Paying the price of vaccine refusal

I’ve warned time and time again what the price will be if the Jenny McCarthy and her fellow arrogantly ignorant band of vaccine “skeptics” continue to get more and more traction. So have many others. It is true that, for the moment, vaccination rates overall remain high in the U.S., but there are numerous troubling signs that the propaganda being spread by Generation Rescue and the anti-vaccine movement is having an effect, with outbreaks of vaccine-preventble diseases popping up in areas with high levels of “philosophical” exemptions. In such areas, vaccination rates can easily fall well below the levels needed for herd immunity. However, fortunately, we have thus far avoided widespread outbreaks. I fear our luck will not hold out much longer. If you want to see what may be in our future, all you have to do is to look to the U.K., which is several years ahead of us on the road to a vaccine-free society where once vanquished diseases are endemic again.

Minnesota, unfortunately, has gotten a taste of what I fear to be the future. This story, published in City Pages, shows just where the anti-vaccine movement is leading us. It tells the story of Julieanna Metcalf, who contracted a disease that she would likely not have contracted were it not for the dimunition of herd immunity resulting from an unholy confluence of the anti-vaccine movement and a shortage of a vaccine. Here is what happened after a couple of days of what at first seemed to be a common viral illness of childhood:

Early the next morning, Flint awoke with a start: Julieanna was screaming–a shrill, sharp wail. Flint held Julie close, and the baby relaxed and dropped immediately to sleep. Flint shifted the little girl away from her body, and Julieanna awoke and screamed again. Flint pulled her close and the baby instantly fell back to sleep. Flint held Julieanna for hours. When the baby’s temperature soared to 104 degrees, Flint called the doctor and made an appointment.

She put Julieanna in a bath to cool her. The little girl slumped against the back of the tub, as if she’d forgotten how to sit up on her own. Flint ran cold water over Julie’s hair. The little girl held her head ramrod straight and her neck stiff. Her blue eyes veered left to meet Flint’s, and the mother read an expression of terror in her baby’s eyes. Flint pulled her daughter out of the tub, toweled her off, and rushed to the emergency room at Ridgeview Medical Center in Waconia.

The doctors admitted Julieanna for severe dehydration. They administered an IV, gave her a battery of tests to rule out pneumonia and bacterial infections, and kept her overnight. The physicians prodded and poked, but Julieanna hardly whimpered.

Flint stayed up all night, lying beside her baby on the hospital bed.

When Dr. Wuerger checked in the next morning, she knew that something was terribly wrong–she had never seen Julieanna so groggy and unresponsive. Wuerger called for a spinal tap.

The E.R. doc pierced Julieanna’s spine with a long needle. The baby was so out of it that she could barely muster a soft moan in response. Flint had never seen her little girl so lethargic, and the sight of it scared her. She cried as the doctor withdrew the spinal fluid: a thick, yellow smear of pus.

“Brendalee, it doesn’t look good,” he said. “It’s supposed to come out clear.”

If there’s one thing I know about pediatrics (or medicine) it’s that pus in the cerebrospinal fluid is a very, very bad thing. In fact, it’s a horrible thing that can easily kill. What Julieanna had was Haemophilus influenza type B–Hib. Hib was the scourge of the pediatrics wards a mere 20 years ago. Indeed, one of the most disturbing memories I have from my pediatrics rotation in medical school during the mid-1980s was a baby in the pediatric intensive care unit deathly ill with Hib. To this day, I don’t know if the girl lived or died. All I know is that she was still alive when I left the rotation to move on and that she had been on a ventilator and constantly kept threatening to die during the week or so I was part of the team taking care of her. I remember her parents, one of whom was always by her bed.

Hib is one of the greatest success stories in the history of vaccination and a very recent one. As pediatrician Dr. John Snyder informs us, as recently as 1987, Hib caused invasive disease in 1 in 200 children under the age of 5. Of these, one half to two-thirds developed meningitis like Julieanna, with a mortality rate of 5% and rate of permanent brain damage of 30%. It is a nasty, nasty bug, and a vaccine against it only went into widespread use in the late 1980s/early 1990s. Now, thanks to the Hib vaccine, there have been generations of pediatricians who have never seen a case of Hib meningitis. Indeed, if your pediatrician trained after 1991, it’s quite possible that he’s never seen a case. By 2006, the incidence of Hib has been cut by 99%. As Dr. Snyder put it, “within a short period of time, the very nature of pediatric medicine seemed changed forever.”

