Tag Archives: Health

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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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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One family’s history

Gram Sloan in 1918. John Francis (left) died a month later in the Spanish flu epidemic.

Yesterday was my parent’s 65th wedding anniversary. I realized in talking with them over dinner that their family stories (and mine, too, of course) provide a pretty good snapshot of how children’s health has improved in the last century, at least on the infectious disease front.

Dad’s 93 now, born in 1919 during the waning days of the Woodrow Wilson administration. His mother (my Gram Sloan) experienced a lot of tragedy with her children. She gave birth to five babies, but only three survived to adulthood. My uncle John Francis died in the 1918 Spanish flu epidemic at the age of three, and Donald was 4 years old when he died of pneumonia in 1924. The striking thing about her experience is that it was basically the norm for families back then. In 1914, the year she married, about one in four children didn’t make it to their 5th birthdays. (I wrote an essay about John Francis for Notre Dame Magazine–link is here.)

Mom is 87 and, though she and her six siblings all survived to adulthood, her childhood was one long string of debilitating infections: whooping cough, diphtheria, scarlet fever, and polio (which left her with a weakened leg), to name a few. She even received the last rites of the Catholic Church once (for diphtheria), but defied her doctor’s dire predictions and pulled through.

Together Mom and Dad had seven babies. The first, my brother James, was born a few weeks early and died at two days of age from hyaline membrane disease (now called respiratory distress syndrome). The rest of us made it through childhood relatively unscathed–oh, we had measles, mumps, and chicken pox, like every other kid, but we were spared diphtheria, polio and the rest. (Mom dragged us to the pediatrician’s office, kicking and wailing no doubt, the day the polio vaccine arrived.)

And now my kids–they’re healthy and in their twenties. Both had chicken pox, the odd ear infection, and some wheezing, but basically had pretty healthy childhoods. The same is true for all of their cousins, a few of whom now have their own healthy children. If this were a century ago, I would probably be talking about a few of them in the past tense.

My career as a pediatrician is another indicator of how things have improved. I’ll just mention what I call the “spinal tap index.” When I started in the early 80s, I did about one spinal tap a week to diagnose or rule out meningitis. Then came the vaccines for Hib, pneumococcus, and meningococcus, and with them a huge decrease in cases of meningitis. It’s been more than a year since I did my last spinal tap.

Talk to your older relatives and friends–you’ll very likely find that they have similar stories. There is much to criticize in the current state of children’s health in the U.S., but on some fronts, particularly infectious diseases, the progress has been remarkable.

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Filed under Infectious diseases