Remembering the Pre-Vaccine Era: The Diseases of Childhood

Many of us of a certain age have vivid memories of the “diseases of childhood.”

We remember missing weeks of school, sky-high fevers, spots and pox, cheeks so puffed from mumps that eating was impossible, for days. Our mothers, for they did most of the parenting back then, would intentionally expose us to sick kids, so we’d get the scourges over with ASAP. The lucky among us made it through with just a pockmark or two.

I had the injected Salk polio vaccine as a toddler, but by the time my sister crunched her pink sugarcube of oral polio vaccine years later, I understood why vaccines were part of life. Protect many and you protect nearly all, because the infection can’t spread. It’s just common sense. Vaccination especially protects kids with chronic diseases, like cystic fibrosis, who can’t be immunized, as well as babies too young to have been immunized.

I posted my own “vaccine memories” last July, ending with research revealing a much more likely cause of autism than vaccines. For this post today, I asked a few friends about their memories of the diseases of childhood. First is Robert Marion, MD, a pediatrician at the Albert Einstein College of Medicine and chief of the division of genetics at the Children’s Hospital at Montefiore. He wrote one of my favorite books, Genetic Rounds: A Doctor’s Encounters in the Field that Revolutionized Medicine.

640px-Polio_vaccine_posterFROM A PEDIATRICIAN

“Until the last few years, the campaigns to immunize children against measles, mumps, rubella, diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzae, and others, have been so successful that most young pediatricians have never seen a single case. But these conditions were the bread and butter of pediatric practice prior to 1960.

The measles-mumps-rubella (MMR) vaccine was developed in the early 1970s, but each of the components was developed in the 1960s. Rubella (German measles) vaccine in particular was developed because of the devastation of congenital rubella.

Throughout the mid 20th century, epidemics of rubella raged every couple of years. Although the disease itself was mild, pregnant women contracting the virus were at risk to have children with deafness, blindness, congenital heart disease, failure to thrive, intellectual disabilities (then called “mental retardation”), and….yes, you guessed it…..autism. How ironic is it that the vaccine developed to prevent the leading cause of autism became the focus of this pseudoscientific crusade to prevent all humans from using vaccines? Pretty amazing, huh?

We see a fair amount of pertussis because it causes its real harm in very young children, before their full course of immunizations is complete. This is a life-threatening illness in infants, who cough so much that they can’t take in air. They’re at risk to develop hypoxic-ischemic encephalopathy, permanent brain damage, as a result, and every year, there are deaths from pertussis in the very young. About 10 years ago, I learned first hand that the pertussis vaccine does not bring life-long immunity. My son, a teenager, developed whooping cough and required intensive care for a few days. Not a lot of fun.

When I was an intern in the winter of 1979-1980, I cared for an adolescent girl who was brought into the hospital by ambulance, comatose. A few hours earlier, she’d complained of a headache, low grade fever, and became lethargic, confused, and finally unresponsive. Just like that. Seemingly out of the clear blue.

When we examined her, we noted healing scabs on her trunk and legs. On questioning, her parents (who spoke little English) let us know that she’d recently gotten over chickenpox. ‘But that was over a couple of weeks ago,’ they told us, implying that that illness couldn’t possibly be related to this illness. Of course, it was.

She had post varicella encephalitis, a rare complication of chickenpox. This poor girl’s CT scan showed cerebral edema with loss of myelin. Her spinal tap showed increased intracranial pressure.

We admitted her to the ICU. We put a bolt in her skull to measure her intracranial pressure. We treated her aggressively to keep the pressure in a tolerable range, so that her brain would continue to be perfused with blood, giving her mannitol (a powerful diuretic) every time her intracranial pressure spiked. We stayed on top of her.

She remained in this state, in the ICU, unresponsive to all but the most painful stimuli, for about five days. She then started to “lighten up,” raising her level of consciousness. Her intracranial pressure normalized and we were able to remove the bolt. One week after admission, we transferred her from the ICU to the medical floor.

