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Thursday September 21, 2017

How Vaccines Can Reduce Our Dependence on Antibiotics


We’d be a healthier nation if we could find ways to reduce our use of antibiotics. Most of us have heard of MRSA, a drug-resistant form of staph infection, and there are many more, enough to make them a major threat to Americans’ health. According to the CDC, at least 2 million people are sickened by these infections each year and 23,000 die.

In addition, antibiotics can result in digestive ailments and other side effects, and kill the good bacteria in our systems as well as the bad.

What can we do about this? Rein in antibiotic use. For many years, these miracle drugs were overused, commonly prescribed even for colds, which are caused by a virus, not bacteria. Doctors and public-health experts have been getting better on this score, though. Their efforts have included changing the guidelines for treating ear infections in young children, because in 80 percent of cases, the body’s own immune system will take care of the problem.

But who would have guessed that vaccines might play a key role – several key roles -- in reducing our reliance on antibiotics?

How do they do this?

For one thing, although most existing vaccines combat viral diseases, some of them protect against bacterial diseases, meaning that immunized people won’t be struck by those diseases and won’t need antibiotics. These include whooping cough, pneumococcal disease and diphtheria.

“Expanding the use of existing vaccines will reduce the use of antibiotics and the development of resistance,” the World Health Organization said in a statement last November.

An August story by the website FiveThirtyEight does an excellent job of explaining how this can work in the lives of everyday families and the doctors who are wise enough to use this information about vaccines and antibiotics:

Ideally, we want to protect our kids from deadly bacteria without disturbing the good ones or worsening the trend of antibiotic resistance. And this is exactly what vaccines do. They give us exposure to the pathogen — be it bacterial or viral — in a weakened, killed or partial form so that we can develop immunity to it without getting the full-blown illness. If we’re exposed to the real thing later, our bodies have antibodies specific to that pathogen ready to fight back. No antibiotics needed, and our friendly microbes can continue to live in peace. But when parents choose not to vaccinate their kids, they’re increasing the kids’ chances of not only becoming seriously ill, but also of needing antibiotic treatment and other medical interventions down the road.

 Dr. Joel Amundson, a pediatrician in Portland, Oregon, finds himself frequently talking about vaccines and antibiotics in the same breath. Oregon has one of the lowest immunization rates in the nation, and Amundson said many of the parents he counsels want to keep their kids “all-natural” and see vaccines as an unnecessary medical intervention. But when he explains that vaccines are a tool for decreasing medical interventions, including antibiotic use, that often changes their perspective. “That’s a huge benefit to my families,” he said, “It definitely has them more interested in doing vaccines when they understand that.”

Some parents who are reluctant to vaccinate worry about side effects, and though some kids will experience short-lived, minor reactions such as swelling at the injection site, serious side effects are extremely rare. Side effects from antibiotics, including diarrhea, rashes and allergic reactions, are generally more common and severe, Amundson said. “I see far more harm from antibiotics than I do from vaccines, by a huge margin. It’s not subtle,” he said.

The article also points out that the flu and other viral diseases can often cause secondary bacterial infections, such as pneumonia, that might require antibiotic treatment.

A second way that vaccines can help is when they unexpectedly protect against diseases that they weren’t intended to fight. In July, as we’ve previously reported in this blog, researchers reported in Lancet that they’d found a surprising side benefit in a vaccination campaign against serogroup B meningococcal disease: The young adults vaccinated were significantly less likely to develop gonorrhea. The bacteria that cause gonorrhea and meningococcal B disease share 80 to 90 percent of their DNA.

The hope is that this connection can be used to develop a vaccine against gonorrhea. That would be an important achievement because antibiotic-resistant strains of the disease are on the rise.

“The bacteria that cause gonorrhea are particularly smart,” said Dr. Teodora Wi, a medical officer at WHO. “Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them.”

Another important finding: An August study published in the journal Pediatrics found that a dramatic drop in the number of ear infections in young children in recent years was largely associated with the pneumococcal vaccine, which protects against a bacterium that also causes many middle-ear infections. More than 5 million ear infections afflict children every year in this country, according to the American Academy of Pediatrics, and even with the watch-and-wait protocol, they lead to the writing of 10 million prescriptions for antibiotics.

“If every child in the world received a vaccine to protect them from infection with Streptococcus pneumoniae bacteria (which can cause pneumonia, meningitis and middle ear infections), this would prevent an estimated 11 million days of antibiotic use each year,” WHO reported in its statement on how vaccines could reduce antibiotic use.

Finally, researchers are hoping to tackle resistant infections head-on with vaccines intended to protect against them.

“New vaccines targeting Staphylococcus aureus (which causes skin and soft tissue infections), Klebsiella pneumoniae (which causes pneumonia and infections of the blood stream and urinary tract), Clostridium difficile (which causes diarrhoeal disease), and many others could protect people against diseases that are increasingly difficult to treat,” the WHO statement says.

A July article in Nature explains why vaccines could be a better route to combating resistant infections. To start, efforts to develop new antibiotics have been much less successful than hoped so far. In addition:

Vaccines have an advantage over antimicrobials in that they rarely generate resistance, says David Livermore, a microbiologist at the University of East Anglia in Norwich, UK. That’s because antibiotics are administered after an infection has started, when there is already a dense population of microbes from which new resistant strains can evolve. Vaccines, by contrast, prevent infections from arising in the first place.

The FiveThirtyEight article does a particularly good job of describing the many ways in which vaccines could aid in the fight against resistant bacteria and overuse of antibiotics. Go here to read the entire article.



A Healthy School Year Starts with Vaccines 


Invest 19 Minutes, Become a Vaccine Expert 

The "Too Many, Too Soon" Myth 



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