Misuse of antimicrobials worldwide has accelerated the evolution of antimicrobial resistance (AMR). For instance, as much as 80 per cent of total consumption is used in livestock to promote growth or to treat and prevent illness. In many countries, antibiotics are available over the counter.

This has facilitated bacteria and other microorganisms to become resistant to the drugs that were once effective in treating them. These ‘superbugs’ were associated with 4.95 million deaths worldwide in 2019. Reports predict that by 2050, antimicrobial resistance could cause 10 million deaths each year and cost the world US$100 trillion.

Fortunately, many nations are taking decisive steps to control what the WHO calls a “silent pandemic.” Acknowledging the gravity of the situation, high-income countries such as the U.S. and Canada have implemented robust plans encompassing surveillance, stewardship and policy reforms.

These efforts should undoubtedly be applauded. However, an important principle of the One Health approach, often neglected, is that this is a global problem, and global collaboration should be prioritized. Low- and middle-income countries bear a disproportionate burden and require increased resource mobilization, knowledge sharing and international co-operation.

As a doctoral researcher, I study the evolution of antimicrobial resistance in bacteria. As an immigrant from Mexico, I am deeply concerned with the disparity observed between high-income and low- and middle-income countries.

For instance, there have been great efforts to regulate antibiotic consumption in many high-income countries, where antibiotic use in livestock has decreased and antibiotics are only accessible under prescription.

While there is still room for improvement in these more affluent nations, there is a less encouraging reality in some LMICs, where antibiotics are usually obtained easily without prescriptions and sometimes used as a way to compensate for the difficulty of accessing health-care professionals.

Likewise, in some LMICs, antibiotic use in animals is predicted to double by 2030 compared to the last decade.

A recent report exploring the burden of antimicrobial resistance in the Americas in 2019 showed the “multiple realities” of the problem. Not surprisingly, by 2019 the four countries with the lowest AMR-linked mortality rates (age-standardized) each had a financed national action plan to combat it, while none of the 10 countries with the highest mortality rates did.

Strikingly, UNICEF reports that more than half of the world’s population does not have access to safe sanitation and more than 2.2 billion people still don’t have access to safe drinking water. This is extremely concerning for a variety of reasons, but good sanitation and hygiene are critical to limiting the spread of microbes and reducing the risk of infection.

The current approach taken by most high-income countries is the equivalent of sheltering in the attic, making sure the fire alarm works correctly, while the basement is on fire.

Resistant bacteria can evolve anywhere. Even if some countries manage to control the problem within their borders, the risk remains. Resistant bacteria or genes that allow bacteria to grow in the presence of the antibiotic can spread across countries through various means, including travel, immigration, trade and even natural processes like water and air circulation.

Such is the case of the resistance gene NDM-1, which was first described in 2009. Only five years after the initial report, this resistance gene was present in virtually the whole world.

It is crucial for nations to enhance communication channels and promote education regarding antimicrobial resistance in several sectors, including the general public, health care providers, farmers and veterinarians. In addition to this, there is a pressing need to establish robust surveillance systems that can promptly detect outbreaks and enable swift action.

Effective cross-border communication could be realized through standardizing surveillance systems. This would enable accurate comparisons of results between countries.

Moreover, it facilitates the sharing of valuable resources, equipment, qualified personnel and access to training opportunities.

Both high-income and LMICs should collaborate to implement measures aimed at reducing infection rates, such as improved sanitation practices. This collaboration encourages the exchange of knowledge and expertise, enabling the adoption of best practices globally.

The United Kingdom government set a good example in August, when it allocated about $360 million to tackle AMR across Asia and Africa over the next three years, understanding that this threat cannot be fought from its own trenches.

These resources will increase surveillance in 25 countries where the AMR threat is highest, and will also be used to upgrade laboratories and strengthen the health workforce in those countries.

To effectively combat AMR, global co-operation is not a luxury but a necessity. High-income countries must recognize their responsibility to support LMICs in addressing this crisis. By sharing resources, knowledge and expertise, we can collectively mitigate the threat.

– This article first appeared in the Conversation, by Reuters.

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In the U.S. at the turn of the century, it was tuberculosis, as per the American Lung Association.

Tuberculosis and its cousin bovine tuberculosis (which also infects humans) are lung-attacking, potentially deadly diseases that humankind has been wrestling with for millennia.

Analysis of Egyptian mummies from 2400 BCE have shown skeletal deformities typical of the disease, according to a 2017 article in the Journal of Preventive Medicine and Hygiene.

History and classic literature is rife with references to TB’s archaic name, consumption. A quick internet search of “famous people who died of tuberculosis,” will unearth a list of kings, actors, actresses, writers, poets and many others. Fantine dies of it in Les Misérables. In Anne of the Island, the titular character’s friend is dying from “galloping consumption.”

TB “has always been a permanent challenge over the course of human history,” the same 2017 article said.

By the end of the 19th century, an estimated 70 to 90 per cent of the urban populations of Europe and North America were infected with the tuberculosis bacillus, according to one Harvard article. Not everyone who encountered the bacteria would get sick but of those that did, about 80 per cent died.

