Category Archives: Infectious diseases

Vaccination: The bad old days

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Have you ever met anyone who had diphtheria? How about tetanus? You may know an older person who had polio as a child, and most people my age can remember measles and mumps, but how about congenital rubella? Hemophilus influenza meningitis? Smallpox?

As vaccines become more effective, and global vaccine campaigns more successful, fewer and fewer people (let alone their doctors) have any direct experience with the infections we vaccinate against.

That’s why vaccine-preventable infections can be a low priority for some young parents: They’ve never seen any of them. As one dad put it not long ago, when we got onto the subject of polio risks for his two month old daughter: “What’s the point of  getting shots for non-existent diseases? It’s like you’re warning us about the dangers of buggy whips.”

That’s how my days go, sometimes…

I really like the illustration that accompanies this post (and thanks to my daughter Claire for sending it to me). The left hand column of red-tinged syringes shows how many cases of a given infection occurred each year in the pre-vaccine era. The mostly red-free column on the right lists the annual totals we see today.

The differences are dramatic, but it’s important to take note of the little slivers of red still visible next to infections like measles, mumps, and congenital rubella. These diseases and the others on the list aren’t extinct, they’re just held at bay by vaccines (and other public health improvements like clean drinking water and improved hygiene).

So keep this chart in mind when thinking about vaccinations for your child. Oh, and those bad old days? In the case of Hemophilus influenza, they weren’t so long ago: the vaccine didn’t come out until I’d been in practice for several years. I (and my patients) lived those 20,000 cases a year…

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Flu shots help prevent preterm birth

5278448067_f76b92377cA research team in Georgia recently published a study that shows the protective effect of flu vaccine for pregnant women.

Led by Dr. Saad Omer of Emory University, the team examined the records of more than 3,300 pregnant women between April 2009 and 2010. They found that those women who received influenza vaccine overall had a 40% lower likelihood of giving birth before 37 weeks of pregnancy than women who were not vaccinated. That protection increased to 72% during the peak of the flu season.

The protection extended to birthweight as well. Vaccinated women were 69% less likely to have a small for gestational age baby than were the unvaccinated women.

Dr. Omer’s study underscores the importance of flu shots for pregnant women. Keep that in mind come next October, when the 2013-2014 vaccine  comes out!

(Photo credit: International Ladies Garment Workers Union Photographs, 1885-1985)

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A great book about living with polio

Anne Finger

Anne Finger

I had the pleasure of meeting the author Anne Finger in 2010, when we were both nominees for the Northern California Book Awards. (Anne was a Fiction nominee for her short story collection, “Call Me Ahab.” Me? I lost to Dave Eggers–does he have to win every award?–in the Creative Nonfiction category.)

Anne’s legs were paralyzed by polio when she was a toddler. Her book, “Elegy for a Disease: A Personal and Cultural History of Polio” (2006) brings all the theoretical discussions of polio and vaccines down to a very personal level. “Elegy” is a remarkable read for anyone who wants to know what it’s really like to live with the damage, both physical and emotional, that polio once wreaked on thousands of American children and adults every year.

Here’s an excerpt from Publishers Weekly’s review of “Elegy for a Disease”:

In skillful prose, Finger merges memoir with historical narrative about how polio was viewed and dealt with in the years before the Salk vaccine was invented 50 years ago. Evocative and often poetic, the memoir is also a litany of the miserable, useless, even harmful treatments imposed by helpless doctors on suffering children. She offers a nuanced history, for instance, of the painful and unorthodox heat treatments espoused by Elizabeth Kenny. Finger… describes the traumatic operations, beginning when she was six, that led in turn to complications when she was in her 40s. Taught to believe that she could overcome her disability, Finger overexercised and, while living in England, attended antiwar demonstrations that were physically dangerous…

“Elegy for a Disease” is a vividly-written reminder of why we should still worry about polio in Pakistan.

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Filed under Birth Day, Infectious diseases, Vaccines, Writing

A personal polio postscript…

What hath polio wrought? Ma and Pa, April 19, 1947

What hath polio wrought? Pa and Ma, April 19, 1947

Actually, I owe my very existence to one particular case of polio.

Ed, one of my father’s best friends in college, had his legs paralyzed by polio in early childhood. When World War II came along, Dad went off to the South Pacific and Ed, his disability disqualifying him from active duty, took a desk job on Chicago’s Navy Pier. As fate would have it, one of the women who worked in his office was a red-haired Irish lass named Peg Dalton. Long story short, Ed thought Peg and Barney would be a good match, and 66 years later, they still are.

Bottom line: No polio, no me. I hate to seem ungrateful to the virus that made my blogging possible, but I can’t wait to see it vanish from the earth.

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Do we still need polio vaccine?

A thing of the past?

A thing of the past?

I picked up a copy of this week’s Time magazine at my health club today (gotta have something to read in the sauna…) and found an excellent article on global polio eradication.

Only three countries are still considered hotbeds of the disease–Afghanistan, Nigeria, and Pakistan–and money and man-and-woman-power are pouring into those countries in a determined effort to finish off polio, much as smallpox was eradicated in the 1970s.

