Pacific One Health & AMR Symposium Programme Guide

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023 23 & 24 AUG

PACIFIC 2023 ONE HEALTH & AMR SYMPOSIUM Fiji

ONE HEALTH Evidence for

Policy and Practise

PROGRAMME GUIDE

JOIN THE VIBER GROUP

EVENT SPONSORS

EVENT PARTNERS:

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MINISTRY OF HEALTH & MEDICAL SERVICES

N RC NATIONAL ANTIMICROBIAL RESISTANCE COMMITTEE

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EMAR FIJI PROJECT

PROGRAM GUIDE

SYMPOSIUM INFORMATION

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

CONGRESS VENUE The Pacific One Health & AMR Symposium (POHAS2023) will be held at the Pearl Resort, Pacific Harbour, Fiji.

CONGRESS DATES 23rd & 24th August 2023

MAJOR SPONSORS This Symposium is made possible through the general support of our sponsors: Department of Foreign Affairs and Trade – Australia, Australian Centre for International Agricultural Research, World Health Organization, World Organisation for Animal Health, Food and Agricultural Organisation of the United Nations, UK Aid, Fleming Fund

PARTICIPATING ORGANISATIONS Ministry of Health and Medical Services, Ministry of Agriculture and Waterways, Ministry of Fisheries and Forestry, Department of Foreign Affairs and Trade - Australia, Samoan Ministries of Health, Agriculture and Environment, Biosecurity Authority of Fiji, Consumer Council of Fiji, Fiji College of General Practitioners, Fiji Pharmaceutical Society, Fiji National University, The University of the South Pacific, The Peter Doherty Institute for Infection and Immunity of the University of Melbourne, University of South Australia, University of Technology, Sydney, Pacific Community (SPC), Oceania Hospitals, Commonwealth Scientific and Industrial Research Organisation, Fiji Medical Association, Ministry of Foreign Affairs and Trade – New Zealand, University of Newcastle, Zens Medical Centre, Vet Essentials Animal Doctors, Goodman Fielder International, Aspen Medical, Future Farms Limited, Wildlife Conservation Society, Deakin University and Australasian College for Infection Prevention and Control, Fiji Meat Industry Board, Fiji Meteorological Service, Scientific Research Organisation of Samoa.

PROGRAM GUIDE

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

PROGRAMME

DAY 1: Wednesday, 23rd August 2023 TIME

PROGRAMME

8.30 am

Registration

9.00 - 9.15 am

Welcome - NARC Chair

9.15 - 9.25 am

Keynote - Ministry of Health & Medical Services

9.25 - 9.35 am

Keynote - Ministry of Agriculture & Waterways

9.35 - 9.45 am

Keynote - Ministry of Fisheries & Forestry

9.45 - 10.05 am

Research for One Health Systems Strengthening (ROHSS) and EMAR - Dr Anna Okello

10.05 - 10.15 am

AMR Management in Samoa - Aiono Dr Alec Ekeroma

10.15 - 10.35 am

COMBAT-AMR Project Presentation - Professor Benjamin Howden

10.35 - 11.00 am

Group Photo and Morning Tea Break Plenary Hall GPR

11.00 - 11.30 pm

One Health in the Pacific Community (SPC) Eric Rafai One Health Coordinator, Pacific Community

11.30 - 11.50 am Facilitators

Speaker Institute 11.50 - 12.10 pm

A&C

AMRS

IPC

Room 1

Room 2

Room 3

Asheefa Aiyub, Royford Magiri

Sheemal Sharma, Vincent Lal

Reshnika Sen, Keresi Lomata

Session 1.1

Session 1.2

Session 1.3

Relooking at the delivering animal

Prevalence of Antimicrobial

Successful establishment of hybrid

health care services in Fiji and the

Resistance Organisms, Knowledge

multidisciplinary bloodstream

South Pacific region

on Antibiotic Use and Resistance

infection management group in

Among Poultry Farmers in Fiji

Solomon Islands.

Shivani Singh

Alice Siuna

Fiji National University College of

Fiji National University College of

National Referral Hospital, Solomon

Agriculture, Fisheries and Forestry

Agriculture, Fisheries and Forestry

Islands

Razia Rashid

Session 2.1

Session 2.2

Session 3.3

Assessment Of Knowledge,

Dairy Production Dynamics and

Tackling Human Health And

Antibiotics Sensitivity Patterns of

Environmental Dimensions Amr

Attitudes And Readiness Of Healthcare Workers To Manage Pathogens With Critical

Bacteria Isolated from Calf Diarrhea Through Strengthening Capacity For in Fiji

Infection Prevention And Control,

Antimicrobial Resistance At Colonial

And Water, Sanitation And Hygiene

War Memorial Hospital, Fiji

Speaker Institute

12.10 - 12.30 pm

Aneley Getahun Strobel

Wati Mocevakaca

Peter Doherty Institute for Infection

Fiji National University College of

and Immunity

Agriculture, Fisheries and Forestry

Ashlyn Datt

Colonial War Memorial Hospital

A&C

GPR

IPC

Session 3.1

Session 11.1

Session 3.3

Public Knowledge, Attitude, And

Governance for One-Health

Towards a collaborative support

Practice Towards Antibiotics And

management of AMR in Fiji

Antibiotic Resistance In Fiji

framework to assist infection prevention and control programmes in low- and middle-income countries: a scoping review

Speaker

Institute

Priya Chand

Seona Meharg

Fiji National University College of

Commonwealth Scientific and

Medicine, Nursing and Health

Industrial Research Organisation

Sciences

(CSIRO)

12.30 - 1.00 pm

Peta-Anne Zimmerman

School of Medicine and Dentistry Gold Coast, Griffith University

Plenary Hall Block 1 Panel Discussions

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PROGRAM GUIDE

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

PROGRAMME

DAY 1: Wednesday, 23rd August 2023 1.00 - 2.00 pm 2.00 -2.20 pm Facilitators

Lunch AMS Room 1

GPR Room 2

AMRS Room 3

Keshwan Nadan, Elva Borja

Chaminda Dissanayake, Ilisabeta Pesamino

Swartika Prasad, Ashodra Gautam

Session 4.1

Session 4.2

Session 4.3

Antimicrobial Consumption for

Managing diamondback moth

Fiji Antimicrobial Resistance

Human and Veterinary Practices in

resistance to insecticides in Fiji: a

Surveillance Dashboard

Fiji

flexible strategy that minimizes use of hazardous chemicals.

Speaker Institute 2.50 - 3.10 pm

Royford Magiri

Fereti Atumurirava

Morgan Lewis Commonwealth Scientific and

Fiji National University College of

Plant Health, Land Resources Division,

Agriculture, Fisheries and Forestry

Pacific Community

Session 5.1

Session 5.2

(CSIRO) Session 5.3

Development Of Antimicrobial Use

Potential impact on one health from

Case Study: Incorporating One

Guidelines For Animal Health In Fiji

heavy reliance on chemical control

Health into a Frontline Field

of pests for plant health protection

Epidemiological Training Program in

Industrial Research Organisation

Papua New Guinea, Lessons Learnt

Speaker

James Gilkerson

Mark Ero

Tambri Housen

Institute

University of Melbourne

Pacific Community

School of Medicine and Public Health, University of Newcastle

3.10 - 3.30 pm

Session 6.1

Session 6.2

Session 6.3

Prospective Observational Study Of

Building One Health Capacity And

One Health Approach For Monitoring

De-Escalation Of Empirical

Relationships Is The Key To One

Amr: A Case Study In New Caledonia

Antibiotics In Patients Admitted To

Health

Colonial War Memorial Hospital, Fiji

Speaker

Tracey Young- Sharma

Institute

Colonial War Memorial Hospital

Sandra Steele Melbourne Veterinary School, The University of Melbourne

Bourles Alexandre Institut Pasteur de Nouvelle-Calédonie

Plenary Hall

3.30 - 4.00 pm

Block 2 Panel Discussions

Wrap-up of Day 1 Launch of WISH Project Documentary Afternoon Tea

4.00 - 4.10 pm 4.10 - 4.40 pm 4.40 pm

KEY: A&C

Awareness and Communication

AMRS

Antimicrobial Resistance Surveillance

IPC

Infection Prevention and Control

AMS

Antimicrobial Stewardship

GPR

Governance Policy and Regulations

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

PROGRAMME

DAY 2: Thursday, 24th August 2023 TIME

PROGRAMME

9.00 am

Registration

9.30 - 9.50 am Facilitators

AMRS

A&C

IPC

Room 1

Room 2

Room 3

Chaminda Dissanayake, Nargina Macaliano

Sheemal Sharma, Ilisabeta Pesamino

Keshwan Nadan, Ashodra Gautam

Session 7.1

Session 7.2

Session 7.3

Exploring the resistome in sediment- Council Spearheads Multi-Sectoral

Veterinary Foundations Of Infection

associated biofilms from rural Fijian

Panel Discussion on Antimicrobial

Prevention And Control Course 2023

watersheds: microbial ecology

Resistance (AMR)

insights from the Watershed Interventions for Systems Health in Fiji Project (WISH -Fiji).

Speaker

Aaron Jenkins

Asheefa Aiyub

Institute

The University of Sydney

Consumer Council of Fiji

9.50 - 10.10 am

Stephane Bouchoucha Australasian College of Infection Prevention and Control Ltd.

AMS

AMRS

IPC

Session 8.1

Session 8.2

Session 8.3

Development, Implementation And

A One Health Epidemiological

Carbapenem-Resistant Organism

Evaluation Of An Antimicrobial

Survey Of Environmental Bacteria

Stewardship (AMS) Educational

Using Whole Genome Sequencing

Surveillance, Prevention, And Control In A Tertiary Hospital In Fiji

Aneley Getahun Strobel

Training Platform For The Western Pacific Region

Speaker

Rodney James

Ethan Wyrsch

Institute

The Doherty Institute

University of Technology Sydney

10.10 - 10.30 am

Speaker

Peter Doherty Institute for Infection and Immunity

AMS

AMRS

AMRS

Session 9.1

Session 9.2

Session 9.3

Global Data Collection on

Strengthening Of Antimicrobial

Genomic diversity of multi-drug

Antimicrobial Agents intended for

Resistance (AMR) Surveillance

resistant Gram-negative and Gram-

Use in Animals (AMU) and ANIMUSE – the New Online Platform

Through Laboratory Antibiograms

positive bacteria in Suva, Fiji

Nahoko Ieda

Tebuka Toatu

Jane Hawkey

Institute World Organisation for Animal Health 10.30 - 11.00 am

The Pacific Community

Department of Infectious Diseases Monash Central Clinical School

Plenary Hall Block 3 Panel Discussions

11.00 - 12.00 pm 12.00 - 12.20 pm Facilitators

AMS Room 1

Day 2 Group Photo | Morning Tea | Check Out AMRS Room 2

Asheefa Aiyub, Royford Magiri

Institute

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Keresi Lomata, Vincent Lal

Session 10.1

Session 10.2

Session 10.3

Some Alternatives to Antibiotics in

Antimicrobial susceptibility of

Lessons learned from bovine

Livestock Production: A Review

Speaker

Swartika Prasad, Reshnika Sen

AMRS Room 3

Siaka S. Diarra University of the South Pacific, Samoa Campus

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bacterial isolates from clinical

tuberculosis surveillance program in

specimens in four Pacific Island countries, 2017–2021

the Fiji Islands

Michael Loftus

Elva Borja

The Alfred Hospital, Melbourne

World Organisation for Animal Health

PROGRAM GUIDE

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

PROGRAMME

DAY 2: Thursday, 24th August 2023 12.20 - 12.40 pm

AMRS

AMRS

AMRS

Session 3.2

Session 11.2

Session 11.3

Examining The Relationships

Attributable mortality and excess

Multi-species carbapenem-resistant

Between Antrhopogenic Activities

length of stay associated with third-

organism (CRO) case investigation

And The Resistome, Mobilome, And

generation cephalosporin-resistant

at Colonial War Memorial (CWM)

Virulome Of Waterbodies

Enterobacterales bloodstream

Hospital, Fiji

infections: a prospective cohort study in Suva, Fiji

Speaker

Barbara Drigo

Michael Loftus

Tracey Young-Sharma

Institute

University of South Australia

The Alfred Hospital, Melbourne

Colonial War Memorial Hospital

12.40 - 1.00 pm

Plenary Hall Block 4 Panel Discussions

1.00 - 2.00 pm 2.00 - 2.20 pm

Lunch Plenary Hall Session 12 FAO and One Health in the Pacific

Speaker 2.20 - 3.00 pm

Raana Asgar and Kachen Wongsathapornchai

Session 13 Panel Discussions on Next Steps/Way Forward for NARC NARC, WHO, WOAH, FAO, SPC, EMAR, COMBAT-AMR, DFAT Closing of Symposium

3.00 pm

KEY: A&C

Awareness and Communication

AMRS

Antimicrobial Resistance Surveillance

IPC

Infection Prevention and Control

AMS

Antimicrobial Stewardship

GPR

Governance Policy and Regulations

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

MEMORIAM

In Memory of Ms Numa Vera

21-11-1976 Ms. Numa Vera was originally from Papua New Guinea. She attained a Bachelor of Pharmacy degree from the University of Papua New Guinea in 2001. She progressed to do a Masters in Science in Pharmaceutical Sciences at Gadjah Mada University in Indonesia and graduated in 2008.

The following year, 2009, she joined the former Fiji School of Medicine as a Lecturer in Pharmacy.

In 2010, Fiji School of Medicine was combined into Fiji National University and Ms. Numa has remained working in the university to date. While working at Fiji National University, she continued to upgrade her education career. In 2010, she graduated with Postgraduate Certificate in Public Health Research f rom Fiji National University. In 2013, she graduated from Monash University, Australia with Postgraduate Diploma in International Health then in 2014 she attained a Postgraduate Certificate in Medical Education from Fiji National University.

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06-07-2023 Ms. Numa held a position as Assistant Professor in Pharmacy and is the Head of Department of Pharmacy & Pharmacology at FNU from 2009 up until her passing.

Her areas of research include Antimicrobial Resistance and Emergency Contraceptives. She is the lead person from FNU-CMNHS for the Enhancing the Management of Antimicrobial Resistance in Fiji (EMAR) project, focusing on human health.

Ms Numa has contributed to research being done by the EMAR Fiji project and was to present at this symposium however she unfortunately succumbed to cancer and passed away on the 6th of July 2023 Rest in peace, Numa.

PROGRAM GUIDE

PROJECT EMAR FIJI PROJECT SUMMARY

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

Enhancing the Management of Antimicrobial Resistance (EMAR) in Fiji Background Antimicrobial resistance (AMR) is a human caused environmental challenge. Furthermore, the global stock of antibiotics, which is a non-renewable resource, is on the decline. In the Pacific region including Fiji, the occurrence of AMR, its causes, impact, and sustainable ways of managing it are poorly understood; sustainable management of complex problems such as AMR is important in costeffective management of complex and disruptive threats, resulting in saving of scarce resources particularly for low income countries such as Fiji.

