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Summary Background Gonorrhoea and antimicrobial resistance (AMR) in Neisseria gonorrhoeae are major health concerns globally. Increased global surveillance of gonococcal AMR is essential. We aimed to describe the 2017–18 data from WHO's global gonococcal AMR surveillance, and to discuss priorities essential for the effective management and control of gonorrhoea. Methods We did a retrospective observational study of the AMR data of gonococcal isolates reported to WHO by 73 countries in 2017–18. WHO recommends that each country collects at least 100 gonococcal isolates per year, and that quantitative methods to determine the minimum inhibitory concentration of antimicrobials, interpreted by internationally standardised resistance breakpoints, are used. Findings In 2017–18, 73 countries provided AMR data for one or more drug. Decreased susceptibility or resistance to ceftriaxone was reported by 21 (31%) of 68 reporting countries and to cefixime by 24 (47%) of 51 reporting countries. Resistance to azithromycin was reported by 51 (84%) of 61 reporting countries and to ciprofloxacin by all 70 (100%) reporting countries. The annual proportion of decreased susceptibility or resistance across countries was 0–21% to ceftriaxone and 0–22% to cefixime, and that of resistance was 0–60% to azithromycin and 0–100% to ciprofloxacin. The number of countries reporting gonococcal AMR and resistant isolates, and the number of examined isolates, have increased since 2015–16. Surveillance remains scarce in central America and the Caribbean and eastern Europe, and in the WHO African, Eastern Mediterranean, and South-East Asian regions. Interpretation In many countries, ciprofloxacin resistance was exceedingly high, azithromycin resistance was increasing, and decreased susceptibility or resistance to ceftriaxone and cefixime continued to emerge. WHO's global surveillance of gonococcal AMR needs to expand internationally to provide imperative data for national and international management guidelines and public health policies. Improved prevention, early diagnosis, treatment of index patients and partners, enhanced surveillance (eg, infection, AMR, treatment failures, and antimicrobial use or misuse), and increased knowledge on antimicrobial selection, stewardship, and pharmacokinetics or pharmacodynamics are essential. The development of rapid, accurate, and affordable point-of-care gonococcal diagnostic tests, new antimicrobials, and gonococcal vaccines is imperative. Funding None.

The purpose of the study is to perform a detailed statistical analysis of passenger traffic flows at stops of various bus routes in the city of Krasnoyarsk. The authors used the following methods: spectral analysis, factor analysis, correlation and cross-correlation analyses. During the study, indicators of passenger traffic irregularity in time and direction in Krasnoyarsk were obtained. The authors established a rather inertial nature of passenger traffic, with a positive correlation of up to two weeks, indicating stable patterns that can be predicted. The spectral analysis revealed three peaks in passenger traffic seasonality. The correlation and cross-correlation analyses showed strong relationships between inter-stop passenger traffic flows. The factor analysis made it possible to determine that only one principal component can provide 65% of information about the entire passenger traffic volume on urban public transport routes.

SynopsisObjectivesThe COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control.MethodsFrom October-December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire including Likert-scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed, and free-text questions were thematically analysed.ResultsSeventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; pConclusionsThis was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses revealed universal patterns but also captured country variability. Although focus is understandably on COVID-19, gains in detecting and controlling AMR, a global health priority, cannot afford to be lost.

A major issue in the surveillance of antimicrobial resistance (AMR) is “de-duplication” or removal of repeated isolates, for which there exist multiple methods. The World Health Organization (WHO) Global Antimicrobial Resistance Surveillance System (GLASS) requires de-duplication by selecting only the first isolate of a given bacterial species per patient per surveillance period per specimen type per age group, gender, and infection origin stratification. However, no study on the comparative application of this method has been reported. The objective of this study was to evaluate differences in data tabulation between the WHO GLASS and the Japan Nosocomial Infections Surveillance (JANIS) system, which counts both patients and isolates after removing repeated isolates of the same bacterial species per multiresistance phenotype isolated from a patient within 30 days, regardless of specimen type. All bacterial data, consisting of approximately 8 million samples from 1795 Japanese hospitals in 2017 were exported from the JANIS database, and were tabulated using either the de-duplication algorithm of GLASS, or JANIS. We compared the tabulated results of the total number of patients whose blood and urine cultures were taken and of the percentage of resistant isolates of Escherichia coli for each priority antibiotic. The number of patients per specimen type tabulated by the JANIS method was always smaller than that of GLASS. There was a small (< 3%) difference in the percentage of resistance of E. coli for any antibiotic between the two methods in both out- and inpatient settings and blood and urine isolates. The two tabulation methods did not show considerable differences in terms of the tabulated percentages of resistance for E. coli. We further discuss how the use of GLASS tabulations to create a public software and website that could help to facilitate the understanding of and treatment against AMR.

