Description
Background
Foodborne diseases and the rising threat of antimicrobial resistance (AMR) pose significant public health challenges, compounded by climate change and zoonotic outbreaks. The use of antimicrobials in food production raises concerns due to antibiotic residues, antibiotic-resistant bacteria, and antibiotic-resistant genes in humans, animals, and the environment. In urban settings, particularly in densely populated and resource-limited areas, factors like overcrowding, inadequate sanitation, and limited healthcare resources amplify the risks of transmission for AMR spread. Conflict-affected areas, like Palestine, face additional challenges due to infrastructure damage, limited food safety resources, increased antibiotic use, restricted medical access, and population displacement. A comprehensive One Health approach, integrating surveillance-response systems, is vital to ensure effective disease control and mitigate AMR. In this doctoral research, we applied the One Health approach to explore zoonotic bacteria and AMR within Palestine's food production chains.
Methods
The research unfolded in a three-phase process from 2020-2023. The initial phase comprised an extensive analysis, involving a systematic review and meta-analysis, exploring prevalent One Health methodologies in the Middle East, with a specific focus on Campylobacter and Salmonella strains. The second phase delved into the Palestinian context, employing a mixed-method study design, incorporating a transdisciplinary approach, a semi-structured observation study, and a survey to assess knowledge, attitudes, and practices related to food safety, zoonotic diseases, and AMR across the food production chain. The final phase encompassed the pilot implementation of an integrated One Health surveillance system, involving the collection and analysis of 592 samples. Additionally, DNA was extracted from 65 Campylobacter jejuni and 19 Salmonella spp. isolates for Next-generation sequencing.
Findings
In the Middle East, the application of the One Health approach was not comprehensive, characterized by weak epidemiological designs, insufficient laboratory techniques for monitoring AMR, and significant variations in data reporting among countries. In Palestine, there is a pressing need to enhance hygiene practices and regulate antimicrobial use in the food production chain. Additionally, there is currently no comprehensive, integrated surveillance system in place for monitoring foodborne pathogens and AMR with insufficiencies in laboratory techniques for AMR monitoring. Noteworthy, isolates from the environment, meat, and humans exhibited high similarity. This research also marks the first report of Salmonella enterica serotype Muenchen in Palestine, with multidrug resistance facilitated by the pESI plasmid. Furthermore, the study revealed a rapid strain turnover in Campylobacter jejuni between 2021 and 2022 and identified a high prevalence of resistance genes.
Interpretation and Conclusion
In Palestine, forming a One Health committee is vital, emphasizing food safety, zoonotic diseases, and AMR. This committee promotes coordination, suggesting measures like an integrated quality control system and enhanced infrastructure. An integrated surveillance system and a transdisciplinary approach are essential for addressing AMR. The implementation of an integrated surveillance system in conflict zones is crucial, offering a comprehensive method for understanding the transmission of AMR. The identified patterns of resistance emphasize the necessity for collaborative efforts. The research strongly recommends continuous surveillance, targeted interventions, and a persistent commitment to the One Health approach as essential strategies for the global control of AMR.
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