To understand the magnitude of the AMR problem, a situational and needs assessment was first done in 2018 together with various stakeholders from the human, animal health, and the environment sectors to identify gaps in the management of AMR. Afterwards, the Enhancing the Management of Antimicrobial Resistance (EMAR) project was codesigned, co-developed, and co-implemented together with all the National Antimicrobial Resistance Committee (NARC) members such as the Ministry of Health & Medical Services, Ministry of Agriculture, Fiji National University, and University of South Pacific. EMAR project is one of the projects under the Research for One Health System Strengthening (ROHSS) being managed by Australia Centre for Agricultural Research (ACIAR) and DFAT's Indo-Pacific Centre for Health Security.

Aim and focal areas The EMAR project is based on complexity science and interdisciplinary research and considers health systems (human, animal and environmental) as complex adaptive systems that are interconnected.

The aim of the project is to enhance the integrated management of antimicrobial resistance (AMR) through existing national structures, resulting in sustainability and improved health outcomes in Fiji.

The project has six interlinked focal areas namely: Ÿ · Integrated AMR surveillance Ÿ · Laboratory capacity building Ÿ · Economics and risk analysis Ÿ · AMR governance Ÿ · Antimicrobial stewardship Ÿ · Policy and community engagement Expected change, outcome, and impacts The EMAR project will increase knowledge on the occurrence of AMR in the Pacific region across the food, health, environment, water nexus. This will consequently lead to increased knowledge on how best to manage AMR in a cost-effective and sustainable manner. The overall impact will be improved wellbeing of people and animals as well as ecosystem resilience. Additionally, the Pacific region more broadly will be the ultimate beneficiary from the project success, due to lowered risk of AMR spread under a regional public goods perspective.

Project partners Project partners include Commonwealth Scientific and Industrial Research Organisation (CSIRO), University of South Australia, University Technology Sydney, NARC members, FNU, USP, SPC, WHO, and FAO. Funding The project is funded by ACIAR and DFAT.

SPEAKER PROFILE: Dr Anna Okello Dr Anna Okello is the Research Program Manager for Livestock Systems at the Australian Centre for International Agricultural Research, a specialist food security agency within the Australian government's foreign aid portfolio.

A registered veterinarian, Anna holds a PhD in political science from the University of Edinburgh's Centre for African Studies. Since 2005 Anna has worked in international livestock development and public health programs in Africa and Asia, with management and research roles in Non-Government Organizations, the University of Edinburgh, United Nations agencies and the Australian government.

Anna has a strong interest in funding research for development projects that highlight the broader societal roles of livestock – including social protection, public health and gender equity – in addition to their important role in global food systems. Anna is a recognised authority on One Health policy and governance; she teaches on this subject at the University of Edinburgh's Global Health Academy, is on the Board of CABI One Health and is a Lancet One Health Commissioner.

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PROJECT SUMMARY

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

COMBAT-AMR: implementation of a One Health capacity building program across Pacific Island Countries COMBAT-AMR works in partnership with government, National AMR Committees and public health counterparts in Fiji, Samoa, Solomon Islands and Papua New Guinea, to implement capacity building and training activities to support the prevention, diagnosis, surveillance, and management of AMR pathogens, under the framework of National AMR Action Plans and priorities. COMBAT-AMR is supported by the Department of Foreign Affairs and Trade's Indo-Pacific Centre for Health Security.

COMBAT-AMR delivers a program of work at major national sites, including referral hospitals and laboratories, across four key themes: (1) infection prevention and control; (2) antimicrobial stewardship; (3) laboratory capacity and surveillance; (4) animal health.

Under the infection prevention and control (IPC) theme, we have worked with the Colonial War Memorial Hospital (CWMH), Suva, Fiji, to support hand hygiene auditing, monitoring, and data collection, developed healthcare associated infection (HAIs) audit tools, reviewed and provided templates for standard operating procedures as well as participated in the Infection Control Committee (ICC) to provide technical support as needed.

In the antimicrobial steward (AMS) theme in Fiji, our project has provided training for 25 individuals representing Lautoka, Labasa and CWMH hospitals as well as Fiji Biomedical and Pharmaceutical Services (FPBS) with clinical and pharmacy background in antimicrobial auditing using the National Antimicrobial Prescribing Survey (NAPS). This survey provides the facilities an opportunity to observe prescribing trends within the hospital as well as carry out point prevalence surveys within the facility. In addition, we have worked with the team at the CWM hospital to support improvement monitoring, feedback and data collection.

The laboratory capacity and surveillance theme at CWM hospital, Suva, Fiji, has supported areas such as bacterial identification, antimicrobial susceptibility testing (AST), quality assurance and quality management, whole genome sequencing at the Microbiological Diagnostic Unit Public Health Laboratory (MDUPHL) in Melbourne, Australia, development of standard operating procedures, continuing remote support through online engagement and capacity building of four laboratory technician at the Doherty Institute, Australia in 2022.

The animal health theme has worked with the Ministry of Agriculture veterinarians and collaborated with The Pacific Community (SPC) to develop an antimicrobial treatment guideline which can be used by paraveterinarians and veterinarians in the field. This guideline has received endorsement from the respective ministry.

Moreover, the COMBAT-AMR project has collaborated with other partners in Fiji to support development and improvement in clinical governance, PCR testing and surveillance capabilities through capacity building exercises and activities addressing Carbapenemase resistant organisms.

SPEAKER PROFILE: Professor Benjamin Howden Professor Benjamin Howden is Director of the Microbiological Diagnostic Unit Public Health Laboratory and Co-Director of the WHO Collaborating Centre for AMR at the Doherty Institute, Australia. He leads an extensive program of work across pathogen genomics, antimicrobial resistance, and clinical microbiology, across research, international capacity building and training, and policy. Professor Howden co-leads the Australian Government Department of Foreign Affairs and Trade funded COMBAT-AMR program.

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ABSTRACTS

PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

ONE HEALTH IN THE PACIFIC COMMUNITY (SPC) Eric Rafai The Pacific Community

Background The Secretariat of the Pacific Community (SPC) now know as the Pacific community over the past decade recognised the importance of One Health approach to address priority issues and unique health challenges faced by Pacific island Countries and territories .The SPC is an international development organisation governed by 27 members, including 22 Pacific island countries and territories around the Pacific Ocean. This abstract provides an overview of initiatives/ projects that were developed within SPC and its partners that have evolved into the current focus on One Health that is aimed at integrating and linkingits key divisions.

Method Several information sources at SPC were used to collate historical events at SPC that allude to the advent of One Heath to its current form. There is a key list of projects by SPC that initiate One Health initiatives by the different divisions with attempts made to enable the interaction of animal, human and environment interface with important challenges and lessons for the next level of development.

Focus The focus of the study is to describe the earliest initiatives and activities of One Health in the Pacific that has shaped the development of a One Health initiative to its current status.

Scope The scope of the study describes the earliest initiative venture into One Health in SPC as the PRIPP project that began 2003 and the different steps and influences that have evolved to the current strategic direction. The future direction is opportunistic with several global initiatives supporting a One Health approach to addressing key priority issues for Pacific islands and equally interested are partners in the One Health Agenda in the region.

SPEAKER PROFILE: Dr Eric Rafai Dr Eric Rafai is the former chair of the National AMR committee in Fiji (2015-2023) and currently employed at the Pacific Community as the One Health coordinator since May 2023. He was previously employed at the Ministry of Health & Medical services in the Chief Epidemiologist role from 2018 and before that as the Deputy secretary for Public Health.

He is a registered Public Health specialist with the Fiji Medical & Dental Council and has undertaken several leadership roles at regional and international level. Dr Rafai has postgraduate training in public health (QUT), infectious disease (UWA) and management (USP) and is a recipient of the Australian Leadership Awards (2011). His first publication as primary author was in 1997 and has since contributed to several publications in a wide range of interest areas (Google scholar profile).

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

ABSTRACTS

SESSION 1.1: RELOOKING AT THE DELIVERING ANIMAL HEALTH CARE SERVICES IN FIJI AND THE SOUTH PACIFIC REGION 1

2

1

Razia Rashid , Walter Okello , Royford Magiri 1

College of Agriculture, Fisheries and Forestry, Fiji National University, P.O Box 1544, Nausori, Fiji Islands.

2

Commonwealth Scientific and Industrial Research Organization

The interaction between animals, humans and the environment are a natural phenomenon that cannot be avoided. Consequently, the health of animals, humans and the environment are all interrelated as 'one health'. The livestock sector is emerging as one of the fastest growing agricultural sub-sectors in Fiji and the expectations are that this growth could further accelerate due to growing incomes and the high-income elasticity of demand for livestock products.

Given the size and relatively equitable distribution of livestock in Fiji, this presents an excellent opportunity for the country to boost rural incomes and accelerate the pace of poverty reduction. But successful capitalization of such opportunities requires a policy regime that facilitates growth in productivity at the farm level as well as in the processing sector. The productive potential of animals depends crucially on the quality of nutrition, genetic material, and the animal health system, and on all these counts, Fiji has a poor record.

The public sector continues to be the primary provider of veterinary services, and the deteriorating fiscal situation of most state governments is making it extremely difficult to either expand the reach of these services or improve the quality-of-service delivery. Although, on efficiency grounds, there is good rationale for commercialized delivery of these services, serious concerns prevail in Fiji about the equity implications of private sector delivery or full cost recovery within the government system.

Evaluation of the desirability of user fees or private delivery of livestock services requires an understanding of the factors influencing the demand for these services. Furthermore, veterinary public health should equally be aligned to the core veterinary services. In this paper, we examine the local delivery of animal health care services, considering the different delivery systems vis-à-vis the different production systems (humans, environment?).

The role of planners and policy makers is examined, to ensure that they are advocating for changes that are compatible with the existing animal production systems and veterinary public health and in line with international norms.

SPEAKER PROFILE: Ms Razia Rashid Miss Razia Rehana Rashid is currently a Masters (Animal Science) student at Fiji National University. She has done Bachelor of Veterinary Science and Animal Husbandry at FNU and graduated in 2020. Miss Razia has worked as a Veterinary Clinician at Vet Essential Animal Doctors for 2.5 years. She left work to pursue her studies after bagging the ACIAR Scholarship. Her study focuses on the Supply and Demand of Animal Health Care Services in Fiji.

She is originally from Nadi and now living and thriving in Suva for 9 years.

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

ABSTRACTS

SESSION 1.2: PREVALENCE OF ANTIMICROBIAL RESISTANCE ORGANISMS, KNOWLEDGE ON ANTIBIOTIC USE AND RESISTANCE AMONG POULTRY FARMERS IN FIJI 1

1

2

2

1

Shivani Singh , Sharon Gaundan , Walter Okello , Anthony Keyburn , Royford Magiri 1

College of Agriculture, Fisheries and Forestry, Fiji National University, Suva P.O. Box 7222, Fiji Commonwealth Scientific and Industrial Research Organization,

2

Antimicrobial resistance is a current significant public health issue. However, in Pacific Island Countries such as Fiji, knowledge on the prevalence of antimicrobial resistance and its trend especially in livestock is scarce. To determine this a cross sectional study was carried out. The results showed that 98.2% of the respondent we're raising more than one type of livestock including poultry.

The knowledge of antibiotics was low; only 31.1% of respondents knew what antibiotic drugs were and 68.9% had never heard about antibiotics. However, the source of this information was mainly from the Ministry of Agriculture officers at 26.7%. Interestingly, 88.9% did not know the meaning of not using antibiotics correctly. Disease treatment option was the top choice on why antibiotics are used in chicken at 18.2%. About 11.11% knew what the common problems were when antibiotic was not used correctly. The general resistance pattern of the isolates to antibiotics was found to be as follows; ampicillin (35%), erythromycin (96%), tetracycline (35%), gentamicin (46%), meropenem (18%), norfloxacin (17%), kanamycin (16%), cefaclor (61%), and streptomycin (25%). To reduce antimicrobial usage and antibiotic resistance, it is required to increase awareness, create, and put into practice solutions

SPEAKER PROFILE: Ms Shivani Singh Shivani Singh, has a Masters of Animal Science. At Fiji National University she learnt how to connect veterinary science with animal production in contrast to Fiji's economy and agricultural practices. She was part of the CSIRO/ACIAR EMAR project as a student microbiologist for livestock production. Ms Singh is currently working for ACIAR PASS CR as their local coordinator.

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

ABSTRACTS

SESSION 1.3: SUCCESSFUL ESTABLISHMENT OF HYBRID MULTIDISCIPLINARY BLOODSTREAM INFECTION MANAGEMENT GROUP IN SOLOMON ISLANDS 1

1

1

1

Dr Alice Siuna Waneoroa , Dr Emire Meone Maefiti , Hilda Zoleveke , Esther Bogese , 1 2 2 2 Frances Kennedy , Wendy Jackson , Dr Matt Mason , Mieke Huthchinson-Kern Dr Nikki 2 Townell 1

National Referral Hospital, Solomon Islands Pacific Region Infectious Disease Association

2

Background: Solomon Islands (SI) is a nation of 700,000 people with a small health workforce and no infectious disease physician. Bloodstream infections (BSIs) are a significant cause of mortality. Historically management of BSI in SI had been challenging, including delays in notification, lack of clinician understanding, non-standardised approach to patient management and lack of appropriate antibiotics.

Purpose: A multidisciplinary group with local and international clinicians was established with the purpose of improving clinical management of patients with BSIs within a larger program to support training, and capacity building to address the threat of antimicrobial resistance (COMBAT-AMR).

Methods/description of process, or experience: The Solomon Blood Stream Infection group includes physicians, surgeons, infection prevention and control (IPC) nurses, microbiology scientists and pharmacists at the National Referral Hospital with online support from international counterparts (PRIDA and Alfred Hospital). Weekly hybrid meetings provide real time review and patient management advice for positive blood cultures and multi-resistant organisms (MROs). There is a strong mentoring and information sharing focus. The meetings provide a forum to discuss issues relating to IPC, antimicrobial stewardship and microbiology.

Results: Weekly meetings have been held since March 2022 with discussions on diagnosis and management of conditions such as infective endocarditis and surgical site infections.

Participants have reported better dissemination of information and improved collaboration between teams.

This resulted in the early identification and containment of two MRO outbreaks, Audits, policies and training have been developed and implemented from gaps identified during meetings. Local champions have reported gaining knowledge and confidence in BSI management.

Conclusion: This project highlights the importance of multidisciplinary involvement and local engagement in the successful management of complex infections in low resource settings. It is expected that the same approach could be effectively applied to the management of non-communicable diseases.

The provision of regular online expert support is an effective and sustainable method to provide mentoring and support development of local champions.

SPEAKER PROFILE: Dr Alice Siuna Dr Alice Siuna graduated from the Fiji School of Medicine with an MBBS degree in 2007.

She has also done her Postgraduate Diploma in Internal Medicine in 2014 and a Masters in Internal Medicine in 2017, both from the Fiji National University.