The purpose of the research is to determine the etiopathogenesis of reproductive dysfunction in highly productive cows. For this, one group of cows was formed on the principle of paranalogs in the amount of 37 animals inseminated in the first sexual hunt after calving, followed by taking blood samples from them using the Monovet system, considering the duration of pregnancy. During the start-up period, blood was taken 1–4 days before calving and on the first day after calving. A total of 253 blood samples were examined. Subsequently, depending on the effectiveness of insemination, animals were divided into two groups. The first group included inseminated cows after the first insemination (20 animals), the second group included 17 unfertilized cows after the first insemination. Subsequently, blood was taken from animals considering the course of childbirth and the postpartum period. Blood counts were studied according to generally accepted methods using certified equipment. The study found that at an early stage of pregnancy, cows have a significant difference in lipid metabolism and in their peroxidation, in the state of antioxidant systems compared to unstable animals. In the process of pregnancy development in cows, there is a decrease in the level of total lipids and their class, and the accumulation of products of transoxidation of lipids is reduced. In animals with retention of the placenta, a low lipid metabolism and a higher level of peroxidation were established already in the dry period. After calving, this difference increases. The obtained data can be used to develop an algorithm for the prevention of postpartum complications in cows by using substances with antioxidant properties.

COACH working group.-- The paper is based on the discussion during the annual meeting of the EPI-Net project in Verona in September 2018., [Objectives] To systematically summarize the evidence on how to collect, analyse and report antimicrobial resistance (AMR) surveillance data to inform antimicrobial stewardship (AMS) teams providing guidance on empirical antibiotic treatment in healthcare settings., [Methods] The research group identified 10 key questions about the link between AMR surveillance and AMS using a checklist of 9 elements for good practice in health research priority settings and a modified 3D combined approach matrix, and conducted a systematic review of published original studies and guidelines on the link between AMR surveillance and AMS., [Results] The questions identified focused on AMS team composition; minimum infrastructure requirements for AMR surveillance; organisms, samples and susceptibility patterns to report; data stratification strategies; reporting frequency; resistance thresholds to drive empirical therapy; surveillance in high-risk hospital units, long-term care, outpatient and veterinary settings; and surveillance data from other countries. Twenty guidelines and seven original studies on the implementation of AMR surveillance as part of an AMS programme were included in the literature review., [Conclusions] The evidence summarized in this review provides a useful basis for a more integrated process of developing procedures to report AMR surveillance data to drive AMS interventions. These procedures should be extended to settings outside the acute-care institutions, such as long-term care, outpatient and veterinary. Without proper AMR surveillance, implementation of AMS policies cannot contribute effectively to the fight against MDR pathogens and may even worsen the burden of adverse events from such interventions.

The aim was to study efficiency of Azoxivet (azoximer bromid) for prevention of cows’ postnatal diseases and indirect influence on calves’ growth. Groups of pregnant Holstein cows (> 6000 kg per lactation) were formed (G1,G2,G3). Cows of G1 (n = 20) received Azoxivet intramuscularly once at 7 days prior to expected date of calving at a dose 24 mg. G2 (n = 20) - 24 mg at 14 and 7 days prior to expected date of calving. G3 (n = 20) was control. Single application of Azoxivet at 7 days prior to calving doesn’t lead to lowering trouble of postnatal endometritis: this disease was registered at 60% cows of G1 and 65% cows of G3. In G2, endometritis was recorded only at 40% of animals. The density of the colostrum in of G1 and G2 was varied: 1060.0±3.1-1063.0±2.9 kg/m3, which exceeded the indicator of the G3 by 13–16 kg/m3 (P < 0.05). There was increased amount of whey proteins in colostrum obtained from cows of G1 and G2: the differences were 6.4% and 19.2% (P < 0.05). In the G3 it was 220.5 ± 12.6 g/l. The amount of total immunoglobulins in the colostrum in G1 was 159.7 ± 9.6 g/l, in G2 - 180.6 ± 4.0 g/l, that was higher than in the G 3 by 35.0% (P < 0.05). The incidence of calves received from cows of G1 and G2 was lower than 15%, than G3, and the safety to the 2-month age was 90–95% against 85% in G3. The average alive mass of 1 calf in G3 was 77.5±1.6 kg that was lower than in G1 by 5.7% (P < 0.05), in G2 – by 9.6% (P < 0.01). The mediated immune-correction with Azoxivet through the system of fetus-mother allows to reduce incidence, to increase viability of calves in the first 2 months of life.

