This module introduces the concept of One Health and explains the importance of a One Health approach in tackling the AMR crisis. It emphasises how a complex mix of factors involving humans, animals, aquatic species, plants and the environment contribute to the spread of antimicrobial resistance (AMR) within and between sectors.
It introduces the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organisation for Animal Health (OIE) individually and collectively as the Tripartite, describing their joint role in developing a One Health approach to tackling AMR. The main functions of multi-sectoral organisational structures to address AMR across all sectors in a country will be discussed, with examples.
One Health AMR surveillance is introduced here but will be expanded in the following modules:
The main guidelines and protocols that contribute to One Health AMR surveillance will be introduced. As learners you will be encouraged to think about how your work might contribute to a One Health approach to addressing AMR in your country. As noted in other modules, we will focus on bacterial AMR, although the same principles apply to viruses, fungi, protozoa and parasites.
After completing this module, you will be able to:
We recommend that you have studied The problem of AMR before beginning to work on this module.
Before you begin this module, you should take a moment to think about the learning outcomes and how confident you feel about your knowledge and skills in these areas. Do not worry if you do not feel very confident in some skills – they may be areas that you are hoping to develop by studying these modules.
Now use the interactive tool to rate your confidence in these areas using the following scale:
This is for you to reflect on your own knowledge and skills you already have.
There are many definitions of One Health, but the following definition captures the key aspects:
A collaborative, multisectoral, and trans-disciplinary approach – working at local, regional, national and global levels – to achieve optimal health and well-being outcomes recognizing the interconnections between people, animals, plants and their shared environment
In the context of
Professionals from different disciplines include, but are not limited to:
Collaboration involves sharing information with, and effective communication among, professionals, with the goal of understanding what factors contribute to AMR in each sector, how each sector contributes to AMR in other sectors, and measures for mitigating AMR. Experts from each sector must identify priorities and make decisions together to achieve optimal health outcomes, recognising the interconnections between humans, animals, plants and their environments that contribute to AMR.
One Health not only refers to professionals from different sectors and disciplines working together, but also refers to governments, academic institutions, non-government organisations and community groups working together; for example, to investigate, design and implement appropriate policies and programmes to reduce the use of antimicrobials.
Table 1 lists a number of important misconceptions about what is meant by One Health and a One Health approach to AMR. We have provided explanations for why these are not truly One Health approaches to help you understand this module.
|Misconception||Explanation of why these are misconceptions|
‘One Health involves all sectors other than human health. For example, the “One Health sectors” are animal health, environmental health, plant health, etc.’
This misconception implies that One Health is the responsibility of sectors other than human health. In reality, One Health is the collaboration of all sectors contributing to and affected by AMR – including human health. There is no such thing as a ‘One Health sector’; One Health includes all sectors, especially human health.
‘The One Health approach is necessary because the overuse of antimicrobials in animals has led to the AMR problem in humans.’
There is a perception that the use of high volumes of antimicrobials in animals is a major cause of AMR in humans, and that the AMR problem can be mitigated by reducing levels of
Scientific evidence does not support the perception that AMU in animals is the major contributor to AMR in humans. While the use of some antimicrobials in animals does contribute to AMR in humans, the current evidence indicates that poor use of antimicrobials in human health care is the major factor driving AMR in humans.
‘One Health means treating all sectors with the same level of priority.’
One Health recognises that maintaining the effectiveness of antimicrobials for human health is the highest priority. This may lead to different levels of funding within grants or government budgets in order to address the most important factors associated with AMR in humans.
Whilst recognising AMR in humans as a priority, a One Health approach also recognises that AMR impacts the health of animals, aquatic species and plants, and is also important for animal health and welfare, and food security. Hence it is important that the One Health approach respects and understands the AMR problem in all sectors and provides adequate resources to investigate and manage AMR in all affected sectors.
‘A One Health approach to AMR and AMU surveillance involves implementing the same surveillance methods in all sectors.’
Approaches to AMR and AMU surveillance may differ between the sectors, depending on the objectives of surveillance in each sector and on the sources of samples from humans, animals, aquatic species and plants. For example, One Health AMR surveillance currently supported by the Fleming Fund is based on the following different surveillance approaches to identify AMR risks for humans in both human and animal populations:
‘One Health involves conducting
One Health involves optimising the use of laboratory resources to conduct AST in samples from humans, animals, food and/or the environment. The particular mix of laboratories will depend on each country’s situation. For example, in small countries with a small animal production sector, the optimal use of limited resources may be to test animal samples in the human health laboratory. In countries that do not have laboratories that provide microbiology services for the food and environment sectors, it may be more cost-effective to test food and/or environment samples in animal health or human health laboratories.
