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Response of M.O.H. to pathogen concerns
Your queries for the editorial of the 6th of October were two days before and I should have asked for the deadline as some questions need a more detailed response and these are usually from those who are experts on the topic.
The title of the editorial "Pathogens discovery calls for urgency" was a considered headline compared to the sensational media release you referenced from the University of Otago's communications team with "Drug-resistant diseases "ticking time bomb" in Oceania".
The Ministry does acknowledge that Acinetobacter baumannii is an opportunistic bacteria primarily associated with hospital-acquired infections. Thus it is expected to be a problem in any setting anywhere, and it's not unique to Samoa. For example, in New Zealand, Methicillin-resistant Staphylococcus aureus (MRSA), is present in 19 per 100,000 patients in a 2017 survey (by ESR) and there is a high prevalence amongst the young, community and Pacific people. Screening of selected patients and staff is performed widely to identify carriers. The antibiotic-resistant bugs tend to cause menace to the immune-compromised and older people. A few of our patients referred to New Zealand for various reasons have been found to carry these antibiotic-resistant bacteria.
The Carbapenemase-resistant Acinetobacter baumannii (CRAB) is yet another one of the many variants and types of antibiotic-resistant bacteria such as the MRSA, Meropenem-resistant Enterobacteriaceae (MEMR), Vancomycin Resistant Enterococcus (VRE) and they have been isolated from some of our patients. The Ministry has for many years, raised awareness on Antimicrobial Resistance advising doctors to reduce antibiotic prescriptions for viral infections to lessen resistance and the concern resulted in the National Action Plan for Antimicrobial Resistance 2022-26, mentioned in the editorial.
Again, these findings are not new. This has been known for a long time although the recent findings in using advanced technology (whole genome sequencing) have characterized them further with a better understanding of its evolution and informing of ways that may break the vicious cycle of transmission.
The multiresistant bacteria can cause a heavy burden on the health service in the cost of laboratory and compliance with infection prevention guidelines, severe infections, and the cost of high-level antibiotics that the bacteria are resistant to. We can identify the bacteria and sensitivity patterns and diagnose them locally so that active management of these cases is addressed appropriately. Whole genome sequencing is expensive and not available locally so further testing is reserved.
Antibiotic-resistant bacteria such as CRAB amongst others are being addressed as part of the MOH Antimicrobial Action Plan which includes bacterial identification, antibiotic supplies, infection prevention control, clinical management protocol, notification channels, laboratory, clinical and public health personnel capacity building as in antimicrobial stewardship) which is ongoing.
Infection Prevention Control practices, such as handwashing, are emphasized in the hospital setting and have been a main part of our community media messaging in containing infection transmission.
We have a Ministry workforce dedicated to monitoring infection control practices by conducting training and auditing activities. There are Infection Prevention and Control guidelines for the management of those identified with antibiotic-resistant bacteria. They involve isolation of cases and visitors until treated or have negative swabs, environmental cleaning and swabbing before and after cleaning to make sure the bacteria are not present.
From the public, we ask that they follow the instructions of visitation to the hospital and restrictions on how many visitors to avoid or minimize transmission of bacteria from the hospital and patients to the community and vice versa. In addition, they assist their doctors by not demanding antibiotics for the common cold. And that they handwash frequently as it is an effective and simple way to reduce infection transmission.
The finding of the study from the University of Otago that raised the interest of your health reporter and editorial is welcomed and acknowledged. While the data has been there for years, it has not been published until now. We congratulate the authors on the publication and acknowledge our Ministry's participation in the data sharing.
The Ministry has worked with partners across the region in addressing Antimicrobial (Antibiotic) Resistance (AMR) and contributed on the topic to the recent Pacific One Health and AMR symposium in Fiji. The next regional symposium on the topic will be held in Samoa in 2025.
By coincidence, the World AMR Awareness Week (WAAW) will be celebrated on the 18-24 November and it is to raise awareness and understanding of AMR and promote best practices to reduce the emergence and spread of drug-resistant infections.
Again, thank you for raising awareness of this important issue through your article and editorial.
