Threat of Antimicrobial Resistance & U.S. Antibiotic Awareness Week  

November 18-24th is U.S. Antibiotic Awareness Week (USAAW), an annual observance that raises awareness of the threat of antibiotic resistance, the importance of appropriate antibiotic and antifungal use, and the threat of antimicrobial resistance (AMR) across the One Health spectrum. One Heath is a collaborative and multidisciplinary approach across local, regional, national, and global levels to achieve optimal health outcomes specifically recognizing that the health of people is intricately connected to the health of animals, plants, and our shared environment.  

Any time antibiotics or antifungals are used, they can cause downstream effects and contribute to the development of AMR, one of the most urgent threats to the public’s health. More than 2.8 million AMR infections occur in the U.S. each year, over 35,000 of which result in death. Many more individuals who are infected with AMR die from related complications.  

Importance of One Health at the Local Level 

There are many ways local health departments (LHDs) across the U.S. can respond to AMR and promote stewardship. LHDs collect and analyze data to identify outbreaks, investigate reportable diseases, and prevent the spread of infections in community and healthcare settings. They are in a unique position to facilitate coordination among agencies to improve antimicrobial stewardship and prevent the spread of resistant organisms. NACCHO spoke with two LHDs, the Chicago Department of Public Health (CDPH) and the New York City Department of Health and Mental Hygiene (NYC DOHMH), to learn how each LHD has taken a One Health approach to tackling AMR in their community. 

One Health Approach in the City of Chicago 

CDPH’s One Health Team consists of two veterinarians, two infectious disease physicians, and healthcare-associated infections (HAI) team members, including a pharmacist, who are passionate about efforts to reduce AMR. While there are no personnel dedicated to One Health, CDPH emphasizes that the ability to regularly convene colleagues with shared vision and goals across sectors has been critical in identifying One Health priorities and effective strategies for project implementation.  

In May, CDPH held their first One Health meeting focused on AMR, in which both human and animal healthcare providers convened to discuss why AMR must be addressed from a One Health approach and to understand the shared stewardship challenges across the human and veterinary health fields. From that discussion, CDPH identified the AMR-related needs specific to their healthcare communities and was able to define the goals for their first One Health project.  

Goal 1:

The need for improved information to make informed decisions (e.g., AMR surveillance system, treatment guidelines with a stewardship lens for common infectious diseases). 

Goal 2:

The need for better public awareness about the challenges of antimicrobial stewardship. 

CDPH now holds regular meetings to track and identify their AMR projects using a One Health scope. Projects CDPH is conducting to address these priority issues include implementation of a survey to assess stewardship efforts in clinical settings and planning for a continuing education event aimed at both human and veterinary healthcare providers. A core challenge CDPH experiences in their efforts is that AMR surveillance systems either do not exist or are not as robust in veterinary and environmental sectors as they are in human medicine, and further collaboration with partners is needed to obtain the data to do the work.  

CDPH’s initial survey of local veterinary providers showed that there is a strong interest in the community about AMR, but there is still limited information to help veterinarians make prescribing decisions. Next steps in CDPH’s One Health approach includes convening a larger group of experts in environmental and human health to identify short-term and long-term achievable objectives in Spring 2024. Funding from their HAI Program will also jump start interventions in the outpatient space, including stewardship in immediate care settings and outpatient prescribing practices across the city. However, more sustainable funding and dedicated staff would allow for a stronger One Health program beyond small projects.  

“It is important to remember that while there is so much work to do in this field and it can feel overwhelming to get started, initiating small and manageable projects that complement existing work can be a great place to begin.”

– CDPH staff

One Health Approach in New York City   

The New York City (NYC) Health Department’s One Health Team is embedded within the Antimicrobial Resistance Unit under the Bureau of Communicable Diseases in the Division of Disease Control at the New York City Department of Health and Mental Hygiene. Their One Health Team is comprised of two epidemiology-trained veterinarians and is supported by AMR Unit colleagues with infectious disease, infection prevention and surveillance data expertise. The One Health Team also works closely with colleagues in other groups, such as those within the Zoonotic and Vector-borne Diseases Unit and the Bureau of Epidemiology Services. The Zoonotic and Vector-borne Diseases Unit have fostered a strong network of veterinary professionals by creating the New York City Veterinary Health Alert System as well as the New York City One Health Animal Working Group. The cross-team collaborations and the partnerships already in place between veterinary colleagues and the LHD were tremendously helpful as the One Health Team began to lay the foundation of their work by connecting with potential stakeholders about AMR related projects.  

