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Never forget

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When the first vaccine for polio came out in the mid-1950s,  polio was causing over 15,000 cases of paralysis and close to 2000 deaths a year in the United States, mostly in children.  Smallpox, likewise, was still causing millions of deaths worldwide each year.

Growing up, I’d still seen cases of people afflicted with polio and had first hand experience with chicken pox as well as German measles.  Since then, I’ve happily rolled up my sleeve for any vaccine recommended for healthcare professionals and the occasional recommended vaccination for foreign travel.

As a result of this willingness, however, I suffer, like most people from a notorious Catch-22… Since vaccines save us from diseases, they can cause us to forget the diseases from which they save us.

Once the threat appears to be gone from our lives, we become lax. Or worse, we make up other things to worry about. Thus, some well-meaning parents avoid vaccinating their children out of misplaced fear that the MMR vaccine (for measles, mumps and rubella) causes autism. Never mind that independent scientific studies have repeatedly demonstrated that no such link exists, most recently in a study of 657,000 children in Denmark.

This irrational fear is why measles has become resurgent, not only in the Philippines but in other parts of the world, even in the United States, which has experienced almost 1,200 cases of measles so far this year, almost two decades after public health officials proudly declared it eliminated.

And yet autism can still seem like a bigger threat than measles, if only because it appears in countless television shows and movies such as Rain Man and Gilbert Grape. Meanwhile, you’re more likely to catch measles at a movie theater than see the disease featured onscreen.

And so, parents forget, or more likely never knew, that 33 of every 100,000 people who experienced actual measles ended up with mental retardation or central nervous system damage. And that’s in addition to those who died. They forget that an outbreak of rubella in the early 1960s resulted in 20,000 children being born with brain damage, including autism and other congenital abnormalities. They forget that, before it was eradicated by a vaccine in the 1970s, smallpox left many survivors blind, maimed or brain damaged.

One remedy for this Catch-22 is to make a conscious effort to remind ourselves about the world before vaccines. Even doctors now tend to only learn about these diseases from textbooks. But before the development of an effective vaccine in the early 1940s, diphtheria was among the great terrors of childhood. In the 1930s it killed thousands of people a year.
It is once again killing children today in Venezuela, Yemen and other areas where social and political upheaval have disrupted the delivery of vaccines. Among other symptoms, diphtheria produces a gray membrane of dead cells in the throat that can block a child’s windpipe, causing death by suffocation.

Diphtheria was terrifying not only because it could kill with stunning speed, but also because it could so easily jump from child to child by way of the coughing and sneezing it induced. Some families may also have unwittingly hastened the dying by having children line up to kiss a dying brother or sister goodbye.

Parents now rarely know such grief because our children are protected by vaccines, including Tdap/DtaP (Tetanus, Pertussis and Diptheria). It’s why we feel secure in having smaller families. It’s also a major reason life expectancy at birth in countries like the United States increased from 47.3 years at the start of the twentieth century to 76.8 at the end.

Vaccination also protects those who cannot get vaccinated, like very young babies and patients who have very weak immune systems.  So when most of the population are immune to a disease, it is less likely for a disease to spread, something called herd immunity.

It is of course true that vaccination entails risks, like everything else in the world. They range from the commonplace, like soreness at the site of injection, to the vanishing rare, like a potentially life-threatening allergic reaction. Medical researchers are typically the first to identify and characterize these risks. A CDC study in 2016, for instance, looked at 25.2 million vaccinations over a three-year period and found 33 cases of severe vaccine-triggered allergic reaction — 1.3 cases per million vaccine doses.

How should parents think about a risk like that? Being a good parent isn’t about protecting children from every medical risk. Instead, it’s about making a judgment, with advice from a doctor, about relative risk. Ask yourself: Which is worse for my child — the remote possibility of an allergic reaction, or the risk of Hib disease, rotavirus, pneumonia, or even chickenpox — which, despite its trivial reputation, killed hundreds if not thousands of children a year before the 1955 approval of an effective vaccine? Which is worse, a fictitious link between the MMR vaccine and autism — now dismissed as fraudulent even by the journal in which it was originally published — or exposing your child every day to the possibility of measles, with all its potentially deadly or debilitating consequences?

For my wife and I, the decision was always to get our children their recommended vaccinations. We still worry, as all parents do. But as our children stay healthy, we sleep better, knowing we have put so many medical terrors of the past safely behind us.

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