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We could expect outbreaks of the
diseases that vaccines prevent
- With the exception of smallpox,
which has been eradicated as a result of a global immunization effort, the
organisms that cause vaccine-preventable
disease and death still
exist. In July 1998, for example, the San Francisco Bay area experienced an outbreak of pertussis (whooping
cough) that resulted in deaths. To read an article about this outbreak, click here.
- Many diseases that are rare in
the U.S. remain rampant in countries where vaccines are less available.
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For example, we could see
resurgence of diphtheria
It's a word that's hard to spell,
because of that extra "h" in the middle and because we rarely are reminded, in
our daily reading, of this disease.
Doctors have abbreviated it to the "D" in "DTP"
(diphtheria-tetanus-pertussis) immunizations.
Just two or three generations ago, however, everyone on the North American continent (as
well as the rest of the world) was alert to diphtheria, a disease that could sweep away
entire classrooms of children and their teachers, as well, within days.
Diphtheria is caused by Corynebacterium diphtheriae, a bacterium that is unique in that it
lives and thrives only in humans.(1) One of the symptoms
of this disease is unique, as well: It causes a thick, tough, gray membrane to form and
grow in the throat. In one of every four cases(2)--and
especially in young children--this membrane extends into the windpipe, gradually closing
off the upper airway until breathing is impossible. Most diphtheria deaths, however, are
caused by damage from diphtheria toxin, a poison that is produced in the body during the
illness and is absorbed by various organs.(3)
About 2,500 years ago, Hippocrates described a disease that matches the description of
diphtheria.(4) In the 17th century, numerous outbreaks occurred in Spain. Not
surprisingly, the disease entered the American colonies early in their history.(5) Even into the early years of the 20th century,
diphtheria was devastating some Native American tribes.
Today, Edward A. Mortimer, Jr., M.D., reports, "The diagnosis of diphtheria in the
United States is rapidly becoming a lost skill because of the infrequency of the disease
in recent years." Widespread use of diphtheria vaccine has dramatically reduced the
presence of this disease; however, it is persistent, and given an opening, diphtheria
quickly resurges. Between 1990 and 1995, for example, diphtheria killed more than 4,000
people in the Soviet Union.(6) In the U.S., because of
high rates of vaccination, the
disease is rare, but even here, it is not unheard of. As of late 1996, it appeared to be
circulating in Alaska, Arizona, Montana, New Mexico, South Dakota, and Washington state,(7) and in June 1997, a case was reported in Georgia.
Other vaccine-preventable diseases are just as tenacious. In fact, the only disease that
can rightfully be described as "eradicated" is smallpox. A massive effort has
been launched to rid the world of polio, too; indeed, it has been eliminated from the
Western hemisphere, but cases still occur in other corners of the world. Between January
3 through December 4, 1993, 5,457 pertussis (whooping cough) cases were reported to CDC.
This represented an 82% increase over the number reported during the same period in
1992, and it was the highest number of cases reported since 1967.(8)
The increases were especially felt in the New England, middle Atlantic, North Central,
and Mountain regions. During 1993, large outbreaks occurred in Chicago and Cincinnati.(9) Measles, mumps, rubella, and other vaccine-preventable
diseases are still only at bay, awaiting a window of opportunity to reclaim prominence
as common diseases.
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We could expect tragic,
unnecessary deaths from vaccine-preventable diseases
In the global neighborhood, disease
prevention is not just about us. Measles--a common disease that can be fatal to children
and adults--has been reduced by immunization
by 95% in the U.S., but it remains rampant in the rest of the world.
Before measles vaccine was available, nearly every child got measles.(10)
It's easy, in this country, to forget how serious measles can be. Measles often leads to
acute inflammation of the central nervous system, permanent brain damage, death,
bronchopneumonia, croup, diarrhea, or otitis media (middle ear infection). Measles
vaccination prevents the disease and its consequences, and history has
shown--tragically--that when the rate of vaccination decreases, the incidence of the
disease rises. Between 1989 and 1991, a measles epidemic occurred in the United
States, killing 120 people. The epidemic struck primarily in under immunized
groups--that is, in people who had not been vaccinated or who had been inadequately
vaccinated. According to the World Health Organization, 1.1 million deaths occurred
worldwide from measles in 1995.(11)
International commerce makes transmission of measles from country to country as easy as
boarding an airplane. In 1996, 47 cases were known to have been imported by people
traveling to the U.S. from other countries.(12) In July
1997, 100 hospital personnel and a number of college students in Pennsylvania had to be
immunized when a student returned from her home country of Brazil with measles.(13)
If measles vaccinations were stopped, 2.7 million measles deaths could be expected
worldwide.(14)
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We could expect life-changing
disabilities as a result of disease
Many older Americans remember the fear
of paralytic polio, a virus that infected 20,000 people in 1952 alone. Without warning,
this disease quickly spread, especially among children and young adults, often changing
their lives dramatically and permanently. The fear had a tangible impact on people's
lives. Where Victorians believed that sleeping in cold, open air was healthy (thus the
"sleeping porch"); modern parents believed (mistakenly) that sleeping in
drafts led to colds, and that colds led to polio, so bedrooms were moved back indoors
and children tucked snugly under the covers.
