National Action Plans for Antimicrobial Resistance: What are they and how do they affect aquaculture?

Sustainable Aquaculture Futures

The aquatic animal health domain is complex and all its various elements are synthesised into component parts for assessment and planning along the OIE PVS Pathway via the PVS Tool ? Aquatic. The PVS Tool ? Aquatic has four Fundamental Components and 47 Critical Competencies. To help countries and AAHS to address evolving challenges and priorities in aquatic animal and public health, some Critical Competencies have been modified in this, the second edition of the OIE PVS Tool. The new edition also improves coverage, with a clearer incorporation of contemporary aquatic animal health issues relating to antimicrobial resistance (AMR) and use (AMU), One Health approach and bio-threat reduction. The new edition also covers biosecurity, the implementation of standards for disease investigation and tracing, aquatic animal product markets (domestic trade), and public?private partnerships.

Aquaculture stands as the fastest-growing food fish sector, expected to satisfy global demand for aquatic products. However, its expansion has led to disease emergence, adversely affecting both production and biodiversity. In response, since the mid-1990s the World Organisation for Animal Health (WOAH) has developed initiatives, notably the Aquatic Animal Health Code and the Manual of Diagnostic Tests for Aquatic Animals, aimed at harmonising health standards for international trade in aquatic animals. With advances in aquaculture came the global spread of pathogens, resulting in significant disease outbreaks and economic losses. Efforts to curb these events led to the establishment of emergency programmes and conferences emphasising surveillance, preparedness and response, and fostering increased collaboration among stakeholders. As aquatic animals grow in importance for global nutrition and food security, the emergence of new pathogens poses a threat. Understanding disease mechanisms and main drivers becomes pivotal for disease prevention. Collaboration across sectors, including government, industry, science and stakeholders, is vital for implementation of effective biosecurity measures to mitigate disease risks. The Aquatic Animal Health Strategy, introduced by WOAH in 2021, reflects the recognition of the growing significance of aquatic animal health and its relevance in food security and outlines a strategic approach to management of aquatic animal health worldwide. Emphasising standards, capacity building, resilience and leadership, this Strategy aims to address critical challenges in aquatic animal health and welfare. Looking forward, the One Health approach will become imperative in confronting global health risks. In this holistic approach to ensuring sustainable aquaculture, it is important to recognise the great value of the people working in aquaculture and their contribution to global food security.

Probiotics play a pivotal role in enhancing the health and growth of aquatic animals in aquaculture. These beneficial microorganisms contribute to improved digestion and nutrient absorption by producing digestive enzymes such as amylases, proteases, and lipases, besides providing essential nutrients. By creating a favorable microbial balance in the gastrointestinal tract (GIT), probiotics reduce harmful microorganisms and promote the proliferation of beneficial bacteria like Lactobacillus spp. and Bifidobacterium spp. This modification of gut microflora leads to more efficient digestion and significantly enhances overall health and growth performance in fish. Additionally, probiotics produce antimicrobial substances, such as bacteriocins and organic acids, which inhibit pathogenic bacteria and bolster disease resistance. They also play a crucial role in improving water quality in aquaculture systems by aiding in the turnover of organic nutrients and reducing toxic substances. Incorporating probiotics into aquaculture practices has demonstrated considerable potential in boosting the productivity and health of aquatic animals, making them an essential component of sustainable aquaculture. This review delves into the multifaceted benefits of probiotics, including enhanced feed utilization, immune responses, and pathogen resistance, and elucidates the mechanisms underlying these effects. Furthermore, it includes a bibliometric analysis of the past 30 years, providing a comprehensive overview of research trends and advancements in this field.