AMR, together with climate change, is considered to be one of the world’s ‘wicked problems’. Wicked problems are threats to human existence that are very complex to understand, solve or manage. Addressing wicked problems (van Woezik et al., 2016) depends on:
Wicked problems do not have easy solutions.
Interaction of an extremely complex mix of factors drives the emergence and spread of AMR within and between populations and their environments, as shown in Figure 1. The figure illustrates the main drivers for emergence of AMR in the different sectors, as well as the transmission pathways within and between sectors.
AMU in humans, animals and plants drives the emergence of resistance within bacterial populations carried by individuals within these populations. Once AMR has emerged it can spread due to poor hygiene, poor waste management or inadequate farm
Bacteria can become resistant to antimicrobials through mutations or through the transmission of
Movement of these elements between bacteria in the host and/or in the environment result in previously non-resistant bacteria becoming resistant. Plasmids are a type of mobile genetic element consisting of circles of DNA that may carry several ARGs. (You were introduced to ARGs and other mobile genetic elements in the Introducing antimicrobial resistance module.) Spread of AMR can therefore be via transmission of the resistant bacteria themselves, or transmission of resistant genes that cause previously susceptible strains to become resistant.
To help understand this complex mix of factors shown in Figure 1, an explanation associated with each letter in the figure is available as a separate PDF file.
Now spend some time exploring Figure 1.
Another contributor to AMR are
Antimicrobial residues may contribute to the emergence of AMR in bacteria carried by host populations other than those in which they were initially used. For example, people may consume antimicrobial residues in food derived from treated animals if withdrawal periods are not adhered to, or in water that contains antimicrobial residues from a range of sources (human, agricultural, animal). Exposure to low levels of antimicrobial residues in this way provides a selective pressure that can result in the development of resistance.
In addition, low levels of antimicrobial residues in the environment contribute to the emergence of AMR in naturally occurring environmental bacteria, making the environment a potential reservoir of ARB and ARGs.
The management of AMR therefore requires a collective effort from people working with humans, animals, agriculture and the environment to effectively address it.
Now that you have explored Figure 1, use the space below to reflect on your own professional experience with AMR. You may find it helpful to refer to Figure 1 and its supplementary PDF file for ideas when you consider sectors you are less familiar with.
Let’s look at an example of a One Health AMR problem involving transmission of AMR from animals to humans.
Transmission of ceftiofur-resistant Salmonella enterica serovar Heidelberg (subsequently referred to as S. Heidelberg) from
You will learn:
This example demonstrates that AMR problems involve many factors and cannot be solved by a single approach, or one sector acting in isolation.
What does this information suggest about a possible relationship between AMR in chickens and people?
It suggests that ceftiofur resistance in Salmonella in poultry has led to ceftiofur resistance in Salmonella in people, and the resistant bacteria or genes may have been transmitted via the food chain.
The key pieces of evidence for a link between ceftiofur resistance in poultry and people, with transmission through the food chain were as follows:
Further evidence of this transmission of resistance from broilers to people via chicken meat was a drop in prevalence of ceftiofur resistance in S. Heidelberg isolates from infected people and a drop in prevalence in chicken meat following the Quebec poultry industry’s voluntary withdrawal of ceftiofur use in hatcheries that produce broiler chicks, during 2005–6.
Subsequently there was a partial reintroduction of ceftiofur use in hatcheries. Suggest what the result of this might be.
The incidence of resistant organisms might increase. Unfortunately, this is what happened, and resistance increased again in both people and chicken meat.
Let’s look at how this ceftiofur resistance emerged in salmonellae in broiler chickens.
The major factor contributing to the emergence of ceftiofur resistance in Salmonella organisms carried by broilers was found to be off-label use of ceftiofur in hatcheries that produce broiler chicks during 2003–4. Small doses of ceftiofur were injected into thousands of eggs immediately prior to hatching and/or into newly hatched chicks to prevent the occurrence of E. coli yolk sac infections (Dutil et al., 2010). This is an example of prophylactic use of antimicrobials to prevent the occurrence of clinical disease and mortality.
