It’s not just measles: Tetanus, Mumps and other vaccine-preventable diseases are still in the US
She walked into the emergency room with an infant in her arms. “My baby, please help my baby,” she said between sobs. I followed her into the room and asked what her baby’s name was and whether I could hold her.
The child was beautiful — a tiny, precious, beautiful baby girl. But the minute her mom put her in my arms, I knew that something was very wrong. She could not move her neck. Her shoulders pressed up toward her ears, and she held very still, visibly uncomfortable.
I am a calm pediatrician who takes pride in my composure. I would normally ask questions while holding and examining her. Not that day.
“You have a beautiful baby,” I said. “I’m going to give her back to you while I grab a few people to help me.”
I closed the curtain and ran to the doctor’s station. This baby had a severe case of meningitis. She needed potent antibiotics, and she needed them now.
Within a few minutes, nurses helped me place intravenous lines and start infusing multiple antibiotics. Her mother watched in disbelief from the corner, not fully registering everything that was happening, despite our best efforts to explain.
We then wheeled the baby to the intensive care unit. Antibiotics were not enough, and she ultimately required brain surgery to wash out the infection before making a full recovery.
Her diagnosis: haemophilus influenzae type B meningitis, a vaccine-preventable illness caused by a bacterium. Her parents had chosen to vaccinate, but she was so young that she had not received the full vaccination series.
The type of invasive disease that afflicted my patient last year is rare, with an incidence of just over 1 child out of every 100,000, according to the latest numbers from the US Centers for Disease Control and Prevention.
More common these days: measles. At least 206 cases have been reported to the CDC this year, with individual cases confirmed in 11 states. These numbers add to the 372 cases reported in 2018 of this serious, vaccine-preventable viral illness.
I’m worried about measles. I’m worried about haemophilus influenzae type B. I worry that more and more parents who are fearful of vaccines will leave their children vulnerable to these illnesses. And there’s more for us to worry about.
Whooping cough that broke blood vessels in her eyes
Dr. Louis Bell, chief of the Division of General Pediatrics at the Children’s Hospital of Philadelphia, distinctly remembers a girl he diagnosed with whooping cough, a vaccine-preventable illness caused by a bacterium called Bordetella pertussis.
“She was coughing so hard and her coughing was so intense that she broke the little blood vessels in her eyelids and caused the white of her eyes to hemorrhage,” he said. After a stay in the hospital, his school-age patient eventually made a full recovery.
For adults and older children, whooping cough can often be treated at home with a course of antibiotics, with the severe hacking cough being the most bothersome symptom.
The real danger, Bell explains, is when whooping cough affects children under 6 months of age.
When young infants contract pertussis, they can have coughing spells during which their oxygen level drops. If it’s severe enough, it can lead to seizures, Bell explained.
It is not uncommon for infants to spend several weeks in the hospital while their breathing stabilizes and they regain the ability to feed on their own.
The number of cases from pertussis fluctuates every year. There were 18,975 cases reported to the CDC in 2017, the most recent year for which data is available.
Infants start the vaccination series at 2 months of age, receiving additional doses at 4 and 6 months. The CDC also encourages pregnant women who have not been vaccinated to do so during pregnancy.
It is up to everyone around young babies to ensure that they’ve been vaccinated, Bell said.
Mumps arrives on campus
This week, 16 cases of mumps — yet another vaccine-preventable illness — were diagnosed at Temple University in Philadelphia.
Mumps outbreaks usually occur among people who are in close contact, such as on college campuses and among sports teams. The illness usually causes swollen and tender salivary glands under the ears, in addition to fever, fatigue, loss of appetite and other viral symptoms.
The MMR vaccine protects against measles, mumps and rubella. One dose of the vaccine is 78% effective in preventing the mumps, and two doses are 88% effective. The vaccination status of the students and whether they had received the recommended booster is not currently known.
In 2018, there were more than 2,000 cases of mumps in the United States. This January, 58 cases were reported, according to preliminary data from the CDC.
Tetanus led to 8 weeks in the hospital, $800,000 in hospital charges
In 2017, a 6-year-old boy went out to play in his family’s farm in Oregon. He fell and cut his forehead, which his family cleaned and stitched up at home. Six days later, he started clenching his jaw and experiencing arm spasms, soon followed by difficulty breathing.
He was flown to the hospital, where physicians diagnosed him with tetanus — the first case seen in a child in Oregon in over 30 years. He had not been vaccinated. The details of his case were published this week in the CDC’s Morbidity and Mortality Weekly Report.
Tetanus is a disease of the nerves and muscles caused by the bacterium Clostridium tetani. Bacterial spores found in soil can enter the body when the skin barrier is disrupted, according to the CDC. The CDC recommends a tetanus vaccination series starting at 2 months of age. The agency also recommends boosters for adults every 10 years.
Fewer than 100 cases per year have been reported to the CDC since the 1980s.
Eight weeks, many medical procedures and $811,929 in hospital charges later, the boy’s parents refused the recommended second dose of the tetanus vaccine. After intensive rehab, he is now doing well and has resumed his normal activities, according to the report.
Thousands of flu deaths every year
Every year, the flu affects 9.3 million to 49 million Americans, and 12,000 to 79,000 die from the illness, according to the CDC.
In addition, close to 1 million people per season can be hospitalized because of flu.
This year, flu activity remains high, and some states are reporting a second wave of infections, the CDC said Friday.
“I just took care of a child under 2 who did not have a flu vaccine and came in with a very severe secondary bacterial pneumonia,” Bell said.
Influenza infection, which is caused by a virus, can predispose children and adults to the development of complications such as bacterial pneumonia, he said. His patient had pus in his lungs and necrosis, or death of lung tissue.
“I think if he had been vaccinated, he could have gotten the flu, but he probably wouldn’t have gotten the secondary pneumonia,” Bell said, referring to the known lower rate of flu complications in people who are vaccinated and still contract the disease.
Chickenpox: The blistery and itchy illness that hasn’t gone away
Chickenpox, the viral illness that causes a blistery itchy rash often accompanied by fever and generalized malaise, has not exactly gone away since the vaccine was introduced in the United States in 1995. In 2017 alone, 8,775 cases were reported to the CDC, a significant reduction from the 4 million cases per year in the pre-vaccine era.
Initially, only one dose of the vaccine was recommended for children. But when experts realized that a small percentage of children didn’t mount robust immunity to that first dose, two doses are currently recommended: one at 1 year of age and a second around 4. The two-dose vaccination program has resulted in smaller number of outbreaks, according to the CDC.
Bell remembers a time chickenpox was so common, children were frequently admitted to the hospital with a complication called acute cerebellar ataxia. That’s when the cerebellum — the part of the brain responsible for coordination and balance — can become inflamed after an infection.
“It’s just such severe dizziness that they can’t walk or stand, and they’re nauseated,” Bell explained.
According to the CDC, most of the cases that make up varicella outbreaks occur in unvaccinated people, and those who are vaccinated typically have a milder disease course.
“We in the medical profession and the developers of these vaccines have been so successful that now, we have a whole generation of parents who just don’t remember,” Bell said.
But there are those who do remember, who have seen these cases. And we are worried.