They Know They Were Lucky: Guy and Rotavirus

[This story is from Israel] 
Guy was 9 months in December 2006, a sweet tempered,
mellow baby. A crawler. He was not very vocal – unlike his younger cousin, he
did not babble a lot – but he smiled frequently and was a very affectionate
baby. His mom, Lilly [name altered to protect anonymity], has just
recently returned to her work as a dentist.
It was Thursday, and his grandmother Sara picked him up.
Normally, she said, he would crawl straight over to her, but not that day: he
was somewhat weak, and she thought at first he had a fever – but he did not. He
refused his usual yogurt, refused to lie in bed for his usual short nap, and
just curled up in her arms, limp and unhappy, clearly unwell.
That evening, his parents took him to the doctor for the
first time. Lilly says: “I was a little concerned because he was a little
apathetic from the start of the diarrhea, even though we gave him as much
fluids as possible, to prevent dehydration.” The doctor diagnosed rotavirus.
“It has a unique smell,” explains Sara. “It’s impossible to miss”.  They took him home, and he seemed to be
improving.
The next day, Sara went to visit her daughter, Lilly. She
describes what she saw: “Lilly was sitting in her dining area on a plastic
chair, a bucket next to her, baby in her arms, and he was throwing up into the
bucket again and again, poor little guy, he was so miserable. He did not even
have the energy to cry.” They took him to the doctor again. Because it was
almost the weekend, the doctor prepared a referral to emergency room, so that
if the baby got worse over the weekend he could be hospitalized without delay.
Lilly describes Guy that Friday afternoon as alternating
between inconsolable fits of crying and episodes where he was completely
unresponsive and limp – “apathetic” – which frightened her even more. Worried,
Guy’s parents took him to the hospital. Lilly says “without hesitation they
hospitalized him and put him on IV.  It
took them a while to be able to find and access his veins because he was
getting dehydrated. And they hospitalized us and gave him fluids and monitored
him – no medication, because it’s a virus.” She called her mother from the
hospital, gave her the news and a list of necessities to bring – since Lilly
had packed nothing for a hospital stay.
Lilly stayed with Guy constantly in the same ward, sleeping
on a couch next to his hospital bed. She says: “Together with Guy there were
ten more babies in the same ward hospitalized because of rotavirus. The door
said “isolation”.  Every time someone
went in or out they had to wash their hands with anti-bacterial soap.  All the mothers were attached to their
babies. It was a nightmare.”
Sara visited her daughter and grandson the very next day.
She arrived just as Guy was being taken for an examination by the doctor, and
she carried the IV while Lilly carried the baby. She says: “he cried so hard,
it broke my heart. He was so miserable.”
After four days in the hospital, Guy was released.  On the way home in the car he started vomiting
and having diarrhea again.  Lilly says:
“when we got home it continued, and he looked bad – he looked pale, apathetic.
He could not cry, he was so exhausted. So we said, there’s no choice, let’s
take him back to the hospital. By then it was night time – 8-9pm.” Again, they
checked Guy in, again, the search for a vein to insert the IV into in the
dehydrated, miserable baby. And three more days of  the ward, with an unhappy baby hooked up to
IV, with ten other suffering babies, with bad sleep on a couch, with stress,
pain, and worry.
And then he got better, and they took him home, and this
time he stayed better.
Lilly and Sara also know they were lucky: living in
an industrialized country, with easy access to a universal healthcare system
and very good medical care, Guy got the help he needed quickly. According to
the World Health Organization, hundreds of thousands of children die from
rotavirus every year and millions are hospitalized, most – but not all –  in developing countries, though the numbers
are declining, thanks to the availability of a vaccine against the disease. In the United States, prior to the vaccine, “rotavirus infection was responsible
for more than 400,000 physician
visits, more than 200,000 emergency department (ED) visits, 55,000 to 70,000
hospitalizations each year, and 20 to 60 deaths.” See also here, for a previous story about and discussion of rotavirus.
Still, even with the best care, Lilly describes the
experience as “stressful, painful, worrying”. 
“I haven’t heard of rotavirus before this,” said Sara. “I raised four
children, and we went through several childhood illnesses – there was no
vaccines for some of them, and they had mumps, rubella, and a host of digestive
issues. They had diarrhea; I remember a night when my daughters were four or
five, and they went to the bathroom in turns for about 18 times, one by one.
But I don’t remember anything close to this bad. Since then, just hearing the
name “Rota” gives me chills. I think the vaccine Lilly was most eager to give [Guy’s
younger brother] was Rota.”
Lilly says, “but there was no vaccine available at the time,
if there had been one we would have given it to him. We made sure to vaccinate
our second child, there was a vaccine then, and it was never in doubt.”

Image from The Public Health Library, Provided by Dr. Erskine Palmer:  http://phil.cdc.gov/phil/details.asp?pid=178

Acknowledgements: I would like to thank Stacy Hillenberg, Clara Obscura, Meleese Pollock and Alice Warning Wasney for comments on drafts, as well as my interviewees, Guy’s mother and grandmother and his grandfather. All errors are, of course, my own. 

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Rubella: the Unborn Pay the Price

