AMR Awareness November 2023
World AMR Awareness Week runs from the 18th to the 24th November 2023 and links with the European Antibiotic Awareness Day (EAAD), a European health initiative coordinated by the European Centre for Disease Prevention and Control (ECDC) on the 18th November. According to the World Health Organization, antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity. It occurs when bacteria, viruses, fungi and parasites change over time so that they no longer respond to medicines. Infections become harder to treat and more likely to result in severe illness and death. There is also an increased risk of disease spread, which is particularly pertinent to detained settings. Following the pandemic, we are all very aware now of how rapidly infectious diseases can spread in crowded, confined, poorly ventilated spaces.
Below, Professor Diane Ashiru-Oredope and Dr Clare Oliver-Williams from the UK Health Security Agency, outline work going on in English prisons on AMR.
Antimicrobial resistance in prisons: How UK Health Security Agency is working to tackle the threat
The UK Health Security Agency (UKHSA) is heavily invested in tackling antimicrobial resistance. It has developed the ESPAUR (English Surveillance Programme for Antimicrobial Utilisation and Resistance) programme and report in 2013 to improve the surveillance of antimicrobial resistance and antimicrobial use. The report also includes national data on antimicrobial stewardship implementation, and awareness activities to improve antimicrobial use by healthcare workers and the public.
The national annual ESPAUR report outlines the scale of the antimicrobial resistance. In the most recent report, it highlighted variations in antimicrobial resistant infections across the country and differences between different demographic groups.
One group of people who may be vulnerable to resistant infections are individuals in contact with the criminal justice system. Infections are common in prisons and places of detention, including Immigration Removal Centres. This includes tuberculosis (TB), dental infections, HIV, sexually transmitted infections, COVID-19, and more. Therefore, antimicrobials are frequently prescribed in prisons and places of detention.
Prisons and places of detention also have other factors that make consistent and appropriate treatment difficult, which increases the risk of resistance developing. These include transfers to other prison units, the poor health of prisoners, and difficulty accessing treatment. For TB in particular, pressure on prisoners to treat themselves; clandestine entry of anti-TB drugs into prison by staff and visitors; release and recurrence without screening of prisoners undergoing treatment, and non-completion of treatment have all been identified as major factors contributing to the development of multidrug resistant TB (Moreira et al., 2022).
Although, it’s widely suspected that levels of antimicrobial resistant infections maybe higher in prisons and places of detention, work to identify which infections and which groups of people within these settings are at the most risk is an important area of investigation.
To add to the body of evidence in this area and to support the development of interventions, UKHSA’s Health and Justice and AMR teams are collaborating to assess the literature and analyse data to understand levels of antimicrobial resistant infections in the prison population and whether these change by ethnicity, sex, and region. Understanding these differences will help improve opportunities to tackle antimicrobial resistance among prisoners.
To curb antimicrobial resistance in prisons, there is a need for diagnosis-specific monitoring of antimicrobial use combined with evidence-based prison-focused antimicrobial stewardship policies. To ensure that the right interventions and policies are put in place, we will synthesise evidenced-based interventions including those focused on infection prevention and control, antimicrobial prescribing, and stewardship. Collaboration with partners will be essential to this work in order to share what we have found and understand its implications and what further work is needed.
This work aligns with the UKHSA’s Health Equity for Health Security Strategy and 3-year road map 2023-2026. The strategy identifies several priority populations to focus our efforts on. The priority populations include people in contact with the criminal justice system, as well as vulnerable migrants, people experiencing homelessness, place-based inequality and a continued focus on ethnicity and deprivation.
To continue improving our understanding of antimicrobial resistance beyond the work outlined here it is important to establish pathways for collecting and reporting data annually on infection incidence, antimicrobial resistance, and antimicrobial use. This includes looking for variation by age, sex, ethnicity, deprivation, geography as well as focusing on for high risk setting such as prisons. This information should then be used to inform the development of policies and interventions.