December 2000
It's hard to believe that a year of the new millennium is just about gone. It has been a very good year especially considering where we were last year with the recall of rotavirus vaccine, thimerosal, and allegations of autism and inflammatory bowel disease being caused by measles-mumpsrubella vaccine. The fallout from the mercury scare did result in a decrease of children receiving hepatitis B vaccine at birth and probably will result in some cases of hepatitis B in these infants. Manufacturers have managed to get thimerosal out of most vaccines so we now have mercury-free options for all vaccines that are given in infancy. There seems to be progress in combining vaccines: an application for a "five in one" was submitted in November.
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Despite some negative publicity about vaccines, the proportion of children who have been immunized is at an all-time high both here and worldwide. Measles cases are at an all time low in the United States and there appears to be so few susceptibles that the introductions from abroad have rarely spread to produce outbreaks. A report of a measles outbreak in the Netherlands involving about 3,000 people reminds us of the need to continue to immunize against diseases which have become rare because of our success in immunizing our children here in the United States. Many have forgotten the diseases that have been prevented and look upon the events associated with immunization as the problem.
We are approaching 60% immunization against varicella for children younger than 36 months, which is still far from our goal. In three sentinel sites where there has been a surveillance of cases to assess immunization efforts, varicella appears to have fallen as much as 80%. If we are to prevent our current childhood cohort from developing varicella as adults, we must assure that they are immunized. It is apparent that those who are immunized will have a diminishing chance of getting chickenpox in childhood.
Both perinatal HIV and group B streptococcal infections of the newborn are down, the latter associated with an increase in screening women during pregnancy and penicillin prophylaxis. There still is a significant number of early onset cases of GBS infections so we still have to do a better job. A survey of some of the maternal screening, moreover, has revealed many inadequacies in obtaining and processing specimens.
Probably the best news has been the licensure of a conjugate pneumococcal vaccine (Prevnar, Wyeth Lederle) based on studies that showed that it produced an impressive reduction in invasive pneumococcal disease. This is good news not only because we can expect a reduction in pneumococcal meningitis but also there is hope that it may also impact the use of antimicrobials. Overuse of these drugs continues to be a major problem.
The vaccine had only a modest effect on prevention of acute otitis media and pneumonia. This is not unexpected, as many cases of diagnosed otitis and pneumonia are not caused by pneumococcus. The reduction in lobar pneumonia in vaccinees, many of which are caused by pneumococcus, was 63%. Similarly, only about 6%-9% of visits for otitis were prevented, but the reduction in tube placement or vaccinees having five attacks of otitis in six months or six in a year were reduced approximately 20%. As pneumococcus is known to produce more severe otitis, the two latter groups are more likely to be afflicted with this organism.
One of the most impressive papers that I heard during the year was one by Dan Granoffin which he proposed a scheme for making vaccines available for children in developing countries. Our children here in the United States enjoy the benefits of vaccines which, although more critical for children in less developed countries, are unaffordable. He reported that almost 100,000 deaths resulted from group A meningococcus in Africa in a single decade; they are unable to afford the vaccine to prevent it. Thus there is no vaccine manufactured. Dan proposes a perfectly feasible scheme to make this vaccine available (Abstract 2086, ICAAC, 2000). A similar situation exists with respect to rotavirus. For the United States the vaccine would be cost-effective. For less developed countries, the disease causes hundreds of thousands of deaths in children. An Indian group is now pursuing a vaccine, which might address this problem.
So, I would like to see us be able to share with the other children of the world the good health that our children now enjoy.
Finally, during the past year, I have watched my oldest grandson play soccer with Palestinian Arab children and my granddaughter invite an Arab child to her sixth birthday party and wonder why our children must be taught to hate.
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