**A Molecular Evaluation of Carbapenem-Resistant Enterobacteriaceae Epidemics in Aquatic Ecosystems across Diverse Geographical Locations and Climatic Conditions during/post the COVID-19 Pandemic**

**Periyasamy Sivalingam1 , Amandine Laffite2 , Crispin K. Mulaji3 , and John Poté2** 1Water Research Institute, National Research Council of Italy (CNR-IRSA), MEG - Molecular Ecology Group, Largo Tonolli 50, 28922, Verbania, Italy

<sup>2</sup> Department F.-A. Forel for Environmental and Aquatic Sciences and Institute of Environmental Sciences, Faculty of Science, University of Geneva, Uni Carl Vogt, 66 Boulevard Carl-Vogt, CH-1211 Geneva 4, Switzerland

<sup>3</sup> University of Kinshasa (UNIKIN), Faculty of Science, Department of Chemistry, B.P. 190, Kinshasa XI, Democratic Republic of the Congo

During this time of global concern due to different epidemics and climate change, research and actions are essential for the prevention and eradication of diseases affecting human health. Before the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19 disease, one of the greatest concerns was the infections caused by multidrug-resistant gram-negative bacteria (MDR-GNB), which are increasingly being reported worldwide. The COVID-19 pandemic, on the other hand, is causing the world to consume more antibiotics, which may result in the emergence of MDR-GNB, a grave and major global health threat. It is alarming in developing countries such as Sub- Saharan Africa and South Asia, where the population is self-medicating using antibiotics to treat symptoms and prevent COVID-19 eventually. Consequently, there is, in fact, the increasing dissemination and emergence of antimicrobial resistance (AMR). In this context, this research explores the prevalence of MDR-GNB harboring carbapenemase in clinical settings and their dissemination into the aquatic ecosystems according to the climatic conditions (temperate/tropical) and COVID-19 pandemic evolution. We aim to build a strong network of stakeholders and scientists with environmental and medical sciences backgrounds in selected countries (Switzerland, DR Congo, and India) to reinforce educational and sensibilization aspects for preventing the COVID-19 epidemic with respect to AMR epidemiology. Quantitative data from hospital and environmental settings will be useful to evaluate the potential human risks and limit the spread of MDR-GNB clinical and environmental settings during and after post COVID-19 pandemic.

Periyasamy Sivalingam1, Amandine Laffite2, Crispin K. Mulaji3, and John Poté2

<sup>1</sup> Water Research Institute, National Research Council of Italy (CNR-IRSA), MEG - Molecular Ecology Group, Largo Tonolli 50, 28922, Verbania, Italy

<sup>2</sup> Department F.-A. Forel for Environmental and Aquatic Sciences and Institute of Environmental Sciences, Faculty of Science, University of Geneva, Uni Carl Vogt, 66 Boulevard Carl-Vogt, CH-1211 Geneva 4, Switzerland

3University of Kinshasa (UNIKIN), Faculty of Science, Department of Chemistry, B.P. 190, Kinshasa XI, Democratic Republic of the Congo

#### How do urban and hospital effluents affect emerging contaminant spread in river settings?

This research (i) explores the prevalence of MDR-GNB harbouring carbapenemases (KPC, NDM, and OXA-48-like) in the hospital (HUG) and communal effluents, wastewater treatment plants (WWTP) and their dissemination in to the aquatic ecosystems, (ii) characterizes their phenotypic and genotypic resistance patterns to antibiotics that are routinely used in treatment and prophylaxis, (iii) provides insight on antibiotic residue, antibiotic resistance genes, mobile genetic elements (MGEs) and pathogens discharged into the aquatic ecosystems, and (iv) assesses the clonal relatedness of MDR-GNB and MGEs isolated from the same species over the period of time.

We also aim to build a strong network of stakeholders and scientists with environmental and medical sciences backgrounds in the studied countries (Switzerland and RD Congo). This project integrates both clinical and environmental settings to describe the epidemiology of MDR-GNB to give novel insights on significant carbapenem-resistant GNB according to the climatic conditions (temperate/tropical) and the degree of development of countries (developed/developing countries).

#### Study Site – Materials and Methods *Sampling of hospital and communal effluents in Geneva, Switzerland.*

Results part 1: Prevalence of ESBL, CRE and XDR in Geneva effluent (A. before treatment and B. after treatment).

Results part 2: Isolates carrying carbapenemase genes identified before the COVID-19 pandemic (in 2018) from Geneva hospital effluents (HUG) , communal, WWTP and river water samples.


