News and Opinions  –  2019

Why are children more vulnerable to resistant infections?

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2019-11-14

Resistant bacteria is making effective treatment of common infections more and more challenging and children are especially vulnerable. Children are more susceptible to resistant bacteria because their immune systems are not fully developed. Children differ from adults in that they have many ways of being exposed to germs and infections because their behavior is different. Children living in poverty are even more susceptible to resistant bacteria.

Children are more susceptible to resistant bacteria because their immune systems are not fully developed.

Photo: Barry Reinhart-Wondoor, Photoshare.

A baby is born with some protection against infections, but this protection only lasts for a few weeks after birth or when breastfeeding has stopped.  Eventually, babies produce their own antibodies, but it takes time for their immune systems to fully develop.  Antibiotics help fight off infections, but when bacteria are resistant to antibiotics, babies are left almost defenseless in fighting off these bacteria.

Children differ from adults in that they have many ways of being exposed to germs and infections because their behavior is different.

Photo: Zaqatalaart Photo, Photoshare.

Babies crawl on the ground and put their hands and objects in their mouth as they explore and learn.  Babies are often unaware of risks and are, therefore, unable to make choices to protect their health and prevent infection.

Children living in poverty are even more susceptible to resistant bacteria.

Children playing next to railroad.
Photo: Rajat Kumar Das, Photoshare.

Over 300 million children live on less than $1.90/day. Children living in poverty are even more susceptible to resistant bacteria, for several reasons. Poor children often lack access to safe drinking water, sanitation and hygiene (WASH). Over 785 million people still don’t have clean water close to home.  Children in poverty suffer from suboptimal housing conditions and poor nutrition. Today, nearly one in three children under the age of five are malnourished, which leaves children too weak to fight off infections and even more dependent on antibiotics.  Furthermore, these children do not have access to quality health care.  At least half of the world still does not have access to critically important health care services. But even when services are available the quality can be questionable. Data from a BMJ report shows that one in four health care facilities lacked basic water services, one in five had no sanitation services and two in five health facilities lack hand hygiene facilities at the points of care.

These factors help explain why infectious diseases are still the leading cause of death among children under the age of five. For children lucky enough to have access to quality health care many of the main childhood infections such as pneumonia, sepsis, and typhoid can be treated with effective antibiotics. However, if antibiotics are not used appropriately so they remain effective, even an infection from a scrape will become near impossible to treat. Right now, one of every three cases of meningitis and neonatal sepsis in sub-Saharan Africa are caused by bacteria resistant to antibiotics; 38% of healthy children in a village in Latin America carried bacteria resistant to colistin – a last line antibiotic; and in Europe, neonates bear the largest burden of antibiotic resistant bacteria, which has increased over the years.

Next week marks the 30th anniversary of the adoption of the Convention on the rights of the Child (UNCRC), the most widely ratified human rights treaty in history.  As the world celebrates and reflects upon the successes in ensuring children’s rights are protected, the global community must also ensure that resistant bacteria do not catapult us back in time unraveling all of the achievements towards realizing children’s rights.

Resources

Brookings: More than half of the world’s poor are children.

“Alarmingly high” number of children malnourished worldwide: UNICEF report.

WHO: Universal health coverage (UHC).

WASH data: Health care facilities.

Unicef: Under-five mortality.

Okomo U. et al. The Lancet Infectious Diseases 19;11 (November 2019): 1219–34).

Giani et al, Eurosurveillance 23, (2018): 1800115e.

Cassini A., et al, Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. The Lancet Infectious Diseases 19, (2018): 56–66).

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