She is currently working at the National Referral Hospital, Solomon Islands, as a Consultant Physician for the past 5 years. She has a special interest in Infectious disease/AMS. Dr Alice is also the chairperson for the AMS and IPC at the National Referral Hospital she works at in the Solomon Islands in the past year with ongoing mentoring.

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PACIFIC ONE HEALTH & AMR SYMPOSIUM 2023

ABSTRACTS

SESSION 2.1: ASSESSMENT OF KNOWLEDGE, ATTITUDES AND READINESS OF HEALTHCARE WORKERS TO MANAGE PATHOGENS WITH CRITICAL ANTIMICROBIAL RESISTANCE AT COLONIAL WAR MEMORIAL HOSPITAL, FIJI 1

2

3

4

Aneley Getahun Strobel , Shammi Prasad , Ravi Naidu , Matthew Richards , Donna Cameron5, Vinita Prasad3, Kirsty Buising1,4

1 Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, the University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia 2 Australian Volunteer international, Pacific People Office, Level 2, BSP Central Street, Suva, Fiji 3 Ministry of Health and Medical Services, Colonial War Memorial Hospital, Waimanu road, Suva, Fiji 4 Royal Melbourne Hospital, 300 Grattan Street, Melbourne VIC 3052, Australia 5 Microbiological Diagnostic Unit, Public Health Laboratory, Peter Doherty Institute for infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia

Introduction and objectives: Colonial War Memorial Hospital (CWMH) is the largest national referral hospital in Fiji.

This survey was conducted to determine the knowledge, attitudes, and readiness of healthcare workers (HCWs) to manage outbreaks of pathogens with critical antimicrobial resistance (AMR) including laboratory detection, case management, and hospital infection prevention and control (IPC).

Methods: This cross-sectional survey was undertaken in July and August 2022. A structured self-administered questionnaire was developed which included: socio-demographics and professional information, and statements regarding knowledge, readiness and attitude to which subjects responded on a 5-point scale (strongly disagree, disagree, neutral, agree, strongly agree). Data were analysed using Statistical Package for Social Sciences. The survey received ethics approval from CWMH and University of Melbourne.

Results: A total of 395 HCWs completed the survey with the response rate of 96%. Respondents comprised nurses (56%), doctors (30%) and laboratory personnel (13%). The majority of respondents (79%) were females and 66% between the age of 20 and 34 years.

Overall, participants reported a high level of knowledge (86%-97%) about IPC measures to reduce the spread of infections.

The majority (>85%) knew the modes of transmission of infections in healthcare settings. Among laboratory personnel, 65% thought they had adequate knowledge to detect critical AMR organisms.

With regards to readiness, 37% of HCWs stated the hospital had adequate capacity to detect critical AMR organisms while 32% stated it had adequate capacity to respond to a critical AMR outbreak. Responses to resource availability for case management were mixed; 42% reported resources were adequate while 41% thought the hospital did not have adequate resources.

HCWs' attitudes were positive (84%) toward changing their work environment to prevent the spread of critical AMR infections. The majority of HCWs (93%) agreed that overcrowding in the hospital increased the spread of infection.

Conclusion: This survey revealed good knowledge of fundamental IPC measures and an emerging awareness of critical AMR among HCWs. Inadequate levels of readiness for critical AMR detection and outbreak response demonstrates the need for ongoing technical support and further resource allocation. The survey results have been used to guide comprehensive capacity building activities to enhance laboratory detection, surveillance, and IPC interventions.

SPEAKER PROFILE: Dr Aneley Getahun Strobel Aneley is a research project manager on antimicrobial Resistance at the Peter Doherty Institute for Infection and Immunity in Melbourne. She is an accomplished public health physician with a career spanning 25 years in Africa, Asia and the Pacific.

Aneley’s research interests are mainly in communicable diseases and antimicrobial resistance. She actively works to establish collaborative networks, fostering partnerships among organizations and experts in the realm of epidemiology and public health to improve population health.

Aneley holds a PhD form the Peter Doherty Institute at University of Melbourne, a Masters in clinical tropical medicine from the University of Mahidol in Thailand and a Medical Doctorate from Addis Ababa University in Ethiopia.

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SESSION 2.2: DAIRY PRODUCTION DYNAMICS AND ANTIBIOTICS SENSITIVITY PATTERNS OF BACTERIA ISOLATED FROM CALF DIARRHEA IN FIJI 1

2

2

1

Wati Mocevakaca , Walter Okello , Anthony Keyburn , Royford Magiri , 1

College of Agriculture, Fisheries and Forestry, Fiji National University, P.O Box 1544, Nausori, Fiji Islands.

Commonwealth Scientific and Industrial Research Organization, Black Mountain Science and Innovation Park, Clunies Ross Street, Acton ACT 260, Australia 2

Introduction: Livestock plays an integral role in many countries, especially in low and middle income. In Fiji, the livestock sector is vital and necessary in the socio-economic development of many rural households. Rearing dairy cattle for producing dairy milk production is paramount as this is a source of dietary animal source protein for the general populace, generates regular income and food security to many rural households and other benefits in the Pacific. Livestock in Fiji contributes $48.3m to total GDP. However, Fiji is still insufficient in its milk demands and has potential to export to many other Pacific Island countries. Antimicrobial resistance (AMR) can hinder the management of calf diarrhea in addition to being a significant threat to public health. Currently, the resistance patterns of organism causing calf diarrhea is unknown in Fiji.

Methods: To determine data from Fiji Agriculture census 2020, Ministry of Agriculture (MOA) as well as Fiji Corporate Dairy Company Limited (FCDCL). Also, this a cross sectional study was carried out to determine antibiotics sensitivity patterns of bacteria isolates from calf diarrhea.

Results: The results showed that more than 50% of all total Milking cows, dry cows, heifer, calf, bull, and steer is between the range of 1-10 followed by the range 11-20 then 21-50 animals per herd with average of milk produced/ day/cow of 4.5 L. About 66% (n=100) of dairy farms produce <4.5L of milk/day/cow. On the hand, 27% (n=41) of farms produce >= 4.5L of milk /day/cow. The studies on antibiotic sensitivity testing show that out of the nine antibiotic which is Ampicillin (AM), Penicillin (P), Oxacillin (OX), Doxyclycline (DO), Polymycin B (PB), Chloramphenicol, Cofactor, Streptomycin(S), and Ethromycin(E), bacteria isolated showed resistant to Oxacillin, streptomycin, Ethromycin.

Conclusion: This information is necessary to develop appropriate intervention strategies to increase milk production and mitigate the emergence of antimicrobial resistance in Fiji.

SPEAKER PROFILE: Ms Wati Moevakaca Wati is a ACIAR (Australia Centre of International Agriculture Research) – Pacific scholar currently undergoing a Master's of Science in Agriculture focusing on livestock production under the EMAR project at the Fiji National University. She is a Veterinary Science and Animal Husbandry graduate from the Fiji National University. Watis' research is on the characterisation of dairy production dynamic in the Fijian dairy farms as well as prevalence and antibiotics sensitivity patterns of bacteria isolated from calf diarrhea in Fiji.

Along with her current research she is also a recipient of the Future Thinkers' ACIAR Pacific Climate Change grant with aims to investigate the perceptions of the impact of climate change on the Fijian Dairy farmers and farm.

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SESSION 2.3: TACKLING HUMAN HEALTH AND ENVIRONMENTAL DIMENSIONS AMR THROUGH STRENGTHENING CAPACITY FOR INFECTION PREVENTION AND CONTROL, AND WATER, SANITATION AND HYGIENE Ilisapeci Nabose, Ashlyn Datt, Shammi Prasad, Bernadette Kennedy, Karishma Priti Nandan, Donna Cameron, Alison Macintyre on behalf of the COMBAT-AMR program Purpose COMBAT-AMR is an Australian Government funded program across four countries in the Pacific, designed to tackle antimicrobial resistance using a One Health approach. COMBAT-AMR has four operational arms: animal health; laboratory capacity; infection prevention and control (IPC) and water, sanitation and hygiene (WASH); and antimicrobial stewardship. The program has been operating in Fiji since 2020. This case study focusses specifically on the implementation of joint IPC and WASH components at the Colonial War Memorial Hospital (CWMH). Adopting a joint IPC and WASH program was a novel approach to strengthen the prevention and control of AMR at the hospital and minimise the risk of spread to surrounding environments.

Focus To jointly address WASH and IPC, a modified WHO Infection Prevention and Control Assessment Framework (IPCAF) was conducted jointly with the IPC team at CWMH. The modifications were made to more comprehensively include WASH across the IPC assessment. A strengths-based report was developed from the assessment to inform a prioritised set of activities to improve IPC and WASH with a focus on AMR. Capacity building has been the central approach to COMBAT-AMR's support to the CWMH IPC team. This has been executed through: regular mentoring sessions; incountry visits; workshops and on the job training sessions; development and update of standard operating procedures; and strengthening of audit processes and reporting. The partnership between CWMH and experts based in Australia has supported the sharing of procedures and expertise from Australian settings and those across the region to inform a best practice approach to a wide range of WASH and IPC areas such as environmental cleaning, surveillance, hand hygiene compliance, and WASH. Conclusion COMBAT-AMR has resulted in strengthened capacity across the hospital to improve IPC and WASH, specifically to tackle AMR and to impact quality of care more broadly.

Funding This work was funded by the Australian Government Department of Foreign Affairs and Trade's Indo-Pacific Centre for Health Security funded COMBAT-AMR Program

SPEAKER PROFILE: Ms Ashlyn Datt Ashlyn Datt is working at CWM Hospital which is one of the largest hospital in Fiji as an Act Team leader for IPC. She has been a nurse for 10 years and spent 5 years of her journey in IPC. She has done bachelors of nursing and is currently doing Foundation in IPC to upgrade her knowledge and skills in IPC.

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SESSION 3.1: PUBLIC KNOWLEDGE, ATTITUDE, AND PRACTICE TOWARDS ANTIBIOTICS AND ANTIBIOTIC RESISTANCE IN FIJI 1

1

2

Numa Vera , Priya Chand , Walter Okelo , Keith R Hayes

3

1

Department of Pharmacy and Pharmacology, Fiji National University CSIRO Black Mountain Science and Innovation Park, Clunies Ross Street, Acton ACT 260, Australia 3 CSIRO Data 61, Hobart, Tasmania, Australia, 7001

2

Introduction: Antibiotic resistance is a threat in Fiji. Frequent outbreaks have been reported in the hospitals.

NARC was established to address the issue. In the current NAP, NARC highlights the need to conduct more public awareness on antimicrobial resistance. Understanding the knowledge, attitude, and practices of the public towards antibiotics and antibiotic resistance is necessary to promote awareness interventions that may help control antibiotic resistance in the country.

Methods: This was a descriptive cross-sectional study conducted in Central, Western and Northern divisions of Fiji from September 2022 to January 2023. Participants who volunteered to take part were interviewed using the structured questionnaire. The demographic characteristics of the participants were analysed using descriptive statistics using Microsoft Excel. IBM SPSS statistic version 27 was used conduct Chi square and binary logistical analysis.

Results: A total of 1220 participants with an average age of 37 ± 12 years participated in the study. Overall, high levels of inadequate knowledge, negative attitude and inappropriate practice antibiotics and antibiotic resistance were documented. Knowledge is associated with attitude and negative attitude is associated with inappropriate practice. Predictors of knowledge, attitude, and practice were identified.

Conclusion: It can be concluded from this study that overall, the public have inadequate knowledge, negative attitude and inappropriate practice towards antibiotics and antibiotic resistance in Fiji. Continuous awareness programs on antibiotics and antibiotic resistance are recommended throughout the country. A more targeted approach towards the predictors identified in this study may improve public knowledge, attitude, and practices towards antibiotics and antibiotic resistance.

Key words: Antibiotic resistance, antibiotics, knowledge, attitude, practice, Fiji

SPEAKER PROFILE: Ms Priya Chand Priya Chand is an Assistant Lecturer in Pharmacy with the Department of Pharmacy & Pharmacology, Fiji National University. She holds a Bachelor of Pharmacy degree from Savitribai Phule Pune University, India and attained her second Bachelor of Pharmacy degree from Fiji National University. She is also a registered pharmacist in Fiji.

In this symposium she will provide an overview on 'Patient Knowledge, Attitude and Practice towards Antibiotics and Antibiotic Resistance in Fiji'. This research was funded by the Australian Centre for International Agricultural Research through the Enhancing the Management of Antimicrobial Resistance project. Researchers have found that the general public plays a pivotal role in the increase and spread of antibiotic resistance. The present study was designed to get a better understanding of the existing pieces of evidence pertaining knowledge, attitude and practices about antibiotics in the general population in Fiji.

Her previous research includes “Analytical method development for estimation of Serratiopeptidase using Quality by Design approach” which was carried out at SCES's Indira college of Pharmacy, India.

Another study entailed “Streptophotometric Analysis of Amoxycillin Capsules” that was part of her Bachelor of Pharmacy program in Fiji. This was a baseline study that would provide information base against which to monitor and assess validation procedure for Amoxycillin Trihydrate capsules. Thirdly, as part of the pharmacy internship program she completed a research study entitled 'Patient Knowledge and Perception about Antibiotics in Community Pharmacy'.

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SESSION 3.2: EMAR FIJI: EXAMINING THE RELATIONSHIPS BETWEEN ANTRHOPOGENIC ACTIVITIES AND THE RESISTOME, MOBILOME, AND VIRULOME OF WATERBODIES Barbara Drigoa, Steven P. Djordjevicb, Ethan R. Wyrschb, Max C. Cumminsb, Walter O. Okeloc, Keith Hayesc, Royford Magirid, Vincent Lale, Numa Veraf, Erica Donnera a

Future Industries Institute, UniSA STEM, University of South Australia, Mawson Lakes, SA, 5095, Australia Australian Centre for Genomic Epidemiological Microbiology, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia c The Commonwealth Scientific and Industrial Research Organization (CSRIO), Land and Water, Black Mountain, Canberra, ACT 2601, Australia d Department of Veterinary Science, Fiji National University, Koronivia, Nausori, Fiji Islands e The Institute of Applied Sciences, The University of the South Pacific, Laucala Campus, Suva, Fiji Islands f Department of Pharmacy and Pharmacology, Fiji National University, Suva, Fiji Islands b

Introduction and objectives: As a One Health issue impacting life across humans, animals, and the environment, antibiotic resistance is found in one of the most basic resources for life – water. Antibioticresistant pathogens and their genes have been found in (waste)waters, streams, rivers, lakes, and oceans.

Here, we used a comprehensive integrated analysis encompassing isolation of carbapenem-resistant bacteria, whole genome, and shotgun metagenomics to track the fate of the resistome, mobilome, and virulome in surface waters and (waste)waters from several waterbodies and wastewater treatment plants in Suva and surrounding peri-urban, agricultural, and pristine areas.

Methods: To provide globally comparative datasets and to link this study directly to local epidemiological data, qPCR assays were designed to mirror molecular assays currently used for international-wide human surveillance for nosocomial and community-acquired antimicrobial-resistant infections.

