Vaccines, History and the Future

I only just read this particular news item from December 1: Avoiding the Flu Shot?.

I have made sure to get a flu shot the last two years — partly because I tend to catch every virus the kids bring home from school, and partly because I am now volunteering a LOT in the schools, so am at extra risk for catching something from somebody. Also, when I get sick, it usually lays me low for a few days so I prefer to do whatever I can to avoid getting sick. I am fortunate that our health plan includes vaccinations, but for this one I would spring for the twenty bucks if I had to.

On the other hand, I refused the second MMR vaccination for our elder child because when the first one was given he ran a high fever and developed a measles rash. No kidding. I figure he is either immune or never will be. We can get his blood titred if necessary to figure out which it is.

On the other hand, the children received all the other recommended vaccinations, including the Varicella (chickenpox) one, which was quite new when they were little. One caught chicken pox (twice) but it was minor, the other didn’t even get a sniffle. So I figure it worked.

Disclaimer: one of the children participated in the vaccination-autism study a few years back…

Why is this important? Because Monday in the seventh grade classroom I help in, they were discussing an article about the way smallpox affected the indigenous peoples of the Pacific Northwest in the wake of the Spanish expeditions of the 1770s. The particular article the children were reading was very clear that between the smallpox and other European diseases that were carried by the sailors and early traders, the population of the Pacific Northwest was already devastated well in advance of the (re)settlement by American pioneers in the 1850s. With no previous exposure, no learned or innate immunity, the Native Americans died — either directly or from the lingering disabilities these diseases created. The actual article is available at HistoryLink.org.

Not one of the nearly 30 seventh graders knew what smallpox is, though most had caught chickenpox at some point and one was able to demonstrate a scar on her face from that. But they are so sheltered, they don’t understand how disfiguring some of these illnesses can be — how disabling — how devastating. Their worst illnesses have been a mild influenza or a bad cold.

This is true for their parents as well, and generally for their grandparents as well, all born after World War II, when technology made life both easier and safer. And many parents nowadays do not accept vaccinations for their children even if they are already paid for, even when there are no reasons (allergies or underlying immune disorder) to avoid them. Which means everyone is at greater risk. More on that later.

We are far removed from the middle ages, when Famine, War, Pestilence and Death were well-known visitors to most homes, and were represented alongside patrons and saints in works of art. It wasn’t just “The Plague,” it was all the illnesses, all the diseases that could be fatal and were often disfiguring and disabling. It was not uncommon for an entire generation in a family to be wiped out by dysentery or cholera. Even when a population had developed some innate immunity, not everyone was safe from the worst effects. For the rest, they struggled on, living as best they could, knowing that the four horsemen were out there, no way to stave off disease.

The purpose of a vaccination is to introduce either a killed virus which cannot cause illness but which can teach the body to develop specialized “watchman” cells that can raise the alarm when a live version appears, or a weakened live virus which does the same job but with a slightly higher risk of causing a full-blown infection. But beyond knowing that once a person had survived a disease like smallpox they couldn’t catch it again, people before the 1800s had no way to vaccinate themselves. It was a gamble either way: avoid getting infected and hope you never do, or get infected and hope you survive.

When I was a child, because my father was in the military and flew to places around the world, I was given the smallpox vaccination even though most children in the United States didn’t. By the time I was a teenager in the 1980s, smallpox was eradicated from the natural world, and we all breathed a collective sigh of relief.

That it was still considered a threat was evident when I enlisted in the Navy and received another vaccination, which I now know was because of the threat of biological warfar. I had no symptoms afterward, most of the young women in my company felt a little under the weather, and one developed a full-blown necrotic infection (but only at the site of the injection). Recent news articles underline the utility of vaccination, since the monkeypox virus doesn’t affect people who have been vaccinated against smallpox. Here is an article on the effectiveness of the smallpox vaccination and one on http://www.cnn.com/2008/WORLD/africa/12/08/pip.zoonotics/index.html?iref=newssearch. Warning, the images in the second link are disturbing.

I had the polio vaccination as a child too — and as a young adult I worked in an office where one of the older women used braces to walk as a result of having had polio as a child. Still later, I made the acquaintance of a woman with post-polio syndrome — a debilitating and progressive disease. That woman hadn’t been ill that she remembered, though she learned later that she had been exposed to polio. Few children in the United States today face this risk, though polio still exists in other parts of the world.

When I was a child, they vaccinated against measles, perhaps against rubella — but not against mumps. I remember having the mumps — though for me it was really “the mump.” I was about four years old, and I remember the pain on one side of my face and neck. I remember curling up with blankets and feeling miserable. I am glad my children will never have to experience that!

But less than one hundred years ago, few of these vaccines were used (though they did have the smallpox vaccine derived from cowpox), and fewer people could afford them. The cost of making and transporting vaccines before reliable refrigeration was available was prohibitive, and opportunistic secondary infections were common. And so, mothers took their young children to houses where measles existed, strict quarantine was observed with some diseases, and people died on a regular basis.

The intelligent, or at least the logical, way to combat these sorts of illnesses is three-fold:

• Maintain good hygiene practices: wash your hands frequently, and ALWAYS before you touch food. You never know what you have been in contact with.
• Stay home if you are ill — what is a minor inconvenience for you might be a very big deal — or fatal to someone else. And if you must be around other people, don’t touch things they touch, and dispose of used tissues properly.
• Finally, if you can be vaccinated against a disease, do so. This will help minimize the chance that you can infect people whose immune system is not well developed, which in turn slows down and may even stop the spread of the disease.

Obviously, people can — and will – continue to get sick. Viruses are only part of the problem. There are also bacterial diseases (strep throat, anyone?) and toxins (botulism) for which vaccines cannot be made.

But I look at my own children, and at the children I work at in the local schools, and I see a future that is brighter because of vaccines. I see the descendents of those indigenous peoples healthy and hopeful, working to rebuild their cultures (yes, even now they are struggling to regain what was lost). I see parents whose biggest worries are the amount of added fats and sugars to the food — not whether the toddler will add to the line of tiny headstones in the burial plot.

Our future is uncertain — it always has been, despite the intoxicating hope that vaccines and antibiotics encouraged in the middle of the last century. Famine, War, Pestilence and Death still come among us… But we have tools that can knock them down to size. If we use them.

Was anybody counting how many hands I used for this post?