- Email: [email protected]
Use of impact factors
CORRESPONDENCE
GASP-WAR: west African network to tackle gonorrhoea Sir—Sexually transmitted infections (STIs) are important cofactors in the spread of HIV, and STI case management can prevent HIV transmission.1 STI control depends on the availability of effective antimicrobials against the most prevalent STI pathogens. In practice, only Neisseria gonorrhoeae and Haemophilus ducreyi (the agent of chancroid) present serious difficulties for antimicrobial resistance to common and cheap antibiotics such as penicillin, tetracycline, and co-trimoxazole (sulphamethoxazole/ trimethoprim five/one).2 WHO has stated that the development of antimicrobial resistance in gonorrhoea was one of the major health care disasters of the 20th century.3 To maintain effective treatment of gonorrhoea, a system of testing and routine surveillance of antimicrobial susceptibility is essential. Surveillance aims to assess degrees of compound activity and treatment effectiveness, and to monitor patterns and trends in development of antimicrobial resistance on a national and international basis. To help achieve these aims, in 1990, WHO started to establish a global surveillance network, named Gonococcal Antimicrobial Surveillance Programme (GASP), to monitor N gonorrhoeae antimicrobial resistance.4 The GASP network was to gather data in different countries and make this information available for implementation of effective treatment regimens at global, regional, or national levels. This has been successful in some regions of the world such as the Americas, southeast Asia, or the western Pacific region where, since 1992, more than 35 000 isolates
Proportion gonococcal isolates (%)
100
Penicillin
Tetracycline
have been tested.5 Attempts to establish GASP in the WHO Africa region have failed because of the lack of a coordinated approach and adequate resources to run the scheme, allied with the fact that only a few centres were able to produce credible results. How can African countries tackle this issue? A workshop, held in The Gambia under the auspices of the National Health Laboratories and the Medical Research Council Laboratories, and the National HIV/AIDS and STI Control Program of Senegal, and attended by 25 experts from eight countries, tried to lay the foundations of a GASP network for the west African region (GASP-WAR). Participants were representatives of HIV/AIDS and STI national reference laboratories and control programmes. The workshop was facilitated by an expert from the west Pacific region GASP network, and supported by the Department for International Development, UK, and WHO. Published and unpublished work on gonococcal resistance from the region shows a disparity in methods of selection of patients, microbiological techniques, and antibiotics tested, but all record high degrees of resistance to cheap antibiotics (figure). Workshop participants agreed on common microbiological and epidemiological approaches, quality assurance schemes, and reporting and dissemination mechanisms. The GASPWAR network will be spearheaded by a team of Senegalese and Gambian laboratories. Each represented laboratory will in turn mobilise its national resources and organise its own network to obtain nationally representative data. It is hoped that the network could act as a resource centre for other African countries, other microbiological surveillance schemes (eg, meningitis), and could help
Co-trimoxazole
90 80 70 60 50 40 30 20 10 0
Gambia, 1997
Senegal, 1997
Burkina Faso, Liberia, 1992–96 1998 Country
Benin, 2001
Nigeria, 1992
Antimicrobial resistance of Neisseria gonorrhoeae in selected countries of west African region during 1990s
THE LANCET • Vol 359 • January 12, 2002 • www.thelancet.com
promote regional STI research interests. The GASP-WAR network will be an additional useful contributor to the increasing collaboration between English-speaking and French-speaking countries in the fight against HIV/AIDS and STIs in west Africa. *Philippe Mayaud, Beryl West, Nellie Lloyd-Evans, Karim Seck *Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Medical Research Council Laboratories, Fajara, The Gambia; National Health Laboratories, Banjul, The Gambia; and Programme National de Lutte contre le SIDA et les MST, Dakar, Senegal (e-mail: [email protected]) 1
2
3
4
5
Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995; 346: 530–36. Ison CA, Dillon JR, Tapsall JW. The epidemiology of global antibiotic resistance among Neisseria gonorrhoeae and Haemophilus ducreyi. Lancet 1998; 381 (suppl III): 8–11. WHO. Report on infectious diseases 1999: removing obstacles to healthy development, WHO/CDS/99.1. Geneva: WHO, 1999. Global surveillance network for gonococcal antimicrobial susceptibility, WHO/VDT/90.452. Geneva: WHO, 1990. Western Pacific Region Gonococcal Antimicrobial Surveillance Programme. Surveillance of antibiotic susceptibility of Neisseria gonorrhoeae in the WHO Western pacific region 1992–4. Genitourin Med 1997; 73: 355–61.
Use of impact factors Sir—The use of impact factors is becoming important for scientific journals. There are, of course, different ways of manipulating these factors. It has come to our attention that editors of some journals are sending copies of reports published in their journals together with the review copy to the referees and asking them to include those reports in the reference list. It is of course a brilliant way of increasing the impact factor for that journal. We question that approach to publishing scientific reports. We think that researchers should be entrusted to decide what work should be referred to. When certain shortcomings are apparent, it should, of course, be handled by the referees. We think that the obvious manipulation of the impact factor as described is not honourable. *Anders Hemmingsson, Johan Edgren, Thorkild Mygind, Arnulf Skjennald Acta Radiologica, Uppsala Science Park Glunten, S-751 83 Uppsala, Sweden
173
For personal use. Only reproduce with permission from The Lancet Publishing Group.
