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Year in review: Top 10 stories for 2010
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As in several of the past years involving the global environment that is infectious diseases, the stories highlighted in Infectious Diseases in Children demonstrate the rapid changes that clinicians deal with in their offices on a weekly basis. We practice medicine today on a stage that requires vigilance and a constant stream of new knowledge to provide high-quality care to our patients. Many of the issues discussed in the top stories from 2010 are beyond our direct control, and the effect of mass communication and the Internet have complicated our practices. Please note that I indicated “most” of the issues are beyond our control. The continued challenge of educating our patients and families, the constant changes in health care and health care finance, and the establishment of quality clinical practices with measurable outcomes will be with us from this point forward.
That is why the 2010 Top Stories highlight three main themes. We have seen “Evolution,” “Opportunities” and “Redemption” in the past 12 months.
The pandemic influenza (H1N1) stories in 2010 highlight the evolution of the influenza virus that began with the H5 “bird flu” global health threat and the continued evolution of influenza viruses throughout last year’s season (H1N1 pandemic dominated 2009-2010 flu season and Lessons learned from response to H1N1 pandemic). The tremendous challenges related to timely vaccine development, specific vaccine production, distribution and implementation highlights how our vaccine production and delivery systems must evolve in the future.
Also under the theme of evolution are the stories related to the mumps outbreak in the Northeast United States (Mumps outbreak totals top 1,500 in New York, New Jersey) and the effect of conjugate vaccines on the evaluation of the febrile child (Approaches to evaluating the febrile child have changed over time). Clinicians will be challenged more in the future with immunization exemptions, the effect of vaccine effectiveness in all age groups, and the interpretation of past practice guidelines based upon clinical research in a different era (pre-conjugate vaccine). For issues that are the most frustrating and could have a tremendous effect on our public health is the story about the economics of vaccination (The economics of vaccination remain an important issue). The changes from these continued challenges of evolution will be with us all in the coming years.
The opportunities identified in 2010 included the roll out of the 13-valent pneumococcal conjugate vaccine (Prevnar 13, Wyeth) (PCV13 increases protection against pneumococcal disease) with the potential to see continued benefits that were apparent but potentially short-lived with the use of the 7-valent pneumococcal conjugate vaccine (Prevnar, Wyeth). The opportunity in the area of judicious use of antibiotics (Education, judicious use necessary to combat escalating antibiotic resistance) and our time-sensitive need to affect the continued evolution of antibiotic resistance among pathogens highlights an area that physicians do have greater control and influence (positive and negative). The top 10 stories on pneumonia as the leading cause of global childhood mortality (Pneumonia remains leading cause of child mortality worldwide) and the pertussis outbreak in California (California health officials report on pertussis outbreak) demonstrate the need and continued opportunity for future research to continue our preventive health progress.
The redemption comes from the retraction of the 1998 Lancet article alleging a link between autism and the measles-mumps-rubella vaccine (MMR, MMR II, Merck) (The Lancet retracts 1998 study linking autism to MMR vaccine). Although some antivaccine groups remain unconvinced, the diligence of the scientific community to refute these claims is redemption. Although the initial report did not get this correct, science won out in the end.
Finally, the horror of poverty and public health disasters from history is highlighted by the 2010 and current stories coming from Haiti (Uncertainty and optimism reign as relief efforts in Haiti continue; Cholera outbreak confirmed in Haiti, fatalities mounting).