pediatric housecalls Robert R. Jarrett M.D. M.B.A. FAAP

5 Immunization-Preventable Diseases Coming Back

Of the thousands of diseases we’ve got to contend with there are only about 24 which are immunization-preventable. Perhaps it seems like more when you’ve got your kids to the doctor for well child care but it’s not.

The CDC and WHO keeps track of these things and that’s all we’ve got. They also keep track of how well we’re fighting them off and guess what—THEY’RE COMING BACK! We seem to be loosing the fight!
Vaccine-preventable diseases immunization rates

Preventable Diseases Coming Back
Disease and Immunization Data Since 2008

If you want to see the real data kept since 2008 about cases of measles, mumps, polio, rubella (German Measles), whooping cough, chickenpox, cholera, diphtheria, meningitis, rotavirus and typhoid give a look at this map.

You’ll be able to see where on the earth these diseases are occurring and probably be surprised of all the cases in developing worlds including those where vaccines are easily and readily available!

Today, we’re going to highlight only five of them (measles, mumps, rubella, pertussis and polio)—because we almost had them licked until all the craziness began with the lying doctor over in England falsifying data to make his fortune (Wakefield). We’ll just highlight them because I’ve already posted about all of them previously.

Community Immunity

Herd immunity - good immunization rate
“Herd” immunity – Good immunization rate

What doctors call “herd immunity” is what happens when a person sick with a disease comes into a community and begins infecting others (see charts).

If there are large numbers of immunized people immediately around the sick person the disease is statistically transmitted to very few others who may not be immunized, for whatever reason (left).

Herd Immunity - poor immunization rate
CAPTION

On the other hand, if the community (herd) is selfishly all relying on others to do their work for them and refuse immunization, then there is no buffer and one sick person contaminates many others which rapidly attacks every non-immunized person (right).

The proportion of a population which needs to be vaccinated (vaccination rate) in order to protect the community is known as the herd immunity threshold (HIT), and it varies depending on the disease.

And the thing is: even if you can say that the US has a 90% immunization rate—it’s meaningless to you in any specific instance. “Protection is only as good as the vaccination rate in YOUR SPECIFIC AREA!”

What smart people all across the globe are trying to do is to target 100% vaccine coverage; because there are always some, like infants and very ill, who cannot be immunized even if they wanted to. And they are the ones who are hurt the most by the loss of community immunity.

That’s why the decision NOT to be immunized is a PUBLIC health hazard and not just a purely private decision.

Measles

Typical rash of measles (rubeola)
Four-year-old hospitalized with measles (Rubeola) meningitis

Measles (Rubeola) is one of the most contagious infectious diseases known in humans, with a greater than 90% secondary attack rate among susceptible close contacts; yet in 2000 we had declared it eliminated from the US because there had been no endemic (started in the US) case here for a long time.

Globally there are about 20 MILLION cases each year causing thousands of deaths in children—yes, measles can kill! Measles began returning in earnest in 2014 when the deliberately unimmunized began breaking the herd-immunity in several us cities and communities.

One such intentionally unvaccinated New York 17-year-old went to London, contracted measles and returned to New York to contaminate 58 immediate cases in two Jewish communities. Before the epidemic that this boy started was through, the New York Department of Health had traced 3,500 contacts and documented SIX GENERATIONS of spread of the infection!

There were absolutely NO cases in vaccinated people but—here’s the terrible part, 21% of the cases were infants too young to have the immunization and exactly the ones with the highest risk of death and nervous system side-effects.

The 668 US measles cases in 2014 was the highest number of cases since eradication was declared and 383 of those were in a deliberately non-vaccinated Amish community of Ohio.

In the first four months of 2015 the outbreaks continued with 5 communities and 166 cases, largely in the vaccine-refusal communities of California, causing thousands of subsequent contacts and exposures.

Look, fully ONE-THIRD, 33.3%, of cases go on to cause serious complications (6.7 million). Why do you think we put such extraordinary work into trying to prevent it? This is not a joke or a game to be thrown up trivially by bloggers full of money-making schemes!

Pneumonia, meningitis and hospitalization are serious stuff in children; and 1-2 of every 1000 infected children worldwide DIE from these complications (20,000-40,000)… every year!

Rubella

"Blueberry Muffin" syndrome, one of the signs of congenital Rubella
The “Blubbery Muffin” rash of congenital Rubella

The Rubella virus is a bit less contagious than measles—less severe and shorter duration; but, that’s NOT why it made headlines world-wide for years. It’s terribly devastating to pregnant women.

This is another area where “herd” or community immunity is critical to those who can’t or aren’t even making the decision to not become immunized.

Innocent infants of non-immunized women, infected by someone else who had also decided not to be immunized and now has the disease, must now live their lives deaf, blind, with heart or nervous system problems and liver or spleen damage. If they even get to live their lives at all because rubella also results in miscarriage, premature delivery and fetal death.

It’s maddening for us physicians who worked for the U.S. elimination of both rubella and congenital rubella syndrome (CRS) which was declared in 2004. Eleven years later they were declared eliminated in the whole America’s region of the world.

Now, to think that it is coming back is not only disheartening to physicians but the American Red Cross, CDC, UNICEF, United Nations Foundation and WHO—all of who have spent billions of dollars and millions of man-hours around the globe to save innocent babies of this malady.

For me at least, it’s disgusting to watch people like the Clintons, Trumps and Kennedys try and win elections and make a name for themselves by trying to “spin-doctor” scientific research through political campaigns or legislation. Simply disgusting! What say you?

Mumps

Child with compromised airway due to mumps.
Child with airway obstruction and meningitis due to Mumps disease.

