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Jae-Hoon Song* & Visanu Thamlikitkul** On behalf of ANSORP

A N S O R P Asian Network for Surveillance of Resistant Pathogens. Envisioning the future against infectious diseases. Jae-Hoon Song* & Visanu Thamlikitkul** On behalf of ANSORP *Samsung Medical Center, Sungkyunkwan University, Seoul, Korea **Mahidol University, Bangkok, Thailand. U. K.

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Jae-Hoon Song* & Visanu Thamlikitkul** On behalf of ANSORP

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  1. A N S O R P Asian Network for Surveillance of Resistant Pathogens Envisioning the future against infectious diseases Jae-Hoon Song* & Visanu Thamlikitkul** On behalf of ANSORP *Samsung Medical Center, Sungkyunkwan University, Seoul, Korea **Mahidol University, Bangkok, Thailand

  2. U. K France Korea USA Japan Thailand Taiwan Mexico Singapore Colombia Brazil Argentina S. Africa Worldwide spread of the Spanish 23F PRSP clone Globalization of Resistance Reason for international collaboration 

  3. local or national international Design and implementation of early intervention Track the spread of resistance patterns Monitor changing trends in resistance Identify emerging resistance problems Surveillance of Antimicrobial Resistance Basic aims

  4. collection outcome-specific data analysis interpretation public health practice planning implementation evaluation utilization dissemination of data policy making education Surveillance of Antimicrobial Resistance Multiple steps and functions

  5. Existing foci Missing pieces Asia Africa USA   Europe South America  Oceania International Surveillance Systems

  6. Total 6,057 millions population sales ($) Total 21.9 billions ($) 548 millions 26 % 314 millions 31 % 3,672 millions 22 % 794 millions 519 millions 21 % 13 millions Population and Antibiotic Use in the World (United Nations Population Division, 2000 ; IMS data, 1999)

  7. Asian-Pacific Research Foundation for Infectious Diseases ARFID ANSORP Asian Network for Surveillance of Resistant Pathogens IDRI ABB Asian Bacterial Bank Infectious Disease Research Institute ISAAR International Symposium on Antimicrobial Agents and Resistance

  8. ARFID and ANSORP Mission ARFID and ANSORP are founded to contribute to the improvement of the public health in the Asian-Pacific region through international collaboration for research on infectious diseases and antimicrobial resistance

  9. ARFID and ANSORP Vision 2010 ARFID and ANSORP will be a central system of biomedical research on infectious diseases and antimicrobial agents and resistance through international collaboration that enables effective control and prevention of infectious diseases and antimicrobial resistance in the Asia-Pacific region

  10. Launching period Set-up period 1st ANSORP project Conception & Initiation of ANSORP 2nd ANSORP project 3rd ANSORP project 4th ANSORP project Moving into the second phase & 4th ISAAR 3rd ISAAR Foundation of ARFID Singapore, 1996 “P” : pneumococci ARFID and ANSORP Historical evolution : The first phase (1996-2002) 1996 1997 1998 1999 2000 2001 2002 2003

  11.              Asian Network for Surveillance of Resistant Pathogens ANSORP : Structural Evolution 1996 2003            26 Investigators 14 Centers 11 Countries/areas 55 Investigators 31 Centers 12 Countries/areas

  12. 2001 2003 1998 1998 Jae-Hoon Song Organizer 1996 2000 2000 1996 Jae-Hoon Song Organizer                                   28 investigators 17 centers 14 countries/areas 26 investigators 14 centers 11 countries/areas 28 investigators 17 centers 14 countries/areas 30 investigators 17 centers 14 countries/areas 26 investigators 14 centers 11 countries/areas 53 investigators 29 centers 12 countries/areas 30 investigators 17 centers 14 countries/areas 43 investigators 25 centers 14 countries/areas                       2nd project launched ARFID was born  3rd project launched 2nd project launched ANSORP was born  1st project launched  4th & 5th projects completed  6th project is coming  4th ISAAR (Seoul, Korea)  ARFID was born  3rd project launched ANSORP was born  1st ANSORP project 3rd project completed  4th project launched  3rd ISAAR                                                         Asian Network for Surveillance of Resistant Pathogens ANSORP : structural evolution

