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Safeguarding Europe's youngest citizens
Editorial
Science Photo Library
Gonorrhoea—old disease, new threat
Neisseria gonorrhoeae See World Report page 2229 For the 29th International AIDS Conference see http://www. aids2012.org/ For WHO’s Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae see http:// whqlibdoc.who.int/ publications/2012/ 9789241503501_eng.pdf
Delegates at the 29th International AIDS Conference in Washington, DC, next month might consider how, in three decades, their field has changed. The progress from the first case reports, to fearful recognition of the extent of the HIV epidemic, to a point at which “an AIDS-free generation” is talked about represents a remarkable success story. Recognition of this achievement, however, must not turn to complacency; nor should it engender forgetfulness about other sexually transmitted infections (STIs). As medical science solves problems, it also creates new challenges. Such is the case with Neisseria gonorrhoeae. It is deeply concerning that in Australia, France, Japan, Norway, Sweden, and the UK, cases of gonorrhoea have been reported that are cephalosporin-resistant—and thus effectively untreatable. This resistance, accompanied by a high incidence of infections and possibly less noticeable symptoms, bodes ill for the future: fertility problems, ectopic pregnancies, stillbirth, spontaneous abortion, premature deliveries, and severe neonatal eye infections resulting in blindness might be its legacy.
It is essential that steps are taken now in accordance with WHO’s Global Action Plan. Health-care workers must be vigilant and prescribe antibiotics appropriately. As with all cases of emerging antibiotic-resistant infections, research into new alternatives for treatment must be prioritised. And public health agencies should strengthen surveillance efforts, as well as targeting safer-sex educational programmes at key groups including young people, men who have sex with men, and sex workers. The growing threat of cephalosporinresistant gonorrhoea also indicates that it is time to break down the barriers between the efforts against HIV, and those against other STIs. As the at-risk groups and means of prevention are so similar, and as untreated gonococcal infection can significantly increase the risk of HIV infection and transmission, it would seem a logical step. Without new ways of thinking, the health of future generations will be blighted by a disease whose worst effects were—not so long ago—thought to have been consigned to history. The Lancet
Marc Romanelli/Getty Images
Safeguarding Europe’s youngest citizens
For more on the report cards see www.childsafetyeurope.org
2214
Protecting the youngest and most vulnerable members of society from harm should concern all parents, health professionals, and governments in high-income and low-income nations. In Europe, unintentional injury is the leading cause of death and disability in children. Implementation of effective prevention strategies could save most of these lives as well as saving governments billions of Euros in treatment costs at a time of increasing economic woe. However, the latest set of Child Safety Report Cards for 31 countries in Europe produced by the European Child Safety Alliance show inconsistencies in policy adoption across the region. The report cards score countries on their level of adoption, implementation, and enforcement of more than 100 proven strategies and policies to prevent unintentional injury. Reports were produced for 18 participating countries in 2007, 26 in 2009, and 31 this year. Overall, there was a substantial improvement in country scores from 2007 to 2012. But the data show that every country could still do better. For example, only 13 countries have a national helmet
law requiring use of a bicycle helmet while cycling. And only 15 countries have laws requiring child resistant packaging of medicines. Furthermore, no country has a law requiring the use of a rear facing child passenger restraint for children aged 0–4 years (although this is normal practice in Sweden where deaths in this age group have been reduced to almost zero). The report cards are an invaluable resource for policy makers in Europe. A detailed one exists for each participating country, highlighting performance gaps, action required, and inequities. No other WHO region has this level of regular assessment for child safety policies. However, many countries are still failing to measure the impact of safety measures that have been implemented—a crucial, necessary assessment to show the effectiveness of policies and which of them save the most lives. Additionally, to date, no European country has adopted all the recommended harm reduction measures. Taking every possible step available to protect children from preventable injuries should be a goal for all countries in Europe and beyond. The Lancet www.thelancet.com Vol 379 June 16, 2012
