Don’t rush for antibiotics, they could make your newborn sickly

Tuesday January 22 2019

Dr Petter Brodin,

Dr Petter Brodin, the founder Little Hills project. PHOTO | CYRIL NDEGEYA | NMG 

The EastAfrican
By The EastAfrican
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Swedish paediatrician and researcher Dr Petter Brodin spoke with The EastAfrican on the gains in immunology and the role of big data in the health sector.

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What are some of the most recent achievements in immunology?

Vaccination is a success story in medicine in recent times.

Through it, we train the immune system, a crucial part of the human body to protect us from infection.

Still, we lack vaccines for many killer diseases. In Africa, for example, HIV and malaria are still challenges.

But the biggest breakthrough in immunology in the last few years has been discoveries in cancer treatment.

For a long time, people have believed that we can use the immune system to protect against or to treat cancer.

Over the past few years, this has become a reality. The immune system recognises cancer cells but it is not strong enough to cure cancer on its own.

Drugs and therapy boost the immune system, enabling it to cure cancer. This discovery has been a major breakthrough. James P. Allison and Tasuku Honjo received the Nobel Prize last year for this discovery.

Sceptics say vaccines cause diseases. Is this true?

There was a study that promoted this scepticism in the UK, but it was proven wrong and the researcher lost his licence.

The scientific community now agrees that there is no link between vaccination and diseases like autism or attention deficit hyperactivity disorder (ADHD).

Vaccines are safe; yes, there can be side effects, but not to the extent that sceptics claim. It is important to set the record straight that this link just does not exist.

Some of the controversies in Africa stem from the fact that we have many vaccine trials, mostly free. How reliable are free vaccines?

Whenever a new drug is developed, it undergoes rigorous testing in various phases. This ensures it is safe for use by humans.

We start with animals then move to a small group of healthy people, before the drug is administered to patients.

Trials cost a lot of money and take a lot of time. We never conduct them on humans without ensuring the safety of the drug.

But whether the regulations are followed is another question, and it varies from country to country.

There have been cases where drugs were not properly tested or monitored.

How has technology boosted immunology?

The immune system is complex, just like the nervous system, the brain and many other biological systems.

All these body systems depend on each other, just like musicians in an orchestra.

Unlike traditional methods, which study each system on its own, recent technological innovations examine the human body as a whole.

This has helped researchers understand the immune system better and boosted the development of vaccines and other drugs.

How has technology affected data collection?

We are collecting a massive amount of information during studies. Most of us have morphed from being just doctors to programmers and statisticians.

In East Africa, we are yet to see serious policy discussions on the importance of big data.

What is missing?

We need to start collecting as much data as possible by monitoring cases, whether in healthcare or education, policy or finance... just start collecting data.

But it must be accessible, organised and well annotated so that you can link it to outcomes.

For example, when patients are treated, what were the drugs they were given? What symptoms did they exhibit? Did they survive? This lays the framework for the application of big data analytics.

Is the lack of health data an issue of governance or resources?

It is mostly a lack of priority, and this is not unique to the East African region.

For example, it is not enough to simply monitor cases of deceased patients.

You have to track specific individuals, know how they lived, what was their age, their sex, any other conditions they had, drugs, etc.

This means having different registries of data, and linking such data to the identification database, and to the birth and death registry and clinical records. This can help to develop a system that can be referred to for comprehensive medical investigations.

What are the findings of your recent study on trends in immunology?

The findings were published in the medical journal Cell. For the first time, we studied how a newborn’s immune system adapts to its surroundings.

We found that each individual has a unique immune system. Then we looked at how much of that uniqueness is determined by what we genetically inherit from our parents and how much of it is as a result of the environment. It turned out that the overwhelming majority is determined by the environment.

Genetics plays a role, but the immune system continues to interact with both the internal and external environment and senses infections.

However, there is something called the hygiene hypothesis that tries to explain a phenomenon that no one understands today.

For example, in East Africa, if you compare the incidence of allergies and autoimmune diseases, it is low among people living in rural areas/ traditional lifestyle. But if you look at say Sweden or the US, it is high.

Why is it that while infectious diseases have subsided in the West over the past century while allergies and other immune diseases are becoming more prevalent?

We do not understand why. But evidence suggests that something happens in early life.

For example, a baby born via caesarean section will have 20 times a higher risk of being infected with diabetes and asthma than a baby born of a vaginal delivery.

Also if you were given antibiotics early in life, the risk is much higher. So there is something about messing up the microbes the baby gets from its mother and the interaction between those microbes and the immune system.

The immune system of a baby is shaped by what it is exposed to in the environment for the first time, including bacteria on the skin and particles breathed in.

There is a need to inform mothers about the risks associated with caesarean delivery especially when it is done for the purposes of convenience.

Don’t get me wrong. Caesarean births are lifesaving both for the mother and baby in cases where they are needed.

If a child inherits a weak immune system, can it be improved by the environment?

Yes, but the first 100 days of life are critical. In case of an infection, a child should be given antibiotics, but we must be careful if it is a newborn.

For example, if a child shows signs of fever, people often give it antibiotics without ascertaining whether the fever stems from a viral or bacterial infection. We should be careful with that because it comes with consequences.

What are the critical health issues that affect our lives as per your study?

My focus is largely on children’s’ diseases. Newborns are susceptible to infections and the general belief is that their immune systems are weak.

That is not entirely true. They are susceptible to infections for other reasons, and particularly if they are born preterm.

One of the things I hope to do with our research is to find ways to identify the most susceptible newborns and determine which child to keep in the hospital for monitoring.

Infant mortality is high in East Africa. How best can it be tackled?

There is a need to pay attention to antenatal care. Pregnant women must be monitored and risks identified in time to manage them effectively.

Neonatal care must also be improved and made accessible to all.

Are you concerned about the state of public health in the region?

In my experience, Rwanda’s approach where health insurance allows mothers and children to visit public hospitals, is the best.

I have been here for a while and I have seen programmes that ensure children are born in hospitals, which is an important step.

But there is more work to be done. For example, there are limitations on the number of children that can be supported or referred under the medical scheme.

Rwanda continues to grapple with malnutrition even amid decreasing infant mortality. What is the missing link?

Rwanda needs to first do a thorough study on the cause of malnutrition. Infectious diseases are one possible cause.

For example parasites can affect the nutritional state of babies. In a limited research setting, it is always more cost-effective to prevent disease than to treat it.

It is important to improve services at baby clinics.