In 1972, Anna and Robert Robak visited the doctor; Anna was
pregnant, and she also had a rash and a fever. Although a first test came out
negative for rubella, a second test came out positive – but the medical staff
did not inform Anna of that fact. Their daughter, Jennifer (Jenny) Robak, was
born on January 12, 1973. The court case describing their story focused on whether Anne can sue the doctors from
not alerting her to the fact that she had rubella – information that would
probably have led her to abort the baby, because of the potential harm to Jenny
from the virus. Indeed,  Jenny had
Congenital Rubella Syndrome, and suffered serious harm from it. 
The court described the effects on the child: “At the time of her birth, Jennifer had a
rash all over her body. She was also suffering from a loss of hearing,
bilateral cataracts, a slight heart defect and possible mental retardation all
common symptoms of a rubella syndrome child. Since then, Jennifer
Robak has undergone two operations to remove cataracts. She has undertaken
occupational and physical therapy and special training and education for the
deaf-blind. She is industrially blind and has a severe to profound hearing
loss; she cannot speak intelligibly. Glasses, contact lenses and hearing aids
have been of only limited use. She will need deaf-blind care and supervision
for the remainder of her life, as well as further operations.”
Jenny is just one
of the many children harmed when their mothers had rubella during the first
trimester of pregnancy. Rubella is normally a mild childhood illness, but if it
affects a woman in the first 16 weeks of pregnancy, it can have devastating
consequences for the fetus. The CDC explains: “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.” 
Children
suffering from Congenital Rubella Syndrome – the ones that survive – often have
severe vision and hearing problems as well as other problems. A vaccine expert writes: “..no organism
is more common, more thorough, or more consistent in its destruction of unborn
children than the rubella virus.”[1]
Here is a story
from another mother who describes her daughter’s problems as relatively “minor”, which she attributes to the immune-globulin she received when pregnant:
“She had congenital
cataracts, a mild hearing loss, very mild cerebral palsy and an atral-septal
defect in her heart that closed on its own about age 4.
Overall, her development was quite slow. She didn’t walk and talk until
she was 3 and 4 years old. In that respect, the congenital rubella showed its
effects. She gained weight slowly. When she was 4-yrs. old, she developed
glaucoma in her right eye which led to its removal. Her left eye still had some
vision, but she was classified as “legally
blind.” “
Not surprising, before vaccines parents were anxious to make sure their
daughters contracted rubella at an early age, before the possibility of pregnancy
arose. Jean said: “My mother made certain that I attended “rubella parties” until I contracted the seemingly innocuous 3-day rash. Every mother knew that contracting rubella during pregnancy could lead to miscarriage and horrific medical consequences for babies infected in utero (the vaccine was not available until the late 1960s)”. And pregnant women worried. Annie
remembers vividly what happened to her mother. Annie was part of a family of
seven, five living children born out of 8 pregnancies. Annie’s mother did not develop natural immunity to childhood diseases. She
had rubella eight times, says Annie. She lost two unborn babies to rubella and
one to measles. Annie says:  “I remember I
was feeling a little ill. [her mother] called me into the bathroom and asked to see my
tummy and back. She took a deep breath, said German measles [rubella is also
called German measles] and started to cry. Then she looked at herself. She was
pregnant. The next day she was in hospital…she cried tears of JOY when she
miscarried her two-months baby. I now know why. Deafness, blindness,
retardation. These things were REAL to her generation and mine.”
Meleese, who taught at an elementary school, found herself
teaching the younger class for the deaf students, even though she was not
trained (she went and got trained the following year). She taught children from
preschool to age 8, with 5 or 6 in the class at a time. Except for one little
girl who had meningitis as a baby, all were rendered deaf through Congenital
Rubella Syndrome.
Meleese herself had the misfortune to get rubella at an older
age, at 21, while at teacher’s college. She describes the experience: “My
mother thought I must have already had it and she didn’t know as I was always
around outbreaks once even on a church camp. When I did get it I was the only
one in the residence to get it. I had so many spots they were all joined
together and I looked sunburned. My mouth and throat ulcerated and I was so
sick I needed 3 weeks off lectures.” The “housemother” where she lived sent for
a doctor, and Meleese was given several prescription medicine. For three weeks
she hardly left her room, with the housemother bringing her her meals. She
says: “The scary thing looking back was 4 girls got pregnant that year
and “had” to get married( those were the days!). I lived with them
and had lectures with them. Imagine if I had passed it onto them!”
The rubella vaccine is controversial because the virus is grown
on cell line taken from a legal abortion in the 1960s.  The abortions were not performed for donating
the cell lines – and it is illegal to perform abortions for that purpose.
Nonetheless, people who are pro-life may understandably object to having to
make the choice and may have doubts about using the vaccine. Here is a meme
addressing this:
Courtesy of
Refutations to Anti-Vaccine Memes, found at:
https://www.facebook.com/photo.php?fbid=507352126001468&set=pb.414643305272351.-2207520000.1373960888.&type=3&theater
The main points to remember are that rubella vaccine saves
fetuses, since rubella can cause not only fetal death, but also malformations
that can lead people to choose abortion, and that the virus for the vaccine is
grown on a cell line descended from just one legal abortion in the 1960s.  The vaccine does not include fetal cells, and
any claim that vaccine production involves (requires?) aborting fetuses now is
simply wrong. 
Because of its potential to save fetal lives, the Roman Catholic
Church,
a body that strongly opposes abortions, recommends the rubella vaccine.  It has issued an official opinion that warns:
“This [the need to accept the vaccine to prevent greater danger] is
particularly true in the case of vaccination against German measles, because of the danger of Congenital Rubella
Syndrome. This could occur, causing grave congenital malformations in the
foetus, when a pregnant woman enters into contact, even if it is brief, with
children who have not been immunized and are carriers of the virus. In this
case, the parents who did not accept the vaccination of their own children
become responsible for the malformations in question, and for the subsequent
abortion of foetuses, when they have been discovered to be malformed.”[2]
This post also analyzes the issue from a pro life perspective,
concluding: “The
cells that were taken from the two aborted babies more than 35 years ago are
much like my loved one’s heart. Two innocent babies were killed. However, they
were able to donate something that has been used not only to make vaccines, but
in many medical research projects over the years. Thus, these cells have been
saving millions of lives for almost two generations! Although the babies were
clearly murdered, the fact that their cells have been saving lives is at least
a silver lining in the dark cloud of their tragic murder.” 
Rubella still harms children even in the first world in places
like the “bible belt” in the Netherlands, Japan and Poland, and
recently seems to have come back to the United States. The rubella
component of the MMR can save the lives of fetuses and save babies from
disability and suffering. For these children’s sakes, it’s important to
vaccinate.
Acknowledgements:  I am grateful to Alice Warning Wasney, Meleese and Annie for feedback on drafts of this post. 

[1]
Paul A. Offit, Vaccinated: Triumph, Controversy, and an Uncertain Future
(2009), p. 71.
[2]
Footnote 15.
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How HiB Hurt Stuart

In
February 1980 Stuart was “very bright, garrulous and had started the process to reading at
just over 2,” says Annie, his mother. At twenty-nine months, he was already
toilet trained, unstoppably active, always alert. Then, he came back from
daycare with a runny nose. It didn’t slow him down: he played normally, and
spent a long time kicking a ball.

Then
he started vomiting. Annie says: “By 7pm that night he was photophobic [light hurt his eyes], vomiting, wailing, comatose and
scarlet red. He went from active but sniffly to comatose in 25 minutes.” His
parents drove him directly to Casualty, the Australian equivalent to the
American Emergency Room. The intern who saw him tried to send him home, saying
Stuart had stomach flu. But Annie says, “I insisted. … his high-pitched,
toneless wailing on top of everything else sounded alarms for me.” Annie was a
nurse. She knew enough not to let her son be sent home. At the time, Annie had
private insurance, so she demanded to see a pediatrician. Upon seeing the
child’s condition, the pediatrician immediately took action. “They admitted him
to isolation. Next step was a Lumbar puncture.”
Stuart had HiB disease, Haemophilus influenzae type b, which is not a
flu, in spite of the name. The CDC’s pink book explains: “Haemophilus influenzae is a cause of bacterial infections that are
often severe, particularly among infants. … Before the introduction of
effective vaccines, H. influenzae type b (Hib) was the leading cause of
bacterial meningitis and other invasive bacterial disease among children
younger than 5 years of age; approximately one in 200 children in this age
group developed invasive Hib disease. Nearly all Hib infections occurred among
children younger than 5 years of age…. The most common types of invasive
disease are meningitis, epiglottitis, pneumonia, arthritis, and cellulitis.” Complications include brain damage,
hearing loss, and death, among others. Epiglottitis – a situation where the tissue at the base of the tongue swells and can block breathing
– was commonly caused by HiB: “before the introduction of Hib vaccines,
epiglottitis was due to Hib in over 95% of cases.”  Dr. Paul
Offit writes: “Once infected, the epiglottis can block the windpipe – no
different, in a sense, than being smothered by a pillow.” (Paul Offit, Deadly Choices, p. 60). 

Stuart
remained
in the Hospital for 8 weeks. He was unconscious for the first 24 hours, and
then, after the doctors and nurses “pumped him full of IV Antibiotics”,
regained consciousness. Annie says: “he was aware, and he was so sick and
miserable.”
Annie and her husband stayed in the hospital with him. She
describes the month as an “awful Indian Summer February. I say that because my
husband and I were automatons operating on Autopilot. I knitted my husband a
cardigan in the hospital…… it is too long, has different length sleeves and
both fronts were the same. as I said, autopilot.” They could not sleep well,
and were intensely worried. Annie was afraid they would lose Stuart. She says,
“I know in my heart we nearly lost him. Just seeing the pediatrician’s face
told me he was in deep s###. I’ve always wanted to find the Intern who told me
to take him home and actually confront him about it…. for 33 years I’ve
dreamed of it.”
 Stuart’s ordeal did not end when he left the hospital. He “came
out of Hospital no longer toilet trained, unable to walk and talk. It took him
a long time to regain any vitality and even longer to be healthy again. School
was a misery for him. We went through 5 years of intensive vestibular
stimulation therapy (rocker boards, spinning, to redevelop his nervous system I
think it was). He suffered from difficulty in visual perception, wore Irlen
lenses
 for years (they
worked). He described to me recently what happened to words when he looked at
them. It was like a spinning radiating rainbow pinwheel and the words had halos
and the letters had haloes and were 3 dimensional and floated off the page. His
perception was totally skewed. He has an IQ of 140 but could not read or write.
He reads avidly now [at over 30], but still cannot write well. … He is not as
eloquent as his intelligence indicates still.”
Annie says: “Back then… there were no vaccinations for it. I think they
were just beginning to look at them here in Australia.” The vaccine started to
be used in Australia in the early 1990s, and publicly funded by the governmentsince 1993. In the United States it was adopted in the late 1980s. HiB has declined
dramatically since then both in Australia and in the U.S.:
Annie said she is happy that other children are not at risk of
suffering the way Stuart did and paying the price he is still paying.
Acknowledgements: Thank you to Kathy McGrath, Clara Obscura and Martin Smith for their help . Above all, thanks to Annie for sharing her story so eloquently. All errors are, of course, my own. 
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Three Women, HPV and Cancer

