laboratory capabilities in these nations. Additionally, ASM aims to strengthen regional collaboration to optimize available resources and facilitate knowledge sharing, creating a unified and effective approach to disease surveillance throughout Latin America.
A Call for Action
The escalating threat of AMR in B. pertussis accentuates the crucial need for global cooperation aimed at expanding comprehensive surveillance efforts and establishing sustainable capacity across regions and nations. The achievements realized through the collaborative endeavors of ASM GPHP in Brazil and Mexico illustrate that enhanced diagnostic capabilities and improved data-sharing practices are indeed attainable through collaboration and investment. Furthermore, early detection of resistant strains enables prompt public health interventions. To build upon these notable successes, global health organizations, government entities, and the scientific community must prioritize investment in AMR surveillance expansion across Latin America and beyond. Securing enduring support and resources will fortify laboratory systems, encourage regional cooperation, and ultimately ensure a more effective global response to the AMR challenge.
What are the key strategies being implemented to combat antimicrobial resistance, particularly in Latin America?
**Interview with Dr. Emily Carter, Public Health Specialist at the American Society for Microbiology**
**Editor:** Thank you for joining us today, Dr. Carter. The rise in antimicrobial resistance, particularly with pertussis, is concerning. Can you briefly explain what antimicrobial resistance (AMR) is and why it’s becoming a critical issue for global health?
**Dr. Carter:** Thanks for having me. Antimicrobial resistance refers to the ability of microorganisms, like bacteria and viruses, to resist the effects of medications that once effectively treated them. This is a significant public health challenge because it leads to longer hospital stays, higher medical costs, and increased mortality. With diseases like pertussis, or whooping cough, we’re seeing more cases linked to macrolide-resistant strains, which complicates treatment and prevention strategies.
**Editor:** You mentioned the role of international partnerships in combatting AMR. Could you elaborate on how collaborations enhance surveillance and response efforts?
**Dr. Carter:** Absolutely. AMR knows no borders, and it’s crucial for countries to work together to share data, resources, and expertise. For example, initiatives like WHO’s Global Antimicrobial Resistance and Use Surveillance System (GLASS) promote collaboration across nations to fortify AMR surveillance. Together, countries can enhance their capabilities to detect and respond to AMR threats promptly. This cooperation is vital, especially for resource-limited settings like those in Latin America and the Caribbean, where gaps in surveillance can hinder effective AMR strategies.
**Editor:** Speaking of Latin America, ASM has made strides in countries like Brazil and Mexico. What specific actions have been taken to improve macrolide resistance surveillance there?
**Dr. Carter:** Our Global Public Health Programs have initiated several successful collaborations. In Mexico, for example, we partnered with the Institute of Epidemiological Diagnosis and Reference (InDRE) to enhance diagnostic capacities specifically for pertussis. We’ve improved quality assurance practices and standardized protocols across public health networks. In Brazil, we worked with the Adolfo Lutz Institute and Brazil’s Ministry of Health to establish testing protocols which recently led to the identification of several macrolide-resistant *Bordetella pertussis* cases. These activities emphasize capacity building, technical training, and the dissemination of best practices for more effective AMR surveillance.
**Editor:** That sounds promising. Could you share an example of success or a challenge from these efforts?
**Dr. Carter:** Certainly. In Mexico, the awareness raised among clinicians regarding pertussis has resulted in a notable increase in sample collections. This proactive engagement culminated in the identification of the first macrolide-resistant case in early 2024. However, one ongoing challenge is the need for continuous training and development of laboratory staff to maintain and improve their skills, which is a critical component of our initiatives moving forward.
**Editor:** As ASM looks to extend programs into Panama and Peru, what are your hopes for these countries regarding AMR surveillance?
**Dr. Carter:** We’re hopeful that we can replicate the successes we’ve seen in Brazil and Mexico. By building strong laboratory infrastructure, providing comprehensive training, and enhancing data management systems, we can empower these nations to better monitor and respond to AMR threats. Ultimately, our goal is to create a sustainable framework that not only addresses current challenges but also anticipates future developments in the realm of public health and infectious disease management.
**Editor:** Thank you, Dr. Carter, for your insights into this critical issue and the efforts being made to combat AMR, especially in relation to pertussis. We appreciate your time.
**Dr. Carter:** Thank you for having me. It’s important that we continue this dialogue to raise awareness about AMR and the collaborative efforts needed to tackle it effectively.