10 Integrated surveillance

Surveillance efforts are usually focused on activities within one sector (human, animal or the environment).

Integrated surveillance involves the systematic collection, analysis and sharing of data on AMR across multiple interconnected domains, including human, animal, the environment and food. It recognises the shared nature of antimicrobial use and resistance across these sectors, and seeks to provide an understanding of AMR dynamics and transmission pathways.

As you have seen, this is the concept of a One Health approach recommended by the Quadripartite organisations. Integrated One Health surveillance comprises a coordinated unifying approach across sectors regarding:

• sampling sources
• AMR indicators
• sampling design
• laboratory methods
• data management
• data analysis
• reporting.

Using a collaborative approach, sectors can learn from each other’s knowledge and methods, support each other’s messages to the public and policymakers, and create common goals in the fight against AMR. Combining data from animal, human and the environmental sectors can provide evidence for sources of AMR and transmission routes. An important precondition for close collaboration between domains, sectors and disciplines is trust and sharing a common language (jargon). Establishing this takes energy and time.

Environmental surveillance (almost) never stands on its own. One environmental compartment is always connected to other domains, and almost all the work conducted during environmental surveillance is to (eventually) support human and animal health. Integration of surveillance activities and collaboration should be core activities for those working on environmental surveillance.

One example of an integrated surveillance protocol is called Tricycle, and you’ll look at that next.