The
HPV Vaccine has a bad reputation and low uptake,
in spite of evidence supporting its safety including very large scale studies,
and growing evidence of its effectiveness. But it is a vaccine that has the
potential to save many, many lives, especially in developing countries but not only: in the United States, for example, close to 12,000 women develop
HPV related cervical cancer each year,
and in 2009, 3909 women died from it. Over 90% of invasive cervical cancers in the world contain some strain of HPV. The strains in the vaccine are responsible for approximately 70% of cervical cancers. HPV can also lead to other cancers. In a recent news story, Michael Douglas announced that his throat cancer was the result of HPV contracted through oral sex. 
In
this post, three very different women talk about their struggle with HPV and about
the effect cervical cancer had on their lives. All of them emphasize how lucky
they were: they all survived, and they all survived without a hysterectomy, and
two of them went on to have children. But they hope in future, fewer women
would suffer as they did. The stories should also highlight that this can
happen to any woman, regardless of life style and family history.
Because
of the private nature of these stories, at the request of two of these women,
their names were changed.
Lynette’s story (name changed to protect
the speaker’s privacy):
When
Lynette married in 1975, at the age of 27, her husband was the first man with
whom she had a sexual relationship. Lynette explains: “With the HPV my husband had a wart on his penis.
I was naive even though I was 27 and didn’t realize what it was.” The HPV was
discovered shortly after the marriage, when she was pregnant with her first child: “I
noticed I had “lumps” on the outside of my vagina, not realizing they
were warts or how I got them. I went to my doctor. My vagina and cervix were
riddled with them. I had to undergo 2 operations under general anesthetic when
I was 5 and 7 months pregnant. Doctor said the pregnancy had allowed them to
flourish. I remember the second op report said I had more than 100 lesions.”
Lynette considers herself lucky: after the second operation, she did not have
any recurrence of the warts. But she believes the operations she had to undergo
directly led to her son’s health problems: ”..he was only 6 and 1/2 pounds (babies
2 and 3 were both nearly 9 pounds).” She mentions a variety of health problems
her child suffered.  In spite of her
initial bad luck – getting HPV from her first husband and partner, having to
undergo two surgeries while pregnant – she did not have lasting damage. She did stay under close medical supervision: for the next 15-20 years, Lynette had to undergo annual pap
smears. She went on to have two more children with her second husband.  
Ironically, Lynette
heard horror stories about the HPV vaccine. At that time, she explains, she got
quite a bit of information from the unreliable site Natural News. So, “I flipped out
when my then 22 year old daughter told me she had had the first in the Gardasil
series. I was believing the stories about girls dropping dead, becoming
disabled. She rolled her eyes and told me not to believe everything I read on
the Internet. That’s when I decided to do some more investigating…” Upon
investigating, Lynette learned how unreliable the information she found on anti-vaccination sites really
was. She now devotes time out of her busy schedule to respond to anti-vaccine
claims, and firmly encourages parents to get the HPV vaccine for their
daughters, to protect them from what she went through.
Annie’s story (name changed to protect the
speaker’s privacy):
Annie
grew up in California, a child of the 1960s. She explained: “I frolicked about;
so did most of my sexual partners.” While in college, she met her first
husband, and they married. However, Annie explains, “when we got out into the
real world, it became apparent that the things that made us get along in
college didn’t work”. They divorced, and sometime later she married her second
husband, who had two children from a previous marriage, and they added a
daughter to the family. Shortly after the marriage, the children’s mother –
Leah (name changed to protect the person’s privacy) moved nearby, and the
children started spending a week in each household. Annie and her
step-children’s mother became very good friend; good enough that when Leah had
cervical cancer Annie knew of it and could appreciate and sympathize with the
pain Leah went through. Leah had to undergo a hysterectomy. Annie described
this as “painful and really, really difficult.”
When
Annie’s own cancer was discovered she had Leah’s story to inform her and Leah’s
painful experience to add to her fears.
It started with an abnormal pap smear that led to further
tests. Annie describes what happened next: “finally it was determined that it
was sufficiently suspicious that I did a cone biopsy. You see, the cervix is
kind of like a donut with a tiny opening (that gets enlarged when you give
birth). So for a cone biopsy they take, they excise, a cone of the cervix.
(Annie added, looking at my reaction: “Dorit has a painful expression on her
face”). Typically it’s done under general anesthesia, and while I was under the
anesthesia the surgeon did, I forget what it’s called, it’s when they sliced
the excised material really thinly, and it did have cancer cells. Basically
because if there was a sufficiently suspicious mass they would stop the surgery
and wake you up and schedule you for a hysterectomy, which is still the primary
treatment for cervical cancer… But I was lucky and that lesion was very
localized. It was a carcinoma in situ, so it hasn’t spread anywhere, but it was
a good thing that I was done having my family, because as the surgeon explained
afterwards I probably wouldn’t be able to carry an infant to term. Because of the
amount  of scarring to the cervix. I had
two weeks of being pretty darn uncomfortable, not as uncomfortable as after
child birth but still painful.”
Annie explained that she was not scared for her life,
because “I knew that the chances of this being a highly survivable cancer were
very high, and there has been no metastasis. But I was scared about having to
have a hysterectomy because that is a major surgery and I knew from my friend,
because she did have a hysterectomy, and it was painful and really, really
difficult, so I didn’t want that. “ Luckily, she did not need a hysterectomy and after the surgery
Annie did not even have to have chemotherapy: everything was removed. She says
“I just had to have pap smears every, it seemed like every five minutes … I
still have to have them more frequently, but not every five minutes.”
Annie concludes: “What makes me such an advocate of HPV is that it prevents disease, number one, and number two, if I had been younger, I
wouldn’t have been able to have children. … I really don’t understand the
anti-HPV. As soon as it was available I encouraged my daughter to get it. It
came available just after she turned 18, still in high school because her
birthday is late. I encouraged her to get it, she did.”
Megan’s Story:
Before discovering her cancer, Megan had four children. Her
eldest daughter was 16, and she says: “in 2000 I went to the doctor because I thought I might be
pregnant, then I did a smear test, and turned out I was four weeks pregnant and
the test came back with a nasty result. Then they said I needed a punch biopsy
to find out what was going on and there was a 75% chance that I’d lose the baby
with a punch biopsy; so I told them if they touched me I was going to break
every bone in their body then I’d go after their families.” Megan continued her
pregnancy and did not have the biopsy done until her daughter was 7 months old.
“…and it turned out that I was stage III, which over here it’s one stage down
from terminal, that’s where we were, and they took me to the hospital to do surgery,
and they removed a great deal of my cervix, didn’t remove all of it but they
did remove quite a large chunk of it, and we came back another month later for
another smear test and an internal so they could have a look and see what
everything looked like, and it seems when they went in to remove it they got
everything. For which I was thankful. That’s why I was so lucky.  I thought I had been given a death sentence,
and it was just a hiccup, really.  They
caught it early enough that I didn’t need any chemo or radiation therapy at
all.” Megan was required to have another pap smear test every three month for
the next three years. For two further years she had to have a pap smear
annually. All in all, she describes the aftermath as “constant smears, tests,
and treatment, for about 6 years”.
Nonetheless, Megan says: “I was very lucky, they did not remove
anything essential. They told me they removed more than they felt they needed to
because they wanted to make extra sure they got it all. II
was one of the really really lucky ones because I survived. And I went on to have
more babies… what I went through was nothing, and I know that in my head, it
was nothing compared to most women who have the cancer, most of them have to go
through radiation and chemotherapy and there’s no guarantee that any of that is
going to work.”
Lynette, Annie and Megan survived. None of them had to undergo a
hysterectomy, as many women who have cervical cancer do. They are strong women,
and talk about their experiences in a very matter of fact, occasionally
humorous, way. But they urge other parents to offer their daughters the
protection available against HPV, which will substantially reduce their chances
of suffering in the way Lynette, Annie and Megan did, having to undergo a
hysterectomy, or losing their lives.

