Nothing fails like success: The great immunization debate

| March 23, 2015
Photo: flickr/ Blake Patterson

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In the winter of 2015 an outbreak of measles is underway, setting loose a passionate discussion about routine immunization.

Why? Immunization campaigns of the past have been so successful that the public no longer has personal experience with the diseases that have been prevented.

I am biased by my personal experience, beginning age six months with a severe case of whooping cough. My family camped on the beach, exposure to salt air all that could be offered. I remember spending a week in a dark room with measles: high fever, nightmares, delirium, severe light sensitivity and a seizure.

Recently, my 85-year-old mother suffered from shingles and related neuralgia, which made her last years painful from a now preventable disease. Shingles can be a life-altering disease of the elderly, occurring as our immunity and defences naturally decline. We don't have to get it. My wife and I have received the varicella-zoster vaccine.

Measles is no joke. In 1963, as a medical student at Stanford, I worked in a Mexican village, where prior to my arrival, the town had been visited by a major measles epidemic, with devastating consequences for the children: many fatalities, some left with hearing loss, chronic ear and chest infections and residual brain damage from the encephalitis.

The day after I arrived I was asked by a distraught father to see his four-year-old daughter, whom he said was completely normal before the measles epidemic. She was curled up in a corner of the house, in deep coma that had lasted for weeks. Sadly I had to say there was nothing that I could do for her.

Soon after, the town was struck with a typhoid epidemic. The problem was contaminated water. Immunizations against typhoid were unavailable in this remote village. The town nurse also contracted typhoid and left. Thus, a medical student became the de facto medical officer of the town, liberally dispensing antibiotics. My patients did well. The village curanderos dealt with typhoid and other diseases by organizing a curing ceremony.

Most serious diseases were thought to arise from "loss of soul." Curing ceremonies were organized to recover the lost soul. Results of the curing ceremonies for typhoid were poor while, with the help of antibiotics, "my patients" had reasonably good outcomes. 

The oldest curandero paid me a visit. He explained that he wanted me to supply him with the drugs, which he would incorporate into his curing ceremonies,  explaining that he regularly used the drug chloroquin as part of his curing ceremonies for malaria. He left with a bag of antibiotics.  

A week later I was surprised to be invited by the father of the brain-damaged child to attend a curing ceremony to be conducted by one of the younger curanderos, one that I was told was a dangerous person. The ceremony began with the child lying on a bed of straw. At one end was a cross and candle, the other end a chicken tied to a post, palm fronds arranged overhead. After 15 minutes of circling the child, the curandero turned to me and asked for my watch, which he said was required for the ceremony. I refused. The curandero became enraged, kicked over the palm fronds, intoning that the child would die and it was my fault. He refused payment and stormed out of the house. The child died several days later. It was time for me to resume my medical studies.

More preventable diseases

In my senior year at Stanford, I obtained a scholarship to study international pediatrics at the Ethio-Swedish Pediatric Hospital in Addis Ababa. I learned many medical and surgical procedures, to treat the many children who arrived in extreme respiratory distress, due to diphtheria and destructive laryngeal diseases.

One night while sleeping in the on-call room, there was a loud banging on the door. I opened the door to see a uniformed soldier, whom I recognized as the Security Chief for the Emperor. When he stepped to one side, there was Emperor Haille Selassie himself, in whose arms was a boy of eight years, his grandson, the son of The Crown Prince. The child was unconscious and having great difficulty breathing.

The anesthesiologist rushed over and with some difficulty was able to pass a small tube into the trachea, which secured the airway and moderated the emergency. I doubt that I would have been able to pass a tube through such a narrow and inflamed airway. This allowed me to do a relatively slow, cosmetic tracheotomy, while a very short Emperor stood behind me on a stool.

The child clearly was suffering from epiglottitis, a severe swelling of the epiglottis, blocking the airway. This disease is caused by H.Influenza, what used to be a common organism in Western countries.

In 2015 in the West, this condition is disappearing as the causative organism is prevented through routine childhood immunization. This organism also causes one of the most common ear infections and a severe form of meningitis, both of which are vanishing due to routine immunization.

Diphtheria follows me

Refusing to serve as a doctor during the Vietnam War, I escaped to Canada in 1967. Soon after my arrival, on duty at the Montreal Children's Hospital, a child presented in extreme respiratory distress. I had seen it all before, diphtheria with blocked trachea. An immediate tracheotomy was required. The attending staff was not in the building. The other residents thought I was crazy. We don't have diphtheria here. We immunize against the disease. The DPT shot (diphtheria, pertussis, tetanus) does that.  I was insistent. I asked the nurse to page the surgeon on call, while  I made for the elevator where the operating suites were located.

The good news was that the head of anesthesiology was sleeping in the hospital. The bad news is that having just arrived from New York and new to the building, I did not know the geography. The bank of elevators that I took entered on the wrong side of the operating suites. I found myself walking with a diphtheria-infected child in my arms through all the operating rooms, contaminating everything as I went. There was no time to wait for the surgeon to arrive. The anesthesiology chief passed a tube and I did the tracheotomy. The surgeons were not happy. All the operating rooms were closed for several days while the entire suite was decontaminated.

Nothing fails like success

The very success of immunizations have allowed those who deny the efficacy of the immunizations or who have issues with modern medicine to find a receptive audience.

These deniers distrust doctors and science, sometimes with good reason. They allow their own personal "freedom" to do what they please with their bodies to trump the public good and for whom association and causation are confused.

Of course, important vaccine side effects do occur but their frequency is many orders of magnitude less than the frequency of major complications and death from the diseases they prevent. Unless we reach those that distrust modern approaches to the prevention of disease, diseases that were eliminated are at risk of reappearing.

The earth is not flat. The climate is warming. Vaccines work and have eliminated diseases that we hope never to see again.

 

Michael C. Klein , M.D., C.C.F.P., F.C.F.P., F.A.A.P. (Neonatal/Perinatal), F.C.P.S., is Emeritus Professor of Family Practice at UBC, Adjunct Professor of Family Medicine McGill University, and Senior Scientist Emeritus at The Child and Family Research Institute in Vancouver.

He is best known for his RCT of episiotomy, demonstrating that it caused the very trauma that it was supposed to prevent, which is credited with contributing to a large drop in routine episiotomy use and a concurrent fall in rectal trauma. Recently he has been the PI on a Canadian National Study of the attitudes and beliefs of all maternity care providers and the women they serve. His current research focuses on providing pregnant women with high quality web-based information to help them work in an evidence-based way with their provider. He teaches at UBC in family practice and midwifery and is on the editorial board of BIRTH.

He was head of a McGill teaching Centre and Department of Family Medicine at a McGill teaching hospital in Montreal for 17 years and Head of the Department of Family Practice at Children’s and Women’s in Vancouver for 10 years.

He has received The Morris Wood Award for Lifetime Contributions to Primary Care Research from the North American Primary Care Research Group, Family Physician Researcher of the Year from the College of Family Physicians of Canada, The Founders Award from the international Doula organization, DONA, the annual research Award from Lamaze International and The Award for Lifetime Contributions to Family Practice Research from the College of Family Physicians of Canada. He is on the Board of DONA.

He and his wife Bonnie emigrated from the U.S. to Canada in 1967 because he refused to be a military physician during the Vietnam War. His son Seth and daughter Naomi were born and work in Canada. Bonnie is a disabled film-maker, writer and disability rights activist. 

Photo: flickr/ Blake Patterson

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