Infectious Disorders - Drug Targets

Childhood disability is a major global public health issue with an estimated 93 million children living with moderate or severe disability, mostly in low and middle-income countries (LMICs). Over the past decades we have seen significant interests and commitments from global health leaders in reducing childhood mortality due to infectious and vaccine preventable diseases. Most of these initiatives are targeted to reduce childhood mortality particularly neonatal and infant deaths in resource poor settings. However, as investment on childhood survival goes up, there is an increasing threat of soaring childhood morbidity including disability as the overall health services and/or infrastructures at primary level in LMICs are not improving homogenously. These heightened responses to global child survival initiatives might lead to a paradoxical increase in childhood disability (e.g. cerebral palsy) in LMICs if not planned and prepared early. Global data suggest that infections are among the leading causes of chronic, developmental disabilities in children. A study conducted in Bangladesh found that almost one in five children with a disability in rural areas were disabled by an infectious agents [1]. A systematic review on childhood disabilities in low and middle-income countries suggests that the commonest causes of hearing impairment (the most frequently studied disability) are meningitis, measles and congenital rubella [2]. Infections are also prominent among the underlying causes of other disabilities including intellectual impairment, and contribute to disability during early childhood [1, 3]. A large proportion of children in developing countries suffer from long-term disabilities, many of which are of infectious origin [1]. These include, inter alia, polio, tetanus, congenital rubella and varicella, Japanese encephalitis, influenza, and meningococcal, pneumococcal and Haemophilus influenzae type b diseases which are preventable by vaccination. Unfortunately, not all of these vaccines are used in the national childhood immunisation programmes of LMICs. Systematic studies to identify each infectious cause and their contribution to total disease, economic and other burdens in disability are lacking. In this special issue we have presented review article [4, 5], systematic review article [6] as well as original research articles [7-14] on the crux of infectious disease and childhood disability both in high and low-income settings. There is an interesting mix of articles ranging from a de novo experimental stud on HSV (Fernandez et al) to applied epidemiological studies on the immunisation status of children with cerebral palsy (May et al) and their mothers (Khan et al) [8, 10 and 11]. We hope these articles inform, educate and entertain the readers, and generate further discussions on disability and infection.