As antimicrobial resistance (AMR) continues to pose a critical global health challenge, rising pertussis cases (whooping cough) and increasing evidence of macrolide-resistant Bordetella pertussis around the world underscores the urgent need to bolster surveillance of, and treatment for, this vaccine-preventable disease.
However, despite progress in parts of Asia, Europe and North America, critical gaps in surveillance coverage persist, especially in Latin America and the Caribbean. For example, prior to 2022, Brazil and Mexico lacked the capacity to conduct macrolide resistance surveillance for B. pertussis, leaving a significant gap in understanding the prevalence of resistant strains. Since then, macrolide surveillance efforts in these countries have been spurred, in part, by the work of ASM's Global Public Health Programs (GPHP) and its global partners, leading to the introduction of standardized methods to assess macrolide susceptibility at national and select state reference laboratories. This has marked an important step toward collaboratively addressing the regional gap in pertussis AMR monitoring.
The Pertussis Project
ASM has contributed to strengthening B. pertussis surveillance and macrolide resistance monitoring in Latin America, with specific efforts in Mexico, Brazil, Peru and Panama. While there have been advances in molecular diagnostics, global implementation of systematic monitoring of AMR in B. pertussis remains challenging, particularly in limited-resource settings such as Latin America. The goal of the ASM GPHP Pertussis Project is to enhance laboratory diagnostics in target countries through culture susceptibility and polymerase chain reaction (PCR) testing, as well as by establishing standardized detection methods across national reference laboratories (NRLs) and state laboratories.
The Pertussis Project began in 2021 in partnership with the U.S. Centers for Disease Control and Prevention (CDC) Global Antimicrobial Resistance Lab and Response Network. Spanning 50 countries, GARLRN aims to foster a collaborative global approach to detect and respond to emerging threats related to AMR, and to better understand the risk factors that contribute to the global emergence and spread of AMR in both community and environmental settings.
Why International Partnerships Are Crucial for AMR Surveillance
Considering the cross-border nature of resistant pathogens like B. pertussis, and varying levels of health systems infrastructure and capacity around the world, international partnerships are vital in the fight against AMR. Such collaborations provide a platform for shared knowledge, data and resources, enabling countries to strengthen their surveillance systems and respond quickly to AMR threats.
Global initiatives, such as the Global Antimicrobial Resistance and Use Surveillance System (GLASS) , launched by the World Health Organization (WHO), demonstrate the value of international collaboration. Similarly, the Global Health Security Agenda utilizes a collaborative approach to bring together countries, international organizations and nongovernmental organizations (NGOs) to enhance countries' capacity to prevent, detect and respond to infectious disease threats, including AMR. These initiatives highlight that individual countries cannot tackle AMR in isolation; international cooperation ensures that resource-limited settings can access technical assistance, training and funding, while all countries benefit from more comprehensive data and early warnings of resistant strains to safeguard global health.
With that in mind, ASM's GPHP has taken a collaborative approach to build capacity in laboratory and health systems, particularly in low- and middle-income countries (LMICs), since 2005. In partnership with funders and local stakeholders, GPHP implements a wide range of initiatives aimed at enhancing and expanding the capabilities of existing healthcare and laboratory capabilities to meet the needs of local populations. These efforts focus on strengthening health security measures, improving laboratory data reporting and advancing AMR detection and response. GPHP supports the development of robust laboratory infrastructure, enhances technical skills and fosters a culture of data-driven decision-making, ensuring these improvements are sustainably integrated within each country's financial, programmatic and policy structures.
Case Studies: Successes and Challenges
The following case studies from Mexico and Brazil illustrate the successes and challenges faced in strengthening B. pertussis surveillance and response systems through ASM's partnerships. These initiatives highlight the impact of capacity-building efforts and underscore the importance of coordinated approaches to AMR surveillance.
The Mexico Case
In Mexico, ASM is partnering with the Institute of Epidemiological Diagnosis and Reference (InDRE) to improve quality assurance practices at InDRE's national reference lab (NRL) and select state laboratories to optimize B. pertussis diagnostic capacity and macrolide resistance screening. In particular, ASM strengthened the culturing methods used at the NRL, improving the isolation of B. pertussis. These enhancements have been incorporated into updated national guidelines, standardizing diagnostic practices across the public health laboratory network. Additionally, through train-the-trainer workshops, ASM promoted clinician awareness of B. pertussis and fostered stronger communication between clinicians and laboratory staff, leading to increased pertussis sample collection. This collaboration resulted in the first identification of a macrolide-resistant pertussis case in Mexico in early 2024.
To further bolster surveillance efforts, the NRL and select state laboratories have implemented WHONET, a free microbiology laboratory database software, which has improved data exchange, usage and analysis related to B. pertussis, and generated valuable information on antimicrobial susceptibility to guide effective prevention programs and policy decisions.
"During the COVID-19 pandemic, some macrolide antibiotics were used indiscriminately," said Irma López Martínez, M.S., Diagnosis and Reference Director at InDRE. "Now, it is important to understand their impact. The diagnostic methodologies introduced by ASM in our institution have significantly helped us improve our capacity to detect B. pertussis infections and conduct AMR surveillance."
The Brazil Case
Since 2021, ASM's successful partnership with Adolfo Lutz Institute (IAL) and the Ministry of Health's General Coordination of Public Health Laboratories (CGLAB) in Brazil has achieved results similar to those in Mexico, including the recent detection of the first 7 macrolide-resistant B. pertussis cases in Brazil. Under CGLAB's guidance, fruitful public-private partnerships between private laboratories and IAL in the São Paulo region have led to significant improvements in testing positive DNA samples, enhancing the ability to respond to recent B. pertussis outbreaks in the region. Additionally, ASM's training and mentoring to the NRL has helped build a skilled team of laboratory staff to support reference testing. The NRL now serves as a training center for the laboratories within the national public health laboratory network, ultimately improving the speed and reliability of test results and supporting both clinical management of B. pertussis and AMR surveillance.
"ASM has provided us with valuable knowledge, especially through technical visits to the laboratory, training workshops and the ASM Microbe conferences," shared Amanda Bertani, a laboratory technician at IAL's NRL. "We believe in the significance of continuous learning and constantly improving our techniques. The teachings from ASM have helped us enhance the laboratory and expand our knowledge base every day."
Panama and Peru: What's Next?
Based on the significant impact of the pertussis project in Brazil and Mexico, ASM is expanding activities to 2 new countries. As outbreaks of B. pertussis continue to rise in the Latin America region, and the first macrolide-resistant cases have been detected, enhancing technical capabilities to screen for AMR by standardizing capacity and improving the readiness of the surveillance laboratory network is essential. Consequently, the Pertussis Project is expanding to Peru and Panama. Building on the achievements and lessons learned in Brazil and Mexico, ASM aims to strengthen surveillance and enhance laboratory capabilities in these countries. Furthermore, ASM seeks to foster regional collaboration to optimize the use of available resources and share knowledge, creating a more effective and unified approach to disease surveillance Latin America.
A Call for Action
The rise of AMR in B. pertussis highlights the urgent need for global cooperation to expand surveillance efforts, aiming at creating sustainable capacity across countries and regions. The successes of ASM GPHP's efforts in Brazil and Mexico demonstrate that through collaboration and investment, it is not only possible to enhance diagnostic capacity and improve data sharing, but also that resistant strains can be detected early, leading to timely public health responses. To build on these achievements, global health organizations, governments and the scientific community must invest in expanding AMR surveillance in Latin America and beyond. By securing long-term support and resources, we can strengthen laboratory systems, promote regional collaboration and ensure a more effective global response to AMR.
