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Saved by the Dr. Bell

Vaccine Preventable Disease

These days we do not lose our children to infectious diseases in the United States. Other third world countries do, but not us. Right?

I have seen a change in medicine from my childhood in the 70's and 80's, to medical school in the 90's, to my practice of pediatrics in the 00's and 10's. I missed getting a smallpox vaccine when I was born in 1969. I got chicken pox in 1975 and had only a few spots. I got a booster vaccine during a measles outbreak in 1986. I had a pneumonia in 1987. Other than that, I did fine.

I saw diseases in medical school that we do not see much of anymore, like chicken pox, hepatitis B, and mumps.

In Pediatric residency in the late 90s we didn’t worry about Hib sepsis or meningitis, but were scared of pneumococcal meningitis in infants and menigococcal meningitis in teens. We sadly admitted babies with rotavirus dehydration in the summer, and admitted pertussis babies to the intensive care for ventilation support.

In pediatrics practice over the last 15 years I have seen a remarkable decrease in ear infections (thanks to the Prevnar vaccine for pneumococcus), decrease in rotavirus dehydration, and we have now started vaccinating children to prevent cancer.

It almost seems easy to raise children without the fear of infection these days. But these diseases are still out there in the world. They are waiting to come back.

What follows is a run down of all the diseases we routinely vaccinate again in our offices. If enough parents choose to delay, breakup, or outright refuse certain vaccinations, these diseases will come back to the United States.

These pictures are graphic, so please view at your own risk.

All statistics and facts were taken from the Center for Disease Control and Prevention, the World Health Organization, or the American Academy of Pediatrics sites. I have listed links to their web sites for further study.

Diphtheria:

  • Bacteria, releasing toxin
  • Symptoms: sore throat, fever, swollen tonsils
  • Complications: myocarditis (heart inflammation), peripheral neuropathy (damaging nerves for sensation and movement)
  • Death/Statistics: 5-10% of infected, by heart failure or suffocating from throat obstruction.
  • In the USSR in 1998, there were 200,000 cases, and 5,000 deaths
  • In its early stages, diphtheria can be mistaken for a bad sore throat. A low-grade fever and swollen neck glands are the other early symptoms.
  • The toxin, or poison, caused by the bacteria can lead to a thick coating (or membrane) in the nose, throat, or airway. This coating is usually fuzzy gray or black and can cause breathing problems and difficulty in swallowing.
  • Those infected have difficulty breathing or swallowing, even show signs of going into shock (skin that's pale and cold, rapid heartbeat, sweating, and an anxious appearance).
  • In cases that progress beyond a throat infection, diphtheria toxin spreads through the bloodstream and can lead to potentially life-threatening complications that affect other organs, such as the heart and kidneys. The toxin can cause damage to the heart that affects its ability to pump blood or the kidneys' ability to clear wastes. It also can cause nerve damage, eventually leading to paralysis.
  • Up to 40% to 50% of those who don't get treated can die.

Tetanus:

  • Bacteria, Clostridium tetani, releasing a toxin, “stepping on rusty nail”
  • Symptoms: muscle spasms of neck, back, jaw,
  • Complications: neonatal tetanus, (from un-immunized mothers, unhealed umbilical stumps), muscle spasms can break bones, brain damage, and cerebral palsy.
  • Death/Statistics: from respiratory failure (lungs unable to expand) or cardiac arrest (heart stops)
  • In 1998 in developing countries, 14% (215,000) of all newborn deaths.
  • Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw."
  • There's no cure for tetanus. Treatment focuses on managing complications until the effects of the tetanus toxin resolve. Fatality is highest in individuals who haven't been immunized and in older adults with inadequate immunization

Pertussis:

  • “Whooping Cough”, Bordetella Pertussis bacteria, from respiratory droplets
  • Symptoms: cold symptoms for 1-2 weeks, followed by overwhelming cough, sometimes vomiting, causing death in infants from suffocation, apnea
  • Complications: pneumonia, convulsions, encephalopathy (infection of the brain)
  • Death/Statistics: death rates of 1.6% in America, 4% globally. 48.5 million cases annually worldwide, and 295,000 deaths.
  • This is not a disease from a foreign country. This disease is here, in Massachusetts, in the Pioneer Valley.Read the sad tale of Brady Alcaide from Chicopee, who died at 6 weeks of age in 2012. Too young to get the vaccine.
  • Brady's Story
  • Pertussis is a bacteria that you can treat with antibiotics if you catch it early enough. After the first 2 weeks of the “cold symptoms”, however, any antibiotic treatment only prevents its spread, it does not stop the deadly “whoop” cough. This cough can last for months.

Polio:

  • Virus, from infected food or water
  • Symptoms: fever, headache, vomiting, stiffness
  • Complications: 1% of infected develop muscle weakness in legs, neck, head or diaphragm, meningitis (infection of spinal cord and/or brain)
  • Deaths/Statistics: 2-10% of those with paralysis die from suffocation because of diaphragm muscle paralysis, making them unable to breathe.
  • Thanks to vaccines, polio cases dropped from 350,000 in 1988 down to on 416 cases in 2013, spreading in the countries of Afghanistan, Nigeria and Pakistan.
  • There is no cure for polio, it can only be prevented.
  • It mainly affects children under 5 years of age.