Results: The class 1 integron-integrase gene (intl1), a proxy for multi-drug resistance, sulfonamide (sul1) and extended-spectrum -lactam (blactxm32, blaSHV, blaTEM, blaGES, blaKPC) genes increased sharply in (waste)water, peri-urban and urban waterbodies. Whereas tetracyclines (tetW), vancomycin (vanA), and quaternary ammonium compounds (qacE) were significantly abundant in agricultural catchments.

Interestingly, polymyxin resistance genes (mcr1-5) were abundant in pristine waterbodies. (Waste)waters, agricultural, peri-urban, and urban waterbodies were carriers of multidrug-resistant and virulent ESKAPE pathogens, including E. coli ST131 and St69.

Conclusion: This comprehensive study of (waste)waters and waterbodies in Suva and surrounding peri-urban, agricultural, and pristine areas provides new insight into drivers of antimicrobial resistance and pinpoints key monitoring targets indicative of where human sources and exposures are likely to be most acute and in need of multi-sector surveillance.

SPEAKER PROFILE: Dr Barbara Drigo Dr. Barbara Drigo conducted her doctoral studies at the Netherlands Institute of Ecology and was awarded her PhD in 2009 from the University of Leiden (Netherlands). Her PhD research involved utilizing several interrelated methods in molecular microbial ecology. Subsequently, she served as a research fellow at Wageningen University (Netherlands), where her focus was on studying the correlation between disease suppression and bio-control agents. Shortly after, she relocated to the Hawkesbury Institute for the Environment (Australia), where she developed novel experimental systems to investigate microbial dynamics and functioning in response to environmental changes. In August 2016, Dr. Drigo joined the University of South Australia, where she currently leads a research group with a strong emphasis on applied research that significantly contributes to microbiological practices in human, animal, and environmental health. During her tenure at UniSA, Dr. Drigo played a pivotal role in securing and managing total research funding amounting to $6M. Moreover, her contributions have been crucial in laying the groundwork for the Cooperative Research Centre for Solving Antimicrobial Resistance in Agribusiness, Food, and Environments (CRC SAAFE; $149M).

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SESSION 3.3: TOWARDS A COLLABORATIVE SUPPORT FRAMEWORK TO ASSIST INFECTION PREVENTION AND CONTROL PROGRAMMES IN LOW- AND MIDDLEINCOME COUNTRIES: A SCOPING REVIEW Running Title: Infection Prevention and Control Collaboration 1

2,3,4*

Festus Adams , Peta-Anne Zimmerman 1.

2.

3.

4.

5.

6.

2,5

, Vanessa L Sparke Matt Mason

2,6

Centre for Environment and Population Health, School of Medicine, Griffith University, Gold Coast, Queensland, Australia Collaborative for the Advancement of Infection Prevention and Control, Queensland, Australia Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia Department of Infection Control, Gold Coast Health, Gold Coast, Queensland, Australia College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia University of the Sunshine Coast, Sippy Downs, Queensland, Australia

Background: Infection prevention and control (IPC) in low and middle income countries (LMIC) is often constrained by limited resources and competing health priorities, necessitating external agency support. Yet, no reported frameworks exist to guide the development of such collaborations.

Aim: This study aimed to identify the core elements of a collaborative support framework to strengthen IPC in LMICs. Methods: A systematic scoping review of literature (2005-2020, in English) was conducted based on PRISMA 2020 guidelines. MEDLINE, CINAHL, Embase, and Scopus databases were utilised, with a search strategy that included varied combinations of MeSH terms, Emtree and IPC-related keywords.

Results: Six core elements of a comprehensive IPC collaborative support framework were identified: 1) Collaborative Projects, 2) Policies and Procedures, 3) Training and Professional Development, 4) Surveillance Systems, 5) Assessment and Feedback, and 6) Partnerships, the latter being a crucial enabling factor. The analysis showed that training and collaborative projects benefit from pre-workshop preparations and multidisciplinary groups, fostering collaboration and skills enhancement. Working groups of multidisciplinary stakeholders proved pivotal in IPC collaborations, providing forums for information exchange and assisting in resource development. Their input fortifies partnerships, underscoring the interconnectedness of the elements.

Conclusion: The identified core elements should guide the construction of a collaborative support model for IPC in LMIC. The next step is developing a framework of equitably empowered partnerships for sustained IPC improvement in LMIC settings.

Keywords: infection control, healthcare systems, collaboration, low and middle income countries.

SPEAKER PROFILE: Dr Peta-Anne Zimmerman Dr Peta-Anne Zimmerman is an internationally respected clinician, educator and researcher in infection prevention and control. Dr Zimmerman's experience includes consultancy work with the World Health Organization (WHO), AusAID, the Asian Development Bank (ADB), the Secretariat of the Pacific Communities (SPC), The Albion Centre and as a member of the WHO SARS Response Team. Her expertise has led her to work extensively in China, South East Asia and the South Pacific, directly on outbreak response, and the development of comprehensive infection prevention and control programmes and integration of public health and acute care response in infectious disease emergencies in low and middle income country settings. Peta-Anne is a Board Director of the Australasian College for Infection Prevention and Control (ACIPC), Chair of the ACIPC Research, Grants, and Scholarship Committee, ACIPC representative and faculty for the Global Outbreak Alert and Response Network (GOARN), and member of the ACIPC Credentialling and Professional Practices (CAPS) Committee. Peta-Anne directs the Graduate Infection Prevention and Control Program at Griffith University and is a Visiting Research Fellow with the Gold Coast Hospital and Health Service, Australia. Her research focus is infection prevention and control and outbreak response, including novel approaches to the teaching and learning of this discipline, and health education in general, including the use of pop-culture and zombies.

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SESSION 4.1: ANTIMICROBIAL CONSUMPTION FOR HUMAN AND VETERINARY PRACTICES IN Fiji Royford Magiri1, Chaminda Dissanayake2, Walter Okello3 1

College of Agriculture, Fisheries and Forestry, Fiji National University, P.O Box 1544, Nausori, Fiji Islands.

Biosecurity Authority of Fiji (BAF), Level 3, Provident Plaza I, Ellery Street, Suva, Fiji 3 Commonwealth Scientific and Industrial Research Organization, Black Mountain Science and Innovation Park, Clunies Ross Street, Acton ACT 260, Australia 2

Abstract Introduction: Globally, the demand for animal protein for human consumption has been increasing at a faster rate in the last 5 to 10 decades resulting in increased antimicrobial consumption in food producing animals. Antimicrobials are frequently used as part of modern methods of animal production, which may put more pressure on evolution of antibiotic resistant bacteria. Despite the serious negative effects on animal and human health that could result from using antibiotics, there are no assessment of antimicrobials consumed by the livestock sector in Fiji as well as other Pacific Island Countries.

Methods: The objective of this study was to quantify antimicrobials imported for consumption in food animals into Fiji from 2017 to 2021 and antibiotics sale at the retail pharmacies. Data on imported antimicrobials, which were finished products, was obtained from Biosecurity Authority Fiji (BAF). Additionally, A total of 83 pharmacists were interviewed in Fiji in 2022 using a standard questionnaire. Data recorded included demographic variables, types of antibiotics sold, antibiotic customers, antibiotic prescribing practices and knowledge of antibiotic use and AMR. Imported antimicrobials were then analyzed by antimicrobial class, and importance to veterinary and human medicine. Similarly, the questionnaire data was analyzed for the sale dynamics.

Results: An average of 92.86 kg per year (sd = 64.12) of antimicrobials as a net weight was imported into Fiji in the 2017-2021 study period. The mean amount of imported active antimicrobial ingredients after adjusting for animal biomass was 0.86 mg/kg (sd = 0.59). From the total antimicrobial imports during the years 2017 to 2021, penicillin's (69.72%) and tetracycline (15.95%) were the most imported antimicrobial classes. For animal health 96.48% of the antimicrobial imports were veterinary critically important antimicrobials. For human health fluroquinolones, macrolides, aminoglycosides, and penicillin's were the imported critically important antimicrobials. Our study also shows that at the retail level, there is a considerable overlap between antibiotic classes sold for both human and veterinary medicine. Penicillin's, metronidazole, fluoroquinolones, and first and second-generation cephalosporins were reported as being amongst the four most sold antibiotic classes by the human drug stores. Whilst in our study, clinical training significantly influenced knowledge on issues related to antibiotic use and AMR and respondents had a relatively adequate level of knowledge about AMR, several inappropriate prescribing practices were identified.

Conclusion: The study concluded that use of antimicrobials in food producing animals is low but monitoring of antimicrobial consumption and antimicrobial resistance was critical in Fiji due to overreliance on critically important antimicrobials and overlap between antibiotic classes sold for both human and veterinary medicine.

Keywords: antimicrobial resistance, antimicrobial consumption, Fiji,

SPEAKER PROFILE: Dr Royford Magiri Dr Royford Magiri is an Assistant Professor of Veterinary Microbiology in the Department of Veterinary Science, School of Animal and Veterinary Sciences at the College of Agriculture, Fisheries and Forestry, Fiji National University.

He studied his PhD in Vaccinology and Immunotherapeutics at the School of Public health, University of Saskatchewan, Canada. His other qualifications are MSc. In Clinical Studies and Bachelor of Veterinary Medicine both from the University of Nairobi, Kenya.

He has been involved in tertiary teaching for the last 10 years in areas of Veterinary surgery, Veterinary internal Medicine, Reproduction and obstetrics, Immunology, Microbiology and Virology, Immunotherapeutics, adjuvants and antibiotics, Vaccine, vaccination and infectious diseases, Animal welfare and ethics working first in Kenya, Canada and Fiji.

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SESSION 4.2: MANAGING DIAMONDBACK MOTH RESISTANCE TO INSECTICIDES IN FIJI: A FLEXIBLE STRATEGY THAT MINIMIZES USE OF HAZARDOUS CHEMICALS 1

1

2

Atumurirava, F. , Nand, N. , Mua, M. and Furlong, M.J. 1 2

2

Plant Health, Land Resources Division, Pacific Community, Suva, Fiji School Of Biological Sciences, The University Of Queensland, St Lucia, 4072 Queensland, Australia.

In Fiji, management of the diamondback moth (DBM), Plutella xylostella L. (Lepidoptera: Plutellidae), has been constrained by resistance to broad-spectrum insecticides and lack of reliable access to selective products. Since 2013, the susceptibility of DBM field populations to a range of insecticides has been monitored and new selective products have been sequentially introduced and incorporated into an insecticide resistance management (IRM) strategy. The strategy is based on the “window” principle promoted by the Insecticide Resistance Action Committee (IRAC). It relies on the limited use of insecticides with different modes of action in discrete temporal windows that equate to the duration of the life cycle of the pest (≈18 days in Fiji) to minimize exposure of successive generations to similarly acting insecticides. Constrained by the insecticides available to farmers, the original strategy, developed in 2014, included indoxacarb, lufenuron, abamectin, AgChem-Bt (aizawai) and chlorantraniliprole. The strategy, which was initially supported by community meetings to engage farmers, worked well through to 2017 and the susceptibility of field populations to the recommended insecticides remained high. In 2018 high levels of DBM field resistance to indoxacarb, chlorantraniliprole and deltamethrin were detected, indicating that the IRM strategy was either no longer effective or not being adopted. Efforts to increase the range of selective insecticides available were increased and AgChem Bt (kurstaki) and spinosad were introduced to the market in collaboration with a local pesticide reseller. The IRM strategy was revised to include these additions and it was promoted in farming communities by information sessions. Between 2019 and 2022 resistance of DBM field populations to the original recommended selective products declined and susceptibility to spinosad and both AgChem Bt products remined high. The importance of continued community engagement for successful IRM and IPM adoption and sustainable insecticide use that minimizes hazardous chemicals will be discussed.

SPEAKER PROFILE: Mr Fereti Atumurirava Fereti Atumurirava, an applied entomologist, specialises in integrated pest management, judicious use of pesticides in crop production, Brassica pest resistance monitoring on pesticides and its management.

Strong advocate of human and environmental health protection.

Representing Plant Health, Land Resources Division (LRD), Pacific Community (SPC).

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SESSION 4.3: FIJI ANTIMICROBIAL RESISTANCE SURVEILLANCE DASHBOARD 1

2

3

3

3

4

Morgan Lewis , Lauren Stevens , Keith R Hayes , Adrien Ickowicz , David Peel , Walter Okelo , and Numa Vera5 1

CSIRO IMT, Kensington, Western Australia, 6151

2

CSIRO IMT, Clayton, Victoria, 3168

3

CSIRO Data 61, Hobart, Tasmania, 7001

4

CSIRO Environment, Canberra, ACT, 2601

5

Department of Pharmacy and Pharmacology, Fiji National University

Introduction and objectives 'Enhancing the Management of Antimicrobial Resistance' is a project in which the Commonwealth Scientific and Industrial Research Organization (CSIRO) partnered with the Fiji Government to enhance the management of antimicrobial resistance (AMR). For the project, the Scientific Computing team at CSIRO developed a prototype dashboard for AMR surveillance. The dashboard visualised eight years of AMR data collected from the Colonial War Memorial hospital, Fiji's largest hospital. The aim was to provide visualisations that would aid in monitoring AMR.

Methods The dashboard tracks the resistance of pathogen-antibiotic pairs, shown at different levels of detail. The focus of the design process was to allow for easy identification of pathogens with high AMR, whilst providing enough information for each pair to show trends across time and patient demographics. The dashboard was developed using the Shiny web framework.

Results The dashboard consists of three key elements: (1) A main table showing antimicrobial resistance for every pathogen-antibiotic pair; (2) a series of filters for the sample dataset to filter by year and sample type; and (3) a sideboard that showed the resistance for a specific pair in more detail, over time and by patient demographic. The dashboard is in use by the National AMR Committee with plans for periodic updates as patient data continues to be collected.

SPEAKER PROFILE: Mr Morgan Lewis Morgan Lewis (BSc (Hons), MPE) is a Scientific Computing Specialist in the Data Analytics and Visualisation Team in CSIRO's Scientific Computing Group. The Group designs and creates novel analytics and visualisation tools to bring data insights to scientists in a diverse range of fields. Since joining CSIRO in 2021, Morgan has collaborated with research groups across topics including AMR, climate science, and AI surrogate modelling.

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SESSION 5.1: DEVELOPMENT OF ANTIMICROBIAL USE GUIDELINES FOR ANIMAL HEALTH IN FIJI Kirsten E. Bailey1,4, Harriet Thornton3,4, Joanna S. McKenzie2,4, James R. Gilkerson1,4; Glenn F. Browning1,4; Laura Y. Hardefeldt1,4; Mauricio J. C. Coppo1,4 on behalf of the COMBATAMR program 1

Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, Faculty of Science, University of Melbourne, Victoria, Australia Massey University, Palmerston North, New Zealand 3 Consultant veterinarian, Samoa 4 COMBAT-AMR, Animal Health Team

2

Antimicrobial resistance is best combatted by development and implementation of good antimicrobial stewardship. A major component of any antimicrobial stewardship programme is the availability and use of guidelines for prescription and dispensing of antimicrobial drugs.