Our Nation's 32nd president, Franklin Delano Roosevelt, contracted polio as an adult.
While the President and his staff went to great lengths to mask the effects of the disease, Roosevelt suffered permanent
crippling effects. Other, even less fortunate polio victims either died or spent the
remainder of their lives in iron lungs, primitive and confining versions of today's
artificial breathing machines. At the close of the 20th century, many middle-aged and
older people are polio survivors.To read a recent article about one woman's experience, click here. Many who survived paralytic
polio are experiencing post-polio syndrome, a progressive weakness and paralysis caused
by the damage inflicted on muscles by polio.(15)
Thanks to polio vaccines, the number of paralytic polio cases in the U.S. fell to
fewer than 100 per year in the 1960s.(16) In fact, the
last case of wild polio acquired from within our own population was in 1979.(17) The last case in the Americas was in Peru, in 1991.
The Western hemisphere was declared free of wild polio in 1994. The World Health
Assembly, governing body of the World Health Organization, launched a vaccination
program in 1988, to eradicate the disease world-wide by the year 2000.(18)
Scientists believe that the end of polio is in sight.
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Little-known effects of
familiar diseases
Many other vaccine-preventable
diseases cause lifelong adverse effects:
- Mumps. In 20% to
30% of men with mumps, the disease causes inflammation of the testes and scrotum.(19) In rare cases, it can cause sterility. (20)
In 1 in 6,000 to 1 in 400 cases in children and adults, mumps can lead to mumps
encephalitis (inflammation of the central nervous system and brain) and
consequently, to recurrent seizures, paralysis, or hydrocephalus (excess fluid on
the brain). A few studies have suggested that mumps may also cause permanent damage
to the pancreas in some people,(21) perhaps even leading to
diabetes mellitus.(22) The highest number of cases of mumps in
one year occurred in 1967, with 185,691 cases reported.
By 1985, just 18 years after mumps vaccine came into widespread use,(23) the number of cases had fallen by 98%. Since then, the
disease has gone through periods of resurgence; however, the number of cases has
always been much lower than in the period before introduction of the vaccine.(24)
- Pertussis (whooping
cough). Complications of pertussis include convulsions, coma, and permanent
brain damage in infants under the age of 12 months.(25) Before
pertussis vaccine became available in the late 1940s,(26)
nearly all children developed this disease. Pertussis peaked in 1922 at 265,269
cases.
By 1970, this number was reduced by 99%. The number of cases has fluctuated since
then, but the total for any year since 1970 has remained a fraction of pre-vaccine
cases.(27) Today, most young pediatricians and those in
training have never seen a case.
- Tetanus (lockjaw).
Tetanus results from infection of wounds with Clostridium tetani, an organism
that grows in soil and produces a highly virulent toxin. Though tetanus is a rare
disease in developed countries, it is uniformly devastating when it occurs. It can
cause lasting impairment of speech, memory, and mental function.(28)
In 1947, 560 cases of tetanus were reported in the U.S.
Widespread use of the tetanus vaccine, improved wound management, and use of the
tetanus anti-toxin has dramatically decreased the number of cases of tetanus. In
1987, 48 cases were reported.(29)
- Haemophilus influenzae type
b (Hib).
- Hib was once the most
frequent cause of deadly bacterial meningitis in children. It can also cause
pneumonia, epiglottitis, sinusitis, permanent joint damage, impaired hearing, or
blindness. Before effective vaccines were introduced, Hib was very common: One in
200 children developed invasive Hib disease by the age of 5
years.(30)
Since introduction of Hib vaccine in December 1987, the incidence of Hib has
declined by 97% to 99%, compared with the pre-vaccine number of cases. Fewer than 10
fatal cases of invasive Hib disease were reported in 1995.(31)
Once an illness commonly seen, today most pediatricians have never seen a case.
