Incomprehensible Risks

Edward (name changed) does not understand how anyone who knows anything about vaccine preventable diseases could oppose vaccines. Living before vaccines meant being surrounded by death and disability from diseases we no longer see. Growing up, today’s vaccine preventable diseases were a vivid reality for Edward, one that marked his family.

Edward’s father told him about losing a little sister to diphtheria during the father’s teen-age years. His mother, working as a nurse, saw children die from diphtheria, whooping cough and small pox. Naturally, Edward’s parents immunized their children against those diseases that had a vaccine available  - the small pox vaccine and the diphtheria preparation.

Those immunizations did not, unfortunately, include the whooping cough vaccine. Edward is not sure why; he explained: “It is possible that we were not vaccinated against whooping cough because of the fear that during polio outbreaks the disease was more likely to disable a limb recently subjected to trauma, including vaccination. I asked my mother about it last year but she couldn't recall.” Without this protection, shortly after the birth of his youngest sister – youngest of six – Edward and all his siblings contracted whooping cough. His infant sister suffered most. “I remember her gasping for breath… she was seriously ill and today would be placed in hospital. In the 1950s there simply weren't enough places and my mother was a nurse.” His sister healed, but the after-effects stayed with her until her teen-age years.

“It was only a few months later that my brother developed tuberculous meningitis. It affected his hearing and balance. He spent over 2 years in hospital. When he was in an isolation hospital I'd go to visit him. I'd stand outside and he'd wave to me from behind a closed window on the first floor.”

The after-effects of polio were also all around him; children at school with shrunken legs in calipers, a music teacher who was also paralyzed by the disease. Co-workers also sported its effects: “one of my colleagues had a big built-up shoe and calipers, another had a small, skinny arm; both from polio.”

In 1962 a small pox epidemic broke out in the area where Edward lived. Edward says: ‘I joined the line snaking down the street outside our doctor's rooms to be re-vaccinated. That outbreak saw 47 cases and with 19 deaths.”

The details of that epidemic can be watched here: 

This was the reality of living before vaccines. Unsurprisingly, Edward has little tolerance for anti-vaccine activists. He lived the alternative; why won't they see its risks?

Protecting Children: Yearning to Stand Before God

Qari Aqeel knows what the absence of vaccines can do. As a child, he was not immunized against polio. He paid the price. Now, he helps prevent this from happening to other children. His father, too, is keenly aware how the lack of immunization blighted Aqeel’s life. “Immunizing one’s child,” he says, “is every parent’s responsibility; yet I was unable to fulfill this duty for my son.”

The father's words - and Aqeel's - can be watched here.

Aqeel was a young child when he contracted polio . The disease left him paralyzed. The society he lived in was not accepting:

“In the first three years”, he says, he had not choice but to stay home. When children saw him, they would hit him with their shoes, spit on him, some would even hit him with bricks. After those first three years his father provided him with crutches, which allowed him to leave his home and move around – but the children would still harass him, push him and make him fall.

Aqeel was not alone in his generation. Vaccine access was not easy, and polio was endemic in the third world long after cases declined in the first world. In the 1980s, over 1000 children were paralyzed every day; in 1986 the World Health Organization estimated annual cases at over 250,000 a year – and those are cases of paralytic polio, not cases of people who contracted the virus. Most people affected with the poliovirus will have no symptoms. But “One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralyzed, 5% to 10% die when their breathing muscles become immobilized.” http://www.who.int/mediacentre/factsheets/fs114/en/index.html. There is no real cure or treatment for paralytic polio. The only protection we have is prevention.  

In 1988, a polio eradication initiative was launched that led to immunization of over 2.5 billion children.  As more and more children were protected, polio cases fell dramatically. By this year, 2013, Polio had been eradicated from all except three countries. Unfortunately,

Qari Aqeel lives in Pakistan, one of those three (http://www.polioeradication.org/Mediaroom/Factsheets.aspx). The most recent information is that “Pakistan has reported six polio cases to date in 2013, compared to 15 at the same time last year.”  Immunization efforts continue, in spite of some media criticism (p. 26) and incidents of violence against those engaged in the immunization efforts. Aqeel helps them, in his area.