Acknowledgements: I’d like to thank Michael Simpson and Alice Warning Wasney for their help with this post, and of course, my three impressive interviewees. 

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When the Good Die Young: How Chicken Pox Took Jesse

Jesse’s picture, and his family’s picture are provided courtesy of his mother, Renay, and posted with her permission.

Jesse Lee was born on November 12, 1991. He was a happy,
funny child, who enjoyed making others laugh, and would say and do funny things
for that purpose.  He had a sense of
humor that was sometimes on the cheeky side, said friends of his mom, Renay –
like his mom. He was “a very caring, loving, kind kid who wouldn’t hurt anyone
or anything”.  His family was close,
loving, warm. He had many friends.  
Jesse had just graduated from third grade and was starting
his fourth. He was healthy, active, charming. He had everything waiting for
him. Nothing prepared Renay for what was about to happen, and the
speed with which it happened left family and friends reeling.
Jesse came home from school on Monday, August 27, 2001 with
a bad headache. Almost as bad as a migraine, Renay remembers. He had no fever,
but he felt horrible. He started vomiting heavily that night and continued through
the next day, Tuesday. He rested as best his could, with his mom watching his
fluid intake and keeping him as comfortable as possible. Worried, Renay slept
in his room for the next few days, watching over him. On Wednesday, when things
were no better, Jesse’s parents took him to the doctor. The doctor prescribed
antibiotics.
Later that day, however, they noticed Jesse had spots over
his chest and belly, signs of chicken pox. And still, no fever. At this point,
Jesse managed to eat a bit. Worried, Renay kept a constant eye on him, and made
sure he was drinking enough.
Jesse was no better on Thursday, except that he was now dry
retching, instead of actually vomiting. He had no fever, but he was in bad
shape. His parents took him to the doctor again, and this time he was sent
immediately to the local hospital, the first of three hospitals he went
through. Renay describes the situation in that hospital as “hectic”; the nurses
were extremely busy, and Jesse was getting very little attention.
In the night between Thursday and Friday, breathing became
harder for Jesse. He was struggling for air. The hospital gave him oxygen, and
X-rayed his chest. That ‘s when they discovered he had a bad case of pneumonia.
He was covered in chicken pox lesions at this point; Renay says, “they went
internally and caused pneumonia”. The local hospital concluded that he needed
treatment beyond what they could give him, and at 7:30 pm sent him to another
hospital. Renay dropped Kimberley at her grandparents house and rushed over,
getting there around 10:30 PM. Renay is not sure why – understandably, that was
not her focus at that point – but that hospital, too, concluded that they could
not treat Jesse and arranged for him to be sent to an even more specialized
hospital in Newcastle. That made three hospitals in less than 48 hours.
A specialist respiratory team came from the Newcastle
hospital, and put Jesse – now receiving oxygen constantly – into an induced
coma for the trip back to Newcastle. Before they put him into the coma, his parents got a last
chance to talk to him while he was still conscious. They said their goodbyes,
not knowing whether or not he would ever wake up, not knowing whether they will
ever talk to him again. Jesse asked his dad whether he was going to die. Paul,
Jesse’s dad, said: “no, mate, we will see you when you wake up.”
In the hospital in Newcastle the Doctors fought for Jesse’s
life. Still in a coma, he was put on several kinds of drugs, and hooked to numerous tubes. But
by this time, says Renay, it was already too late.
By Saturday, Jesse was in critical condition. Renay says,
“they were telling me he was very sick, and they were just doing their best to
help him fight it.”
While Jesse was fighting for his life, his sister Kimberley,
who was brought to Newcastle to say her own goodbyes, was taken downstairs and
given a shot to protect her against chicken pox – not the full vaccine, says
Renay, which she did not get until December, but something to protect her.
Luckily, she did not catch chicken pox.
All through Saturday it was touch and go. Jesse was hooked
to multiple tubes, receiving multiple medicines. His condition seemed to
improve slightly, giving his parents hope. It was short lived, says Renay: “then
he deteriorated and in the end his heart could not take it any more and failed.
His organs just started to shut down. He had chicken pox everywhere, on his
arms and legs, he had them everywhere. He was covered in them.”
Jesse may have looked something like this, or worse:

Numbers based on
Australian data; picture Courtesy of refutations to Anti Vaccine Memes, 
https://www.facebook.com/photo.php?fbid=518429594893721&set=pb.414643305272351.-2207520000.1371660433.&type=3&theater

Jesse left the world just before midnight on Saturday,
September 1, 2001. He was not yet ten years old. Before that he was read the
last rites twice. The Chaplain sang hymn to him. Renay said: “The Chaplain was
wonderful”. Renay asked him to officiate in the funeral, which he did.
The family was in shock. The impact on the community was
also staggering. Chicken pox. A common childhood disease. Who would believe?
Who could believe? And Jesse was gone, leaving a hole in the hearts of his
parents and his little sister and the many other people who knew and loved him,
who were now, says Renay, “shattered”.
“I didn’t know there was a vaccine,” says Renay. The vaccine
came out in Australia six months before that, she learned later.  “Jesse and my daughter Kimberley  have been vaccinated against everything. And I
did not know this vaccine was available. If I had known, he would still be
here.”
It is twelve years now since Jesse’s death. Renay and Paul are brave people; they are living on, working, functioning, taking care of Kimberley,
Jesse’s young sister, and Renay is fighting to protect other children by
raising awareness of the dangers of vaccine preventable diseases. But it still
hurts, every day. Renay says: “I miss him so much. It’s true what they say,
that the good die young.  People have no
idea what we go through every day”.
Renay and I are writing this for two reasons. First, to tell
Jesse’s story. Jesse deserves to have his story told. We want to remind those
who knew him of the wonderful boy lost; and to tell those who did not of who he
was and what happened to him. Second, to warn other parents. Chicken pox is
often a mild disease. But you can’t count on it. Complications can happen. Yes,
it can even kill. Being healthy is no guarantee. There is no way to predict how
it will affect the individual child. And it is preventable. We have a safe vaccine with demonstrated long term effectiveness.
Protect your children. 
Acknowledgements: I am grateful to Renay Newman for sharing her story with me, introducing me to Jesse, and reading drafts and correcting details; Thank you to Alice Warning Wasney and Clara Obscura for their advice, corrections and support. All errors are, of course, my own. 
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Meningococcal: Stalker of our young.

