Vaccines: A Glance Behind and a Look Ahead
Pediatrician Evaluates the Past and Future of Childhood Inoculations
By: Dr. Karen Sadler, MD
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| As parents, we want happy, long, and healthy lives for our kids, and today's children are more likely than ever to avoid life-threatening illnesses as they benefit from one of modern medicine's greatest developments—vaccinations. | ||
| In 1900, the life expectancy in America was 48 years, while today it is approximately 77 years. Improved nutrition, sanitation, and hygiene account for some of this remarkable achievement, as does a better understanding of diseases and the ability to take a pre-emptive strike against them with vaccines. | ||
| Most American children today have never seen anyone with the likes of polio or measles or diphtheria, the big killers of their great-grandparents' generation. Just how dramatically has the landscape changed since our ancestors were born? Take a primer in vaccination history and learn why we owe our forbearers a debt of gratitude for being part of the vaccine campaigns that have changed history. | ||
The Vaccination Record One hundred years ago, 40 percent of all deaths were due to 11 diseases—influenza, pneumonia, tuberculosis, diphtheria, pertussis, tetanus, measles, typhoid, polio, and scarlet fever, as well as diseases causing diarrhea. And in the 1920s, before the diphtheria vaccine came along, 150,000 Americans each year caught this disease and 15,000 died. In 2002, only one case of diphtheria was reported in the United States. Just one. | ||
| A polio epidemic in 1916 paralyzed 27,000 people and left 6,000 dead. The first March of Dimes, in 1938, was a national request to the people of America to send one dime to the White House to be used in the fight against polio. President Franklin Roosevelt, himself a polio victim, saw the White House collect 230,000 dimes in just the first week (and Roosevelt remains on the dime to this day)! A polio vaccine was introduced in the mid-1950s, and within a few decades, wild-type polio was nearly wiped out. The few cases per year that did occur were related to the live virus vaccine, which prompted a switch to the killed version in the 1990s. | ||
| Measles (whose name probably derives from the Latin word for "miserable") still kills one million people each year worldwide. But the vaccine introduced in this country in 1963 has made it rare in the US. | ||
| In the mid-1980s, a new vaccine technology brought the hemophilus influenza B (HIB) vaccine to the market. At that time, this bacterium was the leading cause of meningitis in children under five in the United States. There were 12,000 cases per year; one-fourth of those children were left with permanent brain damage, and one in twenty died. Today, we have virtually eliminated invasive HIB disease from this country. A similar story is underway with the pneumococcus vaccine introduced in 2000. This germ is now the new top cause of meningitis in small children, but the number of cases has already fallen by over 70 percent. | ||
| Clearly, the progress that's been made against these germs has been stunning, with millions of American children saved from debilitation and death over the past 80 years. | ||
Community Immunity Vaccines are about much more than protecting the individual; there's an equally important benefit with something called "community immunity." The medical establishment can never achieve 100 percent vaccination rates—there will always be those who cannot get protected, either because they are too sick or have weakened immune systems and cannot respond to a vaccine (children with cancer on chemotherapy, for example), or because those children's parents refuse to vaccinate them. These children remain vulnerable to illness; yet if enough of the children in their community are immune, they won't be exposed to these germs as there aren't sick children to pass them along. | ||
| To achieve community immunity, over 95 percent of a community needs to be immunized. Thus, childhood vaccinations become more than just a way to keep one child healthy. They are part of a larger social obligation, performed by the healthy and willing for those less fortunate. Another important benefit in having a large portion of the community protected is the prevention of large-scale outbreaks. In 1994, infectious polio made its way to Canada in the form of a traveler from India. Yet because of Canada's high immunization rates, no large outbreak occurred. | ||
The Battle Rages On There are currently 13 different germs covered in our childhood vaccines, but despite these amazing gains against serious diseases, the battle is far from over. With increased global travel, the risk of exposure to both old and new germs increases. As medical advances allow sick and disabled children to live longer, our vulnerable population persists. Even for the healthy and vaccinated, the strong immune response generated in childhood can diminish over time, so that by adolescence or young adulthood, the protection is gone. | ||
| This is what happens in the case of pertussis, the only disease in our current vaccines that has been on the rise, mostly because older children and adults are getting and spreading the illness. Unfortunately, none of these germs has yet been wiped off the planet completely. When a society chooses to stop vaccinating, disease quickly returns. This was the case in Japan in the 1970s. In 1974, with over 80 percent of its population protected against pertussis, it was mistakenly believed that pertussis was no longer a threat, and the number of vaccinated children plummeted. By 1976, only 10 percent of the population was being immunized. Soon after, a pertussis epidemic swept though Japan that sickened 13,000 and left 41 dead. | ||
| Until these germs are truly extinct, our guard cannot be let down. To maintain the progress made, vaccinations need to continue. New vaccines, once proven safe and effective, should also be accepted by today's parents so that our grandchildren can forget the illnesses that plague us today. Doctors are considering extending some vaccines later into childhood and adolescence to boost the immunity that has waned. Along these lines, here are the latest developments and recommendations coming to our communities: | ||
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| The battlefront in the war on disease is ever changing. As new germs emerge, old ones mutate, and resistance to antibiotics becomes more common. New developments on the vaccine front are an important part of our ability to control and sometimes even eliminate serious diseases. | ||
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