Unfortunately, appropriate animal health guidelines are not available for in many countries, severely limiting implementation of good antimicrobial stewardship. The COMBAT-AMR Animal Health team, in close consultation with the Ministry of Agriculture, has developed draft Fijian Antimicrobial Prescribing Guidelines. These guidelines provide advice on when to use antimicrobials to treat animals, which antimicrobials are most appropriate to use for bacterial diseases commonly seen in Fiji in cattle, sheep, goats, poultry, pigs and horses, as well as guidance on best practice dose rates. They also provide guidance about the dose rates for drugs used for chemical restraint and pain relief in each species, the method to use to estimate the body weight of each species to assist in calculating doses, and symptomatic treatments for each disease, where appropriate. In addition, the guidelines include information about vaccination schedules, anthelminthic dose rates and normal clinical parameters for each species. Once approved, the guidelines will be printed on water resistant card, to ensure they are suitable for use by veterinarians and para-veterinarians in the field, to support Fiji's efforts to combat the growing international problem of antimicrobial resistance .

This work was funded by the Australian Government Department of Foreign Affairs and Trade's Indo-Pacific Centre for Health Security funded COMBAT-AMR Program.

SPEAKER PROFILE: Dr James Gilkerson James is a Professor of Veterinary Microbiology at the Melbourne Veterinary School. He is a veterinary graduate from the University of Sydney with a PhD in Virology.

James’ research interests are primarily in the epidemiology and control of infectious diseases in animal populations, and this is how he became involved in research into antimicrobial stewardship and antimicrobial use in animals. James is committed to improving veterinary diagnostic microbiology capacity and using the data generated as a basis for responsible antimicrobial use in animals. James is a Fellow of the Australian Veterinary Association and currently serves as a Director of AVA.

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SESSION 5.2: POTENTIAL IMPACT ON ONE HEALTH FROM HEAVY RELIANCE ON CHEMICAL CONTROL OF PESTS FOR PLANT HEALTH PROTECTION Ero, M, Atumurirava, A and Susumu, G Sustainable Agriculture Programme, Land Resources Division, Pacific Community (SPC), Suva, Fiji

Holistically, plant health is an integral component of one health. All forms of life on earth including the fauna and flora biota are intrinsically connected through the food web and are ecologically interdependent for survival. When one component of the web is disturbed, the impact transcends through other elements of the web that are dependent on it with subsequent flow on effect throughout the web.

All flora including food plants and phytoplanktons in aquatic ecosystems provide source of food for herbivorous feeders that include humans and micro-organisms at the lower trophic level. Cultivated food crops form the key source of food for humans and livestock. Because of the high demand for food compelled by the ever-increasing global human population, natural landscapes are cleared for monocultural cultivation of crops. When large natural land areas are cleared, and single crops are cultivated on large scale, they provide conducive environments for organisms from the disturbed environments to establish as pests and attack the crops.

As quick fix to the pest issues, plant protectionists and farmers rely heavily on pesticides to protect the health of their crops. Unfortunately, heavy reliance on chemical control options imposes negative impacts on humans, biodiversity and the environment. Effective ways of managing pesticides that circumvents the negative impacts is urgently needed. This presentation outlines the negative impacts of pesticides and argue the case for effective control of pests with limited use of chemicals, using the Coconut Rhinoceros Beetle management system as an example for effective pest management with minimal consequences on one health.

SPEAKER PROFILE: Dr Marc Ero Mark Ero is an Entomologist based with the Land Resources Division of the Pacific Community (SPC) managing the regional Coconut Rhinoceros Beetle project. He has a PhD in Insect Ecology from the Queensland University of Technology (QUT) and Post Graduate Diploma in Entomology from the University of Queensland (UQ). He is a PNG national and worked for several local organizations before joining SPC.

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SESSION 5.3: CASE STUDY: INCORPORATING ONE HEALTH INTO A FRONTLINE FIELD EPIDEMIOLOGICAL TRAINING PROGRAM IN PAPUA NEW GUINEA, LESSONS LEARNT 1,2

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Malio, K ., Peni, B ., Hevoho, E ., Yamba, A ., Pukienei, A ., Macfarlane-Berry, L ., Velasco 6 2 6 6 Ortuzar, T ., Ropa, B ., Housen, T ., Kearns, T .

1

World Vision Papua New Guinea National Department of Health Field Epidemiology Training Program, Papua New Guinea 3 West New Britain Provincial Health Authority 4 Autonomous Region of Bougainville Provincial Health Authority 5 National Agriculture Quarantine and Inspection Authority 6 University of Newcastle, Australia 2

Purpose: Given the increasing threat of current and emerging diseases and other hazards events affecting the complex interaction between human, animal and ecosystem health, a coordinated and interdisciplinary One Health approach to prevention, detection and control using a One Health approach was identified as a priority for Papua New Guinea (PNG). In PNG, One Health approaches are being used for antimicrobial resistance and to establish surveillance strategies for zoonotic disease however, there is no training program that incorporates One Health and field epidemiology among frontline workers who are ideally situated to identify events of concern.

Methods: A co-creation approach was adopted during the development of a One Health field epidemiology curricula for frontline workers from human, plant, animal, conservation, and fisheries sectors. The training program was tailored to the PNG context, addressing both sector-specific and cross-sectoral requirements.

The development process included a needs assessment, curriculum development, training of trainers, and clear participant selection criteria. The curricula were piloted and adapted in four provinces of Papua New Guinea.

Focus: The f-FETPNG program was created to address the real-world challenges being faced in PNG. The training integrates One Health principles, community engagement, and field epidemiology techniques to equip participants with the knowledge and skills necessary for detecting, responding to, and preventing events of concern. A secondary aim was to build stronger communication across sectors at the provincial level.

Scope: The One Health f-FETP program was developed through a collaborative effort between the National Department of Health, National Agriculture Quarantine and Inspection Authority, international partners, and other local stakeholders; designed to address the country's specific health and hazardous events of concern.

The program successfully improved the capacity of frontline health workers to identify, report and participate in response efforts to prevent and control events of concern. The curriculum is likely to be relevant to other island nations with similar context and challenges as PNG.

SPEAKER PROFILE: Dr Tambri Housen Assoc. Prof. Housen is affiliated with the Australian National University and the University of Newcastle. She has worked in the areas of complex humanitarian emergencies, primary health care service delivery, mixedmethods operational research, and health security workforce strengthening. In her current role as Papua New Guinea program lead for Field Epidemiology in Action she works closely with the National Department of Health on establishing provincial rapid response teams and building field epidemiology capability through the national field epidemiology training program (FETPNG).

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SESSION 6.1: PROSPECTIVE OBSERVATIONAL STUDY OF DE-ESCALATION OF EMPIRICAL ANTIBIOTICS IN PATIENTS ADMITTED TO COLONIAL WAR MEMORIAL HOSPITAL, FIJI Young-Sharma T, Wati S,Naidu R, Tong D, Sharma V, , Jenney AWJ Introduction: Antimicrobial resistance is a global health threat and Fiji is not exempt. Appropriate prescribing and timely de-escalation of antibiotics is an integral component to any antimicrobial stewardship program.

The purpose of this study was to undertake a prospective observational study of de-escalation of empirical antibiotics in patients admitted with suspected infection admitted in the acute medical and intensive care wards Additionally, the purpose was to report on the de-escalation of these empirical antibiotics in relation to the availability of (example the identity of the organism and its susceptibility pattern).

Aim: The aim of the study was to assess whether empirical antibiotics are being adjusted in a timely fashion in patients admitted with a diagnosis of suspected infection to the Acute Medical and Intensive Care Unit in CWMH over three months, from February to April 2019, in response to microbiological diagnostic information of the infection.

Objectives: Describe the demographics of patients admitted with suspected infection receiving empirical antibiotics admitted in AMW and ICU at CWMH and describe and evaluate their antibiotic regimen and duration, as well as culture results and the timing of de-escalation of antibiotics, from the period February to April 2019.

Methods: A prospective observational study was undertaken.

Results: There were 474 patients prospectively enrolled. Almost all (99%) of the ICU and 75% of the AMW admissions were suspected to have an infection and prescribed antibiotics. Of these 350 (74%) of patients had a final diagnosis of infection, principally, 'infection without a specific focus' (41%) and respiratory tract infection (37%). Blood cultures were positive with significant pathogens in 59 out of 424 (13.9%).Staphylococcus aureus was the most common cause of bacteraemia in 17(4.0%). There were 39 Gram negative isolates that were considered significant in blood culture of which 9 (23.14%) were ESBLs. Only 137 (29%) patients had their antimicrobial regimen de-escalated in the first 72 hours post-admission based on their microbiological results whereas, 207 (42%) were de-escalated more than 72 hours after admission (OR = 0.5,95% CI 0.3 – 0.89; p < 0.016).

Conclusion: At CWMH admissions for infection and multidrug resistant organisms are common. Deescalation is slower than standard practice and may be improved by quicker laboratory results generation, better systems for treating teams to review results and a greater range of narrow-spectrum antibiotics to allow de-escalation.

SPEAKER PROFILE: Dr Tracey Young-Sharma Tracey Young Sharma is a Consultant General Medicine Physician at Colonial War Memorial Hospital ( CWMH), Fiji. Her interest is in infectious diseases, microbiology and research in antimicrobial resistance. She is currently the Infection Prevention Control Committee Chair and involved in antimicrobial stewardship activities in CWMH.

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SESSION 6.2: BUILDING ONE HEALTH CAPACITY AND RELATIONSHIPS IS THE KEY TO ONE HEALTH Anke Wiethoelter, Sandra Steele Melbourne Veterinary School, The University of Melbourne

Local, national and global strategies to manage the increasing rise of antimicrobial resistance (AMR) require a coordinated plan of action across multiple sectors and disciplines. Using a One Health approach is crucial to implement interventions for problems at the intersection of human, animal and environmental health. However, integrated approaches to complex problems such as AMR are constrained by the siloed structures of existing discipline-based health systems. Within our research, teaching and practice of One Health in Australia and the Asia Pacific we have observed a common need to build shared knowledge and understanding of One Health amongst frontline workers, practitioners, decision-makers and stakeholders to optimise long-term outcomes.

Building cross-disciplinary and cross-sectoral relationships is foundational to develop knowledge of skills and expertise of all actors in the One Health space, enabling effective collaboration and communication. This allows identification of both common goals and individual sectoral needs, and the ability to address these in a holistic way. This growth in understanding provides benefits for each sector, further incentivising engagement and cooperation across disciplinary boundaries.

Additionally, strengthening One Health capacity requires education at all levels- from frontline workers to those in governance. Interventions should be designed and implemented using a consultative process, engaging country partners, stakeholders and the community alongside teachers and experts to develop content contextualised to local needs. Use of different modalities, including online and face to face resources, can improve accessibility of training and diversity of trainees.

Development of a strong One Health workforce is imperative in the face of continuing threats to global health and wellbeing, providing a sustainable framework to manage AMR and other existing and emerging problems.

SPEAKER PROFILE: Dr Sandra Steele Sandra Steele is a lecturer in Veterinary Epidemiology and One Health at the Melbourne Veterinary School, University of Melbourne. After graduating from Veterinary Science at The University of Sydney, she worked in clinical practice, completed a Master of Public Health in 2014, and then a PhD on operationalisation of One Health to progress preparedness and response to emerging infectious diseases and zoonoses. Her research interests include building health system capacity by facilitating One Health practice at all levels - from frontline health workers to governance.

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SESSION 6.3: ONE HEALTH APPROACH FOR MONITORING AMR: A CASE STUDY IN NEW CALEDONIA a

a

b

a

a, c

Alexandre Bourles , Matthieu Pot , Frederic Veyrier , Malia Kainiu , Cyrille Goarant , a, d Julien Colot a

.Institut Pasteur de Nouvelle-Calédonie, Pôle de Bactériologie, Groupe de Bactériologie Médicale et Environnementale, CEDEX BP 61, Noumea 98845, New Caledonia b.

Bacterial Symbionts Evolution, Centre Armand-Frappier Sante Biotechnologie, Institut National de la Recherche Scientifique, Universite du Quebec, Laval, Canada c.

The Pacific Community, Public Health Division, Noumea, New Caledonia d.

Centre Hospitalier Territorial Gaston-Bourret, Laboratoire de Biologie Médicale, CEDEX BP J5, Noumea 98849, New Caledonia

The rapid emergence and spread of (multi)resistant and pathogenic bacteria is a priority health issue. Despite their insularity, the Pacific Island Countries and Territories have not been spared by this pandemic. In New Caledonia, the surveillance of antimicrobial resistance traits was historically investigated through clinical studies, based on large numbers of samples from individual patients to provide epidemiological data.

Over the past decade, wastewater surveillance has been increasingly used to reflect the population's gut microbiota, raising the possibility of using wastewater-based epidemiology to directly gain information about antimicrobial resistance. In this context, carbapenemase-producing Enterobacteriaceae, classified as priority pathogens by the WHO and implicated in hospital outbreak in New Caledonia have been isolated from clinical and wastewater sample. Given the diversity of resistant bacteria in wastewater, carbapenemase-producing Enterobacteriaceae were isolated using an easy-to-apply phenotypic method developed in our lab. Several isolates were whole genome sequenced to identify the repertoire of lineages, genes and mobile genetic elements involved in carbapenems resistance in New Caledonia.

Our first results indicated an important diversity among bacterial strains, and the predominance of specific associations of beta-lactam resistance genes and mobile genetic elements. Several genes were only detected in environmental samples before their detection in clinic, highlighting the value of this One Health approach for AMR surveillance. Resistance genes and mobile genetic elements identified in this first project were closely related to those found in the Australian bacterial isolates.

Finally, to complete inventory of antibiotic resistance in New Caledonia, the animal compartment will be investigated.

In addition to the results generated in terms of epidemiology, these results are also important for authorities in terms of knowledge about resistance mechanisms circulating in the country and to optimize the consumption of antimicrobials.

SPEAKER PROFILE: Dr Bourles Alexandre Bourles Alexandre is an Engineer in Medical and Environmental Bacteriology Group at Institut Pasteur of New Caledonia since 2020. His research activities focus on antimicrobial resistance and more precisely on the dissemination of antimicrobial resistance using One Health approach. Culture and metagenomics approaches are used to track multi drug resistance bacteria from several sources (hospitals and the community) down to the coastal area all through the wastewater network.