At the same time, an increased prevalence of ceftiofur resistance was detected in E. coli as well as in Salmonella isolates from broilers, which was likely to be associated with the same driver: prophylactic use of ceftiofur in broiler hatcheries. This was an additional concern because ceftiofur resistance is carried on a mobile genetic element and can potentially be transmitted from one species of bacteria to another.
How did the resistance to ceftiofur spread from broilers to people?
Transmission of the ceftiofur-resistant Salmonella organisms from broilers to people occurred via the food chain. People predominantly became infected during preparation and/or consumption of chicken meat carrying the resistant Salmonella organisms. People working on the chicken farms may have been infected through contact with chicken faecal material if they did not follow good personal hygiene practices such as regular handwashing before eating (Collineau et al., 2020).
Figure 2 shows the emergence of ceftiofur-resistant Salmonella organisms in broilers and transmission pathway to people via the food chain.
Take some time now to think about how Salmonella organisms spread from broilers to people by answering the questions below.
Which of the following behaviours contribute to the spread of resistant Salmonella organisms from chicken meat to people?
Not storing chicken meat at sufficiently cold temperatures
Not washing hands after handling raw chicken meat
Poor hygiene when preparing chicken meals, i.e. cross-contamination from uncooked products to cooked products via contaminated bench surfaces or contaminated knives
All of the above
The correct answer is e.
Which of these is a situation in which cross-contamination with ARB or ARGs can occur?
Mixing broilers from infected and non-infected flocks during transport
Transporting broilers in vehicles/crates previously contaminated with chicken faeces.
Using contaminated water and equipment during slaughter and processing
Contact between infected and uninfected broiler carcases and/or chopping boards and knives in retail outlets
All of the above
The correct answer is e.
Why is ceftiofur resistance in chickens a public health concern?
The public health concern is that use of a
In most countries, ceftiofur is the major 3GC that is used in animals and it is mostly licensed for treating individual sick animals. It is closely related to ceftriaxone, which is the drug of choice for treating severe or invasive salmonellosis in people (Alcaine et al., 2005). There is some evidence of cross-resistance between ceftiofur and ceftriaxone, which may result in 3GC antimicrobials being less effective in treating people with salmonellosis or other serious infections caused by ceftriaxone-resistant E. coli. This can result in people being sick for longer, having a more serious illness and in some cases an increase in mortality. It also leads to the use of alternative antimicrobials such as carbapenems, which are considered a last resort drug for treatment of infections that are resistant to 3GCs.
Our example AMR problem can be controlled through a One Health approach that involves applying different measures in different sectors at multiple levels that range from global to national to farm to individual people. For example:
Let’s think about some of the control measures that can be applied in the different sectors, using the Canadian example of ceftiofur resistance in S. Heidelberg.
Which steps in the infection pathway could be targeted?
Emergence of resistance in broilers
The correct answer is a.
This is the initial step to reduce the emergence of ceftiofur resistance in chicken meat.
Transmission of resistance among chicken meat during food processing
The correct answer is a.
This will help reduce the spread of Salmonella organisms, including those that are resistant to ceftiofur, among chicken carcases and chicken meat pieces during slaughter and retail.
Infection of humans
The correct answer is a.
This will help reduce the transmission of Salmonella organisms, including those that are resistant to ceftiofur, from meat to humans during food preparation and consumption.
Manufacture of 3GCs
The correct answer is b.
The manufacture of 3GCs will not impact the emergence of resistance through the prophylactic use in hatching eggs and chicks, nor the transmission of ceftiofur resistance from chickens to humans.
In summary, the aim of these measures is to preserve the effectiveness of 3GCs that are important for treating both human and animal diseases by reducing the emergence of resistance, and to reduce the probability of humans becoming infected with Salmonella organisms (resistant and non-resistant) from chicken meat.
There are also measures that can be taken in the environmental sector for controlling salmonellosis in countries with poor water sanitation processes, where water is an important source of infection by Salmonella organisms in addition to the food chain. This expands the illustration of a multi-sectoral approach to controlling transmission of antimicrobial-resistant Salmonellae to include the environment.
