The global burden of bacterial antimicrobial resistance (bacterial-AMR)
Although there is widespread agreement that antimicrobial resistance (AMR) poses a global threat to human health, it has been very difficult to estimate the magnitude and geographic distribution of the global attributable morbidity and mortality to antimicrobial-resistant bacterial infections. This is in part due to the heterogeneous patchwork of surveillance systems, diagnostic capacity, and healthcare systems worldwide. Additionally, there is a great need for a wide-scoping understanding of the extent to which antimicrobial resistance emerges from specific pathogens and the associated antimicrobial drugs used to manage the resulting infections.
This week, the largest and most comprehensive study on the global burden of antimicrobial resistance (published in the Lancet) identified that in 2019 alone, deaths attributable to a drug-resistant infection outpaced all other infectious causes of death, including malaria and HIV/AIDS, and is among the leading causes of overall global mortality. A notable feature in this study is the systematic attempt to collect AMR disease burdens from low and middle-income countries (LMICs), where antimicrobial resistance surveillance is often minimal and reliable linkage between a detected infectious disease syndrome, antimicrobial resistance status, and specific morbidity or mortality is difficult to establish. Nevertheless, estimates across 204 nations and territories in this study indicate that the highest burden of global mortality from drug-resistant pathogens is in LMICs of Sub-Saharan Africa and South Asia, even though consumption of antimicrobial drugs tends to be higher among wealthier nations. The greater AMR-associated health burdens identified in LMICs is likely due to infection prevalence, inadequate diagnostics prior to prescriptions, insufficient regulations, inadequate access to treatment options, and use of counterfeit or substandard antibiotics.
The authors of the study conclude that based on these results, a more diverse cadre of interventions are needed, beyond the historical focus on regulating antimicrobial use and administration, including investments in sanitation and hygiene, clean water, community healthcare programs, novel vaccinations, and a development pipeline for new antimicrobials. The results of this study aim to refocus the ways in which informed, and location-specific policy decisions should be shaped with regard to prevention and control programs for antimicrobial resistance.
EPA and WHO to focus on environmental health disparities
With 29 years of cooperation initiated after signing the June 1992 Memorandum of Understanding (MOU), this week the U.S. Environmental Protection Agency (EPA) and the World Health Organization (WHO) signed and reaffirmed a new MOU. This five-year non-binding legal agreement between the two agencies spells out a continued collaboration on a wide range of existing and novel environmental health issues.
In addition to addressing ongoing public health impacts of lead-based paint, hazardous and toxic chemicals, water quality, and climate change, new avenues of cooperation between EPA and WHO include addressing growing disproportionate impacts of environmental challenges on underserved and vulnerable communities. For example, ambient exposure to air pollution often measured as fine particulate matter smaller than 2.5 μm in size (PM2.5) has been identified as the fifth-ranking risk factor for global mortality. PM2.5 are tiny particles that reduce visibility and can make the air look hazy, as occasionally seen in many urban settings around the world. However low-income groups and racial / ethnic minorities, especially in the USA, are at a greater risk of death from PM2.5. The EPA-WHO reprioritization of environmental health disparities comes at the same time as the release of a recent Nature study highlighting that lower socio-economic regions of the U.S. have been exposed to higher average PM2.5 levels versus regions with higher socioeconomic status, despite increasing safety standards set by EPA and WHO 2004–2016.
Additionally, while the WHO has played a central role in the global response to the COVID-19 pandemic, the MOU outlines another new area of cooperation related to the EPA’s recently expanded activities to support pandemic response. Efforts include research and development of antimicrobial disinfectants that can be applied to personal protective equipment (PPE), to increase their re-use, as well as to register disinfectants applicable for SARS-Cov-2. The EPA is currently implementing assays for monitoring SARS-Cov-2 in wastewater and sewage (EPA). The intended efforts of this work are to support ongoing COVID-19 response activities, as well as develop an arsenal of early-detection systems for future pandemic response.
January: National Radon Action Month
January is recognized as National Radon Action Month, and the potential for exposure to radon is particularly salient as a health risk in Minnesota, USA. The average radon level in Minnesota is more than three times higher than the U.S. national average, attributed to the unique geology underlying homes and buildings in the state.
Radon is a naturally occurring colorless and odorless gas that accumulates in indoor air after degassing from underlying soils, rock, and mineral components in the ground. Radon gas poses public health risks, by emitting inhalable particles of radioactive decay that can damage lung tissue, and in the long-term, may result in lung cancer incidence. Radon is the number one cause of lung cancer for nonsmokers and the second leading cause of lung cancer in smokers nationwide. Given that more than 21,000 people die annually in the U.S. due to cancer attributable to radon, Minnesota residents are urged by the Minnesota Department of Health (MDH) to take simple precautions, including regularly monitoring radon levels in homes to effectively reduce the preventable health risks. Mitigating radon levels in homes that have high levels can be done by installing a simple ventilation system, and a listing of licensed radon mitigation professionals can be found on the MDH website.
In a January 5th, 2022 news release, the MDH highlighted a number of misconceptions about radon testing and prevention:
Testing should be conducted regularly (The U.S. Environmental Protection Agency recommends testing every 2 years)— a single test is insufficient, as radon levels fluctuate over time.
Risks of radon may be present regardless of the type of foundation, soil, construction materials, age of the home, or the presence / absence of a basement.
Minnesota homes tend to be well-insulated and heated for a large proportion of the year; these factors also contribute to exposures.
Your neighbors’ radon levels are unlikely to reflect the levels of radon in your own home.
The Department of Health and the Environmental Health division of the Ramsay County Health Department are working to furnish easy-to-use and inexpensive testing kits (Air Check) with prepaid return mailing.
New Lancet Study
LANCET: Ambient air pollution
Nature study on PM2.5 disparities
National ambient air quality standards
WHO air quality standards
MDH Radon news release