In a Policy Forum, Teodora Wi and colleagues discuss the challenges of antimicrobial resistance in gonococci.

Objective: To determine the effect of a drug STEMB, which is a biostimulating tissue preparation based on chicken embryos, on the morpho-biochemical blood values of dry cows. Methods: The study was conducted on 60 Holstein cows, which were divided into three groups (group 1, group 2, and group 3), with 20 cows in each group. During the experiment, all animals in each group were subjected to the same condition of feeding and maintenance. The experimental animals were administered with the STEMB drug three times subcutaneously at an interval of 7 d within 30 d before calving. Group 1 were given 0.050 mL/kg body weight; group 2 were given 0.075 mL/kg body weight; group 3 were given 0.100 mL/kg body weight. Results: STEMB at 0.075 mL/kg body weight improved the blood cell composition, increasing the erythrocytes, hemoglobin, leukocytes, hemoglobin content, the total protein, albumins, alpha globulins, and gamma globulins. It reduced the beta-globulin index and provided a threshold level for the enzymes alanine aminotransferase, aspartate aminotransferase, and A, M, G immunoglobulins. Conclusions: Use of the STEMB drug with a dose of 0.075 mL/kg body weight given subcutaneously three times at an interval of 7 d within 30 d before delivery is optimal for the prevention of complications during calving and postpartum periods, thereby providing an improvement in the blood cell composition.

Healthcare workers (HCWs) are at increased risk of exposure to\udrespiratory pathogens and may transmit infection to vulnerable\udpatients. This study summarises a recent systematic review, which\udaimed to assess evidence that influenza or pneumococcal\udvaccination of HCWs provides indirect protection for those patients\udmost at risk of severe or complicated acute respiratory infection. A\udnumber of healthcare databases and sources of grey literature were\udsearched using a predefined strategy, and citations screened for\udeligibility in accordance with specified inclusion criteria. Risk of bias\udwas assessed using validated tools and results summarised\udqualitatively. Twenty papers were included in the final review, all of\udwhich considered influenza vaccination of HCW. As such, planned\udsubanalysis of pneumococcal vaccination was discarded. The\udmajority of primary research studies included (11/14) were\udconducted in long-term care facilities, but there was marked\udheterogeneity in terms of the population, intervention/exposure and\udoutcomes considered. Consistency in the direction of effect was\udobserved across several different outcome measures, suggesting that\udinfluenza vaccination of HCWs is likely to offer some protection.\udFurther evidence is, however, required from acute care settings.

The International Consortium for Prevention and Infection Control (ICPIC) organises a biannual conference (ICPIC) on various subjects related to infection prevention, treatment and control. During ICPIC 2015, held in Geneva in June 2015, a full one-day session focused on the 2014–2015 Ebola virus disease (EVD) outbreak in West Africa. This article is a non-exhaustive compilation of these discussions. It concentrates on lessons learned and imagining a way forward for the communities most affected by the epidemic. The reader can access video recordings of all lectures delivered during this one-day session, as referenced. Topics include the timeline of the international response, linkages between the dynamics of the epidemic and infection prevention and control, the importance of community engagement, and updates on virology, diagnosis, treatment and vaccination issues. The paper also includes discussions from public health, infectious diseases, critical care and infection control experts who cared for patients with EVD in Africa, in Europe, and in the United Sates and were involved in Ebola preparedness in both high- and low-resource settings and countries. This review concludes that too little is known about the pathogenesis and treatment of EVD, therefore basic and applied research in this area are urgently required. Furthermore, it is clear that epidemic preparedness needs to improve globally, in particular through the strengthening of health systems at local and national levels. There is a strong need for culturally sensitive approaches to public health which could be designed and delivered by social scientists and medical professionals working together. As of December 2015, this epidemic killed more than 11,000 people and infected more than 28,000; it has also generated more than 17,000 survivors and orphans, many of whom face somatic and psychological complications. The continued treatment and rehabilitation of these people is a public health priority, which also requires an integration of specific medical and social science approaches, not always available in West Africa.