Children’s immature immune systems threatened by increasing ‘superbugs’

By Zsuzsanna Jakab

 

The author is the Deputy Director-General of the World Health Organization

 

Spend a few minutes in any playground, nursery or home, and you will probably hear a common request of young children: “Don’t put your fingers in your mouth.” Parents and caregivers repeatedly try to shield their children from germs – either viruses or bacteria – that can lead to common colds or serious infections, like pneumonia.

Infants and toddlers love to crawl on the ground and put their fingers in their mouths, but their immature immune systems render them more susceptible to diseases, including those caused by drug-resistant microbes present in the people, animals and food to which they are exposed.

Today, antimicrobial resistance (AMR) is a major and growing threat to health and human development, affecting our ability to effectively treat a range of infections with antibiotics, including urinary tract infections, sepsis, and some forms of diarrhoea. ‘Superbugs’ or bacteria resistant to multiple antibiotics, are also becoming more prevalent.

Children, especially those living in low-resource settings with limited access to health services face an even greater risk. Lack of safe water, poor sanitary conditions and hygiene practices, and inadequate infection control, further enables the spread of AMR.

Resistance to treatments, like antiretrovirals, antimalarials, anti-Tuberculosis (TB) drugs, and antifungal drugs threatens to reverse progress in reducing child mortality. In low-income countries, where most childhood deaths are occurring, effective and accessible antibiotics are absolutely essential for treating the most common childhood diseases – malaria, pneumonia, other respiratory infections, and dysentery, as well as other conditions such as bacterial blood infections. If these drugs become resistant, children’s chances of survival are threatened.

The data speak for themselves. Today, around 2 million children are exposed to multidrug-resistant TB, and a further 5 million to Rifampicin-resistant TB. One out of every two infants newly diagnosed with HIV is infected with a virus already harboring resistance to the most commonly used first-line antiretroviral (ARV) drugs, with resistance to first-line ARVs being as high as 63.7% in infants diagnosed with HIV.

In addition, rapidly increasing antibiotic resistance in bacteria means several classes of antibiotics traditionally used to combat common but potentially deadly infections in children, such as diarrhoea, pneumonia and neonatal sepsis, are no longer effective.

Yet, AMR is not the only threat to children’s chances to survive and thrive. Lack of access to quality and affordable antimicrobials, particularly in low-resource settings disrupts the ability to treat infections in the first place. In 2016 alone, many of the estimated 6.3 million deaths among children under 5 were caused by infectious diseases which could have been averted by increased access to antibiotics.

At the same time, we also know that resistance develops more rapidly through the misuse and overuse of antimicrobial medicines, especially as antibiotic use in humans is increasing. While it is essential that children get the full-course antimicrobials at the right time and when needed, it is also important that health workers and caregivers guard against AMR by avoiding mis- or over-use of antimicrobials.

As part of World Antimicrobial Awareness Week, WHO and partners aim to increase awareness of AMR and encourage best practices among the public, health workers and policy makers. But they also aim to bring to the forefront, children’s rights to health. World Children’s Day, which falls at the same time, is an opportunity to celebrate and reflect upon our collective efforts to ensure that children’s rights, including their rights to good health and health care – are respected, protected and fulfilled.

Having the right to health means being entitled to quality health care, including access to essential drugs and medicines, such as antimicrobials. It also means having a right to access appropriate health information, including on the proper use of antimicrobials and the risks associated with their mis- or overuse.

Guided by the Convention on the Rights of the Child, recognition of children’s right to health requires governments to develop and implement policies and regulations that ensure children and their caregivers have equitable access to antimicrobials, and to inform them on when and how to use the medicine. In addition, policies, regulations and protocols must be in place to prevent over prescription of antimicrobials by health professionals and to avoid over-the-counter sales.

While we cannot fully stop children from putting their fingers in their mouths, we can better protect them from the increasing threat of AMR. Children must not be left behind in the global AMR response. Their unique needs and vulnerabilities must be addressed and their rights to health upheld.