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WORLD HEALTH DAY

NO ACTION TODAY, NO CURE TOMORROW,

World Health Day is celebrated every year on 7 April, under the sponsorship of the World Health Organization (WHO). In 1948, the World Health Organization held the First World Health Assembly. The Assembly decided to celebrate 7 April of each year, with effect from 1950, as the World Health Day. The World Health Day is held to mark WHO's founding, and is seen as an opportunity by the organization to draw worldwide attention to a subject of major importance to global health each year.

Current World Health Day

The theme of the current World Health Day, marked on 7 April 2011, is "Antimicrobial resistance and its global spread " and focuses on the need for governments and stakeholders to implement the policies and practices needed to prevent and counter the emergence of highly resistant microorganisms. World Health Day 2011 is dedicated to antimicrobial resistance, a major threat to patient care and disease control throughout the world. Antimicrobial resistance is a significant obstacle to success in controlling HIV, malaria and tuberculosisthree of the world's leading infectious killers. This serious problem also makes it more difficult to treat hospital-acquired infections,

9/20/2011MAGNUM RESOURSE CENTRE2 facilitates the emergence of "superbugs" that are resistant to major antibiotics, and creates the need for new, more expensive and more complex treatments. World Health Day 2011 seeks to raise awareness of factors that contribute to antimicrobial resistance, to build commitment to common solutions across diseases, and to encourage the implementation of policies and practices that can prevent and contain antimicrobial resistance.

Theme of World Health Day 2011

Alexander Flemings discovery of penicillin in 1928 greatly contributed to major advancements in pharmaceutical research. Our generation is witness to these breakthroughs that continue help save, improve and prolong lives. Now, the health care community and the patients depend on antimicrobials to treat infections caused by bacteria, viruses, fungi and parasites. But when there is antimicrobial or drug resistance, standard treatments such as antibiotics, antivirals and antimalarials become ineffective. This is the reason that the WHO has chosen the theme "ANTIMICROBIAL RESISTANCE: NO ACTION TODAY, NO CURE TOMORROW" for World Health Day (WHD) on April 7. Each year, the WHO chooses a pressing global health issue and spearheads international and national campaigns to address the concern.

Themes of World Health Days

2011: Anti-microbial resistance: no action today, no cure tomorrow 2010: Urbanization and health: make cities healthier 2009: Save lives, Make Hospitals Safe in Emergencies 2008: Protecting health from the adverse effects of climate change 2007: International health security 2006: Working together for health 2005: Make every mother and child count 2004: Road safety 2003: Shape the Future of Life: Healthy Environments for Children 2002: Move for Health 2001: Mental Health: Stop Exclusion, Dare to Care 2000: Safe Blood Start with Me 1999: Active Aging Makes the Difference 1998: Safe Motherhood 1997: Emerging Infectious Diseases 1996: Healthy Cities for Better Life 1995: Global Polio Eradication

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Antimicrobial agents
Antimicrobial agents are medicines used to treat infections caused by micro organisms, including bacteria, fungi, parasites and viruses. The discovery of antimicrobials is one of the most important advances in health in human history alleviating suffering from disease and saving billions of lives over the past 70 years. Antimicrobials include antibiotics, chemotherapeutic agents, antifungal, antiparasitic medicines and antiviral.

Antimicrobial resistance
Antimicrobial resistance also known as drug resistance occurs when microorganisms such as bacteria, viruses, fungi and parasites change in ways that render the medications used to cure the infections they cause ineffective. When the microorganisms become resistant to most antimicrobials they are often referred to as superbugs. This is a major concern because a resistant infection may kill, can spread to others, and imposes huge costs to individuals and society.

Antimicr obial r esistance Key facts

Infections caused by resistant microorganisms often fail to respond to conventional treatment, resulting in prolonged illness and greater risk of death. About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths. Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxine-pyrimethamine is widespread in most malaria-endemic countries. A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus . Inappropriate and irrational use of antimicrobial medicines provides favorable conditions for resistant microorganisms to emerge, spread and persist.

ANTIMICROBIAL RESISTANCE
Antimicrobial resistance (AMR) is resistance of a microorganism to an antimicrobial medicine to which it was previously sensitive. Resistant organisms (they include bacteria, viruses and some parasites) are able to withstand attack by antimicrobial medicines, such as antibiotics, antivirals, and antimalarials, so that standard treatments become ineffective and infections persist and may spread to others. AMR is a consequence of the use, particularly the misuse, of antimicrobial medicines and develops when a microorganism mutates or acquires a resistance gene.

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Antimicrobial Resistance A Global Concern

AMR kills
Infections caused by resistant microorganisms often fail to respond to the standard treatment, resulting in prolonged illness and greater risk of death.

AMR hampers the control of infectious diseases

AMR reduces the effectiveness of treatment because patients remain infectious for longer, thus potentially spreading resistant microorganisms to others.

AMR threatens a return to the pre-antibiotic era

Many infectious diseases risk becoming uncontrollable and could derail the progress made towards reaching the targets of the health-related United Nations Millennium Development Goals set for 2015.

AMR increases the costs of health care

When infections become resistant to first-line medicines, more expensive therapies must be used. The longer duration of illness and treatment, often in hospitals, increases health-care costs and the financial burden to families and societies.

AMR jeopardizes health-care gains to society

The achievements of modern medicine are put at risk by AMR. Without effective antimicrobials for care and prevention of infections, the success of treatments such as organ transplantation, cancer chemotherapy and major surgery would be compromised.

