A look back at 2001

December 2001

---Philip A. Brunell, MD

It is hard to believe that another year has come and gone. But, what a year this has been. The biggest news for everyone was Sept. 11. This overshadowed anything that could be reported in any news format. The most relevant to IDC was the anthrax cases, which at this juncture, appears to have relented but do not appear to be solved. One case was in a child so it behooves us to be alert to the possibility that we may see additional cases. On the other hand, we should not indiscriminately prescribe antimicrobials, some of which may be particularly deleterious in children. Consideration is being given to the reintroduction of smallpox vaccine. Those of us who witnessed the complications associated with this vaccine hope this decision is made with consideration of the impact it may have on children.

In the vaccine arena, there were several disappointments in that approval was not granted for an intranasal influenza viral vaccine (FluMist, Aviron/Wyeth Lederle)and for a combination DTaP-HepB-IPV vaccine. Think of how much easier this would have made our lives. However, all is not lost. In time these and new combination vaccines probably will be approved. Meanwhile, we had to deal with a delay in delivery of influenza vaccine so that children not at defined increased risk were asked to wait for their immunization until after high-risk people received vaccine. A shortage of dT also made us prioritize who would receive this vaccine. Finally, the long-awaited conjugated pneumococcal vaccine (Prevnar, Wyeth Lederle) also appears to be in somewhat short supply. Thus children 2 years and older who were not in high-risk groups were asked to delay immunization with this vaccine.

The vaccine scene appears to be good. Immunization rates have been at an all-time high. We were reminded of the need to sustain immunization against rubella that appeared to be licked by an outbreak of rubella in a group of Mexican workers in the Midwest. We have gotten thimerosal out and most of the questions about MMR and autism/GI disease and HepB vaccine and multiple sclerosis appear to have been resolved. We learned about an outbreak of vaccine-associated poliovirus on the island of Hispaniola after a long period of absence of polio from the Western Hemisphere. However, this appears to be under control but highlights the need for continued vigilance and for maintaining a high level of immunity to polio in our communities.

Sinusitis and bronchitis were added to the list of common conditions for which we wish we had better answers. We continue to struggle with otitis and purulent rhinitis. There appears to be some restraint in the use of antibiotics, so perhaps discussion of these conditions has had some impact.

While rummaging through my old books to look up anthrax, I came upon a copy of Jonathan Swift’s A Modest Proposal. I thought this tongue-in-cheek essay about solving many problems by using children as a source of food might be interesting rereading. Our 2001 version has photos of 11-year-old children holding rifles as they go to war and states sponsoring programs for teaching children to hate and kill. Children killed or wounded in warfare make the front pages while mothers proudly raise their children to be martyrs. However, I am reminded that things are much different than they were in Swift’s day. Making a world a better place for children is clearly a work in progress. Soon, we get a new year to work, hope and pray for a better world.

A happy New Year and a wonderful holiday season to all.