Aqeel works to remind those around him of what polio can do to a young person. He overcame the harsh environment of his youth and his own paralysis to become a teacher in a Madrassa, teaching 85 children – most of them from poor homes – the Qur’an. He built a life, and does something meaningful. He still suffers, though, when, as a believing Muslim, he is unable to stand before his God, as he would like. Instead, he must remain kneeling when the others stand. Watching children play, he is glad for their innocent joy, but sorry he cannot participate. He still keenly feels the price he paid for not having the polio vaccine as a child.

Aqeel’s father painfully regrets his inability to immunize his child, and the suffering it caused to Aqeel. He, too, agrees with Aqeel’s efforts to support immunization, to prevent other children from suffering as Aqeel did. “My mistake had compromised Aqeel’s entire life.”

That is the message Aqeel gives to hesitant parents: vaccinate your children, protect them from my fate. When those involved in the effort come, he helps them, sometimes administering the oral polio vaccines himself. He is tireless, because he is fighting to provide the children of Pakistan with the protection he lacked. He knows what could happen without it. He was there. 

Out of Sight, Out of Mind

Today's post is a guest post written by polio survivor and author Jan Nichols. Jan Nichols lost her twin brother to polio and survived the disease herself in 1953, at the young age of six. More information about her story can be found on shotbyshot.org and on the site addressing her memoir. This post is also in honor of Frankie Flood. 

My early childhood was idyllic. My twin brother Frankie and I were blessed to live in a prosperous suburb of Syracuse, NY with loving parents who made certain that they adhered to every recommendation made by the public health community: vaccinate against diphtheria, whooping cough, tetanus, and smallpox (the vaccines available to children of my era) and avoid large public gatherings and swimming pools during “polio weather.”  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). Like nearly all older baby boomers I contracted measles, mumps, and chicken pox – “rites of passage” with disastrous consequences for some, until vaccines were available.      

Yes, my life was idyllic until October 30, 1953. That’s when Frankie was admitted to City Hospital with a diagnosis of paralytic polio. Sixty-one hours after admission, he died while en route to the operating room where an emergency tracheostomy was to be performed. Frankie died with my father cradling his only son as best he could while hampered by an iron lung that encased my twin’s body save his head and neck.

  On the night Frankie was buried, I was admitted to the same hospital with the same diagnosis, though I was spared the horror of the dreaded iron lung. Later on that week, my mother suffered a miscarriage. Sadly, our story was not unique before the polio vaccine was licensed in 1955.

The doctors could not tell my parents whether I would survive or not, though they added with some degree of caution that the massive doses of gamma globulin I received once Frankie’s diagnosis was confirmed might (just might) spare my life.  A few days after admission, my fever broke and I awoke to the sound of a tiny baby coughing incessantly down the hall. I asked the nurse what was wrong with the child; she explained that the baby had whooping cough. The fact that I could not move was secondary to the fear I felt for that baby!

                  Because of intensive daily physical therapy and the love and support of family, friends, and the medical community, I eventually made a miraculous recovery. I have missed my birth partner every day of my life since that cruel fall, though I am determined to bring meaning to Frankie’s life by advocating for vaccination and polio eradication.

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I wonder each day whether that baby from fall 1953 died from whooping cough … I shudder when I read that fewer and fewer children are being vaccinated. Vaccines have rendered these diseases “out of sight,” but not out of my mind’s eye!

Childhood vaccine-preventable diseases are no longer “rites of passage.” They are all diseases that can kill or maim.

I would like to introduce you to Frankie and Janice Flood. This photo was taken in our living room a few weeks before Frankie died. My parents obtained permission from the Onondaga County Health Department to wake Frankie in our home, with his casket centered in the room featured in this picture. Frankie’s twin sister placed his precious ball and bat in the casket. She was certain that Frankie would need his baseball paraphernalia in Heaven – Janice Flood Nichols, Frankie’s twin.

Here are several websites that can offer useful information about vaccines:

www.chop.edu/service/vaccine-education-center, www.vaccineinformation.org,  www.immunize.org/express, www.shotbyshot.org,  www.shotatlife.org, and www.ecbt.org.

