Two vaccines were approved and more are in development with good preliminary results. The new rotavirus vaccine should go a long way toward relieving the burden of severe gastroenteritis. The burden is significant: rotavirus is responsible for 30% to 50% of all diarrheal hospitalizations for children younger than 5 years.
The vaccine is expected to cost $114 for the three-dose series. This was mentioned at the Infectious Diseases in Children Symposium in New York last month. One must consider the cost of 50,000 hospitalizations, 500,000 physician visits and the time lost from work added to the worry that parents suffer when a child is severely ill.
Cost will continue to be an issue. High technology equals higher costs. So expect future vaccines to cost more.
The new acellular pertussis vaccine adds to the list of available acellular pertussis vaccines. Although all are efficacious, they have different components, so it is not recommended that the vaccines be changed during a series, Walt Orenstein, MD, Director of the National Immunization Program, said at our annual meeting. However, if a physician does not know which acellular vaccine a child had prior to coming to the office, it is acceptable to continue the series with another vaccine.
Data showed that there was a high prevalence of pertussis this year, but the incidence is probably due to increased awareness. Reports that adolescents and adults are reservoirs of pertussis have put the disease back in the news and in the minds of physicians.
There was more good vaccine news: invasive Haemophilus influenzae type b disease is down, so is varicella. These two stories demonstrate the power of vaccination in the war against infectious diseases.
Of course, the best medicine is prevention, and researchers found a less expensive way to prevent perinatal transmission of HIV. The ACTG 076 protocol told us that zidovudine (AZT) could protect babies born to HIV-infected mothers. But the regimen was too costly for developing countries where most of the 2.7 million child deaths from AIDS have occurred. The less costly AZT regimen should help prevent future cases. If you recall, the researchers involved in this study took some heat because the study was placebo-controlled. Does the end justify the means? In some cases, it may depend on the end. If this new regimen prevents infection among thousands of babies, that is a pretty rewarding end. Of course, the best end will be a vaccine against AIDS, and a trial in humans was begun this year.
We may never know the true importance of another of this year's accomplishments. If you recall, at the end of 1997, a new strain of influenza was reported in Hong Kong. This was a rare and deadly influenza that occurred in birds. Chinese officials took a drastic step in January and ordered the slaughter of 2 million chickens. This act might have prevented a pandemic on the order of the 1918 influenza pandemic, said Robert Webster, PhD, of St. Jude Children's Research Hospital, Memphis, Tenn. Was he right? Thank God, we will never know.
Foodborne illness was also in the news. As we import more food from developing countries, we have to expect more disease. We wouldn't think of eating raw fruit when we visit South America, but we really enjoy those raspberries and whip cream that we get from the supermarket, even if they came from a developing country.
We just expect our food to be safe. Well, the government has gotten the message and is doing more to ensure food safety. Whether these measures will work will depend on the feds' ability to oversee and carry out its plans.
More prudent use does help. One study this year from Finland showed that when certain resistant antimicrobials, in this case, macrolides, were restricted and not used, the resistance pattern changed, and the organisms became susceptible again.
So, if you think individuals cannot make a difference, I think you're wrong, but it won't be easy. It will require spending more time with parents to explain why antibiotics shouldn't be used, and we all realize that in the managed-care squeeze, time is one of the things being squeezed. Still, it can help preserve these precious resources.
We hope you enjoy our little round-up of this year's news. Let me take a moment to explain how we developed our top 10 list of stories. Phil Brunell, MD, and I went through all the stories we wrote this year and picked about 30 that we thought were important. Then, we polled our editorial advisory board who chose the ones they thought were most important. The stories receiving the most votes are featured here.
I know this isn't science, but it is fun. Have a happy and healthy new year.Marie Rosenthal