Results part 3: Isolates carrying carbapenemase genes identified before and after the COVID-19 pandemic in Congo hospital effluents and sediments from river receiving systems. Conclusions

Hospital and urban effluents are considered to be the main sources of Pathogen multiresistances, MDR-GNB-harbouring carbapenemases (KPC, NDM, and OXA-48) and ARGs (blaCTX-M and blaSHV), showing carbapenem resistance (blaVIM, blaIMP, blaKPC, blaOXA-48 and blaNDM) dissemination in aquatic environment under tropical and temperate climatic conditions before and post COVID-19. Our ongoing preliminary results indicate that the COVID-19 pandemic didn't have any effects on the environmental dissemination of pathogens, ARBs and ARGs in developing countries under tropical conditions. Our ongoing study is being performed to quantify and correlate the SARS-CoV-2 virus with ARBs and ARGs in Geneva hospital effluents (HUG), communal, WWTP and river water samples after the COVID-19 pandemic.

Reference: https://www.unige.ch/mbiolenv/en/publications

Background: During this time of global concern due to different epidemics and climate change, research and actions are essential to the prevention and eradication of diseases affecting human health. Before the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19 disease, one of the greatest concerns was the infections caused by multidrug-resistant Gramnegative bacteria (MDR-GNB) which are increasingly being reported worldwide. The COVID-19 pandemic, on the other hand, is causing the world to consume more antibiotics, which may result in the emergence of MDR-GNB, a grave and major global health threat. It is alarming in developing countries such as in Sub-Saharan Africa and South Asia, where the population self-medicates using antibiotics to treat symptoms and prevent COVID-19. Consequently, there is, in fact, increasing dissemination and emergence of antimicrobial resistance (AMR). In this context, this research explores the prevalence of MDR- GNB harbouring carbapenemase in clinical settings and their

dissemination into the aquatic ecosystems according to the climatic conditions (temperate/tropical) and COVID-19 pandemic evolution.


A Molecular Evaluation of Carbapenem-Resistant Enterobacteriaceae Epidemics in Aquatic Ecosystems across Diverse Geographical Locations and Climatic Conditions during/post the COVID-19 Pandemic

## **UK Public Health Rapid Support Team: What Does It Take to Be Ready to Deploy within 48 Hours?**

**Katie Carmichael, Gina Chen, Benedict Gannon, Susan Ismaeel, and Daniel Stewart** UK Public Health Rapid Support Team, UK Health Security Agency

The UK Public Health Rapid Support Team (UK-PHRST) is an innovative government-academic partnership co-led by the UK Health Security Agency and the London School of Hygiene and Tropical Medicine. The UK-PHRST's triple mandate incorporates outbreak response, research, and capacity development. Since they were formed in 2016, the UK-PHRST has undertaken more than 23 deployments in 15 different countries. We have completed 28 operational research projects, with a further 12 in progress. This presentation describes the processes, equipment, and systems that enable the UK-PHRST to respond internationally to outbreaks within 48 hours. It will share lessons learned in the recruitment, onboarding, and training of staff and the team's predeparture processes and systems. It will also describe the support provided in the field and post-deployment processes, both of which feed into the UK-PHRST's capacity for rapid response. The UK-PHRST will present a qualitative summary describing what is needed to rapidly deploy UK-PHRST staff across the globe. Across the five years since they were formed, the UK-PHRST have developed a robust approach to ensuring they remain 'deployment ready' within 48 hours.


The UK-PHRST has developed a robust set of processes and systems to ensure they are able to deploy a highquality outbreak response internationally within 48 hours. The lessons learned set out in this presentation provide a unique learning opportunity for partners looking to set up similar rapid- response teams as part of their efforts to strengthen global health security.

Katie Carmichael, Gina Chen, Benedict Gannon, Susan Ismaeel, and Daniel Stewart

UK Public Health Rapid Support Team, UK Health Security Agency

#### Introduction to the UK Public Health Rapid Support Team

The UK-PHRST is an innovative government-academic partnership funded with UK Aid from the Department of Health and Social Care (DHSC) and co-led by UK Health Security Agency (UKHSA) and the London School of Hygiene & Tropical Medicine (LSHTM), with a consortium of academic partners.

The team has a novel integrated triple-remit of outbreak response, research and capacity strengthening to prevent and control epidemics of infectious diseases in countries eligible for Official Development Assistance (ODA). The team has deployed 26 times to 17 countries between April 2017 and March 2022.

#### The UK-PHRST has the following objectives:


#### What does it take to create a 'deployment ready' team?

1. Establish the objectives of any deployable group and conduct a systematic benchmarking exercise of similar organisations to gain insight into existing

