Specialty Grand Challenge In Pediatric Infectious Diseases

Frontiers in Pediatrics

Philippe Lepage¹ 

关键词: vaccination;    multiresistant pathogens;    pediatric infectious diseases;    emerging infectious diseases;    tropical diseases;   

DOI  :  10.3389/fped.2017.00185

学科分类：儿科学

来源: Frontiers

【 摘 要 】

In recent years, decrease in global mortality and improvement in quality of life have been among the most significant progresses in child and adult health (1). In the field of pediatric infectious diseases, remarkable advances have been achieved in terms of reduction of incidence of childhood infectious diseases and associated morbidity and mortality. This is especially true for vaccine-preventable diseases where immunization against measles (2), Haemophilus influenzae type B (3), pneumococci (4, 5), meningococci (6), rotavirus (7), varicella (8), hepatitis B virus (HBV) infection (9, 10), etc., has dramatically decreased the burden of targeted infections in high- and low-income countries. The global challenge of controlling HBV dissemination well illustrates how preventive measures could hinder the serious course of an infectious disease. Indeed, in the case of HBV infection, perinatal exposure represents an important mode of transmission leading to chronic disease in ~90% of infected newborns. Following its implementation in many countries, the universal vaccination of babies born from HBV positive mothers has considerably modified the epidemiology of HBV infection worldwide (9). When given the best immunoprophylaxis currently available (hepatitis B vaccine and hepatitis B immune globulins), perinatal HBV infection only occurs among ~1% of infants of infected mothers (10). The success obtained from HBV vaccine as well as from many others vaccination campaigns led to consider prevention by life-saving immunizations as one of the seven greatest achievements in pediatric research observed during the last four decades, as emphasized by a recent review (1). In addition to vaccination and prenatal screening, other preventive measures such as improvement of environmental conditions and personal hygiene together with broadening supply in drinkable water also significantly contributed to reduce prevalence and burden of highly transmissible infections (i.e., cholera, shigellosis, or hepatitis A) in different parts of the world. The old principle issued from Chinese traditional medicine “An ounce of prevention is worth a pound of cure” achieves its real significance when thinking about pediatric infectious disease. Again, the recent success story of preventing mother-to-child transmission of human immunodeficiency virus (HIV) well illustrates this keystone concept. In high prevalence regions, universal HIV testing of pregnant women combined with the use of antiretroviral therapy but also with avoidance of breastfeeding and scheduled cesarean section in mothers at high risk of transmission permitted all together to decrease the risk of perinatal transmission to <2% in many countries (11) with subsequent impact on childhood mortality.

【 授权许可】

CC BY