Chuck
was an “Artful Dodger of a cad”, says Maggie. At 14, the 9th grader
was vibrant, full of energy, engaging and funny. “He was a redhead, freckly,
cute as a button boy. He really did light up the room.”  He had “a little
dyslexia” but nothing too serious. Maggie was an experienced teacher, and in
her judgment Chuck was going to be “absolutely fine”. 
He wrote her a letter one day. He told her that although she was hardcore, and
gave them no breaks, he appreciated the fact that she shouted “Safe and
sane!” every Friday.
Because
of his parents’ divorce and his anger at them, Chuck ran away from home. No one
knew where he was staying: each parent thought he was staying with the other,
while he was actually staying with a friend. Maggie knew something was wrong,
but did not know exactly what.
Maggie
does not remember if it was Monday or Tuesday. Chuck had “a horrid headache” in
class in the morning. He kept putting his head down. Maggie kept rebuking him.
She told him to go to the nurse if he was sick. If he was not sick enough to go
to the nurse, he should sit up in her class. A girl sitting behind Chuck
massaged his neck and shoulders, and told him to “come on.” Maggie told her to
“keep your hands off him, we don’t want to reward him for being lazy”.
Later that afternoon Chuck was caught shoplifting. His
headache got so bad he really needed aspirin. Since he was a runaway, he had
none. So he stole some from a store, and got caught. He was in such bad shape
at that point he was taken immediately to the Community Hospital. They could
not save him. He was dead by 7 pm that night.
When
Maggie arrived at school the next day, she saw a school counselor that worked
with Chuck. The counselor said: “Maggie, I need to talk to you about Chuck.”
“Yes,” agreed Maggie. “We need to get him pinned down.” “No, it’s not that,”
said the counselor. “He’s dead.”
Maggie
described this as devastating. Devastating to her, devastating to the
community, and above all to Chuck’s parents. Maggie says, “His parents
were absolutely heartbroken. They were so immersed in their own little drama
that they felt guilty that they have not checked with other. And he was an only
child.”
In addition to the psychological consequences, she remembers that everyone who came in touch with
Chuck – 1400 children, all the adults that had contact with him, and their
family – had to take Rifampin for a month.
Maggie had two little girls, also at risk, also now on the medicine, as was her
partner. She was frightened.
Two
weeks after Chuck’s death a girl burst into tears in class. She was crying
orange tears, from the medicine.
Meningococcal
disease struck Maggie’s students twice more, in 1998 and 2000. This time the
victims were undergraduate students in classes Maggie was teaching as an
Adjunct Professor. Again, the students had a bad headache, and were dead
shortly after. Maggie says: “What’s amazing is how fast they go from I
don’t feel so well, or I got a really bad headache, to dead in about six
hours.” There was a vaccine available at the time; but it was only recommended for high-risk groups. The vaccine was recommended only after the new, conjugate vaccine was licensed in 2005.[1]
******
Meningococcal goes for our young. Children under 5 are
most at risk, followed by adolescents .
People who live in close quarters  – like
college students in dorms – are also at risk.[2] It
kills 9-40% of the people who catch it, depending on the form it takes.
Young Landan Harris was one of the victims of the
disease. A happy, beautiful toddler, he was 3 when he died.

Picture taken from: http://www.meningitis-angels.org/LandanHarris.html, with permission from Lacey, Landan’s mother. 

He was crabby in the evening. His mother described
what happened next (the text is taken verbatim from the site his mother, Lacey created to honor her son’s memory):
“At 9am I woke up to find Landan laying on the floor next to my bed
covered in, what looked to me, like bruises. I thought he was dead, I was so
afraid to touch him. I called my mom & then called 911. We took him to the
best children’s hospital in the area ….
His left foot was completely purple, so were his entire back &
nose. His other extremities were very splotchy purple. … If Landan would have made it he would have had several amputations. But
selfishly we would have taken him any way we could have him as long as he was
still here with us.
Landan fought for 23hrs [sic] at the hospital enduring 3 hyperbaric treatments.
The treatments were helping bring back color to the purple areas. They said it
was a miracle he lasted as long as he did, that’s why are [sic] hopes were
high.
His little heart finally couldn’t take it anymore & stopped, we
watched them doing chest compressions & then the doctor stopped
& my mom asked him if Landan was gone & he said yes, there was no
more brain function. I still was unable to cry at this point, I couldn’t
believe what I’d seen with my own eyes & that he was gone.”
Landan’s mother Lacey created a YouTube dedicated to his
memory.

She is now working to raise awareness of this disease, and
especially of the availability of a vaccine for it. Other parents, suffering
similarly, created the National Meningitis Association, to raise awareness of
the disease and the existence of the vaccine, and offer support to victims and
their families: .
****
About 20% of those who survive the disease will have
lasting damage, including  “hearing loss, neurologic damage, or loss of
a limb.” 

Here is one
such little girl:

Courtesy of:
https://www.facebook.com/pages/The-Vaccine-Meme-Machine/302477036534120, who got it through Charlotte’s website, http://www.charlottecleverleybisman.com/.

Other
pictures of the disease can be seen here – scroll down for pictures of children
suffering from it. Warning: these are hard pictures.

******

One of
the problems highlighted by the National Meningitis Association is the lack of
awareness of the vaccine.  In the United
States, the vaccine is recommended for teenagers but parents may not be aware of
it. Losing a teenager or young adult is always painful; losing them when there
was a vaccine available, and it could have been prevented, but you did not
know, is excruciating.
Somestates now require the vaccine before a student can enroll in a public
university, and others require that students and parents be given information
about the disease and the vaccine. Hopefully, this can help raise awareness among parents, teenagers and young
adults, and help protect them.
The
vaccine is also recommended for high-risk toddlers and infants but notroutinely for toddlers or babies.  In contrast, in Australia thevaccine is recommended at the age of 12 months. The
currently used meningococcal vaccine covers only certain types of the bacteria, and it does
not cover strain B, the one responsible for more than 50% of the cases inchildren under one. So there is no recommendation of the vaccine for routine use in young children. A vaccine that covers strain B
was approved in Europe but as far as I know is not currently in use. Several
vaccines that cover it are currently at different stages of testing in the
United States. 
Lacey,
Landan’s mother, strongly urges parents to get the vaccine for their young
children as well, if they have access to the vaccine and can afford it, imperfect as its coverage is. She wants to protect other
children from what happened to Landan.

She
convinced me.

Acknowledgements: Thank you to the National Meningitis Association, Alice Warning Wasney, Clara Obscura, and Paul Offit for advice and help on this post. Thank you to Maggie and Lacey for sharing their story. 


[1]
Paul A. Offit and Charlotte A. Moser, Vaccines and Your Child,  196 (2011).
[2]
Id.
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Polio through the Eyes of a Child

Judith remembers
the day when it all started very, very clearly. “I was 6, almost 7.  It was in late August 1949 in Connecticut. I
jumped out of bed to run to the bathroom and fell and then couldn’t get up.”
Judith was very, very frightened. By the next day, she was paralyzed from
the neck down. The doctor was urgently called, although it was late at night,
and at his instruction, Judith was immediately transported to the hospital.
Judith thinks that she was taken in her parents’ car, but she is not sure: by
that point, she was running a high fever, and was only partly aware of her
surroundings. The hospital was an hour’s drive away. Upon arrival, Judith’s
parents told her, she was put in an iron lung. Her parents were told she was
not going to survive. Judith was not aware; she says: “I think I was unconscious. My first memory is
waking up and seeing the iron lung next to the bed… I had been removed from
it”.

