Tag Archives: Infectious disease

Vaccination: The bad old days

IMG_4898

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…

4 Comments

Filed under Infectious diseases, 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

2 Comments

Filed under Infectious diseases

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…

Leave a comment

Filed under Infectious diseases, Vaccines