This I Believe
I believe in immunization. I came of age medically in the early 1980s when I completed my three-year pediatric residency in San Francisco. During those years I saw a lot of very sick children who presented with high fever, stiff neck, and a bulging anterior fontanelle—the soft spot on the top of a baby’s head. When I stuck a needle into the backs of these children to perform a lumbar puncture or spinal tap, out would come sickening looking pus instead of the crystal clear cerebrospinal fluid that should be there bathing the brain and spinal cord. When these children recovered, and they didn’t always survive, they were often left with deficits like hearing loss or mental retardation. A few years later in the mid 1980s, a vaccine became available against the most common cause of these terrible infections: the bacteria Haemophilus influenzae type B. This vaccine was soon incorporated into the schedule of immunizations routinely given to children, at least in developed countries. Soon thereafter these terrible infections ceased to occur. What a miracle! This must have been like what an earlier generation of pediatricians experienced after the polio vaccine became available in the 1950s. Instead of thousands of children supported on iron lungs or left with severe residual handicaps, the disease, polio, almost completely disappeared. For me and my generation of pediatricians polio is an abstraction, a disease of historical interest only just as bacterial meningitis is, for the most part, a disease to be read about in textbooks by today’s pediatricians in training. It infuriates me when some people promulgate unfounded beliefs about the dangers of immunization. Those beliefs can scare parents enough to cause them to forego necessary immunizations for their children putting their children and society at increased risk of contracting preventable diseases. Immunizations are tested meticulously for both efficacy and side effects before they are used broadly. If, as rarely happens, a possible side-effect is discovered only after large scale use, as happened in the late 1990s with an early version of an oral immunization against rotavirus, a very common cause of diarrhea in children, an effective and efficient system is in place to halt the ongoing use of that particular immunization. Within days of confirmation of the possibility of an unforeseen side-effect from that immunization, representatives from the company that manufactured the vaccine came to my clinic to remove any stock that might be present to be sure that no child would receive another dose. The old adage, “An ounce of prevention is worth a pound of cure,” is certainly true and seldom demonstrated as dramatically as in the case of immunization. According to the American Academy of Pediatrics, “The ultimate goal of immunization is eradication of disease; the immediate goal is prevention of disease in individuals and groups.”* More immunizations against different diseases are in development and I welcome the expansion of the armamentarium available to prevent and eradicate disease.
* Red Book: 2006 Report of the Committee on Infectious Diseases of the American Academy of Pediatrics.
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