The introduction of antibiotics revolutionized medicine by significantly reducing the burden of bacterial infections. However, antimicrobial resistance (AMR) has emerged as a major global health and economic challenge. AMR arises primarily from the misuse and overuse of antimicrobials in human health, agriculture, and animal husbandry. It leads to treatment failures, prolonged illnesses, and increased mortality. The One Health approach, which integrates human, animal, and environmental health, provides a comprehensive framework for addressing AMR. The extensive use of critically important antimicrobials such as fluoroquinolones, cephalosporins, colistin, tetracyclines, and macrolides in food-producing animals is a key driver of resistance. Prudent antimicrobial use, infection prevention, and enhanced hygiene are vital in human healthcare. In animal agriculture, reducing prophylactic and growth-promoting antimicrobial use is essential. Surveillance systems help track resistance trends across sectors. Internationally, the WHO-led Global Action Plan (GAP), supported by the FAO and WOAH, emphasizes antimicrobial stewardship, resistance surveillance, and policy harmonization. At the national level, countries implement National Action Plans (NAPs) that promote public awareness, antimicrobial regulation, and research into alternatives. Tackling AMR requires a coordinated multisectoral response. The One Health approach embedded in both national and global strategies is crucial for preserving the efficacy of antimicrobials and safeguarding health across species and environments.

Antimicrobial resistance (AMR) is a well recognized threat to humanity in recent times. The severity of the issue is highlighted by WHO statistics showing that in 2023, one in six confirmed bacterial infections worldwide was resistant to standard antibiotics. Among the major reasons for this global rise in AMR are the inadequate diagnostic capabilities of low-income countries, inappropriate antibiotic use, and weak governance in both agricultural and human health sectors, where antimicrobial overuse remains a persistent problem.1,2 Additionally, pharmaceutical manufacturing effluents and untreated human sewage make significant contributions to the spread of resistance yet these sources receive little attention from regulatory authorities and researchers.3 To effectively address this issue, interventions must target not only human use of antimicrobials but also their use in animals and environmental sources. This integrated perspective is embodied in the One Health approach, which seeks to achieve a sustainable balance between human health, animal health and the ecosystem. Although the importance of the One Health approach is widely acknowledged, critical implementation gaps persist.4 Moving from rhetoric to tangible results requires three key strategic shifts. First, comprehensive surveillance of antimicrobial usage and resistance data across human, animal, food and environmental sectors must be ensured, with the integration of technology to detect emerging resistance patterns and transmission hotspots. Second, antimicrobial stewardship should be strengthened across all sectors. Third, research into diagnostics and alternative treatments, such as vaccines must be consistently supported.5 Pakistan developed its National Action Plan (NAP) in 2017 to combat antimicrobial resistance. Currently, NAP 2.0 is being implemented, focusing on improving awareness, optimizing antimicrobial use and investing in research for new vaccines and diagnostic tools. This National Action Plan aligns with the United Nations General Assembly Global Action Plan.6 In conclusion, the One Health approach, emphasizing integrated surveillance, stewardship, and awareness across human, animal, agricultural and environmental domains remains the only viable path forward.

