The Walter Reed Army Institute of Research-Africa (WRAIR-Africa) in Nigeria is part of a laboratory-based surveillance study focused on antimicrobial resistance (AMR) among military and civilian populations across Nigeria. Working alongside the Nigerian Ministry of Defence Health Implementation Program (MODHIP), with support from the Henry Jackson Foundation Medical Research International (HJFMRI), the program trains field and laboratory staff on collection of clinical samples and data at participating military sites. This ongoing study was launched in 2024.
AMR poses a significant risk to force health protection and global health security because it can complicate the treatment of wounds, infections, and other medical conditions. Results from this surveillance study will inform decision‑making on antimicrobial stewardship, infection prevention and control, and risk mapping. This work is part of the U.S. Department of War Global Emerging Infections Surveillance (GEIS) program.
"The growing threat of AMR poses a serious challenge to the effectiveness of antibiotics and other antimicrobial treatments for infections. In Nigeria, the prevalence of AMR is becoming increasingly alarming, with various emerging multidrug-resistant lineages identified among priority pathogens, especially within the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens group," remarked MAJ Thierry Fouapon, the Military Science Officer at WRAIR-Africa-Nigeria. The AMR Surveillance initiative in Nigeria is strengthened by a vital partnership with GEIS and the Multi-Drug-Resistant Organism Repository and Surveillance Network (MRSN) at WRAIR. This study is essential for advancing AMR surveillance and evaluating the presence and levels of multidrug-resistant organisms (MDROs) in both humans and the environment.
At six military health facilities in Nigeria, researchers collect samples from patients presenting with infected wounds from surgical site infections, skin and soft-tissue infections, and other clinically significant bacterial infections. Site laboratory teams conduct preliminary testing and identification of isolates, and some bacterial samples are then shipped to the Defence Reference Laboratory (DRL) in Abuja for confirmation of bacterial species and antibiotic susceptibility. The Nigeria team worked closely with the AMR team from Kenya, led by WRAIR researcher Dr. Lillian Musila, to develop this work, an example of cross-network capacity strengthening and tech transfer.
Researchers also send a selection of isolates from the study to WRAIR’s MRSN laboratory in Silver Spring, Maryland, where Colonel Jason Bennett and his team conduct whole-genome and targeted sequencing to characterize resistance mechanisms, virulence factors, and transmission patterns. This study has already identified a strain of E. coli in the region that is resistant to the last line of antibiotic treatments, highlighting the urgent need for continued AMR surveillance.
“Surveillance of AMR conducted in Nigerian military hospitals has identified concerning drug-resistant genes and virulence factors in bacteria that are increasingly challenging to treat with standard antibiotics. Certain strains of these drug-resistant bacteria are no longer susceptible to last-resort antibiotics such as carbapenems. Our findings indicate that a significant number of pathogenic bacteria circulating among patients in Nigeria exhibit rare traits that contribute to more severe infections and enhance their potential for transmission. Notably, we documented atypical resistance patterns, some of which have been designated as novel by MRSN, highlighting that such patterns have not been reported elsewhere globally. If these infections are not detected early, they may become more difficult and costly to manage.” explained Dr. Aminu Suleiman, the WRAIR-Africa-Nigeria AMR study lead. “Ongoing surveillance of AMR is essential for promptly identifying emerging threats. Accordingly, the findings are also disseminated to MODHIP for their Force Health Protection benefits. This information informs treatment decisions, safeguards military personnel, and prevents broader public health crises in Nigeria and beyond.”
This program builds on a long-standing partnership between WRAIR and MODHIP. In September 2025, WRAIR and MODHIP marked 20 years of groundbreaking military-to-military health partnership. Over the years, this collaboration has provided HIV prevention, care, and treatment services to military and civilian communities in the region and conducted research to counter HIV, malaria, Lassa fever, Ebola and more.