Last night I was reading a book to my daughter at bedtime. It was all about a kid who had chickenpox. I looked at my wife and said, “this is a bit outdated.”
“So what, it’s cute,” she accurately replied.
Wow. I hadn’t thought about it much lately, but chickenpox in the U.S. is disappearing rapidly. “Pox parties” are gone. Kids aren’t missing weeks of school. Pediatric ICUs aren’t seeing much varicella pneumonia. Now that I think about it, a number of important lessons I learned in medical school are becoming historical oddities. On my pediatric rotation, we learned to watch for the ominous “thumb print sign” on lateral neck x-rays, along with the stridor and drooling that accompanies epiglottitis. Thanks to the Hib vaccine, this entity is now very rare.
Of course, these childhood diseases still exist. Mumps is still with us. Measles waxes and wanes. And pertussis (whooping cough) is alive and well.
In my work as an internist, I see a lot of coughs and colds. They are very common, and a lot of my time is spent dispensing grandmotherly advice and helping people understand why antibiotics are not going to cure a virus. But not every cough is completely benign, and much of the teaching I do is helping young doctors to distinguish the difference.
Over the last year, I’ve diagnosed around 4 cases of pertussis. Ideally this shouldn’t have happened. Pertussis is relatively harmless in adults, but it is very dangerous to young children. Pertussis used to be a widespread disease. It is fairly benign in adults, causing a bronchitis-like illness. But children are at high risk of becoming very ill. The greatest risk is for children under 6 months old. If they get pertussis, they almost always need to be hospitalized. Pneumonia occurs in about a quarter of them, seizures and brain damage in about 3-5%. Death rates are about 1-2 in 1000. Serious allergic reactions to the vaccine occur in less than one in 100,000 cases.
If you are unvaccinated and live with someone who has the disease, you will catch it (80-100% transmission rate). Vaccination prevents disease, and when it does not, it lessens the severity. Most importantly, vaccination prevents transmission to those most vulnerable…babies. They are too young to have developed proper immunity. So getting vaccinated is not just for personal protection; it is for the protection of others.
Vaccination is safe and effective…we already have a way to fight this. The problem is, the vaccine’s effects do not last forever, and if an adult catches it, it looks a lot like a common cold; there is no way to identify and isolate the infected to prevent transmission. Vaccinating everyone protects our most vulnerable, and failure to vaccinate everyone puts our infants at risk.
Since pertussis immunity wanes with time, a new adult vaccine containing acellular pertussis is now available bundled with tetanus and diphtheria (if you’re under 65). When you go for your next tetanus shot (every 10 years), ask about it. By vaccinating yourself and your family, you can help prevent a child from getting ill. You might even save a life.
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