The WHO classifies antibiotics for human use into three stewardship groups: Access, Watch and Reserve (AWaRe), as described below. The majority of 3GCs, including ceftriaxone, are in the Watch group, which includes most of the highest priority critically important antimicrobials for human medicine. The WHO recommends that ‘antibiotics in the “Watch” group should be prioritized as key targets of stewardship programs and antimicrobial use monitoring’. The AWaRe database can be accessed from the WHO website (WHO, 2019c).
Access antibiotics ‘have activity against a wide range of commonly encountered susceptible pathogens while also showing lower resistance potential than antibiotics in the other groups.’
Watch antibiotics ‘have higher resistance potential and include most of the highest priority agents among the critically important antimicrobials for human medicine and/or antibiotics that are at relatively high risk of selection of bacterial resistance. Antibiotics in the Watch group should be prioritized as key targets of stewardship programs and monitoring.’
Reserve antibiotics ‘include antibiotics and antibiotic classes that should be reserved for treatment of confirmed or suspected infections due to multi-drug-resistant organisms. Antibiotics in the Reserve group should be treated as “last resort” options.’
The following measures have been taken in a range of countries to reduce ceftiofur resistance in salmonellae carried by chickens:
Improvements in biosecurity, hygiene and incubation conditions on broiler breeder farms can replace the need for prophylactic use of antibiotics by reducing the risk of E. coli infection in newly hatched chicks. These measures reduce the risk of infections being introduced to the farm and further spread within the farm environment (Collineau et al., 2020). For example, chickens can be infected with Salmonella organisms from their environment. Possible sources are contaminated feed, rodents or contact (direct or indirect) between infected and uninfected birds.
Hygiene is vital in all areas, and education and support for poultry farmers is therefore key.
Cross-contamination resulting in the further spread of Salmonella organisms can occur when chickens are transported in a vehicle previously used to transport chickens carrying ceftiofur-resistant salmonellae. Cross-contamination can occur at the chilling stage of processing chicken carcasses, for example if water used for chilling becomes contaminated.
If there is any residual contamination with Salmonella organisms, further growth of the bacteria is prevented by maintaining the temperature below 4°C at all steps up to and including retail (Collineau et al., 2020).
Improved food-handling hygiene by the consumer, maintaining meat at temperatures below 4°C following purchase, and correct cooking practices will reduce the incidence of salmonellosis in people (Collineau et al., 2020). General good hygiene in the household will also prevent person-to-person spread if an individual does become infected.
Modelling the data from the Canadian example suggests that if humans have recently taken antimicrobials before exposure to S. Heidelberg, they are at increased risk of infection with this serovar. This is because antimicrobials in general reduce the bacterial diversity in the human intestine, killing microbes that would normally compete with the pathogenic bacteria.
Therefore, exposure of an individual to resistant bacteria, while they are taking an antibiotic for a different reason, will enable colonisation with that resistant strain (Collineau et al., 2020). A general focus on human antibiotic stewardship and the reduction of use is therefore likely to reduce infection with 3GC-resistant S. Heidelberg, and in principle with any resistant food-borne bacteria.
In countries with poor water sanitation systems, water is an important pathway for transmission of antimicrobial-resistant Salmonella organisms in addition to the food chain and direct transmission (Afema et al., 2016).
In these countries, the environment sector can contribute to controlling the spread of Salmonella organisms by improving the management of waterways to reduce the contamination of freshwater with untreated sewage.
They have signed a Memorandum of Understanding to work together to lead a collective global One Health approach that minimises the emergence and spread of zoonotic diseases and AMR (OIE et al., 2018).
The Tripartite has developed a draft workplan to combat AMR (OIE, 2019c) that aims to:
Spend a few minutes exploring the separate roles of the three organisations in relation to AMR, then answer the questions in Part 2.
Visit the AMR section of the OIE website (OIE, n.d.) and spend a few minutes browsing the information.
Key roles of OIE include the following:
Visit the AMR section of the FAO website (FAO, n.d.) and look at The FAO Action Plan on Antimicrobial Resistance 2016–2020 (FAO, 2016).
Key roles of FAO include the following:
Now test your understanding of the particular roles of the different Tripartite organisations in dealing with AMR.
The correct answer is c.
The WHO Integrated Antimicrobial Stewardship toolkit provides practical guidance on setting up antimicrobial stewardship (AMS) programmes in the human health sector (WHO, 2019b).