Hepatitis B

  • Virus, infected blood (survives outside body for 7 days)
  • Symptoms: fever, fatigue, loss of appetite, nausea, vomiting, jaundice (yellowing skin)
  • Complications: scarring of the liver, cirrhosis, cancer
  • Deaths/Statistics: in 2007, 43,000 new infections in the US,
  • 800,000 to 1.4 million have chronic hepatitis B virus infection, 30-40% of these infections were acquired during childhood
  • Globally, chronic Hep B affects 350 million people, contributes to an estimated 620,000 deaths worldwide each year.
  • Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few weeks to a serious, lifelong illness. It results from infection with the Hepatitis B virus. Hepatitis B can be either “acute” or “chronic.”
  • Acute Hepatitis B virus infection is a short-term illness that occurs within the first 6 months after someone is exposed to the Hepatitis B virus. Chronic Hepatitis B virus infection is a long-term illness that occurs when the Hepatitis B virus remains in a person’s body.
  • It is true that hepatitis can be acquired from sexual intercourse and shared needles. So why immunize infants and children? Because infection can occur from any blood contact, whether at birth or other exposures.
  • 90% of infants who are infected will ultimately develop chronic hepatitis. Only 30% of children age 1-5 develop chronic hepatitis, and only 5-10% of healthy adults who are infected will develop chronic infection.

Hib/Haemophilus influenza (or “Hib”)

  • Bacteria, respiratory droplets
  • Symptoms: causes ear infections, cellulitis (skin infections), infectious arthritis (joint infections), bacteremia (blood infections), epiglottitis (inflammation of the windpipe, like diphtheria), and meningitis (infection of the covering of the brain and spinal cord, stiff neck, fever, photophobia, confusion)
  • Complications: meningitis resulting in coma or death
  • Deaths/Statistics: before the vaccine, in 1992 there were 20,000 US children under age of 5 with severe infection, with 1,000 deaths, or about 3-6% of those infected.
  • Before the vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years of age.
  • Although antibiotics can kill Hib, infected infants can have no symptoms to sudden fever, coma and death within hours.
  • Delaying vaccination for Hib only allows more time for a young infant to be infected and killed by this bacteria in those early months.
  • This bacteria is in the US. In fact, there is a good chance it is dormant in your nasal passages!

Pneumococcus

  • Bacteria, respiratory droplets
  • Symptoms: Sudden onset of fever and fatigue, cough, pleuritic chest pain, blood-tinged sputum. Pneumococcal meningitis may present as a stiff neck, headache, lethargy, or seizures.
  • Complications: similar to Hib, ear infections, cellulitis (skin infections), infectious arthritis (joint infections), bacteremia (blood infections), meningitis (stiff neck, fever, photophobia, confusion)
  • Deaths/Statistics: 900,000 Americans get pneumooccal pneumonia each year and 5-7% die from it. There were 3,300 deaths in the U.S. from pneumococcal meningitis and bacteremia in 2012. About 3,000 cases of pneumococcal meningitis occur each year and of those cases 10% will die from the infertion.
  • Pneumococcus is the most common cause of bloodstream infections, pneumonia, meningitis, and middle ear infections in young children.
  • As Hib, antibiotics can kill pneumococcus, but infants are highly susceptible and can be asymptomatic, developing fever to death in a matter of hours.
  • I can’t emphasize this enough, there is no time to save a baby from Hib and pneumococcal bacteremia or meningitis. I have seen a baby in the nursery seem fine at 9 am and in a coma at 12 noon.

Rotavirus

  • Virus, fecal/oral transmission, contaminated water, food, surfaces
  • Symptoms: diarrhea, vomiting,
  • Complications: dehydration, sometimes severe resulting in cardiac arrest, sepsis, and death.
  • Deaths/Statistics: before widespread vaccination, caused between 55,000 and 70,000 baby hospitalizations, and 20-60 deaths annually in the US.
  • In 2008 worldwide, there were 453,000 deaths in children younger than 5 years of age due to rotavirus infections.
  • As a virus, there is no treatment other than support through oral rehydration or IV fluids.
  • Infants under 6 months of age are highly susceptible to rapid dehydration, and could be life threatening in hours.

Measles

  • World Health Organization on measles
  • Kids' Health on measles
  • Virus, respiratory droplets, highly contagious
  • Symptoms: fever (over 104), cough, runny nose, conjunctivitis (red eyes), red flat rash starting on the face, and spreading down the body.
  • Complications: common complications such as ear infections and diarrhea, to severe complications of pneumonia or encephalitis.
  • Death/statistics: 1 in 20 children develop pneumonia, 1 in 1000 children develop encephalitis, swelling of the brain that can cause seizures, deafness or mental retardation if it is survived.
  • In the U.S., before vaccination in 1963, there were 3 to 4 million cases of measles each year. Of those people, 400 to 500 died, 48,000 were hospitalized, and 4,000 developed encephalitis.
  • Worldwide, in 2013, there were 145,700 deaths.
  • “400 deaths a day, 16 deaths an hour.”
  • Before widespread vaccination, measles caused an estimated 2.6 million deaths each year.
  • Measles was considered eliminated from the United States in 2000. That is, there were no transmitted cases between residents of the US.
  • One dose of measles vaccine is about 93% effective, and two doses are about 97% effective.

