Antibiotics are used in both human and veterinary medicine to treat bacterial infections. They are an indispensable pillar of modern medicine and play a decisive role in various areas such as transplantation medicine or the care of premature babies.
However, inappropriate use - for example, in fighting viral infections, against which they are generally ineffective, or inaccurate dosing - combined with insufficient compliance with hygiene provisions in human and veterinary medicine as well as in agriculture, allow antimicrobial resistance to develop and expand. Additionally, international tourism and trade relations are boosting the spread. The consequence of antimicrobial resistance is that infections that were once easily treated can now only be cured with difficulty - if at all.
The number of bacterial pathogens that have become less sensitive or even fully resistant to antibiotics, is increasing worldwide and becoming a challenge in the provision of health care. In 2014, WHO published a global report about the state of antimicrobial resistance. According to this document, few data are available on antimicrobial resistance since many countries do not have the necessary monitoring systems. The meagre data available from regions outside of Europe and North America in some cases point towards very high resistance rates.
In Germany, measures to fight antimicrobial resistance are coordinated within the German Antibiotic Resistance Strategy (DART 2020). In the long term, however, the fight against antimicrobial resistance can only be won through multi-sector cooperation between human and veterinary medicine, together with agriculture, at international level.
It was for this reason that the World Health Assembly adopted a Global Action Plan on Antimicrobial Resistance in May 2015. It emphasises the 'One Health' approach, which implies the need for a joint approach by human and veterinary medicine as well as agriculture in combating antimicrobial resistance. All Member States are being called upon to adopt national action plans embracing the One Health approach by mid-2017. With DART 2020, Germany has already complied with this demand.
Moreover, during its G7 Presidency in 2015, Germany also addressed the topic of antimicrobial resistance . In their 'Berlin Declaration on Antimicrobial Resistance', the G7 health ministers supported restricting the use of antibiotics to the provision of medical treatment subsequent to an individual, case-based diagnosis. They also pledged to help other countries develop national action plans against antimicrobial resistance and to promote the research and development of new antibiotics and diagnostic tools.
In 2017, antibiotic resistance was one of the topics on the agenda of the German G20 Presidency. Among the priority objectives of that Presidency were the promotion of the 'One Health' approach and the strengthening of incentive mechanisms for the research and development of new antibiotics. In September 2017, at a joint event in Berlin, representatives of the Public Health Institutes of the human and veterinary medicine sector of the G20 exchanged ideas on the joint goal of combating antibiotic resistance.
Nationwide Unique Study
The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) is the only wide-ranging study focusing on young people’s health in Germany. The latest KiGGS study was conducted from 2014 to 2017; the new results include data from examinations and interviews conducted with participants who already took part in the first study (baseline study) completed in 2006. Longitudinal studies like these are crucial to analyse the causes of diseases, but also to study risk and protective factors. The study also provides new data about the current health status and health-related behaviour of young people and on trends since the baseline study. KiGGS data provide an important basis for evidence-based measures aimed at improving the health of the population. First results from selected fields are published in the latest issue of the Journal of Health Monitoring and presented at a symposium in Berlin on 15 March 2018.
Vaccinations are among the most important and effective means of preventing disease in the medical toolbox. Modern vaccines are safe and adverse effects only occur in sporadic cases. People get vaccinated mostly to protect themselves from infectious disease. However, vaccinations are not only effective in the vaccinated individuals themselves (individual protection), but can indirectly protect also unvaccinated persons (herd immunity) by stopping or slowing the spread of an infectious disease.
In Germany, vaccinations are not required by law. The Federal Ministry of Health has set up an independent expert panel, the Standing Committee on Vaccination (STIKO), to draw up and update vaccination recommendations. The STIKO’s recommendations stipulate which immunisations are relevant for public and individual health protection by preventing communicable diseases. Members of the statutory health insurance are eligible to receive these recommended immunisations free of charge. However, this does not include vaccinations for private travel abroad.
There has been a clear increase in immunisation uptake. Paediatric immunisation rates, in particular, have been steadily rising over the last decade. However, gaps still persist in childhood vaccinations against pertussis, hepatitis B and the second dose of measles vaccine, mumps and rubella. Adolescents and adults, too, have inadequate vaccination protection. Especially vaccination coverage rates for measles still fall short of those recommended by the World Health Organization.
Human Papillomaviruses are sexually transmitted pathogens that infect about 70 to 80 per cent of all sexually active women and men over their lifetime. There are more than 100 different types of this virus known to science. Especially the high-risk HPV types 16 and 18 can cause mutations in cervical cells that, in turn, can lead to precancerous lesions and, in rare instances, cervical cancer. To lower the disease burden from cervical cancer, all girls between the ages of 9 and 14 years should get HPV vaccination (types HPV 16, 18). Specifically, they should catch up on any missed HPV vaccinations by their 18th birthday at the latest and the full vaccination course should be completed before their first sex.