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SESSION 7.1: EXPLORING THE RESISTOME IN SEDIMENT-ASSOCIATED BIOFILMS FROM RURAL FIJIAN WATERSHEDS: MICROBIAL ECOLOGY INSIGHTS FROM THE WATERSHED INTERVENTIONS FOR SYSTEMS HEALTH IN FIJI PROJECT (WISH -FIJI) Aaron Jenkins, Gemma C Langridge, John Wain, Lisa Crossman, Stacy Jupiter, Joel Negin, Ponipate Baleinamau, Sikeli Gavidi, Kini Koto Mailautoka, Samuela Lagataki, Sangeeta Mangubhai, Kelera Naivalu, Timoci Naivalulevu, Vilisi Naivalulevu, Nabeela Nasim, Sikeli Naucunivanua, Sarah Nelson, Ingrid Qauqau, Anaseini Ratu, Mereia Ravoka, Shayal Sami, Jacqueline Thomas, Andrew Tukana, Anaseini Ratu, Donald Wilson, Pierre Horwitz Background: Our work has shown that some rural watershed settings in Fiji, particularly those prone to anthropogenic activity resulting in soil erosion and sedimentation, are more likely to be associated with high water-related microbial disease burden than others. Biofilms dominate microbial life in aquatic systems, and bacteria living in biofilm communities have increased resistance to antibiotics. Biofilms are attached to living tissue surfaces and abiotic substrates and can also form microaggregates such as flocculated suspended and bed sediment particles. WISH-Fiji has been developing sampling and metagenomic methods for environmental surveillance of microbial pathogens and understanding the resistome within rural watershed settings, with a focus on sediment-associated biofilms.

Methods: 4L river water samples and 0.25g river sediment biofilm samples were collected from five Fijian watersheds along a spectrum of anthropogenic activity and waterborne microbial disease burden. Water samples were vacuum filtered to 0.2 μm and DNA extracted from filters, and directly from sediment using Qiagen Power Water and Power Soil kits, respectively. 103 samples from the study watersheds were put forward for preliminary metagenomics sequencing on the Illumina MiSeq platform. Sequencing data were processed using Kraken2 for taxonomic classification and FastDeMe for identification of antimicrobial resistance (AMR) determinants.

Results: Microbial communities in water and riverbed sediment biofilms in highly anthropogenically altered watersheds have distinct community composition, including increased abundance of several bacterial groups, particularly Gammaproteobacteria (including Salmonella) and reduced beta diversity (among identifiable taxa), Enterobacteriaceae association with bacterial group Acinetobacter (of concern due to rapid antimicrobial resistance development and long environment persistence), abundant AMR gene presence, and increased bacteria capable of metabolizing plant material.

This set of samples yielded 3702 occurrences of 831 AMR genes encoding resistance to a broad range of antibiotics including beta-lactams.

Conclusions: Our results collectively suggest that increased sedimentation, nutrient runoff, and algal growth in waterways due to human activity alters the microbial community improving ecological conditions for enteric bacterial growth and persistence. Biofilms on sediment provide a micro-niche for bacterial survival and replication, with nutrients readily binding sediment particles and sugars conducive to bacterial growth being released from algae. The eutrophication of waterways and subsequent formation of algal mats on sediment provides an excellent substrate for bacterial growth, particularly biofilm formation, associated with enhanced antibiotic resistance.

SPEAKER PROFILE: Dr Aaron Jenkins Dr Aaron Jenkins is a mid-career researcher and Fijian citizen with a joint postdoctoral appointment as Senior Research Fellow in Planetary Health at University of Sydney School of Public Health and Edith Cowan University Centre for People, Place and Planet. Dr Jenkins is also an adjunct researcher with Fiji Centre for Communicable Disease Control, Fiji National University, and University of the South Pacific. Dr Jenkins is an eco- epidemiologist with 23 years of professional experience in international development working in Fiji, Papua New Guinea, Solomon Islands, Palau, Samoa, Kiribati, Vanuatu, Federated States of Micronesia, Indonesia, Philippines, and Australia. His research has focussed on crosscutting development themes including wetland management for Water, Sanitation and Hygiene (WASH), waterborne disease management, integrated conservation and development, interaction of climate change, natural disaster, land and water management on human health and sustainable fisheries. Dr Jenkins has an excellent record of building partnerships across sectors and communities including key relationships between donors, regional agencies, governments and communities across the Indo-Pacific region. He also has a high level of engagement in international, regional and development affairs including committee membership and advisory roles for WHO, CBD, UNICEF, UNDP, IUCN, SPC, SPREP as well as numerous national environment, health and WASH related committees in Fiji, Papua New Guinea, Palau, and Solomon Islands.

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SESSION 7.2: MULTI-SECTORAL PANEL DISCUSSION ON ANTIMICROBIAL RESISTANCE: KEY FINDINGS BY THE CONSUMER COUNCIL OF FIJI Asheefa Aiyub 1

1

Consumer Council of Fiji

The Consumer Council of Fiji (CCoF) conducted a multisectoral three tier panel discussion on 'The Role of Policy, Practitioners, Academia and Consumers in Addressing Public Health Threat Due to Antimicrobial Resistance' at the Holiday Inn on the 30th of November 2022.

The event brought together actors from different sectors and immensely contributed towards the core messages relating to antimicrobial resistance (AMR) and explored the role of policy, practitioners, advocacy and research in managing AMR. The panelists also contributed towards identifying entry points of action for different actors, current challenges they may face and best ways to address them. Panelists were from public sectors, NGO's, CSO's, academia, health practitioners and consumer reps.

It was generally agreed that shared responsibility, cohesive action, digital innovations, effective communication, education and training are some of key elements required to tackle AMR.

SPEAKER PROFILE: Ms Asheefa Aiyub Ms Asheefa Aiyub has completed her Bachelor of Commerce and Bachelor of Laws Degree from the University of the South Pacific (USP) in 2015. In 2016, whilst pursuing her Professional Diploma in Legal Practice from USP, she was awarded with a gold medal for her outstanding and distinctive performance. Ms Aiyub was given a scholarship to pursue a Master of Commerce Degree by Thesis from USP whereby she focused her thesis on “facilitating university-industry collaboration through intellectual property rights in the South Pacific; which results in successful creation of innovation and technology”. Alongside this, Ms Aiyub had simultaneously undertaken a 'Certified Expert in Islamic Microfinance' program from Frankfurt School of Finance and Management in Germany, whereby she focused on formulation of contractual agreements and policies that could successfully serve the underprivileged environments (individuals living below the poverty line, low income to average income earners). Recently, Ms Aiyub has completed her Master of Laws Degree (in International Business Law) with Distinction from the University of Essex in the United Kingdom.

At present, she is completing her PhD on “how customers repurchase intentions could be facilitated within the cyber and sustainably challenging environment”.

Ms Aiyub has assisted in her family business whilst pursuing her educational journey. She had also volunteered as a lawyer/legal assistant with Jiten Reddy Lawyers, Victoria Chambers and Office of the Director of Public Prosecutions. She had served several years as a graduate research assistant with USP, whereby she had successfully published journal articles. Ms Aiyub is also a reviewer with peer reviewed journals. At present, Ms Aiyub is employed as Manager Research and Policy Analyst with Consumer Council of Fiji – who is actively involved in NARC – AMR (One Health Approach).

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SESSION 7.3: VETERINARY FOUNDATIONS OF INFECTION PREVENTION AND CONTROL COURSE 2023 1

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Jackie Miley ,Stéphane Bouchoucha 1 2

Australasian College of Infection Prevention and Control Ltd. International School of Nursing and Midwifery, Faculty of Health, Deakin University

The Australasian College of Infection Prevention and Control is developing – 'Veterinary Foundations of Infection Prevention and Control' (VFIPC). This course promotes the application of infection prevention and control knowledge and strategies to the veterinary healthcare setting. This course is an AQF Level 8 equivalent – Graduate Certificate/Diploma level. The College has been running the 'Foundations of Infection Prevention and Control' (FIPC) (human health) for 8 years and recognise the need to apply high level knowledge and skills in IPC to the veterinary healthcare setting and give Veterinary professionals the ability to integrate IPC skills as foundation of One Health approach. One Health is promoted throughout the course, through identification and management of zoonoses, reverse zoonoses, effective management of veterinary infections and veterinary healthcareassociated infections. Antimicrobial resistance in the veterinary setting is explored and strategies for local and national surveillance of healthcare associated infections are promoted.

The course runs over 6 months and is aimed at veterinarians, veterinary nurses and technicians from all jurisdictions. It is designed to provide veterinary staff with a broad understanding and introductory skills that will enable them to assess, plan, implement and evaluate infection prevention and control activities within their veterinary workplace. Participants will complete 11 learning modules and related assessments at their own pace and are expected to attend two live video-conferencing tutorial sessions during the six-month course.

Best available evidence and recent IPC Guidelines support the application if IPC principles to veterinary practice. Students apply IPC knowledge to their own setting in the assessment activities.

The course will commence late 2023.

SPEAKER PROFILE: Dr Stéphane Bouchoucha A/Prof. Stéphane Bouchoucha is an Associate Professor and Associate Head of School (International) in the School of Nursing and Midwifery at Deakin University, and the Australasian College for Infection Prevention and Control President-Elect. He is also a researcher based in Deakin’s Institute for Health Transformation and the Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR).

With over 20 years’ experience as a clinician and an academic, Stéphane has worked in a variety of clinical (critical care, Infection Prevention and, Leadership and management) and community settings. Stéphane’s research programme has a focus on Infection Prevention and Control, and clinicians’ behaviours to minimise AMR.

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SESSION 8.1: DEVELOPMENT, IMPLEMENTATION AND EVALUATION OF AN ANTIMICROBIAL STEWARDSHIP (AMS) EDUCATIONAL TRAINING PLATFORM FOR THE WESTERN PACIFIC REGION Stephen Muhi, Rodney James, Karishma Priti Nandan, Callum McEwan, Angeline Ferdinand, Kirsty Buising on behalf of the COMBAT-AMR program.

Aim: To describe the development, implementation and evaluation of an AMS educational platform for clinical staff within hospitals across the Western Pacific region.

Methods: The content of the Western Pacific antimicrobial stewardship (WPAMS) educational modules were adapted and revised from the World Health Organisation Western Pacific Region AMS training workshop [20 January 2020]. To categorise the WPAMS modules, they were divided into two overarching knowledge packages: (1) operational aspects of how to establish and evaluate an AMS program, and (2) case-based clinical scenarios. Early stakeholder engagement further refined the selected topics. The modules were designed to align with the concepts of adult learning theory (Knowles). They were not designed to be passive learning tools; rather, they were intended to serve as baseline information to inform subsequent group-based discussion. These discussions were held online with a panel of interdisciplinary content specialists to expand on their chosen topic. Experiences regarding areas of difficulty were shared. Presenters chose topics within their scope of regular practice, and each module was peer reviewed prior to recording. The modules were hosted on REDCap, alongside an implementation guideline, with recordings hosted unlisted on YouTube and available to download through access to GoogleDrive. Voluntary and anonymous evaluation questions incorporating both quantitative and qualitative measures were within each module of the REDCap program. In 2021, virtual and hybrid workshops were piloted in Fiji, and evaluated using a series of roundtable discussions and interviews.

Results: Sixteen modules were developed and implemented. In total, 90 users had accessed the online modules and completed at least 1 module. Full demographics were completed by 66 users. The majority (74%) were from Fiji, with others from Samoa (13%), Bhutan (8%), or Timor-Leste (3%). Most users reported that their key learning objectives were met and had confidence incorporating knowledge into their role. The majority also agreed that they were engaged with the content, and it was appropriate for their level of understanding. During the Fiji evaluation phase, roundtable discussions and key stakeholder interviews with users (n = 11) were conducted across three hospitals. All stakeholders reported that the WPAMS modules had led to changes in their own professional practice or in identifiable changes on the wards. Module content was shown to be appropriate to the local context. Suggestions for additional modules were made. Engagement with modules varied and was influenced by the presence of local champions. Users expressed an interest in employing a local train-the-trainer approach to deploy the modules more broadly Conclusions: The WPAMS educational platform was largely successful as a tool for delivering AMS knowledge across the region. The next phase must focus on driving sustainability, refining content of local relevance, and promoting the access across the region.

Funding: This work was funded by the Australian Government Department of Foreign Affairs and Trade's Indo-Pacific Centre for Health Security funded COMBAT-AMR Program.

SPEAKER PROFILE: Dr Rodney James Dr Rod James is a Medical Microbiologist at the Melbourne Diagnostic Unit Public Health Laboratory (MDU PHL) and the Director of Clinical Services at the Royal Melbourne Hospital's Guidance Group and National Centre for Antimicrobial Stewardship (NCAS).

Rod has been involved with antimicrobial resistance and antimicrobial stewardship research for the past 10 years, with a major interest in implementation of capacity building programs in regional and remote Australian facilities and in low- and middleincome countries within the Asia Pacific region. Rod is the current Antimicrobial Resistance Theme co-lead at the Doherty Institute.

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SESSION 8.2: EMAR FIJI: A ONE HEALTH EPIDEMIOLOGICAL SURVEY OF ENVIRONMENTAL BACTERIA USING WHOLE GENOME SEQUENCING Ethan R. Wyrsch1, Dmitriy Li1, Max L. Cummins1, Barbara Drigo2, Walter O. Okelo3, Keith Hayes3, 4 5 6 2 1 Royford Magiri , Vincent Lal , Numa Vera , Erica Donner & Steven P. Djordjevic on behalf of the EMAR Fiji Partnership 1

Australian Institute for Microbiology and Infection, University of Technology Sydney, Ultimo, NSW, 2007, Australia Future Industries Institute, UniSA STEM, University of South Australia, Mawson Lakes, SA, 5095, Australia 3 The Commonwealth Scientific and Industrial Research Organization (CSRIO), Land and Water, Black Mountain, Canberra, ACT 2601, Australia 4 Department of Veterinary Science, Fiji National University, Koronivia, Nausori, Fiji Islands 5 The Institute of Applied Sciences, The University of the South Pacific, Laucala Campus, Suva, Fiji Islands 6 Department of Pharmacy and Pharmacology, Fiji National University, Suva, Fiji Islands 2

Introduction: Whole genome sequencing (WGS) has improved our understanding of bacterial phylogenetics beyond early molecular characterisation and biochemical performance to lineage differentiation, uncovering new species and sub-species within most genera. Analysis of bacterial WGS allows the characterisation of potential pathogens, antimicrobial resistance, and identification of potential transfer pathways between sources. Transfer between clinical, agricultural and environmental niches are of particular importance.

Methods: Bacterial isolates (n=379) were from numerous environmental sample types, including manure, soil and water from the Koronivia Research Station (dairy farm [n=55], piggery [n=88] and vegetable farm [n=54]), biosolids from a municipal dump in Sigatoka (n=24), soil from the Colonial War Memorial Hospital (n=42), water and soil from My Suva Picnic Park (n=30), and both sediment and water samples from Laucala Beach (n=86). Most isolates were cultured under antibiotic selection, including carbapenem (n=124), cefotaxime (n=85), colistin (n=132), or ESBL (n=9) testing. Short-read whole genome sequences were generated using an Illumina NextSeq platform and assembled with shovill. Bioinformatic analysis was performed using PhyloSift, parsnp and other pipelines to generate phylogenetic trees, ABRicate to perform genotyping, and specific subtyping pipelines like MLST. Results: Species identification reported 25 separate genus, primarily Gammaproteobacteria. Two were particularly dominant, Enterobacter spp. (n=123) and Stenotrophomonas spp. (n=134), with Pseudomonas spp. third at n=27. The array of antibiotic resistance genes, virulence factors and mobile genetic elements identified from such a varied dataset was large (over 600 alleles), with evidence of both intrinsic and mobilised antibiotic resistance present. Initial phylogenetic analysis of the two primary genus highlighted many lineages shared between different sources and sample types.