Background: Antimicrobial resistance (AMR) has become an emerging multifactorial and complex issue globally in both livestock and public health, especially more health risk in low-income countries including Bangladesh. The antibiotic-resistant bacteria (ARB) and antibiotic resistance gene (ARG) that confer resistance are transmitted and circulated within humans, animals, and the environment. Both the complex AMR and ‘One Health’ connect humans, animals, and the environment, which needs to be effectively addressed in all three interconnected domains of health. This article gives a comprehensive review of the antibiotic era, beginning from the discovery of the first antibiotics until the present-day situation including multidrug resistance (MDR) status with special reference to Bangladesh within the ‘One Health’ concept. Objectives: This comprehensive review was carried out to describe an updated overview of AMR and associated risk factors in livestock and human health within one health approach in Bangladesh. Methods: Review and research articles (n = 315) related to AMR published from Bangladesh (n = 156) and elsewhere (n = 159) in English language have been reviewed through Google search including, Cross-Ref, PubMade, and Bangladesh Journals online by using possible relevant keywords to identify the articles. Findings of antibiotic discovery and mode of action, development of resistance and its mechanism, drivers and risk factors, and measures against AMR including the ‘One Health’ approach have been reviewed and analyzed Results: This review of AMR beginning from the discovery of the first antibiotic penicillin until the present-day situation with the ‘One Health’ approach has been reviewed based on 315 published research reports and their data are analyzed and presented in 51 tables with a high prevalence of AMR in both human and veterinary medicine and their results are discussed. Antimicrobials have diverse applications in different fields including aquaculture, livestock and crop production, and the prevention and treatment of human and livestock diseases, and overuse and misuse of antibiotics lead to the development of antibiotic-resistant bacteria that persist in the affected hosts and their environment. These resistant bacteria are shared between livestock and humans through food and environmental exposure. These resistant bacteria usually persist and circulate through contaminated environments associated with a significant threat to human and animal health. The antibiotic-resistant bacteria contain resistant genes that act as primary drivers (risk factors) which can transfer naturally or through human activities. Surveillance and rapid detection of antimicrobial-resistant bacteria are essential for judicious use of appropriate antibiotics only when necessary and preventing transmission of resistant bacteria will certainly help to prevent the AMR. Conclusions: A high prevalence of AMR, especially in most antibiotics, has been reported from Bangladesh with limited routine antibiogram surveillance reports. Although 178 countries have developed national action plans, fewer than a fifth are funded or implemented. However, several international organizations including WHO, FAO, and World Organization for Animal Health (WOAH/OIE) have now included a ‘One Health’ approach within their action plans to address AMR, which action program would be required in medium and low-income countries including Bangladesh where the highest percentage of AMR occurs in both human and veterinary patients. The ‘One Health’ approach is important for AMR because resistant pathogens can spread quickly through livestock and human healthcare facilities, food, and environment (soil and water), making the treatment and prevention of certain infections shared between livestock and humans more challenging, and increasing the risk of disease spread, severe illness, and death. The judicial use of antimicrobials based on better regulation and policy, improved surveillance, stewardship, infection control, livestock husbandry practices, and finding new antibiotics and alternatives to antimicrobials including vaccines should be included in the action plan to prevent and spread the AMR in the environment. It may be concluded that the collaboration among human, livestock, and environmental health sectors by adopting a ‘One Health’ approach is important to achieve sustainable and long-lasting results.

Eucheuma cottonii has been extensively studied in the field of aquaculture due to its potential as a natural immunostimulant. In this review, we explore the impact of using Eucheuma cottonii as an immunostimulant in aquatic animals. Based on recent literature, we conclude that Eucheuma cottonii can enhance the immune response in aquatic organisms, including increasing Total Haemocyte Count, phagocytic activity, and gene expression related to the immune system, thus enabling aquatic organisms to combat bacterial and viral infections. The mechanism of action of Eucheuma cottonii is believed to involve bioactive compounds such as sulfated polysaccharides that stimulate non-specific immune responses. The implications of using Eucheuma cottonii in aquaculture include the potential to improve the health and production performance of aquatic animals. However, challenges such as quality control of extracts, interspecies effectiveness, and potential environmental risks need to be addressed. Suggestions for further research include a deeper understanding of the mechanism of action, comparative studies among species, development of production technologies, environmental risk management, as well as education and training for aquaculture farmers. With careful and sustainable approaches, the use of Eucheuma cottonii as an immunostimulant has the potential to enhance the sustainability of the aquaculture industry and the overall health of aquatic animals.

Antimicrobial resistance (AMR), the ability of a micro-organism to stop an antimicrobial from working against it, is one the greatest global health challenges. It is projected to be the leading cause of death worldwide, claiming an estimated 10 million lives a year, by 2050, primarily in low- and middle-income countries (1). In 2015, the World Health Assembly (WHA) adopted a global action plan on AMR underscored by the One Health approach (2). One Health seeks to improve health and well-being through the integrative management of disease risks at the interface between humans, animals and the natural environment, based on closer collaboration among individual disciplines and an integrated, cross-sectoral approach to research, surveillance, and response (3). The natural or biophysical environment here includes all living (biotic) and non-living (abiotic) factors affecting the survival of all organisms (including humans) at the individual, population, community or ecosystem level. In this context, an ecosystem refers to a community of plants, animals and microorganisms that live, feed, reproduce and interact in the same area or environment. AMR connects human health to the health of ecosystems and the natural environment, in terms of both drivers and consequences. Concurrently with the WHA action in 2015, member states agreed to publish individual national action plans (NAPs) on AMR by May 2017 (2), (4). Here we present the first analysis of the extent to which these post-2015 NAPs have been successful in integrating the natural environment within a One Health approach. We found that NAPs feature human and animal health prominently but that most do not specifically incorporate the natural environment, and hence fall short of achieving a genuine One Health approach. Given the key role of the natural environment in contributing to AMR, we call for greater integration of the natural environment in existing and new NAPs, so that we can maximise our chances of finding holistic and sustainable solutions to this global health threat.