Stop spitting on the sidewalk

Tuberculosis was previously thought to be hereditary, the Harvard article said. In 1882, researcher Robert Koch identified the bacteria tuberculosis bacillus, which helped convince the medical community it was contagious.

“Preventing the spread of tuberculosis became the motivation for some of the first large-scale public health campaigns,” the article said.

TB can be transmitted from human to human, such as through saliva. The American Lung Association, which formed in 1904 to combat TB, wrote that one of its most successful prevention campaigns involved getting people to stop spitting on sidewalks. Good personal hygiene was also promoted.

Isolation of sick people in “sanitoriums” also became widespread.

One such institution was established in Ninette. Today it’s considered a historic site but in 1929, the staff there were in charge of Manitoba’s campaign to eradicate TB, according to an article from the Manitoba Historical Society.

During the 1940s and 1950s, treatment of TB with drugs made great strides and by the 1960s, pharmacological and surgical treatment had become the rule, the same article said. The sanitorium closed in 1972.

That’s recent enough that one of the Beatles, Ringo Starr, contracted TB as a teenager and spent two years recovering in a sanitorium, a San Diego Union Tribune article said.

No more raw milk

People were also getting TB from cattle, whether through direct contact or from eating and handling raw meat and milk. It became one of the reasons behind milk pasteurization.

“Typhoid and scarlet fever, diphtheria, tuberculosis and various diarrheal diseases were all capable of being transmitted through the consumption of milk,” said an article from McGill University’s Office for Science and Society.

The article said that one in every four infants in New York City died in 1891, many from drinking tainted milk. That dropped to about one in 14 when pasteurization was introduced.

Again, Robert Koch had a hand in eradication. He invented tuberculin, a serum derived from cultures of tuberculosis bacillus. When injected under the skin of a person or animal, swelling occurs if the patient has been exposed to TB.

When Canada first adopted bovine TB control measures in 1896, it was through free testing of herds with tuberculin, wrote Orlan Hall in the 1939 article “Progress of Tuberculosis Eradication in Canada.”

TB today is rare in Canada, although the Canadian government notes that a disproportionate number of the country’s 1,829 active TB cases in 2021 occurred in populations struggling with poverty and other socio-economic challenges.

On the bovine side, Canada is considered free of bovine TB, but cases still emerge, such as at least 32 confirmed cases this year related to a Saskatchewan herd.

Globally, 2022 saw 10.6 million human cases, including 1.3 million deaths.

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Why it matters: HPAI has killed or led to the cull of 58.84 million domestic birds in the U.S. since the start of 2022 and 7.77 million in Canada since late 2021.

North Dakota itself has had no positive domestic cases since April. Manitoba, the state’s closest northern neighbour, last saw HPAI in November, as of the time of writing.

The same cannot be said elsewhere in the U.S. and Canada. Although case numbers pale in comparison to the peaks of 2022, three states in the U.S. (South Dakota, Idaho and New Jersey) confirmed infections since the start of September, affecting about half a million domestic birds. The number is mostly attributed to a single infected turkey operation in South Dakota, according to the U.S. Department of Agriculture.

The Canadian Food Inspection Agency has confirmed six cases since the start of September, five in Alberta and one in Saskatchewan.

NDSU staff warn that the risk of transmission will increase as fall migration continues.

Hunters take heed

Hunters should be aware of the risk of HPAI in wildlife and use measures to prevent spread to domestic poultry. They should also watch for birds with neurological symptoms that might signal infection.

Dr. Gerald Stokka, NDSU Extension veterinarian and livestock stewardship specialist, noted the increase of exposure risk for hunters.

“Hunters should dress game birds in the field when possible and practice good biosecurity to prevent any potential disease spread,” he said.

They should also avoid eating, drinking or smoking while cleaning game and beware of letting blood or other fluids contact their own eyes, mouth or nose, according to the North Dakota Game and Fish Department. Hands, utensils and other surfaces should be washed with hot, soapy water after cleaning is done.

“There is no evidence that anyone has contracted the virus from eating a fully cooked bird, either domestic or wild,” said Julie Garden-Robinson, NDSU Extension food and nutrition specialist, noting that, whether there’s a risk of bird flu or not, any wild meat should be cooked to an internal temperature of 165 F.

Dogs participating in the hunt don’t have a big risk of contracting HPAI, “however, there have been documented cases of dogs transmitting HPAI to domestic flocks,” Stokka said. “If your dog has interacted with wildlife, take measures to keep them away from poultry.”

“According to the Centers for Disease Control and Prevention, the public health risk from the current HPAI outbreak is low,” said Miranda Meehan, NDSU Extension livestock environmental stewardship specialist. “People should not handle dead wild birds and also should avoid transporting sick or dead birds.

“If you hunt and have domestic poultry and birds, do not wear hunting clothes while you are in with your birds,” she added. “Infected birds shed bird flu viruses in their saliva, mucous and feces.”

HPAI symptoms

One of the first clinical signs of the illness in domestic birds is sudden, unexplained death. Most farms with HPAI report a drop in water consumption up to 72 hours prior to the unexplained death.

