Scientists warn of drug-resistant gonorrhea, TB, HIV, malaria

• Experts say antibiotics resistance will kill more than 10m people yearly by 2050
• Nigeria, 154 others begin global polio vaccine switch to end virus

Scientists have alerted that many common infections such as gonorrhea, malaria, tuberculosis, Human Immuno-Deficiency Virus (HIV), Influenza A virus, Staphylococcus aureus are becoming untreatable with antibiotics.

They say unless new drugs are found for common infections, the bugs resistant to antibiotics will kill more than cancer and 10 million people a year could die by 2050.

The World Health Organisation (WHO) warned that antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi which it says are an increasingly serious threat to global public health that requires action across all government sectors and society.

According to the WHO, patients with infections caused by drug-resistant bacteria are generally at an increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are not resistant.

The WHO, however, said people can help tackle resistance by: hand washing, and avoiding close contact with sick people to prevent transmission of bacterial and viral infections such as influenza or rotavirus, and using condoms to prevent the transmission of sexually-transmitted infections.

Also, Nigeria on Sunday joined 154 other countries to mark the beginning of the largest and fastest globally coordinated rollout of a vaccine into routine immunisation programme in history.

According to a report released by the Global Polio Eradication Initiative (GPEI), between April 17 and May 1, 155 countries and territories around the world will stop using the trivalent oral polio vaccine (tOPV), which protects against all three strains of wild poliovirus, and replace it with bivalent OPV (bOPV), which protects against the remaining two wild polio strains, types one and three. The GPEI said this effort would provide better protection for children against polio, particularly those most vulnerable to infection.

The GPEI is spearheaded by national governments, WHO, Rotary International, the US Centres for Disease Control and Prevention (CDC) and the United Nations Children Fund (UNICEF), and supported by key partners including the Bill & Melinda Gates Foundation.

Besides, a WHO Fact Sheet on Antimicrobial Resistance noted: “In 2012, WHO reported a gradual increase in resistance to HIV drugs, albeit not reaching critical levels. Since then, further increases in resistance to first-line treatment drugs were reported, which might require using more expensive drugs in the near future.

“HIV drug resistance may rise to such a level that the first-line and second-line Anti Retroviral Therapy (ART) regimens currently used to treat HIV become ineffective, jeopardising people’s lives and threatening national and global investments in ART programmes.

“In 2013, there were about 480 000 new cases of multidrug-resistant tuberculosis (MDR-TB). Extensively drug-resistant tuberculosis (XDR-TB) has been identified in 100 countries. MDR-TB requires treatment courses that are much longer and less effective than those for non-resistant TB.

“There are high proportions of antibiotic resistance in bacteria that cause common infections (example urinary tract infections, pneumonia, bloodstream infections) in all regions of the world. A high percentage of hospital-acquired infections are caused by highly resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant Gram-negative bacteria.”

WHO said treatment failures due to resistance to treatments of last resort for gonorrhea (third-generation cephalosporins) have been reported from 10 countries.

The WHO said gonorrhea might soon become untreatable as no vaccines or new drugs are in development and that untreatable gonococcal infections result in increased rates of illness and complications, such as infertility, adverse pregnancy outcomes and neonatal blindness, and has the potential to reverse the gains made in the control of this sexually transmitted infection.

The WHO also noted that resistance to one of the most widely used antibacterial drugs for the oral treatment of urinary tract infections caused by Escherichia coli – fluoroquinolones – is very widespread.

Over the past 10 years, antiviral drugs have become important tools for the treatment of epidemic and pandemic influenza. Several countries have developed national guidance on their use and have stockpiled the drugs for pandemic preparedness. The constantly evolving nature of influenza means that resistance to antiviral drugs is continuously emerging.

By 2012, virtually all influenza A viruses circulating in humans were resistant to drugs frequently used for the prevention of influenza (amantadine and rimantadine). However, the frequency of resistance to the neuraminidase inhibitor oseltamivir remains low (one to two per cent).

According to the WHO, resistance to the treatment of last resort for life-threatening infections caused by common intestinal bacteria – carbapenem antibiotics – has spread to all regions of the world. Key tools to tackle antibiotic resistance – such as basic systems to track and monitor the problem – reveal considerable gaps. In many countries, they do not even seem to exist.

Meanwhile, Director of Polio Eradication at the WHO, Michel Zaffran, said: “We’re closer than ever to ending polio worldwide, which is why we are able to move forward with the largest and fastest globally synchronised vaccine switch ever.

“It is a massive undertaking, but it is testimony to how much progress is being made toward achieving a lasting polio-free world and to the commitment of all countries to make this dream a reality,”she said.

The oral polio vaccine (OPV) has been used to stop polio in most of the world. On very rare occasions in under-immunised populations, the live weakened virus contained in OPV can mutate and cause circulating vaccine-derived polioviruses (cVDPV).

According to the GPEI, more than 90 of cVDPV cases in the last 10 years have been caused by the type two vaccine strain. Withdrawing tOPV and replacing it in routine immunisation programmes with bOPV will eliminate the risks associated with the type two vaccine strain and, just as importantly, boost protection against the two remaining wild strains of the virus.

The switch must be globally synchronised because if some countries continue to use tOPV it could increase the risk of the spread of type two poliovirus to those no longer using tOPV. The switch is the first major step toward the eventual removal of all OPV after wild polio transmission has been stopped.

In countries at higher-risk of a polio outbreak, a dose of inactivated polio vaccine (IPV) has been added to routine immunization schedules, in addition to bOPV, to further boost immunity.

To protect against the very small risk of an outbreak of cVDPV type two after the switch, a global stockpile of monovalent OPV (mOPV) type two is ready to be dispatched if an outbreak occurs.

According to the GPEI, the switch is a significant milestone in the effort to achieve a polio-free world. In 2015, there were fewer cases reported in fewer countries than ever before. This year, the focus is on reaching every child with the polio vaccine and stopping the virus in its final strongholds. In order for that to happen, donors must continue to invest in the eradication effort.