- Rubella (German measles).
While rubella is usually mild in children and does not have lasting effects on them,
it can have devastating effects on a developing fetus. If a pregnant woman is
infected with rubella early in the pregnancy, the disease almost always leads to
permanent defects in the fetus, a condition called congenital rubella syndrome
(CRS). The syndrome involves multiple handicaps, including malformations of the
brain, heart, eyes, and ears; impaired growth; low birth weight and all its
consequences; mental retardation; cataracts, glaucoma, or blindness; deafness;
hepatitis (liver inflammation); bone marrow abnormality that leads to bleeding;
chronic pneumonia; diabetes; and low thyroid function, a condition that can lead to
additional mental and physical problems if untreated or inadequately treated. The
average life-time financial costs of caring for a child with CRS was estimated in
1984 to be in excess of $220,000.(32) Today's costs would be
much higher. In 1964-1965, before rubella immunization was used routinely in the
U.S., an epidemic resulted in an estimated 20,000 infants born with CRS; 2,100
newborn deaths; and 11,250 miscarriages.(33)
In 1983, provisional (early) data indicated a record low number of rubella
cases--just 934--were reported to CDC, and only four cases of CRS were confirmed.(34) Use of the rubella vaccine reduced the rate of rubella from
27.75 per 100,000 population in 1970 to 1.72 in 1980 and 0.05 in 1995.(35)
- Hepatitis B. This
disease was once thought to be a "lifestyle" disease, affecting only those
people who used intravenous drugs or had promiscuous sex. Today we know that this is
not true. Hepatitis B can be transmitted from one person to another through blood,
body fluids (including semen and genital tract secretions), and and breast milk. The
disease can be passed from an infected mother to her child at birth. In many
countries, the prevalence of hepatitis B is very high, with entire families infected
as the disease is passed from one family member to another. . Hepatitis B is a
disease that can cause major, debilitating effects such as chronic liver
inflammation, cirrhosis and liver failure, and liver cancer especially if the
disease is contracted before age 5. Conversely, hepatitis B can exist quietly, with
no symptoms, so a person can be a lifetime source of the disease for others and
never know it.
The hepatitis B vaccine is too new to have a major impact on the disease yet;
however, scientists have learned that control of this disease, and prevention of
lifetime disability, begins with immunization against this disease, and that
immunization must begin in children, who are most at risk of lifetime effects.
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Immunization Is Not Just about Us
Joyce Sequichie Hifler, an eloquent
Native American author and philosopher, offers this thought: "We forget and think
we are all there is." (36)
We in the United States are very fortunate to be able to forget how many infants,
children, and adults died, in previous generations, of diseases that we now prevent with
a few injections. Many other countries are not nearly so fortunate. Polio, measles,
hepatitis B, and other diseases still devastate many populations around the glove. The
World Health Organization publishes a weekly bulletin on global immunization efforts. To
view recent and past issues of this newsletter, click here.
Table of contents |
Click here to learn more about the World Health Organization program to
put an end to polio
The CDC National Immunization
Program provides information on polio and other vaccine-preventable diseases. |
 Footnotes |
1. Committee on Infectious Diseases, American Academy of Pediatrics.
Diphtheria. In: 1997 Red Book. 24th edition. Elk Grove Village, IL: American Academy of
Pediatrics, 1997:191-195.
2. Canadian Paediatric Society. Your child's best shot. Ottawa,
Ontario, Canada: Canadian Paediatric Society, 1997:13.
3. Plotkin SA, Mortimer Jr., EA (editors). Vaccines. 2nd
edition.-Philadelphia: W. B. Saunders Company, 1994:43.
4. Plotkin SA, Mortimer Jr., EA (editors). Vaccines. 2nd
edition. Philadelphia: W. B. Saunders Company, 1994:42
5. Plotkin SA, Mortimer Jr., EA (editors). Vaccines. 2nd
edition. Philadelphia: W. B. Saunders Company, 1994:41.
6. Centers for Disease Control and Prevention. Respiratory diphtheria
caused by Corynebacterium ulcerans: Terre Haute, Indiana, 1996, and editorial
note. Morbidity and Mortality Weekly Review April 18, 1997;46(15):330-332.
Available online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00051752.htm.
