Implementing national strategies on antimicrobial resistance in Thailand: potential challenges and solutions.

BACKGROUND: Thailand has developed a national strategic plan on antimicrobial resistance (NSP-AMR) and endorsed by the Cabinet in August 2016. This study reviewed the main contents of the NSP-AMR and the mandates of relevant implementing agencies and identified challenges and recommends actions to mitigate implementation gaps. METHODS: This study analysed the contents of NSP-AMR, reviewed institutional mandates and assessed the implementation gaps among agencies responsible for NSP-AMR. RESULTS: Two of six strategies are related to monitoring and surveillance of AMR and antimicrobial consumption in human and animal. Two other strategies aim to improve antibiotic stewardship and control the spread of AMR in both clinical and farm settings. The remaining two strategies aim to increase knowledge and public awareness on AMR and establish national governance for inter-sectoral actions. Strategies to overcome implementation challenges are sustaining cross-sectoral policy commitments, effective cross-sectoral coordination using One Health approach, generating evidence which guides policy implementation, and improving enforcement capacities in regulatory authorities. CONCLUSIONS: To address AMR, Thailand requires significant improvements in implementation capacities in two dimensions. First, technical capacities among implementing agencies are needed to translate policies into practice. Second, governance and organizational capacities enable effective multi-sectoral actions across human, animal, and environmental sectors.

Detection of phenylketonuria by the newborn screening program in Thailand.

This study evaluated the newborn screening program for phenylketonuria (PKU) in Thailand from 1996 to 2006. During the study period, 5,243,841 newborns were screened, of which 16 were confirmed to have PKU. The phenylalanine levels ranged from 20.30-30.68 mg/dl (mean 25.82 mg/dl). All the patients who were diagnosed through the newborn screening program had normal growth and development after treatment except for 2 cases who were subsequently found to have a 6-pyruvoyltetrahydropterin synthase deficiency. Four additional cases of PKU diagnosed were siblings of screening detected cases who all presented with mental retardation, microcephaly, hypopigmented hair and skin and seizures in one case. Although these patients were treated with a phenylalanine restricted diet, all of them had moderate to severe psychomotor retardation. The results of this study confirm the benefit of early detection and treatment of PKU through the screening program.

Production of monoclonal antibody against hepatitis B surface antigen.

HBV infection is a major health problem in Southeast Asia. Thailand is considered to be an endemic area of HBV infection(18). Prevalence of HBsAg carriers is 5.2 per cent in children, 9 per cent in adults and 5.6 per cent in pregnant women(19,20). We believe that the monoclonal antibody described in the present report will be useful to develop HBsAg-KIT for national serologic screening assay, as considered in terms of sensitivity, specificity and cost effectiveness.

Production and characterization of monoclonal and polyclonal antibodies against digoxin.

Three hybridoma cell lines (DIG 64. 2B. 5, DIG 104. H10.1 and DIG 222. 4D. 5) producing monoclonal antibodies against digoxin were established, and the properties of these monoclonal antibodies were characterized and compared with three polyclonal rabbit anti-digoxin antisera. Both polyclonal and monoclonal antibodies gave association constants ranging from 10(9) to 10(10) (M-1). The monoclonal antibodies were of the IgG1(kappa) or IgG2b(kappa) subclass. Cross-reactivities of these monoclonal antibodies and polyclonal antisera with various related cardenolides and their aglycones were determined by competitive radioimmunoassay. The monoclonal antibodies were specific for digoxigenin-containing glycosides such as lanatoside C and deslanoside, but not for digitoxigenin-containing glycosides. On the other hand, the specificities of the polyclonal antisera were less strict than the monoclonal antibodies and relatively cross-reactive with digitoxin. It was shown that the RIA for digoxin using DIG 64. 2B. 5 is sensitive enough to detect 0.2-0.3 nM (30-60 pg/tube) of digoxigenin-containing cardenolides.

Single-serum diagnosis of recent rubella infection with the use of hemagglutination inhibition test and enzyme-linked immunosorbent assays.

Single-serum diagnosis of recent rubella infection was attempted with the use of hemagglutination inhibition (HI) test and two commercially available enzyme-linked immunosorbent assays (ELISAs). The period during which IgM antibody was detectable by IgM capture ELISA was 4 to 30 days after the onset of rash. Rubella IgG ELISA values relative to HI titer were lower in the sera from the patients with recent infection than in the sera from the subjects with remote infection. IgM ELISA and the combined use of IgG ELISA and HI test are two useful methods of single-serum diagnosis of recent rubella infection.

Production and characterization of high-affinity monoclonal antibodies against morphine.

Twelve hybridoma cell lines producing MAbs against morphine were established by using morphine hemisuccinate-conjugated bovine serum albumin as an immunogen. The MAbs belonged to the IgG1 subclass with kappa- or lambda-chains. The association constants of the antibodies ranged from 4.6 x 10(8) to 4.7 x 10(10) (M-1). These antibodies revealed slightly different cross-reactivities with various agonistic opiates and antagonists. In general, the antibodies were strongly cross-reactive with the opiate agonists, codeine, ethylmorphine, dihydromorphine and dihydrocodeine, while their cross-reactivities with norcodeine and the opiate antagonists, naloxone and naltrexone, were weak. The cross-reactivities with dihydromorphinone, dihydrocodeinone, naloxone, naltrexone, dextromethorphan and homatropine varied from clone to clone. Interestingly, certain MAbs displayed weak but significant cross-reactivities with the synthetic opiate, meperidine. However, none of the antibodies was cross-reactive with the opioid peptides, beta-endorphin, Met-enkephalin, and D-Ala2-D-Leu5-enkephalinamide. Radioimmunoassay for morphine using one of the antibodies (MOR 131.5.13) was shown to be sufficiently sensitive (IC50 = 0.1 nM) for the purposes of forensic analysis of morphine. This set of monoclonal anti-opiate antibodies is assumed to be suitable for analyzing the structure-function relationship in the hapten-antibody interaction, since the antibodies revealed similar but not identical cross-reactivities with various morphine related compounds.