Children aren’t supposed to die. That so many of us accept this statement without a blink is remarkable and wonderful, but it is also a very recent development in human history. Modern sanitation, adequate nutrition, and vaccination have largely banished most of the leading killers of children to the history books. Just look at the current leading causes of childhood death in developing countries to see how far these relatively simple interventions have taken us.
As we have systematically removed the leading infectious killers of children from prominence, other organisms have naturally risen to the top of the list. This has lead some to the fatalistic (and mistaken) conclusion that we are simply opening up niches to be inevitably filled by other virulent organisms. This assumes that there is some mandated quota of say, meningitis, that children must suffer every year, and if one organism doesn’t meet this quota then another will fill it. Were this the case, after vaccination we’d expect to see a shift in the causes of meningitis, but at best a transient drop in the total number of cases per year as other bugs step in to pick up the slack of their fallen, virulent, meningitis-inducing brethren. Such is not the case.
Though new organisms are now the leading causes of invasive bacterial infections in children, and we have indeed seen some increases in non-vaccine targeted strains, as I’ll discuss below, the total number of such infections has dropped precipitously. It’s fair to say that the vaccination program has done a remarkable job improving a child’s chance of surviving to adulthood in good health. However, no one in their right mind would argue that the current state of affairs, as good as it is, is good enough, and so we have shifted our sights to the current leading cause of invasive bacterial infections in children, Streptococcus pneumoniae (S. pneumo, or pneumococcus). (more…)