It’s a remarkable story, and the article is worth a read. Consider this: as recently as 1988 polio killed or paralyzed 350,000 people worldwide, but thanks to an incredible combination of medical know-how, political will, and philanthropy (in particular the Gates Foundation), there were only 215 cases in 2012.

So back to my original question–one that I frequently hear from shot-weary parents–do American kids still need polio vaccine? After all, there hasn’t been an outbreak of wild polio in the U.S. (i.e., person-to-person transmission that wasn’t imported by a foreign traveler or very rare vaccine-related infections) since 1979. And polio epidemics spread via sewage-contaminated drinking water–definitely not a problem here. Yet we still routinely give children four doses of polio vaccine by the time they start kindergarten. This isn’t Afghanistan…can’t we just quit?

There are two main arguments for continuing polio vaccination until the virus is eradicated:

  • The eradication effort in those three final countries is in danger of being derailed by terrorism and war. As reported in the Time article, Pakistan is a particular problem: more than a dozen vaccine workers have been murdered by the Taliban, who believe the eradication effort is really a U.S.-backed spy network.* Since polio can spread quickly, it wouldn’t take much disruption to see the case numbers mount up. And with the ease of modern travel, we could expect infected travelers to appear at least occasionally in the U.S., as has happened in the past.
  • The idea of polio spreading through sewage-contaminated drinking water in the U.S. may seem remote, but as millions learned in the wake of Hurricane Sandy, sewage treatment facilities can fail. An infected traveler in the right place at the wrong time could open a polio Pandora’s box.

Okay, I’ll admit that the reappearance of polio epidemics in the U.S. would take a combination of long-shot coincidences. But given that we’re so close to eliminating polio (and thus polio vaccine) why take a chance? Best to hang in there vaccine-wise until we can do a polio victory dance.

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*The Taliban’s fear of vaccine-worker spies isn’t entirely unfounded. A Pakistani doctor masquerading as a hepatitis-vaccine worker helped confirm Osama Bin Laden’s location just before Bin Laden was killed.

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Filed under Infectious diseases, Politics, Vaccines

Antibiotics: Treading softer nowadays

There’s a time and place for everything.

Pediatrician Perri Klass has an excellent article on antibiotics and children in Tuesday’s New York Times Science Times. She perfectly conveys the dilemma facing pediatricians and others who care for children today. We all have stories of kids whose lives were saved by the timely administration of antibiotics, but we’re also acutely aware–more so with each passing research article–of the consequences of overusing that “magic bullet.”

The physicians who taught me back in the ’70s and early ’80s had good reason to love antibiotics. Many of them had started their careers in the pre-antibiotic era, when infections like pneumonia, meningitis, diphtheria, and others killed a lot of children. Then antibiotics came on the scene and those diseases nearly vanished–until antibiotic resistance kicked in with a vengeance, that is. We’ve been engaged in an escalating arms race with bacteria ever since.

The pro-antibiotic mindset of those times was epitomized by an elderly attending physician in my residency program who, as we were discharging a boy who’d had bad case of pneumonia, quietly said, “When I was an intern that child would already have been dead for a week.”

To his younger self, the boy’s recovery would have been a miracle. Now he believed it was simply a matter of time–and the right antibiotics–and bacterial infectious diseases would disappear entirely. Side effects? Maybe some diarrhea or the occasional allergy, but that was a small price to pay. Right?

It didn’t work out that way, of course. We’re now learning that antibiotics can have far-reaching effects on  children’s health. As Klass points out, there is concern that antibiotic use, particularly in early infancy, may be linked to a variety of chronic health conditions–even obesity, as I wrote about a few months back.

Still, there is a role for antibiotics. Kids still get pneumonia, and meningitis, and any number of infections that may come roaring back if the fear of antibiotics becomes its own epidemic. But not every ear infection needs to be nuked with pharmaceuticals.

So, when to treat and when to let nature take its course? That’s a delicate balance that those of us who learned from doctors who saw antibiotics as a “magic bullet”–which they were, at least at the start–are still working to achieve.

Photo credit: epSos.de

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Early antibiotics and obesity?

An English study of more than 11,000 children has turned up an association between early antibiotic use (that is, antibiotics given to babies less than 6 months of age) and later obesity.  Interestingly, the study did not find that antibiotics given to children between the ages of 6 and 14 months increased the risk of obesity, and the effect of antibiotics on children aged 15-23 months was inconsistent.

Why would the antibiotic-obesity association be found primarily in younger babies? The authors speculate that an altered gut microbiota may be the culprit.

The germs that make up the gut microbiota (GM) are acquired at birth and shortly afterwards. By a few months of age the “core” GM is more or less set for life. An altered GM has long been associated with obesity in older children and adults (see more extended discussions in my posts here and here)–it would make sense that antibiotics given in this sensitive period of GM development would have greater impact than later on, when the GM is more stable.

The added risk of obesity from early antibiotic administration is small for any individual baby,  the study’s authors stress, but even small increases spread over an entire population can have significant public health implications.

Still, sometimes babies need antibiotics. Studies like this one highlight the unintended (but real) consequences of the overuse of a sometimes life-saving tool.

***(Photo credit: Seattleye)

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