Thanks to the anti-vaccine movement, the nature of pediatrics may soon be changing back to the bad old days, and, for the moment, the epicenter appears to be Minnesota. Indeed, this article gives a good overview of the history of the recent anti-vaccine movement. It’s not without its stumbles. For instance, the reporter mistakenly repeats the mercury militia talking point that the symptoms of autism are uncannily similar to the symptoms of autism (they aren’t), but overall the article is a stronger effort than the usual “tell both sides” rule of journalism allows. Most importantly, it puts a human face on the cost of not vaccinating against deadly diseases like Hib.

There was a confounding factor in the form of a vaccine shortage that made it unclear whether decreasing rates of Hib vaccination were due to vaccine refusers or the vaccine shortage or both. As a result of a contamination problem at Merck, its Hib vaccine had had to be pulled from the shelves in early 2008. The CDC and AAP altered vaccination recommendation to keep infants as protected as possible by recommending skipping the booster at 12-15 months. Minnesota health officials investigated:

To solve the mystery, Bahta and her colleagues at the state health department investigated each of the Minnesota cases, searching for a common link. Did the families know one another, and had the children contracted the disease from each other? Or did they know someone in common who carried the disease and spread it from one child to the next? No, Bahta and her team found out, the five families lived miles apart in different counties, had never met, and knew no one in common. So were more children carrying Hib this year? No, the health department swabbed the throats of 1,600 kids and found no difference.

In fact, the only places in the country where Hib had gone up were Minnesota and Pennsylvania, where six children got sick and three died. The national rate hadn’t changed a bit.

Still, the CDC took the Hib cases as an opportunity to push vaccines. “The increase highlights the need to ensure that all children complete the primary Hib immunization series,” one CDC statement read.

In recent years, outbreaks of infectious diseases once thought to be eradicated in the West have popped up in several unvaccinated communities in Minnesota. In 1996, several children belonging to Christ’s Household of Faith in St. Paul got the measles. In 2005, a polio outbreak hit an unvaccinated Amish community in central Minnesota.

As I’ve written about before, in the most recent outbreak in Minnesota most of the victims were completely unvaccinated. Julieanna was the exception:

The worst was over, and slowly, Julieanna began to recover. As a result of the illness, she’d forgotten everything she’d ever learned: how to swallow, crawl, walk, and talk. Her days filled up with therapy appointments. The doctors did more tests and discovered that she had hypogammaglobulinemia, a rare immune deficiency disorder. Julieanna’s body lacked four antibodies needed to fight infectious diseases, the immunologist explained. Even though she’d been vaccinated, the immune deficiency made her vulnerable to contracting Hib. Julieanna was likely to face recurrent infections for the rest of her life.

In other words, Julieanna was one of the children who relies on herd immunity because she has an immune deficiency that kept the vaccine from being effective in her. Although it can’t be proven for sure that the antivaccine movement is directly responsible for Julieanna’s illness, there’s no doubt that the ongoing erosion of herd immunity in pockets of vaccine resistance will, if not checked, result in more Julieanna’s, some of whom my suffer even worse than severe illness and brain damage. There will be more pus on the brain in children. Or so I (and many others) fear.

For example, Dr. Paul Offit puts it in a chilling way:

“All you have to do is drop your guard a little bit, and these diseases come back,” says Paul Offit, chief of Infectious Diseases and director of the Vaccine Education Center at Children’s Hospital of Philadelphia. A prominent vaccine advocate and co-inventor and patent-holder of the rotavirus vaccine, Offit is disturbed by the trend of refusing vaccines. “I used to say this will change when children start to die. Now I’m starting to say, this will change when enough children die.”

He’s probably right. My only question is: How much will be “enough”? I fear that in the next few years, as people like Jenny McCarthy, enabled by Oprah Winfrey and aided by anti-vaccine apologist pediatricians like Dr. Bob Sears and Dr. Jay Gordon, and the rest of the anti-vaccine movement spread misinformation, we will soon find out.