The recent outbreak of pertussis in Washington State has generated a flurry of articles and editorials about vaccination and discussion regarding how to address the unvaccinated population. Parents who refuse to have their children vaccinated intrigue me. I cannot understand why they want to gamble with preventable diseases.
However, this is not a tirade about those decisions. It is a response to what has been said in the lay and professional press lately about the Acute Benign Childhood Diseases (ABCDs), and what some health care professionals have done in reaction to those parental decisions.
I recently read about a primary care provider faced with the challenge of addressing the risk that one family of unvaccinated children was placing his other families in when they presented for well or sick child visits. The provider had mixed feelings: He wanted to respect the beliefs of the one family, but did not feel it proper to impose those beliefs on the other families in the practice. He also noted that the parents’ decision was creating an ethical conflict for him, both personally and professionally. He fully supported vaccination efforts as a component of well-child (and public health) care. As a “win-win” decision, he discharged the family from the practice, allowing both parties to maintain their standards. Standards that, I submit, have drastically changed over the past several decades.
As a child of the ’50s and the third of eight children, for me exposure to those ABCDs was a rite of passage. You were a hero among your friends if you were the first kid on the block to break out in a rash. Parents sought you out to “share” your illness. We had “Chickenpox Parties” so that the neighborhood suffered the infirmary together. It was the best; once the fever broke, all you were was itchy. You, your siblings, and all your friends could still be out in the yard playing. Woohoo, no school for us—and no “makeup” work, either!
When we had measles, mumps, and rubella (MMR), the treatment was quite different. In my family, Mom kept us in a dark room and away from everyone else—quite a singular experience. I recall not being allowed to read or watch television (the few shows that were on) for fear I would go blind. Maybe it was my mother’s way of keeping me quiet. Who knows?
Perhaps because of my experience with the ABCDs, my parents’ belief that vaccines were a good thing, and the fact that “back in the day” you didn’t get into school without them, we received all the available immunizations (that’s what they were called then). There were only a few when I was young; thus, I have natural acquired immunity, which Mosby’s says is “obtained by the development of antibodies resulting from an attack of infectious disease….”1
I still have my original Certificate of Immunization and Tests. I completed my full series of diphtheria, tetanus, and whooping cough and Salk polio immunizations all before I started kindergarten. I also received the smallpox vaccine (and twice since!). In addition, because one of my childhood friends had contracted polio, when the Sabin vaccine became available, every parent and child lined up at the school where it was administered.
Based on my experience with the ABCDs, I long felt that children were missing the “fun” when the MMR and later the varicella vaccines became available. None of us had any of the severe sequelae of the ABCDs, but my one experience with a patient who had varicella pneumonia changed my opinion. I had a completely new appreciation for what damage these seemingly “benign” diseases could cause.
We have had our share of ABCD outbreaks in the past, and the push to have everyone vaccinated or revaccinated occurs in response. Yet we still see active disease. In 1989, after years of low incidence of measles cases, there was a sudden reappearance of the disease. During the 1989-1991 period, more than 55,000 cases were reported, and there were 123 deaths.2 We continue to see cases of measles, which creates a bit of a concern on my part due to a rise from 43 cases in 2007 to 216 in 2011.
Pertussis, one of the first diseases to become vaccine-preventable, reared its ugly head several years ago, moving the infectious disease professionals and immunologists to identify the need to revaccinate adults. Historically, despite the vaccine, cases of pertussis continue to occur, vary from year to year, and tend to peak every three to five years. In 2010, there were 27,550 cases of pertussis reported in the US—and many more cases go unreported.3
Therefore, the recent news about the pertussis outbreak in Washington State was not so surprising to me. Unfortunately, that statewide epidemic is predicted to result in the highest number of reported cases in decades.4 Moreover, with that epidemic comes the potential risk for myriad sequelae that could have been avoided.
I think we have become somewhat isolated with regard to the ABCDs. The vaccine programs over the past 50 years have fully or nearly eliminated several vaccine-preventable diseases, but we cannot stop there. We must remain ever vigilant in our vaccination practices and encourage vaccination “across the lifespan.” We must endeavor to educate our patients and their parents about the benefits of vaccination and dispel the myths and misunderstandings about immunizations. We must also exercise every opportunity to update the immunizations of all our patients, so that the risk for contracting these diseases is decreased for all of us.
What about you—are your immunizations current? Do you review the vaccination status of your patients during their office visits? How do you counsel the parents who refuse to vaccinate their children? Inquiring minds want to know, so please write to NPEditor@qhc.com.
1. Mosby’s Medical Dictionary. 8th edition. 2009; Elsevier.
2. Hinman AR, Orenstein WA, Schuchat A. Vaccine-preventable diseases, immunizations, and MMWR—1961–2011 [supplement]. MMWR Morb Mortal Wkly Rep. 2011;60(4):49-57.
3. CDC. Pertussis (Whooping Cough)–What You Need To Know. www.cdc.gov/Features/Pertussis.
4. Washington State Department of Health. Whooping cough cases reach epidemic levels in much of Washington [news release 12-038]. April 3, 2012. www.doh.wa.gov.