Category Archives: Vaccines

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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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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Super Bowl measles

Catching something else?

Measles just won’t go away

13 cases of measles have now been tied to two infected people who visited the Super Bowl in Indianapolis the weekend of February 5th. The cases are limited to two counties north of the city, but given the huge number of people from all over who visited Indianapolis for the festivities, public health officials–particularly those in New York and New England, where the Giants and Patriots and their many fans are located–are understandably nervous.

This illustrates the ease with which infectious diseases can travel from place to place these days. The last outbreak of measles in my area started with a European tourist who developed full-blown measles shortly after arrival. Fortunately our public health department was able to contain things quickly.

One more reason to stay on top of your kids’ vaccination needs…

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Polio: A milestone in India

Polio-free for a year!

This week India celebrated a milestone many thought would never come. For the first time in its history an entire year passed without a single case of paralytic polio. The last Indian child to be paralyzed by the virus was an 18 month-old girl diagnosed on January 13, 2011. The end of polio in India had been predicted: there were 790 cases in 2009 and only 42 in 2010. Fingers will remain crossed for the near future–the World Health Organization won’t certify a country as polio-free for three years, since asymptomatic polio can circulate for some time.

The Indian government has spent $2 billion dollars fighting polio–hundreds of millions of polio vaccine doses have been administered in recent years–and it knows it will spend many more millions to keep the infection away. Polio is transmitted via sewage-contaminated drinking water, and that’s unfortunately fairly common in that part of the world. More worrisome is the proximity of Pakistan, India’s next-door neighbor, which had nearly 200 cases of polio last year. Viruses don’t respect international borders–the risk of polio resurfacing in India is substantial.

So hats off to India! It’s quite an accomplishment.

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Things I learned en route to looking up other things: Royal edition

Oy! Measles!

Something I didn’t know:

Princess (later Queen) Elizabeth breast-fed Prince Charles for two months in 1948, but was forced to stop when she contracted measles. For safety’s sake the Prince was sent away with the royal nannies for an extended period of time.

Elizabeth recovered, of course, and Charles didn’t catch the measles. But re-lactation wasn’t a royal priority, and so that was the end of breastfeeding for Charles.

Elizabeth was 22 years old when she came down with measles–a rather advanced age to catch a disease that typically attacked young children. Her misfortune was likely due to a kind of hoity-toity herd immunity–years of private tutoring and family-only holidays had greatly limited Elizabeth’s access to other kids (and their germs) during early childhood.

The Princess’s measles and early weaning make for a cautionary tale: pregnant and early postpartum women are particularly vulnerable to a number of infectious diseases.  That’s why pregnant/postpartum women today are offered pertussis vaccine (and influenza vaccine, in season). It’s a good way to prevent serious infection–and maybe an early end to breast feeding–for both mother and baby.

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Filed under Breastfeeding, Infectious diseases, Things I learned en route to looking up other things, Vaccines

Protecting the herd

I’ve noticed that a few anti-vaccine bloggers have lately taken to questioning whether “herd immunity”–ie, the principle borrowed from veterinary medicine which states that a high vaccination rate in a community provides protection to unvaccinated individuals as well–actually exists. Not sure how that one got started, as there’s ample evidence that herd immunity is real. It makes intuitive sense: if more people are vaccinated for measles, say, measles rates in a community drop, which in turn makes it harder for unvaccinated people to catch measles, too.

Here are a few studies that show herd immunity in action:

1) The first, recently published in the journal Pediatrics, looked at trends in chickenpox in children less than a year of age since 1995, the year chickenpox vaccine was first offered in the U.S. (Infants can’t receive chickenpox vaccine until after their first birthday.):

There has been close to a 90% drop in the rate of chickenpox among infants from 1995 to 2008, even though they are not eligible for the vaccine.

“Vaccinating children aged 12 months and older protects infants who are too young to be vaccinated,” says study researcher Adriana S. Lopez, MHS. She is an epidemiologist at the CDC in Atlanta.

2) Then there’s this summary of a 2005 study on pneumococcal vaccine, as described by Dr. Paul Offit from Children’s Hospital of Philadelphia:

“After American children began receiving the pneumococcal conjugate vaccine in 2000, for instance, the incidence of pneumococcus caused by the strains of bacteria in the vaccine fell by 55% among adults ages 50 and older, a group that didn’t even get the vaccine, according to a 2005 study in the Journal of the American Medical Association.”

3) And finally, see my post from September which described how older, unvaccinated siblings in Boston benefited from their younger sibs’ influenza vaccination.

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Mrs. Curtis (1914): Why measles is bad

Mrs. Curtis: Protect your baby!

As I mentioned in a previous post, I often turn to my grandmother’s 1914 edition of Household Discoveries and Mrs. Curtis’s Cook Book for some historical perspective. Here’s what Mrs. C has to say about measles:

“[Measles] is a very fatal disease among young children. It causes three times as many deaths as smallpox, and nearly as many as scarlet fever. Ninety-five percent of all deaths occur in children under five years of age; the death rate in times of epidemic ranges from 4 per cent to 6 per cent.

The danger from measles is chiefly due to complication with other diseases, such as whooping cough and bronchial pneumonia, or to the after-effects, such as consumption, paralysis, meningitis, diseases of the skin and nervous disorders. Inflammation of the ear is a not infrequent complication of measles. This often leads to deafness or worse.”

Mortality rates in third-world outbreaks still reach as high as 10% of all infected children. While complications like pneumonia are much more treatable in first-world countries than they were in 1914, encephalitis and hearing loss remain worrisome measles complications everywhere.

Treatment? Um…none. Mrs. Curtis doesn’t even address it.

Prevention? Obviously, measles vaccine didn’t exist back then, so quarantine was the way to go:

“Isolate all suspicious cases, especially during periods of epidemic. Placard the premises [for two weeks]. No person from a home quarantined for measles should attend school, church, theater or public gathering. Everything coming from the patient’s room should be disinfected.”

In particularly bad outbreaks, Mrs. Curtis recommends burning whatever comes out of the patient’s room, pretty much everything but the people. (Actually, she doesn’t specifically recommend leaving the patient and family unburnt, so I can’t be sure on that one.)

When things resolve…

“…the sick room should be thoroughly disinfected with formaldehyde or sulfur, as described elsewhere.”

Finally, the ever-practical Mrs. Curtis refers the reader to the section on “Cleaning the room of a child who has died from infection.”

Then, presumably, you got on with life–a necessary survival skill for families at a time in history where as many as 2 in 5 children still died before reaching their 5th birthday, mostly from infectious diseases.

“You had to move on,” my father says today about the long-ago deaths of his two siblings (John Francis, who died at age 3 in the 1918 Spanish flu epidemic; and Donald, 4 years old, in 1925). “Otherwise it would just eat you up.”

Here’s a link to an article I wrote for Notre Dame Magazine about John Francis’s death.

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