Europe and the fight against Antimicrobial Resistance

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Europe and the fight against Antimicrobial
Resistance

• Vincent HoudryDG SANCO C3Health Threats Unit

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Intersectoral mechanism

• SANCO health, food, feed, animals, plants
• ENV biocides, agriculture, residues
• ENTR pharmaceutical products, biocides
• RTD basic research, new antibiotics and tests
• ECDC, EMEA, EFSA, JRC, non food scientific
  committees, community reference laboratory for
  AMR

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Feed/animal/food

• Zoonoses Monitoring directive (2003)
• Decisions (2007) on Salmonella, Campylobacter,
  MRSA
• RASFF Rapid Alert System on Food and Feed
• Prohibition of the use of antibiotics as feed
  additives (2003)

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Community reference laboratory on AMR

• Directive on the monitoring of zoonoses and
  zoonotic agents
• Monitoring of antimicrobial resistance
• Ensure quality of antimicrobial susceptibility
  testing and harmonise procedures and
  methodologies

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DG Environment

• Biocidal products directive (1998)
• Revision of all active substances regarding safe
  use for human health and environment (before
  2010)
• SCENIHR scientific opinion to assess AMR effects
  of biocides
• Cross resistance to antibiotics as a new criteria
  in evaluation of biocidal products?

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DG Research

• 5th FP 1999-2002 20M/year
• 6th FP 2003-2006 40M/year
• Translational research Grace and Mosar
• Animal health alternatives to antibiotics and
  transmission of AMR
• 7th FP 2007-2013 First call
• AMR in human health
• Biocides and AMR in food and animal health

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EFSA

• Food as a vehicle for antimicrobial resistance
  EFSA Q 2007 089
• Antimicrobial resistance of decontaminants
  substances (poultry carcasses)/SCENIHR
• Data on AMR in zoonotics agents (salmonella,
  campylobacter) in animals and food of animal
  origin (Zoonoses directive)

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EMEA

• Guideline to applicants to obtain more useful
  prescribing information
• SPC info on prudent use, prevalence of
  resistance
• Veterinary unit
• Guidance on preauthorisation requirements for
  authorisation of antimicrobials potential to
  select for resistance
• Considerations on use of Fluoroquinolones for
  food producing species (cephalosporins,
  macrolides, lincosamines, streptogramins)

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ECDC

• 3 meetings of NFP for AMR
• Country visits on AMR
• Working groups
• Clostridium difficile, MRSA
• DSN EARSS, ESAC, IPSE/HELICS
• First EU Antibiotic day

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DG SANCO Human Health

• EU Network for surveillance and control of
  communicable diseases
• (Decision 2119/98/EC)
• Antimicrobial Resistance
• Nosocomial Infections
• Surveillance of specific pathogens

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EU Public Health Programme 2003-2008

• EUCAST developing common methodology, case
  definitions and data to be collected for the
  surveillance on AMR
• ESAC monitoring the level of consumption of
  antibiotics in the EU.
• EARSS surveillance of AMR in the EU

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EU Public Health Programme 2003-2008

• IPSE development of guidelines and educational
  tools to better and effectively manage the risk
  of HCAI and AMR - Surveillance of AMR in
  intensive care units
• ABS INTERNATIONAL implementing strategies for
  the appropriate use of antibiotics in hospitals
• BURDEN information (morbidity, mortality and
  economic impact) on the burden of disease and
  resistance across Europe
• E-Bug development of educational programmes on
  antibiotics in schools

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EU Public Health Programme 2008-2013

• Work plan 2008 "Improve citizen's health
  security"
• Promotion of risk assessment thematic networks
  for exchange and collaboration on critical issues
  (AMR)

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Community Strategy against AMR

• Council recommendation on the prudent use of
  antimicrobial agents in human medicine 2001
• Intersectoral mechanism
• Strategies towards the prudent use
• Surveillance Systems on usage of ATB and AMR
• Control and preventive measures
• Promote education and training of HCW and Inform
  the general public
• First implementation report 2005
• Commission staff working document

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First implementation report

• Appropriate Intersectoral Mechanism
• Development of Strategies and action plans
• Lack of data at lower level feedback to
  prescribers
• Collaboration human/animal health
• Ban OTC/Self medication
• Prescription guidelines monitoring impact
• Hygiene and infection standards in health care
  institutions
• Enlarge surveillance activities to antivirals and
  antiparasitic agents
• Campaigns toward the general public

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Planned Actions in Human Health

• Second implementation report on the Council
  recommendation on the prudent use of
  antimicrobial agents in human medicine (2009)

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Planned EU Actions in Human Health

• Patient safety proposal
• Commission Communication on Patient Safety
• Council Recommendation on
• patient safety and quality of health services
• the prevention and control of healthcare
  associated infections

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Recommendation on HCAI

• Healthcare-associated infections (HCAIs) affect
  an estimated 4.1 million patients and cause an
  estimated 37,000 deaths in the EU every year.
• HCAIs lead to increase in length of stay,
  illness, mortality and costs.
• Infections caused by these pathogens are often
  difficult to treat due to antimicrobial
  resistance (Council Recommendation 2002/77/EC).
• Organisational and behavioural changes are needed
  to make an impact.
• Studies and impact assessments show that
  intervening is cost-effective !
• However, a strong political commitment is needed
  !!!
• ?
• EU initiative for a proposal for a Council
  Recommendation

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Content of recommendation on the prevention and
control of HCAIs national level

• At the national level
• National strategy for prevention and control of
  HCAIs
• National dedicated multidisciplinary Committee
  for implementation of national strategy
• Senior management of healthcare institutions bear
  responsibility for quality of care
• Recommended objectives of national strategy
• Implement control and preventive measures.
• Organise infection prevention and control
  programmes.
• Establish or strengthen active surveillance
  systems on HCAIs.
• Foster education, training, research and
  information exchange.

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Content of recommendations on the prevention and
control of HCAIs EU level

• Facilitate mutual information, consultation,
  cooperation and action.
• Develop scientific guidance (ECDC).
• Consider with Member States how to publicly
  report data on HCAIs.
• Strategies for reduction of exposure of
  healthcare staff to HCAIs ( safety at work).
• Funding research.
• Cooperation with WHO and others.
• Revise/update recommendations.
• Submit regular implementation reports to the
  Council, on the basis of Member States reports
  on their follow-up to the Council Recommendation.

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EU action plan to fight TB

• MDR and XDR TB
• Framework action plan published next week
• Next step
• Who does what ?
• timetable
• indicators

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AMR on the political agenda

• Council conclusions on AMR
• Community
• Hospital
• New antibiotics
• .

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Thank you for your attention! Commissi
on Public Health website http//ec.europa.eu/heal
th/index_en.htm EU Health Portal
http//ec.europa.eu/health-eu