Thursday, January 12, 2012

A Lesson from History

There are many reasons people are opposed to vaccines. They may have some fear of needles, oppose them for ideological or political reasons, confused a coincidental change in health with a vaccine reaction or simply read and believed propaganda put out by anti-vaccine organizations like the National Vaccine Information Center, Age of Autism, SANEVax and so on. Whatever the reasons for their dislike of vaccines, a frequent question that they ask is, "If your kid is vaccinated, then what does it matter whether or not my kid gets his shots? If vaccines work, then you shouldn't have anything to worry about."

This is a very naive and simplistic question. I addressed this question a while ago and reposted it recently. After presenting some numbers showing what happens when people refuse immunizations, I briefly talked about some people from my own life who could be negatively affected, as well as some hypothetical talk about others that could be harmed.

Recently, a comment at Respectful Insolence brought up a story that I felt should be presented more fully. This is a story of a parent whose child could not be vaccinated and how declines in immunization rates affected the family. Due to the harassing nature of some anti-vaccine activists, identifying details have been altered.

The Setting

England. The summer of 1981. Only two years had passed since the end of the 2-year-long epidemic of pertussis gripped the country. After its introduction in the mid 1950s, the pertussis vaccine brought disease incidence to near zero. But after news reports raised the specter of neurological damage following vaccination, fear of the vaccine caused uptake rates to plummet from 79% in 1973 to a low of just 31% in 1978, a year after the epidemic began. According to the U.S. CDC,
The timing and magnitude of the epidemics, the age group (1-4 years) primarily affected, the fall in levels of vaccine acceptance, and the rise in the number of reported pertussis cases suggest a direct relationship between the decline in vaccination coverage and the occurrence of these epidemics. No other explanations, including socio-economic factors, satisfactorily account for the 1977-1979 epidemic (2-5).
Although the dramatic increase in cases from 1977-1979 stirred people to turn once more to immunize, uptake continued to lag, and another year long epidemic was just beginning.

Introducing James

James had been a sickly child from birth. Born with severe spina bifida and hydrocephalus. He required the placing of a shunt to allow cerebrospinal fluid to flow in the right direction and relieve the pressure on his brain. He also suffered from hydronephrosis, a condition where urine elimination is impaired, resulting in it building up in the kidneys, requiring a vesicostomy. Physicians advised his parents to avoid all immunizations and gave his mother drugs to make her milk dry up. His prognosis was so poor that the doctors went so far as to tell his parents to just go home and forget they ever had a baby.

Frequent urinary tract infections and shunt blockages had James in and out of the hospital where his father worked over the first several years of his life. Everyone knew him, and his parents became very skilled in determining what was wrong by his symptoms. James' parents whisked him off to the children's ward whenever he was ill and needed more attention than just the loving care of his mom and dad. With all of this good medical support, his parents, fortunately, did not have to mourn him.

The Blue Lips

The family had gone on holiday. It was a much needed break for everyone. A time to relax and enjoy being together without the stresses of daily life. At some point during the vacation, James developed a cough. At first, it was just a cough, nothing to worry about. But as time passed, it got worse and worse, until the family felt compelled to cut their break short and get James to the hospital.

Now, his parents were no strangers to the hospital. A visit to the hospital was a near daily experience. The nurses in the children's ward all knew them, and everyone knew what to expect. But this was different. His coughing had grown so bad that, for long stretches, James could not draw breath. As his father recalls:
By the time we arrived at the hospital James was coughing and coughing and struggling for breath. My most vivid memory is of his lips turning blue, which was very frightening. When James was examined, we were very surprised to be told it was whooping cough - pertussis. Even in 1981 this was a disease that I associated with the past.
James' father does not remember what specific treatment his son received. Antibiotics by that point would have done little other than prevent spreading the infection. It is most likely he was placed on supportive care, with medical staff working to minimize his cough and keep him breathing.

Looking Back

It's only in retrospect that James' parents realized that fear of the pertussis vaccine and subsequent drop in immunization rates very nearly claimed their son's life. They were fortunate. Pertussis kills anywhere from 1 in 1,500 to 1 in 500. James survived, but he and his parents went through a great ordeal all because unfounded fears of a vaccine allowed an epidemic to ravage the country.

James' story illustrates the importance of vaccination to protect those who cannot be immunized. Had vaccination rates not declined, pertussis would almost certainly not have raged across the land, and James may never have been put through the trial of the "100-day cough". That was 30 years ago. This is today. The next time someone questions vaccines and asks, "Why does it matter whether I vaccinate or not", think about James and all of the other children like him. They depend on us to do our part to prevent the spread of vaccine-preventable diseases.

Further Reading:
Impact of anti-vaccine movements on pertussis control: the untold story (PDF)
Pertussis immunisation and serious acute neurological illnesses in children

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