Low-Tech Disease Control

This word came last October 14: “Despite the existence of inexpensive and efficient means of treatment, diarrhoea kills more children than AIDS, malaria and measles combined, according to a report issued today by UNICEF and the World Health Organization (WHO).”
The WHO – not Pete Townshend, Roger Daltrey, John Entwistle (RIP), and Keith Moon (RIP) – identified such waterborne diseases as the second leading cause of childhood mortality worldwide. Modern water and wastewater treatment practices have largely eliminated these diseases from the developed world. So thanks again to all of you who have dedicated your careers to keeping our water supply safe.
But this does beg the question: what is the most deadly of all childhood diseases worldwide? Answer: pneumonia. That surprised me. Pneumonia is generally a bacterial disease, caused by Streptococcus pneumoniae. Many bacterial diseases can now be combated effectively by antibiotics and more recently vaccines. Antibiotics are administered to people who have a disease already. That’s especially difficult outside of the developed world, where access to health care is incredibly limited. But vaccines are preventive measures, so the timing of their administration is far less critical: you need to receive the vaccination anytime prior to contracting the disease. And the use of vaccines has been increasing in the undeveloped world.
The LA Times reports today on the brief history of pneumonia vaccines. http://www.latimes.com/news/nation-and-world/la-sci-vaccine25-2010feb25,0,7748272.story For once, I’m not going to spar with the Times! The vaccine Prevnar was first marketed in 2000, so it has not been around for very long. Despite its brief history, “By 2007, the overall incidence of disease … had been reduced by 99%.” That is truly a medical miracle. Unfortunately, there is so much bad news that the Times had to address that this story got buried on page A7.
But all the news is not quite that tremendous on the Prevnar front. Bacteria are remarkably adaptable creatures, and the original seven strains targeted by Prevnar are being replaced by other pathogens: “Researchers now think that as many as three-quarters of new cases … are caused by six additional strains…” As great as modern medicine may be, it seems it is no match for the microorganism. More and better vaccines are coming, no doubt, but medicine is in a constant race against the wily pathogen.
Which brings us back to modern water and wastewater treatment practices: the physical removal and chemical disinfection practices used in these technologies do not provide our enemies – the pathogens – with an opportunity to adapt. These practices are decidedly low-tech, and perhaps even old-fashioned, but they have successfully eradicated cholera, typhoid, dysentery, and the like, while giving no quarter to our microscopic adversaries. And the benefit to public health has been – and remains – one of the greatest achievements of our civilization.

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