What Lies Ahead With Children’s Infections

By Jeff Cersonsky, MD, FAAP

The developments in children’s infectious diseases are coming fast and furious. Possibilities for the near future include:

Combination Vaccines

Parents are often concerned about the number of injections their infants and children need to receive to fully immunize them against many diseases. We already have combination vaccines for Hemophilus influenza b (HIB) and Hepatitis B (Comvax®) and HIB and diphtheria-tetanus-acellular pertussis (DTaP) (Trihibit®). In truth, many of our vaccines, such as DTaP and Polio, are combinations in themselves, combining three or more antigens. There is work being done on combinations such as DTaP-Hepatitis B-Polio and DTaP-HIB-Polio. There have been questions about the effectiveness (immunogenicity) of these combinations although the DTaP-HIB-Polio vaccine is approved for use in Canada. There is also work being done on a meningococcal-pneumococcal-HIB vaccine covering all the most common causes of bacterial meningitis in children. Look for more combination vaccines being released about every year for the next five to ten years.

Rotavirus Vaccine

Although the RotaShield® was withdrawn because of a slight association with a bowel obstruction called intussusception, an improved vaccine is being developed and tested that might not have that side effect. The new, improved vaccine would be very welcome because rotavirus can cause severe diarrhea, vomiting, and dehydration.

Flu Vaccine

The flu vaccine will be given by a nose spray next year if things go as planned. With this safer, non-painful vaccine, we might see the recommendations change to include all children 1 year of age or older.

Pertussis Vaccine

The pertussis vaccine in current use (acellular pertussis) has many fewer side effects than the old vaccine. With the old vaccine, adolescents and adults could not be immunized because of severe reactions. Therefore, the adults kept circulating a pool of pertussis bacteria, making it impossible to eradicate the illness. Soon, we will be giving boosters to adolescents and adults with the dTaP vaccine instead of the dT vaccine we already give.

Herpes Vaccine

A vaccine against Herpes I and II might be available in 3 years, initially recommended for sixth graders, to prevent later sexual transmission of herpes.

Lyme vaccine

The Lyme vaccine has not been a great success, both in effectiveness and safety. Improvements in the vaccine might change that in the not-too-distant future.

Hepatitis A Vaccine

Hepatitis A, B, C, and D viruses cause an infection in the liver that can make children very ill and some of these viruses can cause permanent liver damage. The Hepatitis A vaccine is currently available, but is only recommended for children in certain circumstances (travel to tropical countries, breakouts of Hepatitis A in the community, etc.). As we gain more experience with this vaccine, the recommendation might change to a routine immunization program. The good news is that a combined Hepatitis A-Hepatitis B vaccine looks promising. Immunizations against Hepatitis C and Hepatitis D are also being worked on.

RSV

Many new drugs and a vaccine are under development for Respiratory Syncitial Virus (RSV), a potentially serious infection of the respiratory tract.

Ear Infections

Newer antibiotics are being developed all the time, a few of which might be appropriate for highly resistant bacteria causing ear infections. Also, more and more data indicate that mild ear infections with few symptoms may not need to be treated. (Many have misinterpreted this information as meaning we need not treat any ear infections. The risk of permanent hearing loss would be too great if we left all infections untreated.)

Viral Infections

Many new anti-viral drugs are being developed, including ones to treat influenza, the common cold, and RSV. In the next 5 years, we will be using many of these to treat what used to be untreatable illnesses.

I’ll try to keep you posted on these and other developments. Look for articles about many of these illnesses (such as rotavirus and RSV) on my Web site at http://www.erols.com/jmcsdii/page2.html.

(Some of the information in this article was taken, with permission, from a column by Dr Stan L. Block, associate clinical professor of pediatrics at the University of Louisville and the University of Kentucky, Lexington, as published in the January, 2001, issue of Pediatric News.)