                         Iron lung picture courtesy of “The Vaccine Meme Machine” –             https://www.facebook.com/pages/The-Vaccine-Meme-Machine/302477036534120?fref=ts
There were 200
children in the hospital, some very young, infants or toddlers in diapers.
There was a shortage of nurses because many nurses, after serving in World War
II, quit their hard, challenging jobs and went home to marry and raise a family.
For the first month, Judith was in quarantine. Here is how she describes that experience:
“Twice a day, an orderly comes in
with a stack of towels, fills the washer tub with steaming hot water that
snakes through a black tube from the faucet, and drops them in. The towels are
actually cut-up recycled army blankets. With gloved hands he feeds the dripping
wet wool towels into the wringer and then passes them to a nurse, who wraps
them around the girl’s arms and legs. The therapy is working; each day she is
stronger. She is coming back to life.
This morning, her blanket and
top sheet are drenched, but not from the hot packs. A while ago the nurse
brought in a breakfast tray with Rice Krispies and a glass of orange juice,
then poured milk into the cereal bowl, filling it almost to the top. “There you
go, honey,” she crooned. Later, when the girl spooned the cereal into her
mouth, the milk slopped over and ran off the tray. When the nurse came to
retrieve the tray, she saw the mess. Angry, forgetting herself, she said,
“Clumsy girl. You’re going to have to wait until I’m done with my rounds.”
The girl can shut out this world
by remembering the earlier days of summer when she played on the beach everyday
and learned to swim. She relives the first moment of trusting the water and
lifting her feet from the soft sandy bottom, kicking a splashy wake behind her.
.. the nurse returns and
wordlessly pulls off the wet sheet and blanket and flings crispy dry ones over
the girl, tucking them in quickly. A warm tingly flood of relief flows through
the girl. She is respectfully quiet and watches the nurse, who looks a bit like
her mother, except she’s older and her mouth is turned down. She has black
shiny hair pulled up and tucked under a white cap with “Englewood Hospital”
embroidered on it. Her uniform has dark stains down the front and she wears a
wedding ring.
“Your mother and father are
coming to visit today,” the nurse says, going over to check the window and then
looking out at something below. “You’re a lucky little girl,” she says, turning
back to face her, “but better mind your Ps and Qs.” The girl thinks these are
actually conditions the nurse has placed on the visit and she thinks about how
she may have misbehaved. A child in the room next door starts to cry.
She was brought here in the
middle of the night about a month ago, and no one has told her what that means
and she does not know what questions to ask, nor does she dare because maybe
she is not supposed to know why.
An orderly comes to the doorway
and drapes what looks like chicken wire across the entrance to waist level,
hooking it onto nails driven into the sides. “Getting ready for your visitors,”
he says, leaning in a bit. The child next door stops crying. The girl’s eyes
close and she falls asleep, dreaming about her little sister.
She is awakened by the sounds of
her visitors. “Hello, sweetie,” her mother calls from the doorway, waving. She
has on red lipstick and wears a yellow ruffled summer dress. She lightly pushes
at the wire mesh and ruefully blows a kiss toward her daughter. The girl’s
father stands stoically next to her mother, smiling and brave, like the soldier
he still is. The girl is half sitting up and straining to see the details of
them, but they are so far away. She wishes they could all leave together and
drive to the beach in their yellow Plymouth convertible and swim under the hot
sun.
“A present for you,” her father
says, and he aims and tosses a bright green rubber frog in a gentle arc toward
the bed. It bounces off and onto the floor, skittering away. “Oh, dear,” her
mother cries, “now it’s no good.” The girl knows this is true; anything that
touches the floor is taken away because now it has germs on it. She fears for
the fate of her lifelong panda bear with the black button eyes. “We’ll get you
another one next time,” her father announces, fixing the problem.”
******
 After the first month, Judith was taken out
of quarantine and moved to a ward with other recovering children. She spent
four more months there, for a total of five months in the hospital, away from
her family. Understaffing made things harder. Judith says: ‘I remember things being so bad that we had to
share a bedpan, over and over, passing it around.  
While
I was in the hospital, my family was ostracized. People stayed away from them
because they thought they were contagious.”
After
returning home, Judith had a severe fear of being abandoned, and was afraid to
let her mother out of her sight. Once her mother left Judith in the car to go
into a store. The distraught little girl became hysterical and started
screaming, causing a crowd to gather around the car.
Judith
concludes: “I was lucky. Only one leg was left paralyzed. I went through
physical rehabilitation and had surgeries. I developed severe scoliosis and had
to wear a back brace along with the leg brace. I was anxious and depressed,
although in those days people didn’t talk about their feelings, and so I didn’t
either.” Judith was also surprised to discover that her sister believed she had
lost all feelings in her leg. That was not true; she had “total feelings” in
the leg.
Judith
recovered. But she concludes: “I never really had a childhood. I never played
sports, danced, ran or hiked in the woods.
If
there’d been a vaccine, obviously I would have been vaccinated.”
She
does not understand why anyone would refuse to vaccinate. From her point of
view, they are lucky to be ignorant about the potential consequences of such a
decision.
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Measles: Common, yes; Mild, no

Maureen does not remember much from her experience with
measles. She remembers “being in a huge room all by myself. And I remember the nurse
with the blue eye shadow who gave me needles. I hated her.” Maureen was four,
and the year was 1960, before the measles vaccine. She had a very bad case of
measles. Her mother told Maureen that she “even had spots on the soles of my
feet”. The measles turned into pneumonia; Maureen was hospitalized and in an
oxygen tent. She spent a week in the hospital. The doctors thought, initially,
that she had scarlet fever because she was having so much trouble breathing.
Then they confirmed it was measles. 
Measles in history:
Measles was documented at least as far back as 900 BC. Here is a short summary of its history, courtesy of Refutations to Anti-Vaccine Memes:
Here is an example of what it can do to a population, from the same source:
Measles did not only affect the poor or malnourished. In 1711,
the son and heir of Louis XIV, the French Dauphin, succumbed to smallpox, and
his son became the dauphin. On February 5, 1712, the new Dauphin’s young wife –
princess Adelaide, then 26, and the joy of the aging monarch – developed a
fever. Two days later, her condition worsened: “A piercing pain, worse than
anything she had ever endured, then laid her low and continued for twenty-four
hours despite the best (or worst) efforts of doctors… At last some spots
emerged and fever was announced; hope was felt that she would recover when the
rash had broken completely. It did not happen. … by daybreak on Friday 12
February the Princess was in extremis. Her fever continued to rise, and
eventually she died.” The young woman knew she was dying, and accepted her
fate.  “Six days later, her husband
followed her to the grave. Their 5-year-old son died on March 8. All that was
left was the younger son, only two years old… (Antonia Fraser, Love and Louis XIV).
Measles in the pre-vaccine
20th Century:
In 1916 measles killed nearly 12,000 people in the United States – most of them under the age
of five (Note also the
video in the link, describing the complications).
Measles is extremely contagious; in the pre-vaccine days, pretty
much everybody got it – between 1953-1962, there were over 500,000 cases a year
in the United States, with 440 deaths a year on average.
Even in regular, uncomplicated cases, measles can be painful and miserable.
Meleese remembers when she and her brother caught it: “My brother hallucinated
from the fever. I was kept in a darkened room and not allowed to read – for 2
weeks – pure torture as I was a bookworm and an early reader. I was about 7-8
and could read before I started school.”
Says Robin: “I was 5, I
think. I remember mum worrying that my sisters, who were tiny babies, would get
it. I was so sick I didn’t eat for a few days, and had a huge fever and
vomiting. I remember I had never felt so sick in my life. I had been
vaccinated, and was lucky that it was comparatively mild.”
Alice says: “I was 8, in third grade. I was so sick I don’t
really remember much of it. I do know that I spent days in my room with the
window shade down, alone, and I must have been very sick because I don’t
remember being bored or asking if I could have something to read. That alone should
tell the tale. The other thing I remember is the look on my mother’s face when
I got better. She was never one to let us see if she was worried when we got
hurt or were sick. There was a lot of, “Shall I call an ambulance?”
if we cried over a skinned knee, even while she made sure it was well taken
care of. But the day she allowed me to come downstairs and lie on the couch,
with her sunglasses on (Her sunglasses, which none of us were allowed to wear
and which always stayed in their case), she asked me if I was hungry and what I
might want to eat. The look on her face when I asked for a hamburger is still
in my mind. She didn’t say anything but, “Oh, you must be feeling
better!” and went right out to the kitchen to get it, but I could tell how
very relieved she was.”
Here are some examples of the measles rash on children:
Courtesy of the CDC/Dr. Lyle Conrad, provided through the Public Health Image Library, found at: http://phil.cdc.gov/phil/details.asp?pid=6887
Courtesy of the CDC/Dr. Barbara Rice, provided through the Public Health Image Library, found at: http://phil.cdc.gov/phil/details.asp?pid=990
The complications were estimated at about 30%, and the
complications could be really bad. They included pneumonia, encephalitis, ear infection that could lead to deafness or hearing loss and other problems. Says Alex: “My mom had it as a kid, as did all my aunts and uncles.
My uncle went blind in one eye, and my mom ended up with impaired vision and
hearing loss. My uncle really took the blindness hard, not at the time, but
later in his teen years.  He wanted to
play sports, but vision in one eye only ruined that.”
And even without malnutrition, at a rate of about 1 or 2 in a thousand,
measles killed. Author Roald Dahl’s daughter, Olivia, was one of the victims.
Olivia was seven when she got the disease. Initially, it looked like all would
be well. But, tells us Dahl, “Then one morning, when she
was well on the road to recovery, I was sitting on her bed showing her how to
fashion little animals out of coloured pipe-cleaners, and when it came to her
turn to make one herself, I noticed that her fingers and her mind were not
working together and she couldn’t do anything. 