Mumps

  • Virus, respiratory droplets
  • Symptoms: fever, headache, muscle aches, fatigue, parotitis - swollen and tender salivary glands under the ears or jaw
  • Complications: inflammation of the testicles (orchitis) leading to atrophy and possible sterility. inflammation of the brain or meninges (encephalitits and meningitis), inflammation of the ovaries (oophoritis), deafness.
  • Deaths/Statistics: symptomatic meningitis (headache and stiff neck) occurs in up to 15% of patients. Orchitis occurs in up to 50% of males. Encephalitis occurs in 2 per 100,000 cases. Deafness occurs in 1 of 20,000 cases. An average of one death from mumps per year was reported during 1980-1999.
  • There is no specific treatment for mumps, only supportive measures.
  • Before vaccination, was responsible for 10% of viral meningitis in the United States.
  • Was the most common cause of sensorineural deafness in childhood.

Rubella

  • “German Measles”, virus
  • Symptoms: low grade fever, tender lymph nodes, rash on face that spreads down body
  • Complications: in pregnant women causes Congenital Rubella Syndrome (CRS), born with growth and mental retardation, heart defects, eye defects (such as cataracts), deafness, liver, spleen and bone marrow complications.
  • Death/Statistics: 20% chance of damage to the fetus if a mother is infected early in pregnancy. During the 1962-1965 global rubella pandemic, an estimated 12.5 million rubella cases occurred in the United States, resulting in 2,000 cases of encephalitis, 11,250 therapeutic or spontaneous abortions, 2,100 neonatal deaths, and 20,000 infants born with CRS.
  • Although Rubella has been eliminated in the United States, it is endemic in the rest of the world, responsible for an estimated 100,000 infants born with Congenital Rubella Syndrome each year.

Varicella/Chicken Pox

  • Virus, very contagious
  • Symptoms: fever, fatigue, itchy, blister-like rash
  • Complications: dehydration, pneumonia, encephalitis, sepsis, toxic shock syndrome, bone and joint infections.
  • Deaths/Statistics: until nationwide vaccinations in the 1990s, an average 4 million people got varicella, 10 to 13,000 were hospitalized, and 100 to 150 died each year. The highest rate of varicella was in preschool aged children.
  • Although most cases are mild, scarring can be severe, and other skin complications will last a lifetime.
  • In my medical school years I saw a preschooler with varicella pneumonitis, or chicken pox pneumonia, which would lead to scarring of the lungs. (You could see the pox marks on her chest x-ray.) I also saw varicella encephalitis in a grade school boy who miraculously woke from his coma without lasting neurological damage.
  • Those medical school experiences taught me that even though it was rare, it was very real to those parents, and there was the very real possibility of them losing their child to this virus.

Meningococcus

  • Bacteria, Neisseria meningitidis
  • Symptoms: sudden onset of fever, headache, and stiff neck, also nausea, vomiting, photophobia, and confusion
  • Complications: sepsis (bloodstream infection) meningitis
  • Deaths/Statistics: 10-15% of cases are fatal, of patients who recover 11-19% have permanent hearing loss, mental retardation, or loss of limbs.
  • Infants less than 1 year of age and adolescents aged 16 through 21 have the highest rate of disease.
  • 10% of people have this bacteria in the back of their nose or throat with no signs or symptoms, they are carriers.
  • I have seen a teenager who had a headache and fever in North Adams at his camp, given a shot of antibiotic but arrived at Baystate Hospital in full sepsis and full organ failure, eventually losing 3 limbs from gangrene necrosis.

Human Papilloma Virus

HPV - group of 150 related viruses, resulting in warts (papillomas)

HPV is the most common sexually transmitted infection. HPV is a viral infection that can be spread from one person to another person through anal, vaginal, or oral sex, or through other close skin-to-skin touching during sexual activity. If you are sexually active you can get HPV, and nearly all sexually active people get infected with HPV at some point in their lives. HPV16 and HPV18 cause 70% of all cervical cancers.

As you can see, these diseases are still very common worldwide, but uncommon in the United States, thanks to the vaccine program developed over the last century.  Within the Center for Disease Control, the Advisory Committee on Immunization Practices (ACIP) review and study vaccines, its efficacy and safety, with approval from American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and American College of Obstetricians and Gynecologists (ACOG). 

It is my hope that this review of these diseases further informs you regarding the necessity of vaccines and universal vaccine coverage.  My next blog will hope to explain in depth the safety of vaccines and its components.