AMR threatens health security, and damages trade and economies

The growth of global trade and travel allows resistant microorganisms to be spread rapidly to distant countries and continents.

Facts on antimicrobial resistance

About 440 000 new cases of multidrug-resistant tuberculosis (MDR-TB) emerge annually, causing at least 150 000 deaths. Extensively drug-resistant tuberculosis (XDR-TB) has been reported in 64 countries to date. Resistance to earlier generation antimalarial medicines such as chloroquine and sulfadoxinepyrimethamine is widespread in most malaria-endemic countries. Falciparum malaria

9/20/2011MAGNUM RESOURSE CENTRE5 parasites resistant to artemisinins are emerging in South-East Asia; infections show delayed clearance after the start of treatment (indicating resistance). Percentage of patients with P. falciparum parasitaemia on day 3 after treatment with an artemisinin-based combination therapy (20062010) A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci. Resistance is an emerging concern for treatment of HIV infection, following the rapid expansion in access to antiretroviral medicines in recent years; national surveys are underway to detect and monitor resistance. Ciprofloxacin is the only antibiotic currently recommended by WHO for the management of bloody diarrhea due to Shigella organisms, now that widespread resistance has developed to other previously effective antibiotics. But rapidly increasing prevalence of resistance to ciprofloxacin is reducing the options for safe and efficacious treatment of shigellosis, particularly for children. New antibiotics suitable for oral use are badly needed. AMR has become a serious problem for treatment of gonorrhoea (caused by Neisseria gonorrhoeae), involving even "last-line" oral cephalosporins, and is increasing in prevalence worldwide. Untreatable gonococcal infections would result in increased rates of illness and death, thus reversing the gains made in the control of this sexually transmitted infection. New resistance mechanisms, such as the beta-lactamase NDM-1, have emerged among several gram-negative bacilli. This can render powerful antibiotics, which are often the last defence against multi-resistant strains of bacteria, ineffective.

What drives antimicrobial resistance?

Antimicrobial resistance is facilitated by the inappropriate use of medicines .Inappropriate and irrational use of medicines provides favorable conditions for resistant microorganisms to emerge and spread. For example, when patients do not take the full course of a prescribed antimicrobial or when poor quality antimicrobials are used, resistant microorganisms can emerge and spread. Underlying factors that drive AMR include:

Inadequate national commitment to a comprehensive and coordinated response, illdefined accountability and insufficient engagement of communities; Weak or absent surveillance and monitoring systems; Inadequate systems to ensure quality and uninterrupted supply of medicines Inappropriate and irrational use of medicines, including in animal husbandry: Poor infection prevention and control practices; Depleted arsenals of diagnostics, medicines and vaccines as well as insufficient research and development on new products.

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Low-quality medicines, Wrong prescriptions Poor infection control also encourages the development and spread of drug resistance. Lack of government commitment to address these issues, poor surveillance Treat and prevent also hinder the control of drug resistance When taking substandard doses or not finishing a prescribed course of treatment

Combat drug resistance: no action today, no cure tomorrow

The emergence of AMR is a complex problem driven by many interconnected factors; single, isolated interventions have little impact. A global and national multi-sectoral response is urgently needed to combat the growing threat of AMR.

WHO's response
WHO is engaged in guiding the response to AMR through.

Policy guidance, support for surveillance, technical assistance, knowledge generation and partnerships, including through disease prevention and control programmes; Essential medicines quality, supply and rational use; Infection prevention and control; Patient safety; Laboratory quality assurance.

WHO has selected combating antimicrobial resistance as the theme for World Health Day 2011? On this day, WHO issues an international call for concerted action to halt the spread of antimicrobial resistance and recommends a six-point policy package for governments. WHO calls on all key stakeholders, including policy-makers and planners, the public and patients, practitioners and prescribers, pharmacists and dispensers, and the pharmaceutical industry, to act and take responsibility for combating antimicrobial resistance.

Six-Point Policy Package

During the WHD 2011, the WHO will promote a six-point policy package to address AMR centering on Commitment, Accountability, Surveillance,

9/20/2011MAGNUM RESOURSE CENTRE7 Quality, Supply, Rational drug use, Infection control and empowerment. Most of us live longer and healthier lives today, partly because powerful and effective medicines known as antimicrobials are available to treat infectious diseases. Until the discovery and availability of antimicrobials in the 1940s, people died needlessly from infectious diseases. Today, none of us can imagine living in a world without antimicrobials. We are now on the brink of losing this precious arsenal of medicine. The use and misuse of antimicrobials in human medicine and animal husbandry over the past 70 years have increased the number and types of micro organisms resistant to these medicines, causing deaths, greater suffering and disability, and higher health-care costs. If this phenomenon continues unchecked, many infectious diseases risk becoming uncontrollable and could derail progress made towards reaching the health related United Nations Millennium Development Goals for 2015. Furthermore, the growth of global trade and travel allows resistant organisms to spread worldwide within hours. We should remember that single, isolated and divided efforts to combat AMR showed little gains. Hopefully, the WHD will serve as a wake-up call and a platform for a concerted plan of action by all the stakeholders.

CONTRIBUTED BY
MAGNUM RESOURSE CENTRE. DR SYED FAHIM AHMED
MBBS, MPH, MBA drsyedfahimahmed@hotmail.com drsyedfahimahmed@yahoo.com magnumresoursecentre@hotmail.com

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