  13.           Asian Network for Surveillance of Resistant Pathogens ANSORP : Founding members Jae-Hoon Song (Seoul) Nam Yong Lee (Seoul) Wang Fu (Shanghai) Anan Chongthaleong (Bangkok) Nalinee Aswapokee (Bangkok) Satoshi Ichiyama (Nagoya) Ryoji Yoshida (Nagasaki) Cheng-Hsun Chiu (Taipei) M.K. Lalitha (Vellore) Bui Xuan Vinh (HCM city) Farida Jamal (Kuala Lumpur) Ti Teow Yee (Singapore) Jennifer Perera (Colombo) Usman C. Warsa (Jakarta)

  14. Asian Network for Surveillance of Resistant Pathogens Far East Section Samsung Medical Center Beijing Children’s Hosp. Dong-A Univ. Kyungbook Univ. ChoongNam Univ. Chungbuk Univ. ChonNam Univ. Kangbuk Hosp. Hallym Univ. Veterans Hosp. Beijing Chaoyang Hosp.   Chang Gung Children’s Hosp. & National Univ. of Taiwan Shanghai Children’s Hosp.    Rui Jin Hosp. (Shanghai) Princess Margaret Hosp. (Hong Kong)

  15. Asian Network for Surveillance of Resistant Pathogens Southeast Asia Section Univ. of Medicine & Pharmacy (HCM city) Nguyen Tri Phuong Hosp (HCM city) Chulalongkorn Univ. (Bangkok) Mahidol Univ. (Bangkok) RITM (Manila)    SGH   Univ. Putra Malaysia (Kuala Lumpur) NUS (Singapore)  Univ. Malaya (Kuala Lumpur) Univ. of Indonesia (Jakarta)

  16. King Saud Univ. (Riyadh) Asian Network for Surveillance of Resistant Pathogens Southwest Asia / Middle East Section Christian Medical College (Vellore)  Univ. of Colombo (Colombo) 

  17. Pneumococal resistance among clinical isolates Pneumococal resistance among carriage isolates Pneumococal resistance among invasive isolates CAP Gemifloxcin in vitro study Screening of hVRSA Enteric pathogen Moxifloxcin in vitro study Asian Network for Surveillance of Resistant Pathogens ANSORP : Program evolution Surveillance & In vitro studies 1996 1997 1998 1999 2000 2001 2002 2003

  18. Asian Network for Surveillance of Resistant Pathogens ANSORP : Program evolution Molecular analysis of MDR pneumococci Molecular analysis of FQ-R pneumococci Molecular analysis of Macrolide-R pneumococci Clinical trial & Basic research Phase IIIb gemifloxacin clinical trial for PRSP pneumonia 1996 1997 1998 1999 2000 2001 2002 2003

  19. Pneumococci Treatment guidelines Surveillance VRSA Clinical trials Policy making & guidelines VRE ESBL Basic research Enteric pathogens Antibiotic usage Asian Network for Surveillance of Resistant Pathogens ANSORP : Program evolution

  20. ANSORP Data : Pneumococcal Resistance Penicillin resistance in Asia 71 * 685 invasive isolates from 12 Asian countries % of PRSP 55 India Vietnam China Korea Taiwan Malaysia Thailand Sri Lanka Hong Kong Singapore Philippines Saudi Arabia (penicillin MIC  2 mg/L) (Song JH & ANSORP. Antimicrob Agents Chemother, in press)

  21. ANSORP Data : Pneumococcal Resistance Macrolide resistance in Asia 92 86 * 685 invasive isolates from 12 Asian countries 81 77 74 % of erythromycin resistance China India Taiwan Korea Malaysia Singapore Vietnam Thailand Sri Lanka Philippines Hong Kong Saudi Arabia (erythromycin MIC  1 mg/L) (Song JH & ANSORP. Antimicrob Agents Chemother, in press)