In laying barns, decreased egg production and depression are signs. Purple or dry combs, being quieter than normal, frequent lying down and swelling around eyes are other symptoms.

Chickens and turkeys are most susceptible to HPAI. Waterfowl such as geese and ducks carry the virus and spread it to other birds.

“The best defence against HPAI is having a biosecurity plan in place,” said Mary Keena, NDSU Extension livestock environmental management specialist. “A biosecurity plan is critical in protecting your birds. It is your job as a flock owner to create a line of separation between your clean flock and the potential unclean issues that wildlife or visitors may bring.”

Keep out the wild

Non-lethal methods to deter wild birds are available on the U.S. Department of Agriculture’s wildlife damage webpage: https://bit.ly/deter-wild-birds.

Producers can also discourage wild birds by cleaning up litter and spilled feed around domestic poultry housing.

If anyone on a poultry farm comes in contact with or handles wild birds, they should change into clean clothes, wash their hands and disinfect footwear prior to contact with domestic birds.

Sick or deceased wild birds should be reported to local conservation staff.

Flock-to-flock

Industry can also take steps to avoid spreading HPAI between domestic flocks.

Keep distance from other flocks and restrict access to property and birds. Allow contact from people who care for the birds but minimize visitors.

If a producer has been near other poultry or poultry owners, such as at feed stores, car and truck tires should be cleaned and disinfected.

New birds should be kept separate from the rest of the flock for at least 30 days.

Shared lawn and garden equipment, tools or poultry supplies between neighbours or farms are also possible vectors.

– With files from Alexis Stockford

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Manitoba poultry farmers were on high alert after wild birds in two locations tested positive for the avian flu strain H5N1. On April 20, the province confirmed the virus in samples taken from snow geese near Waskada as well as a bald eagle near Dauphin.

Days later, the Canadian Food Inspection Agency (CFIA) announced the first farm case. A poultry flock in the Municipality of Whitemouth, east of Winnipeg, had tested positive for highly pathogenic avian influenza.

Why it matters: Neighbouring states and provinces in three directions from Manitoba are reporting increasing H5N1 infections on farms.

Manitoba had been at the centre of a slowly closing area not affected by an international outbreak of H5N1. 

• Read more: Managing Manitoba’s growing animal disease watch list
• Read more: Spring planting work can kick up avian flu, feather sector warns

Jake Wiebe, chair of the Manitoba Chicken Producers, said they are urging members to lock down biosecurity practices, including changing foot ware upon barn entry and vigilant disinfection.

The sector limits access to the vicinity of barns “generally, but certainly other than service or feed trucks, we really don’t want anyone in that area,” he said.

The bigger concern, he added, are backyard flocks. 

Migratory birds are the main vector for HPAI, one of the issues that makes controlling the disease difficult. Backyard flocks, meanwhile are often at most risk, given more their common access to the outdoors, and thus greater chance of direct contact with infected birds. 

Should a small flock become infected, “it affects all of us,” Wiebe said. “because suddenly we’re in a risk zone.”

Backyard and free-range flock owners are being urged to keep birds inside to reduce risk, Manitoba Egg Farmers vice-chair Harold Froese said.

They have released similar messaging as the Manitoba Chicken Producers to their members. Biosecurity and vigilance has been stressed, while producers have also been urged to monitor and follow reporting protocols, should they suspect their birds are ill.

“We encourage farmers to watch their contacts with their neighbours, other people in the area, just to reduce the risk,” Froese said. “These migratory bird patterns happen every year, so it’s just something that we have to be prepared for.”

At the time of writing, no infected farms had been reported, according to Dr. Scott Zaari, chief veterinary officer for the province. He said, however, that his office is expecting to report more wild cases in the coming weeks and months.

In the U.S., circumstances since early 2022 have morphed into the worst HPAI outbreak in years. As of April 25, the U.S. Department of Agriculture estimated that almost 31.7 million commercial birds had been affected. North Dakota infections counted 13 premises.

Canadian farm cases spread from the Maritimes in late 2021 into Ontario, and then on to Quebec, British Columbia, Alberta and Saskatchewan. 

As of April 21 (the most recent update available), CFIA reported 35 premises infected nationwide – including one near Douglaston, Sask., half an hour from the Manitoba border—impacting over 717,000 birds. Since then, three more cases in Saskatchewan, four in Alberta, two in Ontario and one in Quebec have been reported.

Outside ag

The cases come during Manitoba’s spring hunting season for wild turkey and several species of geese. Maria Arlt, director of the province’s fish and wildlife branch, urged hunters and other members of the public to take care.

The risk of bird-to-human transmission is low, she said, but still urged people to avoid touching dead birds and wear gloves if contact is necessary. Masks and protective eyewear were also encouraged, she said, and hands should be washed or sanitized afterwards.

Bird feeders still get the green light for most people, although they should be regularly cleaned, she said. Poultry farm residents, however, should take feeders down.  

The public is being asked to report suspicious bird deaths. Clusters of six or more dead waterfowl, any dead raptors, any scavengers like gulls or ravens or large numbers (20 or more) of any kind of dead bird should be reported at 1-800-782-0076.

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