According to the World Health Organization (WHO), infections with antimicrobial resistant bacteria result in an estimated number of 700,000 human deaths globally per year. In the 2016 United Nations General Assembly, world leaders acknowledged the link between antimicrobial resistance (AMR) and the misuse of antibiotics in public health, animal, food, agriculture, and aquaculture sectors, committing to a concerted One Health approach to AMR involving the various sectors and actors in defense of human, animal, and environmental health. The use of antibiotics promotes the development of AMR and influences co-selection processes in bacterial communities leading to the dissemination of antibiotics, AMR bacteria, and antibiotic resistance genes (ARGs) among humans, pets, livestock, wild animals, and the natural environment. Considering the promiscuity of bacterial gene transfer systems, the presence of ARGs in the environment is increasingly beheld as an ecological problem. Hence, there is an urgent need to understand the dynamics of AMR and a One Health approach is essential to evaluate the origin, spread, and flow mechanisms of AMR and ARGs. Some AMR bacteria and ARGs are spreading more rapidly than others, becoming pandemic. Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen with serious morbidity and mortality. MRSA strains used to be associated with nosocomial infections but have now disseminated to the community, animals, and environment. Besides, MRSA strains are constantly changing with new different clones emerging in different geographical areas. Thus, it is globally recognized the urgency to monitor and better understand the characteristics and transmission routes of AMR and ARGs in MRSA strains.

Animal health is fundamental to efficient animal production and, therefore, to food security and human health. This holds true for both terrestrial and aquatic animals. Although partnership between producers and governmental services is vital for effective animal health programmes, many key activities are directly carried out by governmental services. Noting the need to improve the governance of such services in many developing countries, the World Organisation for Animal Health (OIE), using the OIE Tool for the Evaluation of Performance of Veterinary Services, conducts assessments of Veterinary Services and Aquatic Animal Health Services (AAHS) to help strengthen governance and support more effective delivery of animal health programmes. While good governance and the tools to improve governance in the aquatic animal sector are largely based on the same principles as those that apply in the terrestrial animal sector, there are some specific challenges in the aquatic sector that have a bearing on the governance of services in this area. For example, the aquaculture industry has experienced rapid growth and the use of novel species is increasing; there are important gaps in scientific knowledge on diseases of aquatic animals; there is a need for more information on sustainable production; the level of participation of the veterinary profession in aquatic animal health is low; and there is a lack of standardisation in the training of aquatic animal health professionals. Aquaculture development can be a means of alleviating poverty and hunger in developing countries. However, animal diseases, adverse environmental impacts and food safety risks threaten to limit this development. Strengthening AAHS governance and, in consequence, aquatic animal health programmes, is the best way to ensure a dynamic and sustainable aquaculture sector in future. This paper discusses the specific challenges to AAHS governance and some OIE initiatives to help Member Countries to address them.