GASP-WAR: west African network to tackle gonorrhoea Sir—Sexually transmitted infections (STIs) are important cofactors in the spread of HIV, and STI case management can prevent HIV transmission.1 STI control depends on the availability of effective antimicrobials against the most prevalent STI pathogens. In practice, only Neisseria gonorrhoeae and Haemophilus ducreyi (the agent of chancroid) present serious difficulties for antimicrobial resistance to common and cheap antibiotics such as penicillin, tetracycline, and co-trimoxazole (sulphamethoxazole/ trimethoprim five/one).2 WHO has stated that the development of antimicrobial resistance in gonorrhoea was one of the major health care disasters of the 20th century.3 To maintain effective treatment of gonorrhoea, a system of testing and routine surveillance of antimicrobial susceptibility is essential. Surveillance aims to assess degrees of compound activity and treatment effectiveness, and to monitor patterns and trends in development of antimicrobial resistance on a national and international basis. To help achieve these aims, in 1990, WHO started to establish a global surveillance network, named Gonococcal Antimicrobial Surveillance Programme (GASP), to monitor N gonorrhoeae antimicrobial resistance.4 The GASP network was to gather data in different countries and make this information available for implementation of effective treatment regimens at global, regional, or national levels. This has been successful in some regions of the world such as the Americas, southeast Asia, or the western Pacific region where, since 1992, more than 35 000 isolates
Proportion gonococcal isolates (%)
100
Penicillin
Tetracycline
have been tested.5 Attempts to establish GASP in the WHO Africa region have failed because of the lack of a coordinated approach and adequate resources to run the scheme, allied with the fact that only a few centres were able to produce credible results. How can African countries tackle this issue? A workshop, held in The Gambia under the auspices of the National Health Laboratories and the Medical Research Council Laboratories, and the National HIV/AIDS and STI Control Program of Senegal, and attended by 25 experts from eight countries, tried to lay the foundations of a GASP network for the west African region (GASP-WAR). Participants were representatives of HIV/AIDS and STI national reference laboratories and control programmes. The workshop was facilitated by an expert from the west Pacific region GASP network, and supported by the Department for International Development, UK, and WHO. Published and unpublished work on gonococcal resistance from the region shows a disparity in methods of selection of patients, microbiological techniques, and antibiotics tested, but all record high degrees of resistance to cheap antibiotics (figure). Workshop participants agreed on common microbiological and epidemiological approaches, quality assurance schemes, and reporting and dissemination mechanisms. The GASPWAR network will be spearheaded by a team of Senegalese and Gambian laboratories. Each represented laboratory will in turn mobilise its national resources and organise its own network to obtain nationally representative data. It is hoped that the network could act as a resource centre for other African countries, other microbiological surveillance schemes (eg, meningitis), and could help
Co-trimoxazole
90 80 70 60 50 40 30 20 10 0
Gambia, 1997
Senegal, 1997
Burkina Faso, Liberia, 1992–96 1998 Country
Benin, 2001
Nigeria, 1992
Antimicrobial resistance of Neisseria gonorrhoeae in selected countries of west African region during 1990s
THE LANCET • Vol 359 • January 12, 2002 • www.thelancet.com
promote regional STI research interests. The GASP-WAR network will be an additional useful contributor to the increasing collaboration between English-speaking and French-speaking countries in the fight against HIV/AIDS and STIs in west Africa. *Philippe Mayaud, Beryl West, Nellie Lloyd-Evans, Karim Seck *Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK; Medical Research Council Laboratories, Fajara, The Gambia; National Health Laboratories, Banjul, The Gambia; and Programme National de Lutte contre le SIDA et les MST, Dakar, Senegal (e-mail: [email protected]) 1
2
3
4
5
Grosskurth H, Mosha F, Todd J, et al. Impact of improved treatment of sexually transmitted diseases on HIV infection in rural Tanzania: randomised controlled trial. Lancet 1995; 346: 530–36. Ison CA, Dillon JR, Tapsall JW. The epidemiology of global antibiotic resistance among Neisseria gonorrhoeae and Haemophilus ducreyi. Lancet 1998; 381 (suppl III): 8–11. WHO. Report on infectious diseases 1999: removing obstacles to healthy development, WHO/CDS/99.1. Geneva: WHO, 1999. Global surveillance network for gonococcal antimicrobial susceptibility, WHO/VDT/90.452. Geneva: WHO, 1990. Western Pacific Region Gonococcal Antimicrobial Surveillance Programme. Surveillance of antibiotic susceptibility of Neisseria gonorrhoeae in the WHO Western pacific region 1992–4. Genitourin Med 1997; 73: 355–61.
Use of impact factors Sir—The use of impact factors is becoming important for scientific journals. There are, of course, different ways of manipulating these factors. It has come to our attention that editors of some journals are sending copies of reports published in their journals together with the review copy to the referees and asking them to include those reports in the reference list. It is of course a brilliant way of increasing the impact factor for that journal. We question that approach to publishing scientific reports. We think that researchers should be entrusted to decide what work should be referred to. When certain shortcomings are apparent, it should, of course, be handled by the referees. We think that the obvious manipulation of the impact factor as described is not honourable. *Anders Hemmingsson, Johan Edgren, Thorkild Mygind, Arnulf Skjennald Acta Radiologica, Uppsala Science Park Glunten, S-751 83 Uppsala, Sweden
173
For personal use. Only reproduce with permission from The Lancet Publishing Group.