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PLOS BLOGS Speaking of Medicine

What Kills Little Kids?

Peter Hotez (@PeterHotez), co-Editor in Chief of PLOS NTDs and Jennifer Herricks (@JenHerricks) of the National School of Tropical Medicine, Baylor College of Medicine comment on the recently released global mortality numbers, specifically those for children under five.

Image Credit: Marcie Casas
Image Credit: Marcie Casas

The Global Burden of Disease Study 2013 (GBD 2013) based at the Institute of Health Metrics and Evaluation at the University of Washington recently released its global mortality numbers for the year 2013.

We find the under-five childhood deaths particularly instructive.  Of the almost four million children between the ages of one and 59 months who tragically died before their time, almost one-half of them died from infectious diseases, led by lower respiratory infections (708,600), malaria (570,000), or diarrheal disease (474,900).

More interesting is when the respiratory and diarrheal diseases are broken down by specific infections with known etiological agents.  This information is shown in the Table.

Today, malaria, most caused by Plasmodium falciparum, is the leading killer of children under the age of five – most of these deaths occurred in sub-Saharan Africa.  Although great progress has been made in reducing these deaths through mass interventions such as insecticide-treated bednets and anti-malarial drugs we still urgently need a malaria vaccine, especially as resistance to current interventions increases.

Disease Number of Deaths
All causesa 3,665,700
Malariaa 570,000
Pneumococcal pneumoniab 264,000
Nutritional deficienciesa 260,700
Congenital anomaliesa 248,700
Rotavirus enteritisb 122,400
Meningitis 121,100
Haemophilus influenzae type b pneumoniab 108,700
Measlesb   82,100
Drowningb   80,100
Road injuriesb   64,500
HIV/AIDSa   63,900
Syphilisa   56,900
Whooping cougha   56,400

a children 1-59 months;  b children < 59 months

However, just having a vaccine developed and manufactured is not always the complete answer.  Of the dozen or so killer diseases of children, five of them are infections for which vaccines are available – pneumococcal pneumonia, rotavirus enteritis, Haemophilus influenza type b pneumonia, measles, and whooping cough.  The GAVI Alliance has done an amazing job in dramatically reducing those deaths over the last decade by increasing access to immunizations, but there is more work to do.  Hopefully, the anti-vaccine movement – which is at least partly responsible for causing a resurgence of measles in North America and Europe – will not take hold in vulnerable areas of the world, including highly populated BRICS and other countries.

HIV/AIDS and syphilis are two leading causes of childhood deaths, mostly associated with mother-to-child transmission, and for which increased access to life-saving interventions is needed.   Congenital anomalies also remain leading causes of death, as do drowning and road injuries.

Finally there are the deaths from mostly non-infectious causes.  Nutritional deficiencies still kill more than 200,000 young children annually, many of them from protein-energy malnutrition, but there are other causes including severe anemia that results from hookworm infection, together with other parasitic diseases.  Our Sabin Vaccine Institute and Texas Children’s Hospital Center for Vaccine Development is developing a new human hookworm vaccine in collaboration with a HOOKVAC consortium based in Europe and supported by the European Union and Dutch Government, which if successful could reduce the number of deaths from malnutrition.

The GBD 2013 continues to shed light on the major global health afflictions of humankind.  These new data on childhood deaths provide a sobering reminder of our need to develop and deliver new vaccines and other life-saving interventions.

Discussion

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