Kosovo's national action plan for antimicrobial resistance

Antimicrobial resistance is one of the most complex global health challenges today. The world has long ignored warnings that some antibiotics are losing effectiveness after decades of overuse and misuse in human medicine, animal health and agriculture. Antivirals, antiparasitic agents and antifungals are also becoming increasingly ineffective. Though we live in an age of technology and innovation, we could soon find ourselves in an era where simple infections kill millions of people every year. Common illnesses like bacterial pneumonia, post-operative infections, certain cancers, as well as the world's biggest infectious killers--tuberculosis, human immunodeficiency virus (HIV) and malaria--are increasingly difficult to treat because of the emergence and spread of drug resistance. (1) Worsening antimicrobial resistance could have serious public health, economic and social implications around the world. The World Bank has warned that antimicrobial resistance could cause as much damage to the global economy as the 2008 financial crisis. (2) Antimicrobial resistance can only be tackled through a concerted global effort, led by heads of state and global institutions, and through coordinated action by the health and agricultural sectors, in partnership with the food industry, campaign groups and community organizations. Governments need closely aligned policies on the responsible use of medicines in human and animal health, and new standards for antibiotic use in agriculture and food production. A one health approach, involving close coordination among all relevant sectors and actors, should be urgently implemented by all governments. In the past two years, we have seen global political momentum for addressing antimicrobial resistance. In May 2015, at the Sixty-eighth World Health Assembly, governments adopted a global action plan which identifies a set of strategic objectives. (1,3) In 2016, the United Nations General Assembly held the first high-level meeting on antimicrobial resistance and passed a political declaration. (4) The issue has also been on the agenda of recent group of seven (G7) and group of twenty (G20) meetings. Since May 2015, progress has also been made in the implementation of these global commitments. Over one hundred countries have completed, or are about to complete, their national multisectoral action plans. WHO has established a global antimicrobial resistance surveillance system to track which drug-resistant pathogens are posing the biggest challenge. (5) In May 2016, the Drugs for Neglected Diseases initiative and WHO launched a global research and development partnership to develop new antibiotics and promote their responsible use. (6) In August 2016, WHO updated its guidelines for the prevention and treatment of the three common sexually transmitted infections--chlamydia, gonorrhoea and syphilis. …

Antimicrobial resistance (AMR) is a major 21st century global health challenge. The WHO African Region Member States committed to develop and implement multisectoral national action plans (NAPs) that address AMR, in line with the Global Action Plan on AMR (GAP). The aim of this paper is to present the progress of AMR response in the WHO African Region based on the annual Tracking AMR Country Self-Assessment Survey (TrACSS), with a focus on human health indicators. This was a secondary data analysis of responses from forty-one countries that participated in the 2021 TrACSS. Of the 41 countries that responded to the 2021 TrACSS, 35(85%) have developed NAPs. Fifteen 15(37%) of countries have functional AMR multisector working groups. 55% (21/41) of countries are collating data nationally on AMR surveillance. Forty nine percent of countries conducted small-scale AMR awareness campaigns and 53% (21/41) covered AMR in some pre- and in-service training for human health workers. While 83% of countries reported having laws and regulations on the prescription and sale of antimicrobials, only 32% (13/41) have national systems for monitoring antimicrobial use. Twenty-three (58%, 23/41) reported having Infection Prevention and Control (IPC) programs at select health facilities. Countries have developed and are implementing AMR NAPs. Gaps still exist across key indicators monitored through TrACSS. Effective AMR response requires established functional multisectoral governance mechanisms in the One Health approach; political commitment, sustainable funding, and clear monitoring and reporting is critical.

<div><!--block-->The European Union has prepared and enacted a number of laws, directives and decision relating to the aquatic animal health for implementation in member and candidate countries. Based on the authorization given by this legislation, Aquatic Animal Health Professionals in the EU countries fulfil the necessary legislative provisions. In our country, aquatic animal health legislation studies have been made based on the EU directives and decisions, but authorization has not been given in this legislation to Fisheries Engineers who take courses related to aquatic animal health in Fisheries Faculties. However, despite the difficult conditions in fishery businesses, Fisheries Engineers and Fisheries Technology Engineers has been devoted themselves to practices on the field. Aquatic Animal Health Professionals have also been authorized together with other related occupational groups on aquatic animal health issues in Aquatic Animal Health Code, which is published by the World Organisation for Animal Health (OIE), and in Animal Health Law of the European Parliament and Council. It will be appropriate to give authority to the Fisheries Engineers and Fisheries Technology Engineers, who specialize in fish health and carry out aquatic animal health practices in aquaculture enterprises in the national legislative arrangements to be prepared in accordance with the European Union's legislation on aquatic animal health.</div>