Infections: Forgotten but not gone

EDITORIAL

Recently a non-medical acquaintance asked me if I had a special areaof interest within pediatrics. When I answered that I specialize in infectiousdiseases, a quizzical look came over her face, and she asked, "Do childrenstill get infectious diseases?" I reminded her that though there havebeen great successes with infections like polio and measles, children arestill plagued by respiratory viruses, ear infections, and, of course, HIV.That she had to be reminded indicates how successful the battle againstthe major infectious diseases of childhood has been. Because of vaccines,many of the infections that parents in past generations most feared--diphtheria,polio, whooping cough--are rare or nonexistent among children in the UnitedStates. Because of antibiotics, rheumatic fever, though not entirely eliminated,is unusual in developed countries. These were diseases to which whole hospitalswere devoted just decades ago.

As my friend's question indicates, the public (that is, the parents ofour patients) has begun to take the prevention and quick treatment of infectiousdiseases for granted. Recent events, however, have demonstrated that wecannot rest comfortably on past successes, and we cannot allow people tobe poorly informed. The realization that thimerosal in vaccines might eventuallybe too much of a good thing, that rotavirus vaccine might pose an unacceptablerisk for intussusception, and that antibiotics, however effective they mayseem at first, can arm bacteria with powerful defensive weapons--all thisshould remind those of us who provide medical care for children that weneed well-informed allies among the public.

There is great hope for newer vaccines. Lyme disease vaccine will undoubtedlybe available to children and younger teens within a few years. The releaseof conjugated pneumococcal vaccine is eagerly anticipated. Perhaps, beforetoo long, an effective RSV vaccine will make its way to patients. It won'tbe enough for the medical establishment to recommend these immunizationswithout educating the public about why they're needed.

Most parents have never seen a child with pneumococcal meningitis ora hospitalized infant with bronchiolitis struggling to breathe. Parentswill not accept vaccines to protect against these conditions just becausewe tell them they should, just as they do not accept reductions in the inappropriateuse of antibiotics just because we tell them to.

It is important that the public understand the continued impact of infectiousdiseases for children, in spite of the remarkable successes of the pastcentury. We need their help in a battle that is not yet won.

Julia A. McMillan, MD, Editor-in-chief of Contemporary Pediatrics, isVice Chair, Pediatric Education, and Director, Residency Training, JohnsHopkins University School of Medicine, Baltimore.

Julia McMillan. Infections: Forgotten but not gone. Contemporary Pediatrics 1999;9:9.