This Facebook page also links to some helpful sources: https://www.facebook.com/pages/Credible-sources-on-vaccines/394399423985819?fref=ts. 

A Mother’s Fear and Pain

Sitting by her son’s hospital bed, Meleese worried and hoped. The doctor came and checked on him daily; every day, he would start by asking how Meleese younger daughter, then 7 months old, was doing, and he “checked her out from top to toe each time as well as examining my son”. After all, she was at risk too.

Meleease’s son was only three.  He had rotavirus. Rotavirus “is the most common cause of severe diarrhoeal disease in infants and young children globally. Rotavirus is responsible for approximately 527,000* deaths each year, with more than 85% of these deaths occurring in low-income countries in Africa and Asia, and over two million are hospitalized each year with pronounced dehydration.” ; and see here, for detailed numbers. No, it’s not just a stomach bug; According to the CDC “Rotavirus infection in infants and young children can lead to severe diarrhea, dehydration, electrolyte imbalance, and metabolic acidosis…. In the prevaccine era 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.”

This is what happened to Meleese’s son. At the time, there was no vaccine to prevent rotavirus. When the young boy started feeling bad his parents thought he had nothing but a stomach bug that caused diarrhea and vomiting. But the child was suffering, so they took him to the doctor. Three times. The doctor gave them a couple of prescriptions, but they did not help. He was getting worse: throwing up continuously, having severe diarrhea, weakening. The third time the doctor saw the child he sent him directly to the hospital.

Meleese says: “I'll never forget that trip. He was so sick he couldn't sit in his car seat and tried to lie on the floor. I ended up sitting in the back with him and holding him while we made the trip.  He was completely listless. He was so dehydrated that they had trouble finding a vein for the drip and when they finally got one in, he went into shock.

“My son lay in the hospital bed, hooked up to drips and monitors. I truly thought I was going to lose him.” Meleese’s fear lasted for a week; luckily, her son did not die, and her infant daughter did not get the disease. But the fear stayed with her. And the distress. Meleese remembers, today, that one of her father’s brothers died at the age of three months from “diarrhea”. She thinks it was rotavirus, but the disease was not named until later. She is grateful to have her son. It still hurts her to think of that time, her son’s suffering and her own pain and fear.

This was not the only vaccine preventable disease Meleese’s children went through. They also both contracted chicken pox (that vaccine, too, was not available at the time). Meleese describes their suffering: “Although my children didn't require medical treatment beyond trying to soothe the itching and cuddles if they could bear to be touched it was a miserable experience for them. They [the lesions] were in their mouth, their ears and my little girl especially was miserable because of where they were on her.” Meleese breastfed both children for over 2 years; but that did not prevent the disease.   

Children suffer when they are ill, and a parent’s heart aches with them. We fear, and we hurt. Before vaccines, Meleese’s story was all too common, and did not always end with a whole child coming home, or a child coming home at all, as other posts on this blog demonstrate. Children still get sick and hurt, unfortunately; but Meleese's experience is no longer routine. 

In Meleese’s case, the story had a happy end not just for her son but for other children. A young doctor, touched to the core by seeing a child die from rotavirus, decided to do something about it. Dr. Paul Offit  explains: “I was an intern at Children's Hospital of Pittsburgh and witnessed an infant die of dehydration secondary to rotavirus. It was my first exposure to how serious this disease could be. It was also the first time I ever had to tell a mother that her previously healthy child had died. Late at night in a busy city emergency room. Awful. I'll never forget it.”

Dr. Offit's response to the tragedy was to dedicate his life to preventing similar tragedies. He spent 25 years working on a vaccine for rotavirus, creating Rotateq. Meleese said: “That's why Dr Paul Offit Is my hero. I'll never forget the day I read in the paper there was now a rotavirus vaccine. I raced and found my husband and screamed "Look! Look!"”

With a little luck, children that have access to the vaccine and that are not medically prevented from getting it can avoid suffering this way: (meme courtesy of Refutation to Anti Vaccine Memes)