The correct answer is b.
The OIE provides a list of antimicrobial agents recommended for use in food-producing animals, separating these into levels of importance with a view to preserving their efficacy.
The correct answer is a.
For example, the FAO hosts the Codex Alimentarius, which provides guidelines designed to minimise the transmission of AMR through the food chain. You can read about Codex Alimentarius on the FAO website.
The correct answer is c.
This is called the Global Antimicrobial Resistance Surveillance System (GLASS), which you can read about on the WHO’s GLASS website. There is also more information in the Introducing AMR surveillance systems module.
The correct answer is a.
For example, the FAO’s own action plan on AMR aims to increase existing laboratory capacities for monitoring AMR and detecting antimicrobial residues (FAO, 2016).
The correct answer is b.
The OIE supports surveillance of AMU in animals by providing a system and tools for countries to report AMU in animals at the country level (OIE, 2020).
You may have found it difficult to identify the relevant organisation for each activity because there is some cross-over, so don’t worry. This is one reason why it is so important that these organisations collaborate!
You probably noticed that all the organisations mention the importance of a One Health approach, and are committed to implementing the Global Action Plan for AMR (WHO, 2015), which has five strategic objectives to:
There is a range of multi-sectoral organisational structures across different countries to address the major functions needed for a One Health approach to control AMR. The five major functions are described in Table 2 with a description and examples of the name of national organisations addressing each function.
Policy and budgetary allocation
Ministerial-level collaboration that endorses AMR policies in each sector and agrees on budgetary allocation.
Some countries have a designated organisation to support policy-making related to One Health programmes (which includes AMR), while in others the senior government members of the national AMR committee may agree on policy. In other countries, AMR policy may be endorsed through other government mechanisms.
Inter-Ministerial Committee for One Health (IMCOH), Bhutan
National leadership of the AMR programme
A multi-sectoral committee responsible for strategic planning and oversight of the National Action Plan for AMR, e.g. National AMR Coordination Committee (AMRCC).
Multi-sectoral Coordinating Committee (MCC), Tanzania
Antimicrobial Resistance Multisectoral Steering Committee (AMRMSC), Nepal
Some countries have a designated platform for engaging with the broad range of AMR stakeholders, which may include government, academic, non-government, professional, community and industry organisations. This platform functions to support awareness of AMR and the design and implementation of programmes to mitigate AMR.
One Health AMR platform, Uganda
AMR technical leadership
One Health Technical Working Committees (TWCs) or Technical Working Groups (TWGs) that comprise experts from AMR-related disciplines from each sector provide multi-sectoral technical leadership for AMR management and advise the AMRCC on policies and programmes.
In some countries the TWC or TWG is a sub-committee of the national AMRCC.
National Technical Working Committee (NTWC), Nepal
National drug administration
Organisation(s) responsible for the national administration of drug importation and overseeing the responsible use of antimicrobials to preserve their effectiveness to treat human, animal and plant diseases.
In many countries a single authority administers drugs for both humans and animals, while in others, separate organisations administer drug importation and use in human and animals.
National Drug Authority, Uganda
National Drug Technical Advisory Committee, Bhutan
Look again at Table 2 use the space below to note down the names of the national organisation(s) in your country that address each of these functions.
You will learn more about bacterial AMR surveillance in the following modules:
Here we will just introduce the concept of a One Health approach to AMR surveillance.
One Health AMR surveillance:
In addition to this specific focus on ARB and/or ARG that may contribute to resistance in multiple sectors, multi-sectoral sharing of each sector’s broader AMR surveillance results helps the multi-sectoral AMR Technical Working Group (TWG) and the AMR Coordinating Committee (AMRCC) understand the multi-sectoral epidemiology of AMR in their country. This broader understanding is important for building a multi-sectoral approach to managing AMR.
Figure 3 shows an example of a One Health AMR surveillance programme involving the human health and animal health sectors, with each sector sharing and interpreting their combined surveillance results, using them to update the AMRCC with information generated through surveillance, and recommendations for policy and programmes. The programme can include other sectors such as the environment and/or food quality management as these sectors become engaged.
The aims of One Health AMR surveillance are to:
It should be noted that One Health AMR surveillance should be conducted in conjunction with One Health AMU surveillance so that information on AMU is used to inform the design of AMR surveillance, and feeds into the interpretation of AMR data.
