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Friday, January 29, 2010

Treating Severe Childhood Diarrhea

Diarrhea is not a topic most of us like to think about much, but this week's New England Journal of Medicine brings it to the front burner. That's because childhood diarrhea is a leading cause of death, yes, that's right, death, for millions of infants and children worldwide. Most of that diarrhea is caused by a virus known as a rotavirus, and the good news is, vaccines are effective at preventing it.

Effect of Rotavirus Vaccination on Death from Childhood Diarrhea in Mexico describes the utility of vaccination in preventing a significant number of deaths due to rotavirus caused diarrhea. Depending on the age of the children vaccinated, the death rate declined by about 40%. Effect of Human Rotavirus Vaccine on Severe Diarrhea in African Infants showed that severe diarrhea and death was reduced about 55% in children who received two or three doses of the vaccine.

This is great news, right? Let's just ship out lots of vaccine to these countries and prevent a leading cause of child mortality. Well, as William Shakespeare and Rick intone, here's the rub: there are serious challenges to the distribution of the vaccine to the hinterlands. Once reconstituted, the vaccine must be refrigerated, and that's almost impossible in many parts of the world. But perhaps the biggest issue, and this is an indictment of Western society, is the money.

Turns out that here in the US, vaccination costs about $75 to $100. For much of the developing world, that may as well be $1 million dollars, since such a sum may comprise the family's budget for months. Right now, manufacturers are providing the vaccine at a very reduced cost, just pennies per dose in fact, but that's a limited time offer. Soon this lifesaving preventative will be beyond the reach of those who need it desperately.

Such stories give us pause as we argue and labor over reform of our healthcare system (such as it is) domestically. Seems like we should be able to earmark dollars for prevention, clearly the best strategy for virtually all health conditions, and especially for the young worldwide.

Other topics this week include how to use antibiotics in adults in the ICU in this week's Lancet, use of steroids and insulin in ICU patients in JAMA, and also in JAMA, the best way to treat that common heart condition, atrial fibrillation. Here's the link to the podcast: Until next week, y'all live well.

1 comment:

  1. debemos recordar que cualquier molestia que tengamos en nuestro cuerpo debemos ir al medico lo mas pronto posible para asi evitar complicaciones futuras...


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