BECAUSE WE'RE RICH:

More people die of strep A than measles, rotavirus, whooping cough, tetanus, and bacterial meningitis (all vaccine-preventable). Why? There is no vaccine.

There are reasons for this absence. First, deaths from strep A in high-income countries fell after antibiotics became widely available and access to health care improved. The vast majority of yearly deaths occur in low- and middle-income countries -- nearly invisible to vaccine manufacturers in developed countries. Second, the US Food and Drug Administration imposed what was essentially a ban on further strep A vaccine testing in humans from 1970 to 2007 because testing of a poorly characterized vaccine in human subjects resulted in worse disease (despite safe testing in hundreds of thousands of people in the decades before). Third, no major vaccine company is working on a strep A vaccine. Finally, funding for strep A research increased from $1 million to $16 million as of last year, but remains chronically underfunded.

Strep A is a master of disguise. We are all familiar with strep throat. In North America and Europe, after a diagnostic test, penicillin is curative. Unfortunately, in under-resourced parts of the world, access to diagnosis and treatment is poor. Some children with untreated strep infections will develop inflammation of the heart and its valves, the joints, the skin, and the brain. Acute rheumatic fever may also develop. Unfortunately, future strep A infections may occur and each return further damages the heart valves. After a few decades, the heart begins to fail -- like the heart failure that we see in older people but in 20- and 30-year-olds. Rheumatic heart disease caused by strep A is a major cause of death in pregnancy and poor pregnancy outcomes (still birth, low birth weight babies) in low- and middle-income countries.

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