There are examples of effective One Health AMR surveillance programmes in a number of countries, including the Canadian CIPARS programme described in Section 4.1 that was responsible for detecting the transmission of ceftiofur-resistant S. Heidelberg from broiler chickens to people via the food chain. CIPARS monitors trends in AMU and AMR in selected bacterial organisms from human, animal and food sources across Canada. (More information can be found on the Canadian government’s website (Government of Canada, 2006).)
As yet there are no examples of effective One Health Bacterial AMR surveillance systems in low- and middle-income countries, which is a major reason for the Fleming Fund programme supporting their development and implementation in a range of countries.
What makes a One Health AMR surveillance system ‘One Healthy’?
We suggest the following points:
How does your role contribute to AMR surveillance? Do you meet with colleagues from other sectors to discuss AMR surveillance results?
The WHO and FAO guidelines are summarised in this section, as well as the OIE’s set of standards to support One Health AMR surveillance that aims to identify public health AMR risks associated with bacteria carried by healthy animals raised for human consumption. Also included is the AMR surveillance protocol that Mott MacDonald produced to support countries design an active surveillance programme for AMR in healthy broiler and layer poultry. There’s also a brief overview and key features of the document produced by each organisation.
As described in Section 8, One Health AMR surveillance measures resistance to a common set of antimicrobials in a common set of zoonotic bacteria in samples from humans, animals and/or food products and the environmental. All of the documents support a One Health approach to AMR surveillance by focusing on measuring resistance in zoonotic bacteria to antimicrobials that are of critical importance to human health.
The WHO guidelines guide integrated surveillance in the common set of bacteria and antimicrobials in samples from humans, animals and food products. While the other three documents do not guide surveillance in humans, they support the animal health sectors to design and implement their contribution to One Health AMR surveillance through testing samples from animals and/or animal-derived food products. An important factor of One Health AMR surveillance is to harmonise AST methods and interpretation of results across samples from humans, animals and/or food products.
WHO-led Advisory Group on Integrated Surveillance of Antimicrobial Resistance (AGISAR), in collaboration with FAO and OIE (WHO, 2017)
Guidelines for the integrated surveillance of AMR in food-borne bacteria from humans, animals and food.
Regional guidelines for AMR surveillance in zoonotic bacteria carried by healthy animals raised for human consumption and animal-derived food products focused on south-east Asia.
OIE (2019a), with an equivalent set of standards for AMR and AMU surveillance in aquatic species in Chapters 6.4 and 6.3, respectively, of the Aquatic Animal Health Code (OIE, 2019b)
OIE standards for AMR and AMU surveillance in terrestrial and aquatic animals raised for human consumption and in animal-derived food products.
A Protocol for Active AMR Surveillance in Poultry – Towards a One Health AMR Surveillance System: Protocol for Active AMR Surveillance in Commercial Broiler and Layer Chicken Populations for the Fleming Fund Grants Programme
Mott MacDonald, Management Agent for the Fleming Fund Programme
Guides animal health officials in the countries supported by the Fleming Fund Country Grants (FFCG) programme to design and implement an active surveillance programme for AMR in zoonotic bacteria carried by healthy broilers and chickens.
Now try Activity 9.
They guide surveillance for AMR in bacteria carried by humans.
They guide surveillance for AMR in pathogens that cause clinical disease in animals.
They guide surveillance for resistance to all antimicrobials in all bacteria.
They guide surveillance for AMR in bacteria that may be transmitted from animals to humans.
The correct answer is d.
One Health AMR surveillance focuses on surveillance for AMR in zoonotic bacteria carried by animals and the same bacteria carried by people. Zoonotic bacteria may be spread from animals to humans via direct contact with animals, via animal-derived food products or via the environment.
Antimicrobials that are commonly used in human health.
Antimicrobials that are critically important for human health.
Antimicrobials that are critically important for animal health.
Antimicrobials that are commonly used in animal health.
The correct answer is b.
One Health AMR surveillance focuses on testing for resistance to antimicrobials that are critically important for human health, in zoonotic bacteria carried by animals and the same bacteria in humans. Critically important antimicrobials for human health are those that are the only available antimicrobial, or one of limited available therapies, to treat serious bacterial infections in people.