“There are some really great One Health activities being conducted across the country, led by or in collaboration with public health entities. I would love to see greater coordination, so that we can collectively work smarter and not harder.”

– NYC DOHMH staff

One of the One Health Team’s highest priorities is to establish surveillance and data streams to better understand the occurrence and transmission of antibiotic-resistant bacteria that are urgent threats to public health in NYC animals, such as carbapenem-resistant organisms (CROs). In addition, they want to learn from different communities of NYC animal health professionals about their experiences in infection prevention and antimicrobial stewardship so they can provide resources and support to prevent and control the spread of antibiotic resistant bacteria in animal care settings.    

The One Health Team continues to partner with multiple laboratories including commercial veterinary diagnostic laboratories to request retrospective companion animal antimicrobial susceptibility data. They are also exploring opportunities to increase molecular characterization of CROs when they are identified from NYC animals. In an exciting development, the Division of Disease Control has officially proposed amending the NYC Health Code to require CROs found in animals to be reported to the health department. This additional data would improve the One Health Team’s ability to identify and respond to these threats. This proposal was published for public comment and is waiting for the Board of Health to consider adopting at its next meeting. 

 
Lessons learned and advice from the NYC One Health Team to improve One Health policies and practices in the community include: 

• Reinforcing the importance of engaging in clear communication with stakeholders;  
• Practicing inclusiveness and open communication with both internal and external partners to understand each stakeholder’s interests, reasons for collaboration, and limits to participating; and 
• Ensuring the right people are included in the conversation and providing the opportunity for them to contribute early on—communication is paramount to the One Health approach. 

“We aim to strengthen awareness and partnerships on antimicrobial resistance with not only  the Health Department and NYC veterinary professionals, but also to generate more collaboration,  knowledge-sharing, and cross pollination between the human, animal, and environmental sectors more broadly. We are brainstorming and thinking through exciting projects to help facilitate this type of  collaboration in the future.”

– NYC DOHMH staff 

NACCHO Policy Statement 

NACCHO’s policy statements reflect the voice of LHDs regarding key policy issues on the federal level. The statements are developed by LHD staff who are members of subject matter expert workgroups convened by NACCHO. They contain the latest scientific data and public health approaches on a wide range of topics. NACCHO uses these policy statements to represent the perspectives of LHDs through the advocacy activities conducted by NACCHO’s Government Affairs team. 

Given the growing role of LHDs in combatting AMR, NACCHO recognizes that a collaborative One Health approach between LHDs and national, state, and local antibiotic resistance stakeholders is vital to combat AMR. NACCHO is in the process of updating its 12-09, Antimicrobials in Animals policy statement to reflect more of a One Health approach. This policy statement reinforces the importance of reducing the spread of AMR, while protecting the health of animals. If you are familiar with the topics discussed in the policy statement and are interested in supporting the updating and review process to reflect current One Health priorities, please contact Kimberly Nalley at [email protected]. 

Resources 

• Join “Go Purple for USAAW” to show support of USAAW and follow social media conversations on @CDC_AR. Individuals, organizations, and communities are invited to wear purple or light up a landmark or building of their choice in purple to honor survivors and people impacted by antibiotic resistance and promote appropriate use of antibiotics and antifungals. 
• Find more ways to participate using the U.S. Antibiotic Awareness Week webpage and the 2023 USAAW Partner Toolkit for key messages, sample social media posts, and graphics.  
• The updated Be Antibiotics Aware Partner Toolkit provides additional resources for patients, families, and healthcare professionals. 
• Health Equity and Antibiotic Prescribing in the United States: A Systematic Scoping Review report showed clinician antibiotic prescribing behavior varied by patient and clinician characteristics, such as patient’s race and ethnicity, socioeconomic factors, and healthcare setting. These findings further emphasize the importance of integrating health equity into antibiotic stewardship policies, practices, and research.

We’d like to thank the following LHD individuals for helping us tell this story:

CDPH: Dr. Stephanie Black, Dr. Michelle Funk, Dr. Janna Kerins, and Dr. Do Young Kim

NYC DOHMH: Karen Alroy, Will Greendyke, Caroline Habrun, and Elise Mantell