First, it is a critical reminder of the disproportionate impact of NTDs on children and adolescents. Not only are children more likely to be infected in the first place but also pediatric infections are often more severe. Even non-life-threatening infections in children may cause profound life-long impacts on growth and neurodevelopment, with invisible health, economic, and social consequences. For example, malaria is a major cause of death in young children, in Africa and elsewhere, and frequently combines with hookworm to result in profound and incapacitating anemia [ 5 ].
These diseases are also major afflictions of adolescents, especially for adolescent girls, in whom these tropical infections lead not only to malnutrition and anemia but also to genitourinary tract disease, which may promote the spread of HIV [ 7 , 8 ]. In addition, as adolescent girls reach reproductive age, many of these infections, such as malaria and dengue, have harmful effects on gestation and birth, leading to poor pregnancy, birth, and early-childhood outcomes that perpetuate the cycle of poverty, disease, and inequity [ 9 — 13 ].
Lastly, this information also has important implications for training, workforce development, and research as outlined in detail below , both for resource-poor countries in Africa, Asia, and Latin America and for the NTDs noted to occur in areas of deep poverty of the United States and other high-income nations. The impact of tropical infections on children is an important message for workforce training.
In the US, recent information from the IDSA reveals that many fellowship training slots in pediatric infectious diseases currently go unfilled [ 14 ]. For example, in , almost one-half of the 60—70 available fellowship slots in pediatric infectious diseases including those recognized by the Pediatric Infectious Diseases Society [PIDS] went unmatched [ 14 ]. Among the reasons for this situation are the long work hours, lack of job opportunities in desired locations [ 16 ], and comparatively low compensation, compounded by rising educational debt and increased cost of living.
Overall, in the US, we are simply not training sufficient numbers of future clinicians, researchers, and leaders who are knowledgeable about pediatric tropical infectious diseases. Outside of the US, we have less information about pediatric tropical medicine workforce capacity. A report in found that there were fewer than 24 physicians with formal training in infectious diseases in the nation of India, with most of those individuals obtaining their training in the US, United Kingdom, or Australia [ 17 ].
Similarly, it has been estimated that the number of pediatricians practicing on the African continent is in the range of 0. Luckily, there are some important efforts underway to address gaps in the global pediatric tropical disease workforce [ 19 ]. Currently, this initiative treats annually approximately , children in more than 12 countries [ 22 ].
The American Academy of Pediatrics AAP maintains a section of International Child Health [ 25 ], and there are also multiple centers devoted to global child health and distinguished pediatrics departments in disease-endemic countries, although they are not necessarily specifically focused on pediatric tropical medicine.
Beyond the workforce, new technologies are urgently needed to address the NTDs of children worldwide. In , a consensus document was prepared by the major product development partnerships for these diseases [ 26 ], but it needs to be updated and specifically focused on the needs of pediatric tropical medicine. We also need to recognize that, in the last few years, the area of global health innovation has undergone major shifts.
There is now an array of new basic science approaches to neglected diseases that include not only single-cell combinatorial indexing RNA sequencing sci-RNA-seq , gene editing, functional and comparative OMICs, and systems biology [ 27 ] but also new and alternative funding streams, which are desperately needed [ 28 , 29 ]. We are also seeing shifts in the governance for the support of new diagnostics, drugs, and vaccines, some of which parallel the installation of new global health leaders [ 30 — 32 ].
In some cases, these activities are under threat as a result of organized antiscience movements, including a rising antivaccine initiative in the US and Europe [ 30 ]. With increasing recognition of the severity of the tropical diseases affecting children in developing nations, as well as among the poor living in wealthy countries, including the US, Europe, and Australia [ 33 ], should we consider reassessing the overall framework of pediatric tropical medicine? Under this rubric, at least one way to proceed in the US might include building on our existing pediatric infectious diseases fellowship programs and adding, as a stackable credential, one of the several diploma or certificate courses in tropical medicine and in-country experiences that currently lead to certification by the American Society of Tropical Medicine and Hygiene ASTMH [ 35 ].
This might be a first step toward new recognition and sub-subspecialty credentialing in pediatric tropical medicine, which might be paired with a period of laboratory investigative training or a partnering opportunity in disease-endemic countries for patient-oriented research Fig 1. More broadly, the majority of US pediatric infectious diseases training programs are based in geographic regions with a low incidence of imported tropical infectious diseases.
However, NTDs can be surprisingly common [ 36 ], and imported infections are quite literally only a plane flight away. A high index of suspicion and accurate recognition of tropical infections are critical for appropriate infection control measures and global health security. To facilitate widespread awareness and improve training on pediatric-specific management of such infections, an abbreviated online training module—modeled after the highly successful primer on healthcare epidemiology and infection control currently provided by the Society for Healthcare Epidemiology of America SHEA [ 37 ]—could begin to fill this knowledge gap for pediatric infectious diseases trainees.
But these measures alone will not be sufficient to create a cadre of established experts in pediatric tropical medicine, nor will they advance a next generation of urgently needed drugs, diagnostics, vaccines, and vector control agents to combat these diseases. We need to not only better shape and develop career paths for our trainees but also focus attention on undergraduate medical education and provide role models for encouraging medical and graduate students to take an interest in the problem of tropical infectious diseases of children. There are a number of possible concrete strategies that would help support trainees interested in tropical pediatrics.
The National Institutes of Health NIH loan forgiveness program should be expanded to reward those individuals who spend their careers in public health or tropical infectious diseases.
Second, a key concern for young physician-scientists across disciplines is the uncertainty of the research funding climate [ 39 ]. Compounding this concern are the unique challenges to research in tropical infectious diseases, including the technical complexities of basic investigations on the nonmodel organisms that cause NTDs, as well as the administrative uncertainties and capacity-building that may be required for patient-oriented research in endemic field sites. Our major academic societies and organizations devoted to infectious and tropical diseases and the health of children, including IDSA, PIDS, ASTMH, AAP, and ABP, have emphasized the importance of global health training and research in the context of global security, but they might also work to launch an awareness campaign on the devastating effects of malaria, arbovirus, and helminth infections on the growth, development, and futures of children and the necessity of maintaining and supporting a pediatric tropical medicine workforce to combat these infections at home and abroad.
Together, these societies have a tremendous voice and potential for impact and could help foster an environment that is conducive for enticing trainees to consider careers in pediatric tropical medicine. Currently, the trends are ominous: 1 the pediatric tropical disease burdens are huge and do not appear to be declining, 2 fewer trainees are entering the field, and 3 the antivaccine lobby and other antiscience movements are growing and becoming more powerful. We need to begin reversing this tide and seek ways to comprehensively address pediatric tropical medicine training in the context of a global strategy for improving child health [ 19 ].
Funding: The authors received no specific funding for this work. Introduction New information released by the Infectious Diseases Society of America IDSA and the National Resident Matching Program shows continued declines in interest in pediatric infectious diseases as a career, highlighting that we risk losing a generation of trained experts in pediatric infectious and tropical diseases. Download: PPT.
Prevalence or incidence of tropical infections in children under 5 years old information from [ 1 — 4 ]. Table 2. Prevalence or incidence of tropical infections in children and adolescents under 20 years old information from [ 1 — 4 ].
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