Mumps is a disease in which the frivolous ad agencies and uninformed artists of years past pissed a whole lot of medical people off with their silly (but cute) little images of boys with swollen faces and a handkerchief wrapped around their head and jaw.

Absolutely anyone who actually had to care for patients inflicted with mumps knew that the disease wasn’t trivial at all. It is extremely contagious by the most minute personal contact with a person having the disease.

True, 30% of persons with the disease don’t know it’s raging inside their body because symptoms may not be noticeable. And true, 40% are ill with swelling of the parotid glands and its painful (but limited) consequences for ten days. But that still leaves another 30% in the “other” category doesn’t it.

Death from the mumps virus occurs but is rare. What is NOT RARE however are complications like: meningitis, encephalitis, deafness and hearing loss, infection of the testicles and ovaries, pancreatitis and myocarditis (heart)—those ARE deadly!

We’ve now got epidemics in the US, UK, Germany, Span, Macedonia, Israel, Egypt, Servia, the Netherlands, Columbia and Guam—to name a few; with disease clusters in the US, Canada, Vietnam and Australia.

Mumps is hard enough to eradicate, due to it’s many sub-types, without loosing community immunity too! Mumps immunization is of 88% efficacy for the full disease. The thing is though, even if an immunized person does get the disease it’s at a MUCH LOWER rate and more mild. So immunization is still the best answer.

And honestly, to think that the public’s health safety could be in the hands of the Kennedys and Andrew Wakefields for wealth and popularity reasons is down-right terrifying.

Pertussis (Whooping Cough)

Infant suffering from whooping cough - Pertussis
Caption

Of all the vaccine-preventable diseases in the United States, pertussis (whooping cough) is the most poorly controlled, with peaks in disease occurring every 3-5 years.

The sad thing is that it is also the only one I’ve mentioned so far which is caused by a bacteria, Bordetella pertussis, and is easily (still so far) treated with antibiotics; BUT, it almost never is until too late! For all intents and purposes it never can be.

It has three stages (catarrhal, paroxysmal and convalescent) which first looks completely like a “it’s just a cold” for ten days; then like “I’m gonna die” with every spasm of coughing for up to SIX WEEKS; and, finally, like “I’m going to have to live my life with this” for many, many months afterward.

By the time the deadly spasms of coughing begin the disease is already in the second stage so the only thing antibiotics can do is (hopefully) blunt its severity and stop its contagiousness—both, almost like shutting the barn door after the horse already got out.

Trigger to coughing spasms make them completely unable to breath in leaving them cyanotic (blue) and limp. The deadly attacks average at 15 times per day, more frequently at night.

Even once the disease begins to resolve it takes weeks; then, for many months afterward, any little “cold” will trigger paroxysms of coughing.

Whooping cough is deadly to infants and they cannot be immunized
Whooping cough is deadly to infants, cannot be immunized

Fifty percent of infants and children are hospitalized. Sixty-seven percent of those stop breathing with apnea, 23% progress into pneumonia, 2% have seizures, 2% die with an additional half-percent living with brain damage.

Older unimmunized children and adults become dehydrated, have nosebleeds, hernias, ear infections and rupture and urinary incontinence as the minor complications. The more severe complications include refractory pulmonary hypertension, pneumothorax, rectal prolapse, subdural hematoma—and 4% have bleeding into their eyes and actually break their own ribs from coughing.

You almost never see me be so blunt about the severity of a disease like this in general print; but, like I told you, this disease is the most needlessly-occurring and poorly controlled disease in the US and we’ve just got to do something about it!

Immunity to this disease is slow to develop so takes a series of immunizations beginning as soon as an infant is able to make antibodies. Immunity, we’ve not found, also wanes over times so boosters are required if we ever hope to maintain community immunity.

Poliomyelitis

Immunization is HIGHLY effective against Polio
Immunization is HIGHLY effective against Polio

There are three types of Polio to infect humans (types 1, 2, and 3) and believe me it is NOT the same as what veterinarians diagnose in your cow or camel! Their polioencephalomalacia is dietary related, Human poliomyelitis is caused by the HIGHLY infectious and potentially fatal poliovirus which invades the nervous system tissue.

Person-to-person spread is via a fecal-oral route from contaminated “stuff”: foods, hands, things you touch and things you put in your mouth. But the virus is so contagious that being very careful and hand washing is only rarely effective.

In most of your parents life, Polio was the MOST FEARED DISEASE IN THE UNITED STATES permanently paralyzing more than 15,000 people every year—which means that 1.5 MILLION people were infected. Up to 10% of those paralyzed died when their respiratory muscles were affected.

Only unheard of massive immunization effort began to corral it through most of my childhood and into medical training.

Now, most of you go to doctors you have never even seen an iron lung outside of pictures and museums. I have (luckily not in active use) several times when I moved it in a hospital storeroom, still full of the tiny toys of its last user.

The simple four-dose immunization given to US children has (so far) prevented the virus still prevalent around the world from regaining residence in the US. But it only takes one traveler with polio (which can be incubating for up to a month inside them) to bring the disease back.

It is critical to maintain high immunity (protection) in the population against polio through vaccination if we want to keep the United States polio-free.

Today

The practice of immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles; however, an additional 1.5 million deaths could be avoided if global vaccination coverage improved.

Unfortunately, due largely to the sometimes-hysterical fear and avoidance brought on by despicable folks like Andrew Wakefield, global vaccination coverage – the proportion of the world’s children who receive recommended vaccines – has remained steady for the past few years.

World Immunization Week, 24-30 April 2017

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7 Posts in This Series