Measles

The girl remained in the hospital for nearly a month, and then she was transferred to a pediatric rehab hospital. Because of the demyelination, she had lost significant muscle strength and wasn’t able to walk, barely able to sit up on her own. According to her parents, she had regained many of her cognitive skills, but when she left, they told her that she still “wasn’t herself.” I never saw her again, so I’m not sure whether she ever regained all of her function. But it’s clear that all of this could have been avoided had there been a vaccine.”

FROM NON-DOCS

Even routine cases of the childhood diseases were, at the very least, disruptive. Even if a kid wasn’t particularly ill, the disease spread.

“I had chickenpox in the third grade. I got hundreds, in my nostrils, in my throat, on my scalp, everywhere inside and outside. I couldn’t blink without it hurting. I wore gloves at night so I wouldn’t scratch my face. I couldn’t swallow, so I couldn’t eat. When I was finally better and put on shoes, they were too big because I’d lost so much weight. It was horrific. I was 8.” Sharon P., lawyer in NYC

“In 1960, when my father, who had a withered leg from polio, and my mother took me and my sister to get our oral polio vaccine, a line snaked around the block. Every kid in the neighborhood was there and nobody, but nobody, was talking about not getting it.

In high school, I caught rubella and wasn’t sick, just covered with red dots. It was the last day of the school year and I wanted to get stuff from my locker. On my way out, I stopped to say goodbye to my favorite English teacher. I told her I had German measles, thinking it was a sort of joke, and she just shrank away from me and whispered, “I’m pregnant!” I rushed out of the room and went home and stayed there. I felt awful and never saw her again.” Jennie Dusheck, science writer

“My sister and I both got measles midsummer. We were confined to our bedroom. Mom had to keep the drapes closed and we had to wear sunglasses to protect our eyes. I remember all the red splotches and being very itchy and some sort of lotion being applied. We stayed in that room for 7 days, with high fevers, not feeling well at all, and sleeping a lot. It’s hard to believe any parent would want to put their child through that!

Mumps_PHIL_130_loresI didn’t get mumps, but my mother did! It was during May of my senior year in high school. I had a huge term paper due and Mom was going to type it. I was also preparing to go to my senior prom, and give a speech at the National Honor Society induction ceremony. The day before that event, Mom started to get swelling in her face and throat, but the day of the induction ceremony she wrapped a warm scarf around her neck and attended. She could have infected lots of folks by being there. She went to the doctor’s after that and got the mumps diagnosis, and then was instructed to stay in the house. And she did type my paper!” Phyllis Kovall, music teacher

I don’t usually resort to name-calling, but in the case of refusing vaccines, I bow to a New Yorker cartoon by e. flake that shows a doctor examining a spotted child, in front of two befuddled parents: “If you connect the measles it spells out ‘My parents are idiots.’”

Indeed they are. It isn’t cool to be anti-science, or anti-medicine. It’s dumb. And deadly.

UPDATES

eman and flagsI was gratified to read in The New York Times, The New Yorker and elsewhere about the self-appointed neighborhood public health groups in Liberia who have slowed and possibly halted the Ebola epidemic. Emmanuel Gokpolu, my young friend in Liberia, led one of those efforts, chronicled in How Ebola Kills and previous posts.

DNA Science covered use of mitochondrial DNA from a third party to create embryos free of mitochondrial disease nearly a year ago, when researchers debated the controversial technology at an FDA hearing. The news this week isn’t about the science, but about renewed discussion in the UK. I’ll get back to mitochondria soon, about a way to possibly fight mitochondrial disease without tinkering with embryos.


Ricki Lewis is a science writer with a PhD in genetics. The author of several textbooks and thousands of articles in scientific, medical, and consumer publications, Ricki’s first narrative nonfiction book, The Forever Fix: Gene Therapy and the Boy Who Saved It, was published by St. Martin’s Press in March 2012. In addition to writing, Ricki provides genetic counseling for parents-to-be at CareNet Medical Group in Schenectady, NY and teaches “Genethics” an online course for master’s degree students at the Alden March Bioethics Institute of Albany Medical Center.