7. Centers for Disease Control and Prevention. Toxigenic Corynebacterium
diphtheriae: Northern Plains Indian community, August-October, 1996, and editorial
note. Morbidity and Mortality Weekly Review June 6, 1997;46(22):506-510.
Available online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00047859.htm.
8. Centers for Disease Control and Prevention. Resurgence of
pertussis: United States, 1993 and editorial note. Morbidity and
Mortality Weekly Review December 17, 1993;42(49)952-960. Available online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00023030.htm.
9. Centers for Disease Control and Prevention. Resurgence of
pertussis: United States, 1993 and editorial note. Morbidity and
Mortality Weekly Review December 17, 1993;42(49)952-960. Available online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00023030.htm.
10. Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3..
11. Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3..
12. Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3..
13. PR Newswire. Measles case confirmed in patient of Delaware
County Hospital Immunization News Service July 17, 1997:2.
14. Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3..
15. Canadian Paediatric Society. Chapter 11: Polio. In: Your
Child�s Best Shot: A Parent�s Guide to Vaccination. Ottawa, Ontario, Canada:
Canadian Paediatric Society, 1997:43-52.
16. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm.
17. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm.
18. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm.
19. Baum ST, Litman N. Chapter 135: Mumps virus. In Mandell GL,
Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 4th
edition. New York: Churchill Livingstone, 1997:1496-1498.
20. Baum ST, Litman N Chapter 135: Mumps virus. In: Mandell GL,
Bennett AG, Dolin R, editors. Principles and Practice of Infectious Diseases. 4th
edition. New York: Churchill Livingstone, 1997:1496-1498.
21. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm.
22. Canadian Paediatric Society. Chapter 11: Polio. In: Your
Child�s Best Shot: A Parent�s Guide to Vaccination. Ottawa, Ontario, Canada:
Canadian Paediatric Society, 1997:43-52.
23. Committee on Infectious Diseases. 1997 Red Book. 24th edition.
Elk Grove Village, IL: American Academy of Pediatrics, 1997:368.
24. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm.
25. Canadian Paediatric Society. Chapter 11: Polio. In: Your
Child�s Best Shot: A Parent�s Guide to Vaccination. Ottawa, Ontario, Canada:
Canadian Paediatric Society, 1997:43-52.
26.Centers for Disease Control. Diphtheria, tetanus, and pertussis:
recommendations for vaccine use and other preventive measures: recommendations of the
Immunization Practices Advisory Committee (ACIP).Morbidity and Mortality Weekly
Review August 8, 1991:40(No.RR-10):1-28. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00041645.htm.
27. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review January 24, 1997;46(RR-3):1-25. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00046568.htm
28. Canadian Paediatric Society. Chapter 11: Polio. In: Your
Child�s Best Shot: A Parent�s Guide to Vaccination. Ottawa, Ontario, Canada:
Canadian Paediatric Society, 1997:43-52.
29. Centers for Disease Control. Diphtheria, tetanus, and pertussis:
recommendations for vaccine use and other preventive measures: recommendations of the
Immunization Practices Advisory Committee (ACIP) Morbidity and Mortality Weekly
Review August 8, 1991:40(No.RR-10):1-28. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00041645.htm.
30. Centers for Disease Control. Diphtheria, tetanus, and pertussis:
recommendations for vaccine use and other preventive measures: recommendations of the
Immunization Practices Advisory Committee (ACIP)Morbidity and Mortality Weekly Review
August 8, 1991:40(No.RR-10):1-28. Online at http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00041645.htm.
31. Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3.
32. Advisory Committee on Immunization Practices. Poliomyelitis
prevention in the United States: introduction of a sequential vaccination schedule of
inactivated poliovirus vaccine followed by oral poliovirus vaccine. Morbidity and
Mortality Weekly Review 3(22);301-10,315-8.
33.Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3.
34.Department of Health and Human Services, Centers for Disease
Control and Prevention. Selected issues on immunizations: Background information for the
National Medical Association, Vaccine Task Force Meeting [briefing]. Atlanta, GA: DHHS,
CDC, April 20, 1997:3.
35. National Center for Health Statistics. Table 56: Selected
notifiable disease rates, according to disease: United States, selected years 1950-95.
In: Health United States, 1996-97 and Injury Chartbook. DHHS publication no.
(PHS)97-1232. Hyattsville, MD: Department of Health and Human Services, Centers for
Disease Control, 1997:173.
36. Hifler, JS. A Cherokee Feast of Days. Vol. II: Daily Meditations.
Tulsa, OK: Council Oak Books, 1997. |
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