Science Photo Library
Gonorrhoea—old disease, new threat
Neisseria gonorrhoeae See World Report page 2229 For the 29th International AIDS Conference see http://www. aids2012.org/ For WHO’s Global Action Plan to control the spread and impact of antimicrobial resistance in Neisseria gonorrhoeae see http:// whqlibdoc.who.int/ publications/2012/ 9789241503501_eng.pdf
Delegates at the 29th International AIDS Conference in Washington, DC, next month might consider how, in three decades, their field has changed. The progress from the first case reports, to fearful recognition of the extent of the HIV epidemic, to a point at which “an AIDS-free generation” is talked about represents a remarkable success story. Recognition of this achievement, however, must not turn to complacency; nor should it engender forgetfulness about other sexually transmitted infections (STIs). As medical science solves problems, it also creates new challenges. Such is the case with Neisseria gonorrhoeae. It is deeply concerning that in Australia, France, Japan, Norway, Sweden, and the UK, cases of gonorrhoea have been reported that are cephalosporin-resistant—and thus effectively untreatable. This resistance, accompanied by a high incidence of infections and possibly less noticeable symptoms, bodes ill for the future: fertility problems, ectopic pregnancies, stillbirth, spontaneous abortion, premature deliveries, and severe neonatal eye infections resulting in blindness might be its legacy.
It is essential that steps are taken now in accordance with WHO’s Global Action Plan. Health-care workers must be vigilant and prescribe antibiotics appropriately. As with all cases of emerging antibiotic-resistant infections, research into new alternatives for treatment must be prioritised. And public health agencies should strengthen surveillance efforts, as well as targeting safer-sex educational programmes at key groups including young people, men who have sex with men, and sex workers. The growing threat of cephalosporinresistant gonorrhoea also indicates that it is time to break down the barriers between the efforts against HIV, and those against other STIs. As the at-risk groups and means of prevention are so similar, and as untreated gonococcal infection can significantly increase the risk of HIV infection and transmission, it would seem a logical step. Without new ways of thinking, the health of future generations will be blighted by a disease whose worst effects were—not so long ago—thought to have been consigned to history. The Lancet
Marc Romanelli/Getty Images
Safeguarding Europe’s youngest citizens
For more on the report cards see www.childsafetyeurope.org
2214
Protecting the youngest and most vulnerable members of society from harm should concern all parents, health professionals, and governments in high-income and low-income nations. In Europe, unintentional injury is the leading cause of death and disability in children. Implementation of effective prevention strategies could save most of these lives as well as saving governments billions of Euros in treatment costs at a time of increasing economic woe. However, the latest set of Child Safety Report Cards for 31 countries in Europe produced by the European Child Safety Alliance show inconsistencies in policy adoption across the region. The report cards score countries on their level of adoption, implementation, and enforcement of more than 100 proven strategies and policies to prevent unintentional injury. Reports were produced for 18 participating countries in 2007, 26 in 2009, and 31 this year. Overall, there was a substantial improvement in country scores from 2007 to 2012. But the data show that every country could still do better. For example, only 13 countries have a national helmet
law requiring use of a bicycle helmet while cycling. And only 15 countries have laws requiring child resistant packaging of medicines. Furthermore, no country has a law requiring the use of a rear facing child passenger restraint for children aged 0–4 years (although this is normal practice in Sweden where deaths in this age group have been reduced to almost zero). The report cards are an invaluable resource for policy makers in Europe. A detailed one exists for each participating country, highlighting performance gaps, action required, and inequities. No other WHO region has this level of regular assessment for child safety policies. However, many countries are still failing to measure the impact of safety measures that have been implemented—a crucial, necessary assessment to show the effectiveness of policies and which of them save the most lives. Additionally, to date, no European country has adopted all the recommended harm reduction measures. Taking every possible step available to protect children from preventable injuries should be a goal for all countries in Europe and beyond. The Lancet www.thelancet.com Vol 379 June 16, 2012