Conclusion: This dataset represents one of the first One Health surveys of bacterial WGS in Fiji, serving as a first step to generating a detailed understanding of the presence of pathogens and antimicrobial resistance in the Fijian environment.

SPEAKER PROFILE: Dr Ethan Wyrsch Dr. Ethan Wyrsch is a postdoctoral research associate at the Australian Institute for Microbiology and Infection (AIMI) at the University of Technology, Sydney. He has a Ph.D. in molecular microbiology and genomic epidemiology, and his current research includes characterising bacterial pathogens and antimicrobial resistance through whole genome sequence analysis. While the majority of Ethan's work has focused on agricultural and environmental Escherichia coli, he has experience with the characterisation of diverse bacterial genus from environmental sources.

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SESSION 8.3: CARBAPENEM RESISTANT ORGANISM SURVEILLANCE, PREVENTION, AND CONTROL IN A TERTIARY HOSPITAL IN FIJI 1

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Aneley Getahun Strobel , Shammi Prasad , Matthew Richards , Ravi Naidu , Vinita Prasad , 4 4 5 5 1,3 Prinika Prasad , Ashlyn Datt , Donna Cameron , Benjamin Howden and Kirsty Buising 1

Department of Infectious Diseases at the Peter Doherty Institute for Infection and Immunity, the University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia 2 Australian volunteer international, Pacific People Office, Level 2, BSP Central Street, Suva, Fiji 3 Royal Melbourne Hospital, 300 Grattan Street, Melbourne VIC 3052, Australia 4 Ministry of Health and Medical Services, Colonial War Memorial Hospital, Waimanu road, Suva, Fiji 5 Microbiological Diagnostic Unit, Public Health Laboratory, Peter Doherty Institute for infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia

Background and objectives: It is important that all health services are prepared to manage outbreaks of pathogens with critical antimicrobial resistance (AMR). The aim of this project was to better prepare Colonial War Memorial Hospital (CWMH), Fiji to detect, manage and respond to infections caused by these pathogens to help mitigate their impact.

Methods: A multifaceted approach was used to assess the existing situation and capacity at CWMH. This included a survey of staff, a desktop review of policies/procedures/guidelines, ward audit and observational walkthrough. A formal tabletop exercise was then conducted to further highlight gaps that needed to be addressed. The collated information was used to inform the development of standard operating procedures for the laboratory and clinical staff about screening strategies and management of colonised and infected patients. A series of formal and informal education sessions for clinical and laboratory staff were undertaken and audit tools were developed and used to monitor compliance with procedures.

Results: For the duration of the project, a total of 394 nurses/doctors and 42 laboratory staff attended 20 training sessions. Between 12 January and 31 of April 2023, 82 high-risk patients, mainly from the intensive care unit, were screened; 13 were identified as colonised with a carbapenem-resistant organism (CRO). Monitoring of compliance with management procedures implemented showed high levels of adherence to CRO case isolation (100%) and notification of cases to clinical team (91%). Auditing of compliance with contact precautions demonstrated particular steps in donning and doffing personal protective equipment that needed further education.

Conclusion: This project has demonstrated the feasibility of establishing critical AMR surveillance and management of CROs in a middle-income country. Ongoing support is needed for its sustainability. High staff turnover and short supply of laboratory consumables were among the major challenges.

SPEAKER: Dr Aneley Getahun Strobel Aneley is a research project manager on antimicrobial Resistance at the Peter Doherty Institute for Infection and Immunity in Melbourne. She is an accomplished public health physician with a career spanning 25 years in Africa, Asia and the Pacific.

Aneley’s research interests are mainly in communicable diseases and antimicrobial resistance. She actively works to establish collaborative networks, fostering partnerships among organizations and experts in the realm of epidemiology and public health to improve population health.

Aneley holds a PhD form the Peter Doherty Institute at University of Melbourne, a Masters in clinical tropical medicine from the University of Mahidol in Thailand and a Medical Doctorate from Addis Ababa University in Ethiopia.

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SESSION 9.1: GLOBAL DATA COLLECTION ON ANTIMICROBIAL AGENTS INTENDED FOR USE IN ANIMALS (AMU) AND ANIMUSE – THE NEW ONLINE PLATFORM Nahoko Ieda, Ph.D. Regional AMR Project Officer Regional Representation for Asia and the Pacific, World Organisation for Animal Health

Abstract The World Organisation for Animal Health (WOAH, founded as OIE), since 2016, has been committed to the data collection on Antimicrobial Agents intended for Use in Animals (AMU) from its Members.

It is also WOAH's responsibility to manage the accumulated data in a global database as well as to publish global AMU report annually. According to the latest annual AMU report published in June 2023, 157 countries and territories in the world submitted their response to WOAH's data collection survey.

The Regional Representation for Asia and the Pacific (RRAP) of the WOAH has been supporting the Regional Members in building their capacities on AMU data collection at national level through physical and virtual training. One of the key and unique activities in the Region is the National AMU Workshop, which were conducted in 13 countries before the COVID-19 pandemic. Revitalizing the workshop series and supporting more Members with identifying the key stakeholders in AMU supply chain will benefit the countries who are aiming to improve its data quality, and to ultimately promote more responsible AMU. The presentation will also introduce the WOAH's new online platform ANIMUSE, launched in September 2022, and its key features that are designed to encourage and reinforce the ownership and management of the AMU data by each of the Members themselves.

SPEAKER PROFILE: Dr Nahoko Ieda Nahoko IEDA is Antimicrobial Resistance (AMR) Regional Project Officer within Regional Representation for Asia and the Pacific in Tokyo. Her mission is to contribute to the WOAH’s strategy on AMR and responsible use of antimicrobials intended for use in animals (AMU). She is the WOAH responsible staff for the implementation of the various regional and national projects on AMR and AMU in Asia and the Pacific, as well as for coordination with Quadripartite and other partners.

She holds PhD in Bioagricultural Sciences at Nagoya University, Japan (2015), specialized in mammalian reproduction, reproductive endocrinology and neuroendocrinology. Before joining the WOAH, she was the Livestock Development Officer at FAO Regional Office for Near East and North Africa (Cairo, Egypt; 2017-2019), followed by Animal Production Health Officer at FAO Representation in Syria (Damascus, Syria; 2019-2022). Previously, she worked as a researcher in the area livestock reproduction based in Japan with collaborators in South East Asia and South Asia for several years.

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SESSION 9.2: STRENGTHENING OF ANTIMICROBIAL RESISTANCE (AMR) SURVEILLANCE THROUGH LABORATORY ANTIBIOGRAMS a

a

b

c

d

Toatu Tebuka , Saketa Salanieta , Uluiviti Vasiti , Naivalu Taina , Babiau Raikabakaba Asaeli , Baleivanualala e

a

a

f

Sakiusa , Buadromo Eka , Leong Margaret , Cole Russell , Varea Lalomilo

a

a

Pacific Community (SPC), Public Health Division, Narere, Suva, Fiji Islands.

Pacific Islands Health Officers Association (PIHOA), Hawaii, Honolulu, USA. c Department of Pathology and Medical Laboratory Science, Fiji National University, Suva, Fiji Islands. d World Health Organization (WHO), South Pacific, Suva, Fiji Islands. e Otago University, New Zealand. f Pacific Pathology Training Centre, Wellington, New Zealand. b

Introduction: AMR surveillance and control is a challenge in most PICTs partly due to the following reasons weak AMR surveillance, lack of collaboration between microbiology and pharmacy in developing drug formulary on specific organisms, lack of antibiogram database, ineffective national Drug and Therapeutics Committee and weak Infection Prevention Control (IPC) both in hospital and community settings.

SPC and its partners (FNU, PIHOA, PPTC & WHO) developed a training curriculum to assist Labs in the region in implementing quality Antimicrobial Susceptibility Testing (AST) that will contribute to the development of a quality antibiogram to guide informed decisions.

Objective: The objective of this approach is to strengthen quality implementation of quality microbiology processes to produce an accurate and reliable antibiogram that will guide informed decisions and actions to tackle AMR issues in the region.

Method: From 2019 to 2022 a standardise training curriculum focusing on strengthening quality microbiology diagnostic procedures to produce quality AST was rolled out to few selected Pacific countries. In 2023 a developed antibiogram database was rolled out to countries which participated in the training to produce an accurate and reliable antibiogram on the susceptibility of antibiotics used to treat infection. The generated information on the antibiogram would be used to guide informed decisions to address AMR. Results:

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Conclusion: Compilation and reporting of an antibiogram data to guide informed decision is a challenge in most laboratories in PICTs. Majority of countries still rely heavily on paper-based system. The developed excel user-friendly antibiogram database has been rolled out to three (3) piloted site countries and already beneficial outcomes are noted in these countries. The trend in sensitivity pattern over time can now be made quickly using the simple functionality of the tool.

SPEAKER PROFILE: Mr Tebuka Toata Mr Tebuka Toatu is from Kiribati and has been working with The Pacific Community (SPC) for the past twelve years. Prior to joining SPC, he had been a Director of Laboratory Services for over ten years at the Ministry of Health and Medical Services in Kiribati.

Mr Toatu is a Medical Laboratory Scientist by profession and holds a Bachelor of Applied Science in Medical Laboratory Science from RMIT University in Melbourne with majors in Advance Cytopathology and Haematology. In 2008, he completed his post graduate studies doing a Master of Science in Medicine from the University of Sydney.

Currently, Mr Toatu is working with the Pacific Community at SPC Public Health Division as a Pacific Public Health Surveillance LabNet Coordinator providing laboratory strengthening activities in PICTs but focusing more on strengthening AMR surveillance and control through microbiology capacity training in the region.

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SESSION 9.3: GENOMIC DIVERSITY OF MULTI-DRUG RESISTANT GRAM-NEGATIVE AND GRAM-POSITIVE BACTERIA IN SUVA, FIJI Hawkey J, Prasad A, Prasad V, Vakatawa T, Young-Sharma TEMW, Jenney AWJ, Naidu R, Stewardson AJ, Loftus MJ, Peleg AY Introduction: Antimicrobial resistance (AMR) is a global health threat, with third-generation cephalosporin resistant (3GCR) and carbapenem-resistant infections of particular concern. There is currently a lack of genomic data on AMR organisms in the Pacific region. This study aims to address this gap by examining the genetic diversity of a collection of 450 clinical isolates collected between July 2020-Feb 2021 from Suva, Fiji.

Methods: Genomes were sequenced using Illumina and assembled with Unicycler. Species and sequence types (ST) were determined using PathogenWatch; AMR genes were assigned using AMRFinderPlus. Nine isolates underwent additional long-read sequencing to determine the location of carbapenemase genes.

Results: Of 450 sequenced isolates, 362 were Gram-negative and 88 were Gram-positive bacteria.

For Gram-negative bacteria, there were 126 3GCR isolates and 107 carbapenem-resistant Acinetobacter and Pseudomonas. Klebsiella pneumoniae was highly diverse, with most STs represented by a single genome; there was less diversity in Escherichia coli, 42% of genomes belonged to ST131 or ST69. The median number of AMR genes was lower in sensitive strains (1-6 vs 917, genus dependent). Fourteen ESBL genes were detected; CTX-M-15 was the most common (22% of genomes, all Enterobacterales). Eighteen carbapenemase genes were detected, primarily in Acinetobacter and Pseudomonas. OXA-23, OXA-66 and NDM-1 were the most prevalent, found in 10%, 18% and 17% of genomes respectively. Phylogenetic analysis of two dominant clones (A. baumannii ST2 and P. aeruginosa ST773) revealed Fiji-specific clades comprising highly related strains. For Gram-positive bacteria, Staphylococcus aureus ST1 was dominant; phylogenetic analysis revealed a single Fijian clade, however strains were relatively distinct from one another.

Conclusions: This study provides crucial genomic data on AMR organisms in Fiji, highlighting the diversity of 3GCR and carbapenem resistant species in the region. Local transmission of two carbapenem-resistant clones within Fiji was observed, underscoring the importance of local spread of these resistant strains.

SPEAKER PROFILE: Dr Jane Hawkey Dr Jane Hawkey is a Research Fellow in the Department of Infectious Diseases at Monash University. She undertook her PhD at the University of Melbourne, where she developed a novel genomic method for detecting bacterial transposases in whole genome sequencing data, to study how transposases have impacted the on-going evolution of Shigella species. Jane’s current research uses her genomics skills to study the evolution and spread of antimicrobial resistance in Gram negative bacterial pathogens, with a specific focus on developing new methods for tracking the transmission of plasmids.

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SESSION 10.1: SOME ALTERNATIVES TO ANTIBIOTICS IN LIVESTOCK PRODUCTION: A REVIEW 1

Siaka S. Diarra and Paul A. Iji

2

1

Discipline of Agriculture and Food Technology, the University of the South Pacific, Samoa Campus

2

College of Agriculture, Fiji National University

The overuse of antibiotics in livestock farming has raised significant concerns due to the development of antibiotic resistance (AR) and its potential impact on human health. As a result, there is a growing need to explore alternative strategies to maintain animal health and productivity while minimizing the use of antibiotics.

Several compounds, which selectively stimulate the growth and/or activity of beneficial microorganisms in the gut, have emerged as promising alternatives to antibiotics in livestock production, especially in monogastric species. This review aims to provide a comprehensive overview of the use of selected antibiotic alternatives (prebiotics, probiotics, dietary fibre, and phytogenic compounds) as an alternative approach to antibiotics in livestock, focusing on their mechanisms of action, effects on gut microbiota composition, and their impact on animal health and performance.

The review highlights the potential of several alternative compounds to antibiotics in maintaining animal health and addressing the concerns related to AR. There is , however, the need for further investigations on the practical application and cost-effectiveness in large scale livestock operations.

SPEAKER PROFILE: Dr Siaka S. Diarra Dr. Siaka Seriba Diarra is an Associate Professor of Animal Science in the Discipline of Agriculture and Food Technology at USP Samoa Campus. Academic qualifications: Bachelor of Agriculture (Animal Husbandry) from Mali, MSc. (Animal Production and Management), PGD (Education), and PhD (Monogastric Animal Nutrition) from Nigeria. Work experience: taught animal production courses in different institutions in Nigeria and joined USP in August 2012. I have successfully supervised and examined several Higher Degree (Master and PhD) theses in Animal Science from different institutions. I have published in excess of 100 publications in alternative feed resources and animal welfare in peer reviewed journals and presented at several international conferences. Language experience: Bambara (native language), French, English, and Hausa.

