Published October 30, 2017
Surrounded by a circular river system that receives the wastewater discharge of a population approaching 20 million, the physical geography of Bangladesh’s capital city, Dhaka, contributes to a number of significant public health hazards, including the interaction of pathogenic bacteria with antibiotic residues and chemicals.
Despite substantial challenges ranging from the topographic to the infrastructural, Bangladesh has been making progress in increasing the public’s access to safe water and improved sanitation. That said, the entire country’s vast web of river systems—and their flood-prone nature—create a dangerously-efficient means for bacterial pathogens to circulate, develop immunity to commonly-prescribed antibiotics, and thereafter infect people and livestock, the latter of which can, in turn, infect or re-infect human beings, who, in turn, deposit their waste products (replete with antibiotic-resistant bacterial pathogens) back into the environment.
In practice, this vicious cycle of the waterborne circulation of superbugs means that patients, including those who have not taken antibiotics, show up at local hospitals with serious, antibiotic-resistant bacterial infections. How to treat these patients is a very pressing public health concern, as is gathering information about the circulation and infection pathways of these pathogens.
While antibiotic resistance (also known as antimicrobial resistance, or AMR) is a global concern, the prevalence and extent of the problem is particularly significant in Bangladesh. With support from the Community for Global Health Equity (CGHE), this past July a research team composed of Drs. Diana Aga (Chemistry), Jared Aldstadt (Geography), and Shamim Islam (Pediatric Infectious Diseases) traveled to Bangladesh to study the problem of environmental AMR and to meet with UB collaborators at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).
Established in the 1960s, icddr,b is renowned for its role in the development, testing, and scaling of the use of oral rehydration solution to combat pernicious diarrheal diseases including cholera. In its early years, icddr,b also founded a robust public health and demographic surveillance site some 50 kilometers south of Dhaka: Matlab. Now the longest-running site of its nature globally, Matlab is an inspiration and a veritable data mine to researchers in public health throughout the world.
Welcomed by icddr,b partners Dr. Munir Alam and Dr. Mahbub Rahman, Aga, Aldstadt, Islam, and I met with their research team at the organization’s headquarters in Dhaka. With the guidance of icddr,b researchers, the UB team took water samples from river banks, public water fountains, clinic wash basins, and other sources for eventual mass spectrometry analysis in Aga’s lab back in Buffalo. The UB group was also taken to Matlab to do more water sampling and to meet with icddr,b practitioners, researchers, and surveillance administrators.
Going forward, with the support of CGHE and thanks to the collaborative partnership of Alam, Rahman, and their team at icddr,b, UB’s AMR “dream team” will continue to investigate the environmental transformation of bacterial pathogens, and assess drivers and transmission dynamics. Islam notes that many important questions remain to be answered: “To what extent does accumulated antimicrobial residue in the environment select for AMR, at both a bacterial and genetic level? How fluidly is AMR spread in water? What are the effects of naturally-occurring phenomenon, such as monsoons and floods on the spread of AMR? How easily do humans pick-up AMR from water and food sources, and how stable is this carriage?” Noting that it will take “serial investigations” to address the complexity of AMR in Bangladesh and beyond, Islam’s aspiration is that the joint research of UB and icddr,b will eventually result in improved AMR mitigation and prevention strategies.