Wednesday, April 4, 2007

Haiti's Plague is Poverty

The Haitian baby to the right presented with seizures, fever, bulging tense fontanelle, primitive neurologic reflex at his right hand, and eye deviation to the right. He quickly became mottled and more lethargic. He was treated quickly with IM ceftriaxone and steroids. He was comatose for several days, but woke up and began interacting and eating. Most Haitian babies don't do this well with bacterial meningitis.

WHO estimates that about 1.6 million people, including up to 1 million children under 5 years old, die every year of pneumococcal pneumonia, meningitis, and sepsis. In populations with high child-mortality rates like Haiti, pneumonia is the leading infectious cause of mortality and accounts for about 20-25% of all child deaths. In these populations, Streptococcus pneumoniae is identified consistently as the leeading cause of bacterial pneumonia, and pneumoccal bacteremia is an important cause of child mortality. HIV infection increases risk for pneumococcal disease 20-40 fold, and antibiotic resistance makes threatment difficult and expensive. Thus pneumococcal idsease is a major global-health issue.

Haitian poor children are only given the standard vaccines. They do not get pneumococcal vaccines. If any group of children need the pneumoccal vaccines it is the Haitian children.

Pneumococcal conjugate vaccines can prevent most serious pneumoccal disease. The seven to 13 serotypes included in conjugate pneumoccal vaccines are expected to prevent 50-80% of all pediatric pneumococcal disease worldwide.

Also, the decline in disease in unvaccinated people is accounted for by the reduction in colonisation in vaccinated children and thus decreased transmission to unvaccinated contacts. In the USA, this herd immunity effect prevents twice as many cases as the direct effects of vaccination alone.

Based on studies done in Africa, there is a compelling case for giving pneumoccal vaccination in Haiti. Pneumococcal invasive disease, pneumonia, and meningitis, and a decrease in all cause mortality has been documented.

What are we waiting for?

"Many fledging moralists in those days were going about our town proclaiming that there was nothing to be done about it and we should bow to the inevitable. And Tarrou, Rieux, and their friends might give one answer or another, but its consclusion was always the same, their certitude that a fight must be put up, in this way or that, and there must be no bowing down. The essential thing was to save the greatest possible number of persons from dying and being doomed to unendng separation. And to do this there was only one resource: to fight the plague. There was nothing admirable about this attitude; it was merely logical."

---From The Plague, by Albert Camus

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