Regional Guidelines for Monitoring and Surveillance of Antimicrobial Resistant Bacteria from Healthy Food Animals Intended for Consumption (FAO)
A Protocol for Active AMR Surveillance in Poultry (Mott MacDonald)
‘Harmonisation of national antimicrobial resistance surveillance and monitoring programmes’ (OIE)
Integrated Surveillance of Antimicrobial Resistance in Foodborne Bacteria: Application of a One Health Approach (WHO)
The correct answer is d.
All protocols focus on surveillance for resistance to critically important human antimicrobials in zoonotic bacteria. WHO’s document provides guidance for implementing surveillance in humans as well as animals and food. The FAO, OIE and Mott MacDonald documents provide guidance for implementing surveillance in animals and food, supporting these sectors to contribute to a One Health AMR surveillance programme.
Well done – you have reached the end of this module and can now do the quiz to test your learning.
This quiz is an opportunity for you to reflect on what you have learned rather than a test, and you can revisit it as many times as you like.
Open the quiz in a new tab or window by holding down ‘Ctrl’ (or ‘Cmd’ on a Mac) when you click on the link.
In this module you learned that AMR is an extremely complex health problem involving interconnections between humans, animals, plants and their environments, and it cannot be effectively addressed by each sector working independently. You learned the definition of One Health and worked through a real-world example of how a One Health approach was applied to detect and reduce the transmission of AMR from animals to humans via the food chain. You should now be able to give examples of measures for controlling a One Health AMR problem that can be implemented at global, national, food processing and retail, farm, household, and individual levels. You had a brief introduction to One Health AMR surveillance and should be able to recognise guidelines, standards or protocols that can assist you to design and implement a One Health AMR surveillance system.
You learned that the One Health approach to addressing AMR is led at the global level by the Tripartite, comprising the WHO, the FAO and the OIE. You also learned about the roles of a range of national multi-sectoral organisations for controlling AMR. You should be able to name the multi-sectoral organisations that are addressing AMR in your country and identify if and/or how your work contributes to a One Health approach to addressing AMR.
You should now be able to:
Now that you have completed this module, consider the following questions:
When you have reflected on these, go to your reflective blog and note down your thoughts.
Do you remember at the beginning of this module you were asked to take a moment to think about these learning outcomes and how confident you felt about your knowledge and skills in these areas?
Now that you have completed this module, take some time to reflect on your progress and use the interactive tool to rate your confidence in these areas using the following scale:
Try to use the full range of ratings shown above to rate yourself:
When you have reflected on your answers and your progress on this module, go to your reflective blog and note down your thoughts.
Now that you have completed this module, take a few moments to reflect on your experience of working through it. Please complete a survey to tell us about your reflections. Your responses will allow us to gauge how useful you have found this module and how effectively you have engaged with the content. We will also use your feedback on this pathway to better inform the design of future online experiences for our learners.
Many thanks for your help.
This free course was collaboratively written by Joanna McKenzie and Dawn Harmon, and reviewed by Priya Khanna, Claire Gordon, Natalie Moyen and Hilary MacQueen.
Except for third party materials and otherwise stated (see terms and conditions), this content is made available under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 Licence.
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Module image: © Sudowoodo/iStock/Getty Images Plus.
Figures 1 and 3: Mott McDonald.
Figure 2: hatching broiler chicks, © chayakorn lotongkum/iStock/Getty Images Plus; broiler chicken farm, © davit85/iStock/Getty Images Plus; chicken being prepared in a household, GSDesign; hospital, Alexey Hulsov/Pixabay.
Section 5.1: © junpinzon/iStock/Getty Images Plus.
Section 5.4: © Flatfeet/Shutterstock.
Section 5.5: RitaE/Pixabay.
Section 5.6: Ulrike Leone/Pixabay.
Section 5.7: © Weerayuth Kanchanacharoen/123RF.
Section 9.1: Integrated Surveillance of Antimicrobial Resistance in Foodborne Bacteria: Application of a One Health Approach. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
Section 9.2: Food and Agriculture Organization of the United Nations, 2019, Monitoring and surveillance of antimicrobial resistance in bacteria from healthy food animals intended for consumption, http://www.fao.org/ 3/ ca6897en/ CA6897EN.pdf. Reproduced with permission. Image: © FAO/Jim Caro.
Section 9.3: World Organisation for Animal Health.
Section 9.4: Fleming Fund.
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