’Are you feeling all right?’ I
asked her.
‘I feel all sleepy,’ she
said.
In an hour, she was
unconscious. In twelve hours she was dead.
The measles had
turned into a terrible thing called measles encephalitis and there was nothing
the doctors could do to save her.” The vaccine was not yet available for
Olivia; in his moving story, Dahl called on parents to protect their children
from Olivia’s fate and vaccinate.
Then there is the latent killer. SSPE, subacute sclerosing panencephalitis. If a child got
measles while young (typically under the age of two), they could develop this
rare but incurable complication. Some years after the disease – 5 or more – the
measles virus would start destroying the child’s brain cells. It is
unpredictable how SSPE would develop – but it leads to slow deterioration of
the child’s skills, and eventually, death.
This is what happened to a little girl in Germany named
Angelina, as told by Just theVax and Skepticalraptor. Angelina had
measles as a 7 months old baby, before she was to be vaccinated, and seemed to
recover. Then, a little before the age of 6, her mother says “”In February of this year, we noticed pronounced problems with our daughter. She kept falling off her bike, and had speech blockades. When this was getting worse, we went to the clinic. The diagnosis SSPE was a shock for us. Our child became dependent on care within 8 weeks. She cannot walk nor speak and needs to be tube fed. She would have entered school this year. This blow of fate is very hard for us all.”” All that is left for the
parents who raised her lovingly for six years to do is watch her deteriorate
and die.
Measles today:
We have an extremely effective (though, of course, not 100% effective) vaccine against measles today.
The MMR provides long term, maybe lifelong immunity to 99% of people who
receive two doses. Still, measles kills over a hundred thousand people, most in
the third world. According to the World Health Organization “In 2011, there were 158 000 measles deaths globally – about 430
deaths every day or 18 deaths every hour.”  That’s a decrease fromover 500,000 in 2000. Most of the deaths are
in children under the age of five. Lack of access to the vaccine costs life;
and malnutrition and vitamin A deficiency make measles much more dangerous.
Consider, for example, the recent epidemic in Pakistan. In one of the hospitals:
“The
ward is so packed with babies and young children that they are sharing beds. At
one stage, up to 70 new patients were arriving at the hospital every day. They
are covered in rashes and burning with high temperatures, some fighting for
life.
In
one corner, a boy lies motionless on his back, his eyes rolled back as flies
crawl across his face.
At
least 40 children have died in this hospital since the epidemic spread from
southern Pakistan to Lahore and other parts of Punjab province at the beginning
of the year.”
A
family whose children were not vaccinated is watching their daughter struggle.
“Mohammed
is cradling his daughter Yasmeen, who will be two this summer. She is covered
in the measles rash and has had an alarmingly high temperature.
Just
a few days ago, her brother Ehsan died at the Lahore Children’s hospital from
complications arising from measles. He was nine months old.
‘I
didn’t get him vaccinated because I was on my own at home with so many
children,’ says Nasara. [the mother] ‘And we had to go out to get the
vaccinations, so it was difficult because they were small.’”
In
the first world too, outbreaks increased in recent years, affecting primarily
the unvaccinated, including children too young to vaccinate. And they came with
complications – not as many deaths as in the third world, but still,
preventable deaths and disabilities. In 2011, Europe saw 28,868 cases.
Over 80% of cases were in unvaccinated individuals. The largest infected group
were children under one year old whose parents will only know many years after
the fact whether or not they will develop SSPE. The known complications
included 8 deaths, 26 cases of encephalitis, 1040 cases of pneumonia, and over
a thousand others.
Outbreaks
were also seen in the UK, concentrated in Wales.
The
United States had so far seen lower numbers of cases,
though outbreaks seem to be increasing recently. 2013 has so seen outbreaks in
North Carolina,
in Colorado, and in an Orthodox Jewish community in New York, among unvaccinated individuals. Several outbreaks started with an unvaccinated individual traveling abroad and
coming back with the disease.
Measles
does not have diphtheria’s mortality rate of 10% or polio’s scary paralysis.
But it is not an easy disease by any means, and it can cause very nasty
complications in substantial percentages of those who get it. It is also very
contagious, and can come back easily as vaccination rates drop. And it is
preventable: we have an extremely effective vaccine. Given this background,
allowing measles to come back, bring certain pain and suffering and potential
complications, even death, seems, well, just wrong. 
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Life in the Shadow of Vaccine Preventable Diseases