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SESSION 10.2: ANTIMICROBIAL SUSCEPTIBILITY OF BACTERIAL ISOLATES FROM CLINICAL SPECIMENS IN FOUR PACIFIC ISLAND COUNTRIES, 2017–2021 Michael J. Loftus,a Richard J. Everts,b,** Allen C. Cheng,a,c Perenise Eti,d Timote Fakasiieiki,e Lupeoletalelei Isaia,d Enita Isopo,f Adam W. J. Jenney,a,g Viali Lameko,h Hinauri Leaupepe,d Folototo Leavai,d Sue J. Lee,a Mele Moungaevalu,e Andrew J. Stewardson,a Rosemary Tekoaua,f Douglas Tou,i Geoffrey Wuatai,i and Anton Y. Pelega,j,* a

Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia Nelson Bays Primary Health, Nelson, New Zealand c School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia d Tupua Tamasese Mea'ole Hospital, Apia, Samoa e Vaiola Hospital, Nuku'alofa, Tonga f Tungaru Central Hospital, Tarawa, Kiribati g College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji h Oceania University of Medicine, Apia, Samoa i Rarotonga Hospital, Rarotonga, Cook Islands j Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia b

Abstract Background There are limited antimicrobial resistance (AMR) surveillance data from low- and middle-income countries, especially from the Pacific Islands region. AMR surveillance data is essential to inform strategies for AMR pathogen control.

Methods We performed a retrospective analysis of antimicrobial susceptibility results from the national microbiology laboratories of four Pacific Island countries – the Cook Islands, Kiribati, Samoa and Tonga – between 2017 and 2021. We focused on four bacteria that have been identified as 'Priority Pathogens' by the World Health Organization: Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.

Findings Following deduplication, a total of 20,902 bacterial isolates was included in the analysis. The most common organism was E. coli (n = 8455) followed by S. aureus (n = 7830), K. pneumoniae (n = 2689) and P. aeruginosa (n = 1928). The prevalence of methicillin resistance among S. aureus isolates varied between countries, ranging from 8% to 26% in the Cook Islands and Kiribati, to 43% in both Samoa and Tonga. Ceftriaxone susceptibility remained high to moderate among E. coli (87%–94%) and K. pneumoniae (72%–90%), whereas amoxicillin + clavulanate susceptibility was low against these two organisms (50%–54% and 43%–61%, respectively). High susceptibility was observed for all anti-pseudomonal agents (83%–99%).

Interpretation Despite challenges, these Pacific Island laboratories were able to conduct AMR surveillance. These data provide valuable contemporary estimates of AMR prevalence, which will inform local antibiotic formularies, treatment guidelines, and national priorities for AMR policy.

Funding Supported by the National Health and Medical Research Council.

SPEAKER: Dr Michael Loftus Dr Michael Loftus is an Infectious Diseases Physician and researcher from Monash University, Australia. From 2019 - 2022 he completed his PhD on antimicrobial resistance in the Pacific Islands, with a particular focus on Fiji. His other research interests include the intersections between climate change and health.

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SESSION 10.3: LESSONS LEARNED FROM BOVINE TUBERCULOSIS SURVEILLANCE PROGRAM IN THE FIJI ISLANDS Elva Borja2, Anabel Argelis Garcia1, Richard J. Whittington1, Jenny-Ann L. M. L. Toribio1 1 2

Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Camden, NSW,Australia, World Organisation for Animal Health

Mycobacterium bovis causes tuberculosis in cattle and when transmitted to humans typically causes extra-pulmonary tuberculosis (EPTB). Bovine tuberculosis (bTB) has a global distribution and is controlled in most countries to protect animal and public health.

Cattle farming has long been traditionally considered as a promising livestock livelihood in Fiji. Thus, the control of bovine tuberculosis (bTB) is highly considered a priority for animal health, biosecurity, and human health authorities in this small island as evident from the long-term funding of the Bovine Brucellosis and Tuberculosis Eradication and Control program (BTEC). The surveillance program made notable improvements since it commenced in the 1980's, sustained by government funding and industry cooperation. Two retrospective studies utilizing data of the Fiji BTEC program from 1999 to 2020 was undertaken thru the University of Sydney with support from the Fiji Government. All available bTB data for cattle were analyzed to evaluate the performance of the Fiji BTEC program from 1999 to 2014 and again from 2015 to 2020. A pilot investigation was conducted to look for putative zoonotic TB (extra pulmonary tuberculosis) in people, complimentary to the Fiji BTEC program cases. The study aimed to evaluate practices that might contribute to persistence and transmission of M. bovis between cattle and to humans. Existing data sets were shared between Ministry of Agriculture and Ministry of Health Fiji.

This case study highlights the lessons learned for bTB control in Fiji, the One Health consequences associated with the persistence of bTB infection in cattle herds in Fiji, the importance of technical and social considerations to achieve success in disease control; the impact of contribution from regional partners in the process.

Control of bTB in Fiji is a long-term objective that must have multiple stakeholder engagement and regular review to measure success. Further strengthening of the program targeting the main contributors to bTB persistence, maintenance of a comprehensive reporting and traceability system, industry awareness and support are key actions.

Correlation of bovine tuberculosis and EPTB cases in humans, particularly in the cattle farming communities in Fiji, needs to be fully established thru follow up study including an assessment of lifetime EPTB diagnoses, classification of farms based on more recent bTB test data and molecular typing of M. bovis isolates from humans, cattle and the environment. A targeted awareness and education approach is required to reduce the future risk of zoonotic TB and to help ensure uptake of recommendations and practices aimed at controlling and preventing bTB. Keywords: bovine tuberculosis, zoonotic TB, One Health, disease control, surveillance, BTEC, Fiji,

SPEAKER PROFILE: Dr Elva Borja Dr Elva Borja, is a veterinarian with a Masters degree in Veterinary Public Health Management. She is currently a Support Consultant of the World Organisation for Animal Health of the Regional Representation for Asia-Pacific based in Tokyo. Her role is focused on supporting WOAH regional activities on national veterinary workforce development and transboundary animal diseases, particularly in the Pacific Island countries.

Her 16-years work experience in the Pacific gave her the opportunity to take on various roles and be connected with different agencies in the veterinary domain, including as an Animal Health Laboratory Scientist and Animal Health Training Officer for the SPC LRD Animal Health and Production, Senior Veterinary Officer at the Fiji Veterinary Laboratory, OIC for Animal Health with the Ministry of Agriculture, as consultant with GIZ on climate change livestock adaptation and with World Animal Protection for livestock emergency management.

She also established a private veterinary clinical practice to cater for pet animals along the SuvaNavua corridor. Dr Borja also had academic teaching experience conducting trainings on animal health, veterinary epidemiology, veterinary microbiology, laboratory diagnostics, Paraveterinary training, livestock emergency management and animal welfare. Her research publications is focused on zoonotic bovine tuberculosis, documenting the progress of the bovine tuberculosis control program and its impact on the communities of Fiji.

As a veterinarian in the Pacific, her main goal is to foster a community with a healthy population of animals and humans harmoniously living together in a rich natural environment with a selfsustaining livestock livelihood.

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SESSION 11.1: GOVERNANCE FOR ONE-HEALTH MANAGEMENT OF AMR IN FIJI 1

Seona Meharg and Rachel Williams

1

1

Commonwealth Scientific and Industrial Research Organization, Black Mountain Science and Innovation Park, Clunies Ross Street,

Acton ACT 260, Australia

Antimicrobial resistance (AMR) is a complex challenge of global significance that decision makers are addressing at multiple scales – local, national and international. Addressing AMR effectively requires governance interventions tailored to local and national contexts connected to global initiatives, building shared understanding, networks and capacity.

The Enhancing the Management of Antimicrobial Resistance (EMAR) project explored the governance of AMR and antimicrobial use (AMU) in Fiji, taking a One Health perspective. My presentation will share how this work built on previous One Health and Pacific climate adaptation governance research, the tools and approaches used, and project outcomes.

SPEAKER PROFILE: Dr Seona Meharg Dr Seona Meharg is an interdisciplinary social scientist researching how individuals and organisations learn and change, specifically asking what enables individuals and groups to take up ownership of knowledge, tools, and processes for more informed decision-making in complex domains such as climate adaptation, disaster risk reduction and health.

Seona’s research addresses the vital challenge of implementation, asking why even with the necessary information, people do not act. In addition, her research measures the impact of how changes in behaviour and knowledge lead to improved decisions and actions.

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SESSION 11.2: ATTRIBUTABLE MORTALITY AND EXCESS LENGTH OF STAY ASSOCIATED WITH THIRD-GENERATION CEPHALOSPORIN-RESISTANT ENTEROBACTERALES BLOODSTREAM INFECTIONS: A PROSPECTIVE COHORT STUDY IN SUVA, FIJI MichaelJ.Loftusa,1, TraceyE.M.W.Young-Sharmab,1, SueJ.Leea, ShitanjniWatib, Gnei Z. Badoordeen a, Luke V. Blakeway a, Sally M.H. Byers a, Allen C. Cheng a , c, Ben S. Cooper d , e, Hugh Cottingham a, Adam W.J. Jenney a , f, Jane Hawkey a, Nenad Macesic a , g, Ravi Naidu b, Amitesh Prasad b, Vinita Prasad b, Litia Tudravu b, Timoci Vakatawa b, Elke van Gorp a, Jessica A. Wisniewski a, Eric Rafai h, Anton Y. Peleg a , i , 2, **, Andrew J. Stewardson a ,2, * a

Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne,

Australia b Colonial War Memorial Hospital, Suva, Fiji c

School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia d Centre for Tropical

Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom e MahidolOxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand f Fiji National University, Suva, Fiji g

Centre to Impact AMR, Monash University, Melbourne, Australia

h

Fiji Ministry of Health and Medical Services, Suva, Fiji

i

Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia

Objectives: There are scant primary clinical data on antimicrobial resistance (AMR) burden from low- and middle-income countries (LMICs). We adapted recent World Health Organization methodology to measure the effect of third-generation cephalosporin resistance (3GC-R) on mortality and excess length of hospital stay in Fiji.

Methods: We conducted a prospective cohort study of inpatients with Enterobacterales bloodstream infections (BSIs) at Colonial War Memorial Hospital, Suva. We used cause-specific Cox proportional haz- ards models to estimate the effect of 3GC-R on the daily risk (hazard) of in-hospital mortality and being discharged alive (competing risks), and we used multistate modelling to estimate the excess length of hospital stay.

Results: From July 2020 to February 2021 we identified 162 consecutive Enterobacterales BSIs; 3GC-R was present in 66 (40.7%). Crude mortality for patients with 3GC-susceptible and 3GC-R BSIs was 16.7% (16/96) and 30.3% (20/66), respectively. 3GC-R was not associated with the in-hospital mortality hazard rate (adjusted hazard ratio [aHR] 1.13, 95% confidence interval [CI] 0.51–2.53) or being discharged alive (aHR 0.99, 95% CI 0.65–1.50), whereas Charlson comorbidity index score (aHR 1.62, 95% CI 1.36–1.93) and Pitt bacteraemia score (aHR 3.57, 95% CI 1.31–9.71) were both associated with an increased hazard rate of in-hospital mortality. 3GC-R was associated with an increased length of stay of 2.6 days (95% CI 2.5– 2.8). 3GC-R was more common among hospital-associated infections, but genomics did not identify clonal transmission.

Conclusion: Patients with Enterobacterales BSIs in Fiji had high mortality. There were high rates of 3GC-R, which was associated with increased hospital length of stay but not with in-hospital mortality.

SPEAKER PROFILE: Dr Michael Loftus Dr Michael Loftus is an Infectious Diseases Physician and researcher from Monash University, Australia. From 2019 - 2022 he completed his PhD on antimicrobial resistance in the Pacific Islands, with a particular focus on Fiji. His other research interests include the intersections between climate change and health.

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SESSION 11.3: MULTI-SPECIES CARBAPENEM-RESISTANT ORGANISM (CRO) CASE INVESTIGATION AT COLONIAL WAR MEMORIAL (CWM) HOSPITAL, FIJI 1

2

1

1

Tracey Young , Annabelle Turner , Sanjeshni Autar , Ana Suka , Aneley Strobel Getahun1, Ashlyn Datt1, Anisi Kavoa1, Kirsty Buising3,4, Benjamin Howden2,5,6 and on behalf of the broader COMBAT-AMR Team* 1

Colonial War Memorial Hospital, Suva, Fiji, Microbiological Diagnostic Unit Public Health Laboratory, The University of Melbourne at the Peter Doherty Institute for Infection & Immunity, 3 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia, 4 Department of Infectious Diseases, The University of Melbourne, Melbourne, Australia, 5 Department of Microbiology & Immunology, The University of Melbourne at The Doherty Institute for Infection and Immunity, Melbourne, Australia, 6 Department of Infectious Diseases, Austin Health, Melbourne, Australia. *COMBAT-AMR broader team members include Adam Jenney, Rodney James, Chantel Lin, Donna Cameron, Mathilda Wilmot and Karishma Nandan 2

Introduction: Carbapenem-resistant organisms (CROs) cause infections in hospitalised patients and are associated with limited options for treatment, and elevated rates of morbidity and mortality. Long-term colonization leads to complex outbreaks, with transmission frequently detected in hospital settings due to staff movement and shared equipment. Recognition of increased CRO isolated at CWM hospital prompted detailed case investigation and enhanced microbiological testing.

Methods: All isolates underwent routine antimicrobial susceptibility testing (AST) at CWM laboratory with those displaying first-line resistances undergoing meropenem susceptibility disc test (subject to availability). Where CROs were confirmed, epidemiological surveillance data was collected to investigate similar isolates detected in patients with geographical or temporal links. One hundred and ninety-seven isolates were referred to Doherty Institue for enhanced AST and whole genome sequencing (WGS).

Results: Between June 2022 and March 2023, 196 patients at CWM Hospital had isolates of CRO confirmed, reaching a peak of 40 cases detected in January 2023. CROs were almost exclusively Acinetobacter baumannii, Escherichia coli and Pseudomonas aeruginosa, and many were from patients with clinical infections. Epidemiologic investigation revealed a concentration of patients with admissions to ICU, burns ward, acute medical ward and acute surgical ward; with disproportionate clustering of different gramnegative species in these wards. WGS of isolates indicated a dominance (48.7%) of NDM-7 E. coli (n=50) and NDM-1/OXA-23 A. baumannii (n=46).

Discussion: Support to ensure laboratories are capable of extended antimicrobial resistance (AMR) testing and hospital staff can collect epidemiologic information will facilitate the accurate detection and investigation of suspected hospital outbreaks of resistant pathogens. Targeted policies aimed at infection prevention control measures for CRO case management, alongside ensuring availability of a suite of appropriate antimicrobials for treatment, are needed. Outbreak characterization and the investigation of putative transmission clusters may benefit from the use of WGS, with extended AST to inform empiric treatment guidelines.

SPEAKER: Dr Tracey Young-Sharma Tracey Young Sharma is a Consultant General Medicine Physician at Colonial War Memorial Hospital ( CWMH), Fiji. Her interest is in infectious diseases, microbiology and research in antimicrobial resistance. She is currently the Infection Prevention Control Committee Chair and involved in antimicrobial stewardship activities in CWMH.

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N R C EMAR NATIONAL ANTIMICROBIAL RESISTANCE COMMITTEE

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