An Overview of DoD International Activities on Antimicrobial Resistance

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An Overview of DoD International Activities
onAntimicrobial Resistance
To see CDR Witts script for each page, download
this file and view it in the Notes Page format

• CDR Clara J. Witt VMD, MPH
• Chief, Foodborne, Veterinary and
• Antimicrobial Resistance Surveillance

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Presidential Decision Directive NSTC-7 June 1996
The mission of the DoD will be expanded to
include support of global surveillance, training,
research, and response to emerging infectious
disease threats. DoD will strengthen its
global disease reduction efforts through
centralized coordination improved preventive
health programs and epidemiological capabilities
and enhanced involvement with military treatment
facilities in the United States and the overseas
laboratories.
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DoD-GEIS

• GEIS pillars surveillance (especially
  laboratory-based), research, response, and
  training and capacity building
• GEIS is a critical and unique resource of the
  U.S. in the context of global affairs. It is the
  only U.S. entity that is devoted to infectious
  diseases globally and that has broad-based
  laboratory capacities in overseas settings.
  (IOM, NAS)

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Major DoD Elements Participating in GEIS
WRAIR/NMRC
AFIP

Egypt
Navy Hub
Air Force Hub
Thailand
Peru
Kenya
Indonesia
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DoD-GEIS Approach

• Encourage partners, national and international,
  to assign higher priority to emerging infectious
  disease (EID) issues including antimicrobial
  resistance
• Enhance and facilitate surveillance and response
  components of domestic and international public
  health infrastructure
• Support WHO and other bodies to perform a
  stronger role in the surveillance of, prevention
  of, and response to EIDs
• Expand formal training and outreach to health
  care providers

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DoD Overseas Medical Research Unit Role in GEIS

• Global Surveillance - drug-resistant enteric
  organisms, drug-resistant malaria, influenza, and
  unexplained fevers
• Global Response - uniquely capable, permanent,
  multi-disciplinary platforms for staging and
  supporting a wide range of field, laboratory,
  human, and veterinary health investigations
• Building Global Capacity - focal points for
  leveraging local capacity through training and
  infrastructure strengthening

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DoD Antimicrobial Resistance Activities

• Example Malaria
• Anti-malarial drug discovery and development
• Surveillance for presence, spread and
  intensification of anti-malarial drug resistance
• Basic and applied research on the mechanism(s) of
  anti-malarial drug resistance and its epidemiology

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DoD Antimicrobial Resistance Activities

• Example Malaria cont.
• Training in laboratory diagnostics and malaria
  control practices
• Basic and applied research in vaccine development
• Application of Malaria Genome Project to drug,
  vaccine and diagnostic development
• Vector control research

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DoD Antimicrobial Resistance Surveillance
Activities

• Example Enteric Pathogens and Resistance
• Monitoring for antimicrobial resistance in
  Shigella, Salmonella, EHEC, ETEC and
  Campylobacter in community or hospital settings

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DoD Antimicrobial Resistance Prevention Control
Activities

• Strengthening laboratory diagnostic capabilities
  in support of the prevention and control of AR
• Training
• antimicrobial susceptibility testing
• laboratory specimen management and processing for
  better test result analysis and information
  dissemination
• Generated AR information is shared with MoHs and
  local partners for evidence-based decision making
  on antibiotic usage and enteric disease treatment
  strategies

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DoD Antimicrobial Resistance Research Activities

• Developing and testing PCR probes and molecular
  diagnostic tests for Shigella (ipaH and rfc),
  Campylobacter (ecuE), Salmonella (invA), and ETEC
  (ST and LT) to rapidly identify and quantitate
  different enteric pathogens in clinical samples
• Developing and evaluating candidate vaccines for
  Shigella sonnei, Campylobacter, and ETEC

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Partners in Enteric Pathogen AR Activities

• Bolivia - Fundacion ITA, CENTROP
• Cambodia - MoH, NIPH, MND
• Ecuador - Hospital Vozandes de Oriente, Hospital
  Militar de Guayaquil
• Egypt - MoHP, CPHL, district and regional
  hospitals
• Indonesia MoHSW, provincial and district health
  authorities and hospitals
• Kenya - African Medical and Research Foundation
  AMREF and Kenya Medical Research Institute
  KEMRI

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Partners in Enteric Pathogen AR Activities

• Laos - Center for National Laboratory and
  Epidemiology, NTA, regional health departments
• Nepal - CIWEC Clinic
• Peru - INS, regional reference labs and hospitals
• Thailand - Bumrungrad Hospital, Kwai River
  Christian Hospital, Ft Somdejpranaresaun Hospital
• Vietnam - NIHE, St Paul Hospital

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