8. Safe water
and sanitation
10%GLOBAL
DISEASE BURDEN
2-3
million deaths
every year
Prevent
Good hygiene
40%DIARRHOEA
Practicing
the 5 Moments
for hand
hygiene
ABHR
A clean,
well-functioning
environment
and equipment
Infection prevention
and control programmes
and teams
30%
INFECTION
Infection
prevention
measures
Safe water
and sanitation
50%
INFECTION
Safe food preparation and good nutrition
50%DIARRHOEA
30%RESPIRATORY
INFECTIONS
IN CHILDREN
Vaccinations
The main ways to prevent infection are:COMMUNITY
HEALTH
CARE
22. 手指衛生を向上させるには？
Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy
WHO Hand Hygiene Self-Assessment Framework 2010
① システムの改善
② 教育と研修
③ 評価とフィードバック
手指衛生改善のための5つの構成要素
WHO-5
④ 職場での注意喚起
⑤ 施設の安全文化
23. 2つで 1つ！
Guide to Implementation of the WHO Multimodal Hand Hygiene Improvement Strategy
WHO Hand Hygiene Self-Assessment Framework 2010
手指衛生の5つのタイミング
手指衛生改善のための5つの構成要素
WHO-5
39. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌への感染者
2,000,000人/年
Antibiotic Resistant Threats in the United States, 2013
40. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌による死亡
Antibiotic Resistant Threats in the United States, 2013
23,000人/年
41. ANTIBIOTIC RESISTANCE THREATS
in the United States, 2013
耐性菌への追加コスト
Antibiotic Resistant Threats in the United States, 2013
20,000,000,000㌦/年
200億㌦≒2兆円
50. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations : December 2014
ガン
8,200,000
糖尿病
1,500,000
交通事故
1,200,000
下痢性疾患
1,400,000 2013年
耐性菌
700,000
51. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations : December 2014
ガン
8,200,000
糖尿病
1,500,000
交通事故
1,200,000
下痢性疾患
1,400,000
耐性菌10,000,000
2050年
58. ANTIBIOTIC RESISTANCE
from the farm to the table
RESISTANCE Animals can carry harmful bacteria in their intestines
When antibiotics are given to animals...
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
家畜への抗菌薬
耐性菌の選択と増加
http://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
人の場合と同じように、抗菌薬の継続利用は
動物の消化管内での耐性菌の選択圧を高め、その増殖を促す。
59. 耐性菌の拡散
When antibiotics are given to animals...
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
EXPOSURE People can get sick with resistant infections from...
contaminated food contaminated environment
Antibiotics kill
most bacteria
But resistant bacteria
can survive and multiply
spread to...
repared food through
ontaminated surfaces the environment when animals poop
ck with resistant infections from...
contaminated environment
When antibiotics are given to animals...
Ant
mo
SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces
EXPOSURE People can get sick with resistant inf
contaminated foodhttp://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
食肉と土壌/水資源等の環境が耐性菌によって汚染される。
環境の汚染による作物表面への耐性菌の付着も確認されている。
食肉と環境の汚染
60. SPREAD Resistant bacteria can spread to...
animal products
produce through
contaminated water or soil
prepared food through
contaminated surfaces the environment when animals poop
EXPOSURE People can get sick with resistant infections from...
contaminated food contaminated environment
IMPACT Some resistant infections cause...
mild illness severe illness and may lead to death
Learn 4 steps to prevent food poisoning at www.foodsafety.gov
About 1 in 5 resistant
infections are caused by germs
from food and animals.
