Vaccines an aid in tackling AMR

November / December 2017   Comments

Q.  What is the relationship between vaccines and antimicrobial resistance?

A. Antimicrobial resistance (AMR) is a global health crisis with social, political and economic implications. AMR occurs when a microorganism (bacterium, virus, fungus or parasite) evolves and gains resistance to medications that were previously effective. Even though AMR is a natural phenomenon, it is accelerated by the overuse of antibiotics in both humans and animals, leading to increased risk of mutations.

Many infections, such as pneumonia, tuberculosis and gonorrhea, are becoming difficult to treat because the antibiotics used for their treatment are becoming less effective. Life without effective antibiotics is a frightening thought, as this would impede our ability to perform routine surgeries and transplants and administer chemotherapies, thereby posing a great threat to modern medicine.

Among the proposed solutions to address AMR are the judicious use of antibiotics in both humans and animals, surveillance and monitoring of infections and antimicrobial use, stronger infection control practices, and development of new antibiotics and vaccines. There is a growing awareness and understanding that AMR can affect anyone, as it knows no borders. Therefore, everyone has a role in reducing the impact of this public health concern. It is estimated that, unless effective actions are taken, AMR will result in 10 million deaths per year and total economic losses of US$100 trillion by the year 2050.

Vaccines are well recognized for their role in reducing the burden of many infectious diseases globally and thus have a vital role in public health. They prevent infectious diseases such as polio, whooping cough, diphtheria, measles, chicken pox and mumps. Furthermore, vaccines have drastically decreased the incidence of these infections (93-100%) within five years of being introduced.

The emergence of AMR highlights another important value of vaccines. Vaccines prevent bacterial infections and reduce the need for antibiotic use. A great example of a vaccine that has an impact on AMR is the conjugate pneumococcal vaccine. It provides protection against pneumonia and ear infections, and it may even protect against pneumococcal strains that are resistant to currently available antibiotics. Many vaccines similarly have an impact on antibiotic use by decreasing the transmission, carriage and colonization of a pathogen, thereby contributing to herd immunity. In simple terms, vaccines lessen transmission, reduce infections and decrease the need for antibiotic use.

The flu vaccine, for one, plays a crucial role in decreasing the need for prescribing unnecessary antibiotics. While influenza is a virus, and viruses cannot be treated with antibiotics, the most common complication of influenza is secondary bacterial pneumonia, which does require antibiotic treatment.

Even though we know that antibiotics are ineffective against viral infections, literature shows that about 30-50 per cent of antibiotics prescribed in the outpatient setting are used for this purpose. The reasons include lack of tests that distinguish viral infections from bacterial infections, patients’ requests for antibiotics, and prescribers’ habits and their noncompliance with best practice guidelines. Prevention of inappropriate antibiotic use to treat viral infections will not only help in the efforts to prevent AMR but will also decrease the excess burden of adverse effects.

Since nurses are the largest health-care professional group and they interact with patients at different points in the health-care system, they are perfectly positioned to capitalize on the opportunity to protect patients from the consequences of inappropriate antibiotic use by benefiting from vaccine administration. Educating patients about potential antibiotic harm and ensuring their immunizations are up to date are important nursing roles in the fight against AMR.

Linda Jorgoni, RN, MScN

Linda Jorgoni, RN, MScN, is the clinical nurse leader of the antimicrobial stewardship program at Sinai Health System and University Health Network in Toronto.

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