Bill was born in England, in 1936; he lived through the
blitz. He had an older sister and a younger sister. After World War II, two
more brothers were born. Bill says: “Disease was a constant part of our lives. Mother drummed it into
us that we must wash regularly or we would end up with a deadly disease… My
first memory of an outbreak was when my sister and I caught measles. It went
through the school like wildfire. I was quite young and I don’t recall too much
except being kept in bed in a darkened room because my eyes were very painful.
Mumps followed. Chicken pox. my mother told me that I had a mild case of
whooping cough.
“It was when I was a bit older in the late nineteen forties at
school with the usual circle of friends and when my younger sister and two
brothers came along that I became aware of the shocking effects of some of the
diseases. My brothers both caught whooping cough more or less at the same time.
I was horrified to hear them cough so deeply, retching as the cough forced more
breath from their lungs than they could possibly hold, going blue in the face
then a tremendous breath inwards with a blood curdling gasping ‘aaaaaaaaagh
whoooooop’ which seemed to go on for a long time, lungs expanding beyond their
control, then coughing it all out again to start all over. Mother called the
doctor but he was too busy to call immediately because the disease was
everywhere. We heard later of those who were permanently brain damaged by the disease.
I knew one girl who suffered brain damage, which affected her for the rest of
her life.
“When my younger sister caught measles I had to soak bedsheets
and flannels in cold water to help control the fever she had. Once again we
heard of others who were permanently affected. We were running scared of the
effects of these diseases.”
School years were no better: “…at least two friends of mine were
badly affected by polio in the 1940s, one had a permanent limp and the other
had a withered arm for the rest of their lives. One boy at my school died of
the disease when I was there. The spectre of being put in an iron lung hung
over us. When there was an outbreak of polio (known in those days as infantile
paralysis) we never went swimming, or to the sports changing rooms, school
toilets were dreaded places for fear of catching the disease in those places.”
                            Picture courtesy of CDC, found on the Public Health Image Library.
Polio was not the only disease to affect his school mates:  “Two died of influenza. One is deaf because
of measles.”
Bill worries about decline in vaccination rates. He worries that
it might “bring those miseries back to haunt our children and grandchildren”. He
points out that: “We
children knew nothing different, it is only with the benefit of hindsight that
we can see how bad it was. Nowadays, very few people are even aware of the
mental, social and physical toll those fears had on past generations. The
stress felt by mothers looking after their sick and suffering offspring, caring
for the disease damaged for years, watching their children die, must have been
dreadful for them.  ” 
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Pertussis (whooping cough): When a Baby cannot Breathe

Greg says: “Pertussis nearly cost me my life and my future, and I was a
healthy 18 year old. I cannot see how any infant can survive what I went
through.” Today, still (or again) some parents are forced to watch their babies
struggle to breathe because of whooping cough, and for some, it ends badly. Any such death is a tragedy;
but the rates today are much, much lower than before the pertussis vaccine
existed (and hopefully, we can keep it that way). Before the whooping cough
vaccine many infants were killed or scarred for life
by this cruel disease.
In 1941, according to the President of the RoyalAlexandria Hospital in Sydney, Australia, 80 children died from whooping cough,
out of 293 hospitalized, four times the number of cases of diphtheria.
In summer 1948, at least 24 children died in Adelaide from whooping cough and
the disease was spreading to Melbourne, with 2 babies dead at the point of the
article.  In 1950 in the Northern Territory in
Australia, 19 babies died;  many more
were hospitalized.
A newspaper article described it as “the cause of half of all deaths of children in
the first six months of life”.
In the United States, in 1934, there were 265,269 cases of
pertussis (whooping cough) and 7,518 people died from it.
Compare that to 2012, a year with very high rates of pertussis, where with a
much larger population in the United States there were 41,000 cases and 18 deaths: the post vaccines
numbers are substantially lower even with the recent problems with the new
acellular vaccine.
What does whooping cough do? It starts with a runny nose,
“sneezing, low-grade fever, and a
mild, occasional cough, similar to the common cold. The cough gradually becomes
more severe, and after 1–2 weeks, the second, or paroxysmal stage, begins.” CDC. Then it gets worse. In older children and adults: “The whoop is unmistakable.
It is a spasmodic cough, consisting of a number of quick expirations followed
by a long, shrill, indrawn breath and followed by expulsion of mucus from the
throat, or sometimes vomiting [sic]. Usually three or four spasms follow each
other, leaving the child gasping and exhausted. It is quite common for children
to cling to some support or to another child to gain breath.” Another article said: “If the coughing spells are very severe, the patient’s
face may become deep red or purple, the veins of the face and scalp may
swell, and the eyes fill with tears. Young children are especially likely to
vomit after a spell of coughing.”  
There is no
real treatment – the CDC describes the treatment as “supportive”, while
highlighting that antibiotics can help if the disease is caught early enough. 
Even without
complications, it is a long, hard disease. Says Greg, who had the disease at
the age of 18:
“I was coughing so
hard I would vomit and pass out at least once daily for seven months…. I was on
inhalers and a cocktail of drugs and none helped, only time. There were times
when I very literally accepted that I was about to die – my throat would swell
shut and I would suffocate until I lost consciousness, often vomiting while I
was coughing or even while I was passed out. The coughing fits were so severe
that I would pull muscles and rupture blood vessels and I had so little energy
that I needed to nap several times per day. I couldn’t sleep at night, my
roommate hated me because I kept him up by coughing too, and I couldn’t work
for most of the year because of all of those factors.”
Even if you survive, the harms from the disease may stay with you:
“Rae
MacAlpine was four when the disease, which claimed countless babies in her
generation, invaded her tiny lungs. … A hacking, painful cough is a daily
reminder of the sacrifices she has had to make ever since the childhood disease
left her with the chronic lung infection bronchiectasis.
She
still weeps when recounting how, as a young wife, she became so embarrassed
about the cough and subsequent mucus, that she asked her husband to stop
kissing her.
When
her children were small, she could never hold them close to her face for fear
she would have a coughing fit.
She
has lost count of the days and weeks spent in hospital with pneumonia or
undergoing torturous lung taps and operations to “wash and drain out”
her chest.” 
Those highest at risk from the disease, and most
likely to die from it, were always infants. Unfortunately, we have recent evidence
of what the disease can do to them. Rates of whooping cough, while still much,
much lower than before vaccines, have risen in the last decade or so. This
cannot be placed only, or even primarily, at the feet of the anti-vaccination
movement; scientists were dismayed to find out that the protection provided by
the acellular pertussis vaccine (containing only a minute part of the pertussis
bacteria), adopted in the 1980s after popular concern about the side effects of
the whole cell vaccine, waned much quicker than they expected.
The acellular vaccine provides less protection,
and it’s for a shorter time. That said, it is important to remember that rates
of whooping cough are higher among the unvaccinated (see also here) and outbreaks are more common in
areas where there are high concentrations of unvaccinated individuals, putting at risk even the vaccinated in those areas (and see here). An unvaccinated child or
adult is still more likely to pass the disease on to a baby. How does it affect
babies?
Little
Osman, at 7 weeks, caught the disease. According to the excellent Australian
documentary Jabbed, “What started as a runny nose and a mild cough has become frightening
episodes when he is struggling to breathe.” His mother said: “My little son Osman
has been sick from Monday, He started changing color to blue, and after they
found out it’s the whooping cough.” Here is little Osman suffering from
whooping cough. Warning: these are hard scenes.
Little Osman
fully recovered, happily. So did little Tyce. Other children were not so lucky, and in
recent years, several parents had to endure watching an infant die painfully
from it. Shotbyshot.org features, among others, the stories of SebanaBrady, Kaliah, Carter, and Dylan. Here are a few short quotes from Kaliah’sstory:
“After 3 hours of surgery to
implant the ECMO machine, I remember going back in that room to see her. I
could barely recognize her. My little girl was swollen everywhere. Her eyes
were more puffy then before, she felt like her skin was tight and full, she was
also really warm. There were two tubes inserted by her neck and right shoulder.
… Kaliah’s body was turning purple from all the blood and medicines leaking
from her veins. It was so hard to see her that way… [after learning there was
no more hope]: I held my sweet baby in my arms, with Tanner beside me; we held
her hands. I kissed her on the forehead and told her I loved her so much and
she wouldn’t have to fight anymore. Tanner kissed her on the hand and told her
he loved her. A few moments later we were doing the hardest thing I think I
will ever have to do in my entire life. We watched the doctor take her off life
support. Kaliah gasped for breath. We sat there and watched our little girl
go.” 
Vaccines
reduced the rates of whooping cough, and are our best hope for protecting
babies from this danger. The CDC now recommends that expecting mothers vaccinate
during the third trimester of their pregnancy, to offer more protection to their newborns, so much
at risk, until they can be vaccinated. It also encourages those coming to
contact with newborns to get a booster shot. Pertussis kills babies; we owe
them the best protection we can give.
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