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article imageKid-killer streptococcus 19A forcing a rethink of immunizations

By Paul Wallis     Oct 14, 2008 in Science
In the Very Unfunny category is serotype 19A. It’s a nasty streptococcal bacteria which is a cause of pneumococcal meningitis as well as pneumonia. Infections from 19A are rising despite new immunization programs.
The idea of the anti-strep vaccinations was to stem meningitis, which can be fatal. While overall the vaccinations, begun in 2001, seem to have done their job well, he worry is that statistically serotype 19A infections are rising in multiples of previous numbers, and rapidly.
The New York Times
Since 2000, American toddlers have been immunized against Streptococcus pneumoniae, or pneumococcus, an organism that preys largely on children younger than 5 and the elderly. Pneumococcal meningitis can be fatal, and survivors are often left with deafness and other lifelong neurological problems.
And by most measures, the vaccine has worked: by 2002, rates of infection from these bacteria had dropped as much as 80 percent in some places. But progress has now stalled, and infection with a particular type of pneumococcus, Serotype 19A, is steadily rising.
“It’s very much a concern,” said Bernard Beall, a pneumococcal expert at the federal Centers for Disease Control and Prevention. Last year, in The Journal of the American Medical Association, pediatricians described an outbreak of Serotype 19A ear infections in Rochester that could be cured only by surgically implanting tubes, or by turning to adult medicines not yet tested for safety in children
The use of adult medicines constitute drastic measures, by any standard. That is a classic last resort, usually involving life or death, when nothing else is working.
It’s also why the stats are now looking very threatening. The incidence is showing a sudden, vicious looking spike:
A greater worry, however, is the frequency of meningitis, pneumonia and bloodstream infections from Serotype 19A. Since 2001, rates of these and other invasive pneumococcal diseases have crept upward, to more than 10 per 100,000 children from about 2 per 100,000. A fourfold increase in life-threatening infections has also occurred among the elderly.
So these infections are now 4 or 5 times more common, in a relatively common bacterial agent. Everybody has strep bacteria to some degree, and they’re usually harmless.
I can tell you from personal experience that strep infections are no fun. I had a severe infection in the 80s. It was diagnosed as everything but a strep infection, until someone figured it out. I was given painkillers, and had to work standing up for 6 months, because just getting out of a chair was painful. I was running fevers every day, usually several times. For years afterwards I wasn’t sure if I was running a fever if I got hot. I was given some antibiotics as a matter of course. They weren’t much use, if any. I stopped taking the painkillers after the first course, and must have had multiple re-infections.
Fortunately for me, my immune system is as psychotic as I am when it gets annoyed, and I think it beat the infection out of sheer fury.
I dread to think what a young kid of 5 or under would suffer, with anything like the thing I had. The prognosis would not be good.
Serotype 19A is at least causing some good science, mainly because it’s becoming a challenge. It’s not generally believed that vaccination was any real stimulus to its onset, but this particular strain is definitely being difficult:
Disease experts also wonder what organisms like 19A mean for the future of pneumococcal infections. Public health experts once hoped the infection could be defeated, but it now appears that pneumococci may be playing a game of cat and mouse.
“The pneumococcus has shown an extraordinary ability to evolve to our strategies,” said Dr. Beall of the C.D.C.
As you can see from KJ's previous post on this subject on DJ, evolving new strategies for this problem isn't exactly happening at light speed. That's not good, because strep is a universal bacterial presence with human beings. A few further evolutions on the part of 19A, and this damn bug could produce a pandemic of its own. An increase of 500 per cent in as many years is a massive jump, and it means that 19A is spreading widely.
We better out-evolve it, before it out-evolves us.
More about Streptococcus, Serotype 19a, Childhood infections
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