Source: Antibiotic Resistant Threats in the United States, 2013
ヒトへの暴露
http://www.cdc.gov/foodsafety/pdfs/ar-infographic-508c.pdf 改編
耐性菌に汚染された食肉/作物の摂取でヒトの腸管内へ取り込まれる。
また農業に従事するヒトの手からの感染も報告されている。
耐性菌感染症の20%は食品/家畜関連
61. 環境の汚染
• 3世代セフェム耐性 大腸菌
9.1％ vs 3.1％
➾ 約 3 倍 （p=0.040）
• ESBL産生 大腸菌
6.3％ vs 1.5％
➾ 約 4 倍 （p=0.046）
英国のサーファーの腸内に耐性菌！
Leonard AFC, Environ Int. 2018; 114: 326
79. そんなこと可能？
Sabuncu E, PLoS Med. 2009; 6: e1000084
2000-2001
reported in Table 2. The first campaign yielded immediate
returns, with statistically significant estimated reductions for the
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
However, a significant decrease of 45% in the linear regression
coefficient between FLS incidence and antibiotic prescriptions was
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
prescriptions is divided by the number of regional inhabitants for the respective year in each of 22 France’s regions: Al (Alsace), Aq (Aquitaine), Auv
(Auvergne), BN (Basse Normandie), Bou (Bourgogne), Br (Bretagne), CA (Champagne-Ardenne), Ce (Centre), Co (Corse), HN (Haute Normandie), Li
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
prescriptions is divided by the number of regional inhabitants for the respective year in each of 22 France’s regions: Al (Alsace), Aq (Aquitaine), Auv
(Auvergne), BN (Basse Normandie), Bou (Bourgogne), Br (Bretagne), CA (Champagne-Ardenne), Ce (Centre), Co (Corse), HN (Haute Normandie), Li
2001-2002 2002-2003 2003-2004
2004-2005 2005-2006 2006-2007
80. そんなこと可能？
Sabuncu E, PLoS Med. 2009; 6: e1000084
2000-2001
reported in Table 2. The first campaign yielded immediate
returns, with statistically significant estimated reductions for the
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
However, a significant decrease of 45% in the linear regression
coefficient between FLS incidence and antibiotic prescriptions was
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
prescriptions is divided by the number of regional inhabitants for the respective year in each of 22 France’s regions: Al (Alsace), Aq (Aquitaine), Auv
(Auvergne), BN (Basse Normandie), Bou (Bourgogne), Br (Bretagne), CA (Champagne-Ardenne), Ce (Centre), Co (Corse), HN (Haute Normandie), Li
whole population and for inhabitants .15 y old (29.8% [95% CI
214.9% to 24.7%] and –12.5% [95% CI 216.8% to 28.1%],
respectively). The evolution of this change differed according to
age group. Nevertheless, by 2006–2007, the campaign had
achieved significantly fewer antibiotic prescriptions: rates were
227.0% (95% CI 233.5% to 220.5%) versus baseline for the
whole population, 230.1% (95% CI 240.7% to 219.6%) for the
observed after the first campaign (1.19 before versus 0.66 after,
p = 0.006). After controlling for the influence of the FLS incidence
rate, we observed a 226.5% (95% CI 233.5% to 219.6%)
change in winter antibiotic consumption for the total population, a
decrease similar to that obtained without controlling for the FLS
incidence rate. Including four dummy variables in the model for
the April–September period did not show any clear change during
Figure 2. Winter antibiotic prescriptions in France by region, from October 2000 to March 2007. The number of October–March
prescriptions is divided by the number of regional inhabitants for the respective year in each of 22 France’s regions: Al (Alsace), Aq (Aquitaine), Auv
(Auvergne), BN (Basse Normandie), Bou (Bourgogne), Br (Bretagne), CA (Champagne-Ardenne), Ce (Centre), Co (Corse), HN (Haute Normandie), Li
2001-2002 2002-2003 2003-2004
2004-2005 2005-2006 2006-2007
5年間で抗菌薬使用量を27％削減
144. 適切な抗菌薬の供給は
小さな命を救う
Figure 1: Estimated pneumonia deaths avertable in under-5 populations with improved antibiotic access
Countries with less than 100 deaths averted are not labelled. Data on under-5 population with suspected pneumonia receiving antibiotics are from 1990 to 2013;
0 20 40 60 80
Trendline weighted by
the under-5 population
of each country
100
0
1
2
3
4
5
6
Pneumoniadeaths(duetoStreptococcuspneumoniaeandHaemophilus
influenzaetypeb)per1000childrenagedyoungerthan5years
Under-5 population with suspected pneumonia receiving antibiotics (%)
India
Nigeria
DR Congo
Pakistan
China
Ethiopia
Afghanistan
Sudan
Indonesia
Somalia
Mali
Niger
Uganda
Chad
Tanzania
Burkina Faso
Kenya
Yemen
Mozambique
Cameroon
Myanmar
Philippines
Côte d’Ivoire
Bangladesh
Guinea
Iraq
Madagascar
Nepal
Malawi
Ghana
Burundi
Benin
Sierra Leone
Uzbekistan
Zambia
Egypt
Haiti
Senegal
Iran
Central African Republic
Togo
Vietnam
Morocco
Brazil
Rwanda Zimbabwe
Mauritania
Cambodia
Tajikistan
Algeria
Congo (Brazzaville)
Guinea−Bissau
Bolivia
ColombiaTurkey
Thailand
North KoreaLaos
Argentina
KazakhstanPeru
Timor−Leste
Dominican Republic
Equatorial Guinea
Kyrgyzstan Syria
Gambia
Comoros Swaziland
Honduras
Paraguay
Ukraine
India (169760)
Nigeria (49407)
Nepal (2434)
Hypothetical under-5 pneumonia deaths
averted with universal antibiotic access
Laxminarayan R, Lancet. 2016; 387: 168