  22. High-level Macrolide Resistance in Asia Country MIC90 % of strains by mechanisms (ug/mL)erm mef erm+mef Korea (n=67) > 128 40.4 21.1 38.6 China (n=86) > 128 76.9 3.1 20 Taiwan (n=47) > 128 70.7 29.3 0 Hong Kong (n=102) > 128 24.4 66.7 8.9 Vietnam (n=60) > 128 45.3 5.7 49.1 Thailand (n=32) 4 28.6 71.4 0 Singapore (n=17) 128 44.4 55.6 0 * Invasive pneumococcal pathogens (2000-2001) (Song JH et al. J Antimicrob Chemother. 53;457, 2004)

  23. ANSORP Data : Pneumococcal Resistance Multi-drug Resistance in Asia * 685 invasive isolates from 12 Asian countries % of MDR strains 71 45 45 41 23 Vietnam Hong Kong Korea Taiwan China MDR  3 drugs among invasive strains (Song JH & ANSORP. Antimicrob Agents Chemother, in press)

  24. Spanish 23 F clone  ANSORP Data : Pneumococcal Resistance Spread of resistance in Asia Sp 23F Asian strains (Song JH et al. Clin Infect Dis 28 : 1206-11, 1999)

  25. 100% 100% 8.7 8.7 14.2 90% 23.5 3.8 21.2 90% 29.6 26 80% 80% 1 45.9 50 53.7 54.4 3 43.5 70% 70% 63.8 60% 54.5 60% 86.7 86.6 84.7 87.2 88.6 0 97.9 100 100 50% 50% 87.5 58.2 70.6 40% 40% 77.8 71 3.4 26.8 34.6 30% 30% 54.1 41.8 47.8 20% 20% 32.8 31.3 5.1 0 19.5 10% 10% 8.4 15.4 13.4 12.8 12.2 11.4 10.2 1.8 5.9 4.9 3.8 0 0 0 0% 0% India India China Korea China Korea Taiwan Thailand Malaysia Philippin Viet Nam Thailand Malaysia Sri Lanka Philippin Viet Nam Sri Lanka Saudi Ara Singapore Singapore ANSORP Data : Pneumococcal Resistance Carriage of DRSP in Asian Children Penicillin resistance Macrolide resistance (Lee NY & Song JH et al. Clin Infect Dis. May, 2001)

  26. Asia : Center of the world ANSORP Data : Pneumococcal Resistance Country with high prevalence of resistance

  27. Established the network system in Asia and the Middle East : - the first international network for research on infectious diseases and antimicrobial resistance in the region - expanded to include 31 centers in 18 cities in 12 countries/areas Completed 10 collaborative studies during its first phase : - 6 surveillance studies, 3 basic molecular works, and 1 clinical trial Established the supporting systems : - Asian-Pacific Research Foundation for Infectious Diseases (ARFID), Asian Bacterial Bank, Infectious Disease Research Institute & ISAAR Asian Network for Surveillance of Resistant Pathogens In its first 7 years, ANSORP has ..

  28. Future ANSORP System Expanded structure More comprehensive surveillance Rapid & reliable information source Interactive communication Strong partnership

  29. Future ANSORP System A gateway to Asia • In 2010, ANSORP will have .. • more than 50 centers • in 20 - 25 cities • in > 15 countries / areas • in Asia and the Middle East • To perform international collaboration • against infectious disease threats               New candidate centers Current centers

  30. Future ANSORP System Partnership with other organizations WARN SENTRY ALEXANDER EARSS APUA TSN WHO CDC ANSORP PAHO

  31. CAP project (2001-2002) VRSA project (2001-2002) Molecular characterization (2001-2004) Enteric pathogen project (2002-2004) Pneumococci project (2001-2003) ESBL project (2004-2005) MRSA project (2004-) VRE project (2004 -) Future ANSORP Projects

  32. ARFID and ANSORP will be the center of biomedical research on infectious diseases and antimicrobial resistance in the Asia-Pacific region ARFID and ANSORP will envision the future against infectious diseases and antimicrobial resistance ARFID and ANSORP

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