{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T15:52:51Z","timestamp":1791301971082,"version":"4.1.0"},"reference-count":28,"publisher":"IWA Publishing","issue":"6","license":[{"start":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T00:00:00Z","timestamp":1605657600000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The emergence and spread of antimicrobial resistance (AMR), including clinically relevant antimicrobial-resistant bacteria, genetic resistance elements, and antibiotic residues, presents a significant threat to human health. Reducing the incidence of infection by improving water, sanitation, and hygiene (WASH) is one of five objectives in the World Health Organization's (WHO) Global Action Plan on AMR. In September 2019, WHO and the Health-Related Water Microbiology specialist group (HRWM-SG) of the International Water Association (IWA) organized its third workshop on AMR, focusing on the following three main issues: environmental pathways of AMR transmission, environmental surveillance, and removal from human waste. The workshop concluded that despite an increase in scientific evidence that the environment may play a significant role, especially in low-resource settings, the exact relative role of the environment is still unclear. Given many antibiotic-resistant bacteria (ARB) can be part of the normal gut flora, it can be assumed that for environmental transmission, the burden of fecal-oral transmission of AMR in a geographical area follows that of WASH-related infections. There are some uncertainties as to the potential for the propagation of particular resistance genes within wastewater treatment plants (WWTPs), but there is no doubt that the reduction in viable microbes (with or without resistance genes) available for transmission via the environment is one of the goals of human waste management. Although progress has been made in the past years with respect to quantifying environmental AMR transmission potential, still more data on the spread of environmental AMR within human communities is needed. Even though evidence on AMR in WWTPs has increased, the reduction in the emergence and spread of AMR by basic sanitation methods is yet unresolved. In order to contribute to the generation of harmonized One Health surveillance data, WHO has initiated an integrated One Health surveillance strategy that includes the environment. The main challenge lies in rolling it out globally including to the poorest regions.<\/jats:p>\n               <jats:p>This article has been made Open Access thanks to the generous support of a global network of libraries as part of the Knowledge Unlatched Select initiative.<\/jats:p>","DOI":"10.2166\/wh.2020.033","type":"journal-article","created":{"date-parts":[[2020,11,18]],"date-time":"2020-11-18T12:46:20Z","timestamp":1605703580000},"page":"858-866","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":34,"title":["Updated research agenda for water, sanitation and antimicrobial resistance"],"prefix":"10.2166","volume":"18","author":[{"given":"Daisuke","family":"Sano","sequence":"first","affiliation":[{"name":"Department of Frontier Sciences for Advanced Environment, Graduate School of Environmental Studies, Tohoku University, Sendai 980-8579, Japan and Department of Civil and Environmental Engineering, Graduate School of Engineering, Tohoku University, Sendai 980-8579, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid","family":"Louise Wester","sequence":"additional","affiliation":[{"name":"Center for Antimicrobial Resistance, Norwegian Institute of Public Health, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heike","family":"Schmitt","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands and Faculty of Veterinary Medicine, Utrecht University, Institute for Risk Assessment Sciences (IRAS), P.O. Box 80178, 3508 TD, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohan","family":"Amarasiri","sequence":"additional","affiliation":[{"name":"Department of Health Science, School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kirby","sequence":"additional","affiliation":[{"name":"Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA and Center for Global Safe Water, Sanitation, and Hygiene, Rollins School of Public Health,Emory University, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Medlicott","sequence":"additional","affiliation":[{"name":"Water, Sanitation and Hygiene, World Health Organization, Geneva, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana Maria de","family":"Roda Husman","sequence":"additional","affiliation":[{"name":"National Institute for Public Health and the Environment (RIVM), P.O. Box 1, 3720 BA, Bilthoven, The Netherlands and Faculty of Veterinary Medicine, Utrecht University, Institute for Risk Assessment Sciences (IRAS), P.O. 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