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A Crack in the Armor

I remember back in 1985, when I was a brand new pediatric nurse, I encountered my first patient with bacterial meningitis.    The little boy was wheeled into the Pediatric Ward on a gurney, such a tiny boy with brown curls, and long lashes that dusted his round cheeks.  He was so sick, rigid and unresponsive.  Despite intensive treatment, he never really recovered.  He was never the same.  He never walked again, nor did he ever talk, his development stopped that day.  Even now, 30 years later, I still remember that boy.  Because the most shocking thing was, 24 hours before he arrived on our Pediatric Ward, he was a completely normal, exuberant little 2 year old.  Bacterial meningitis can hit hard and it can hit fast.  And as sad a story as this is, it becomes even sadder because he wasn’t the only one,  there were many more.   November was the month we feared, that was the month we saw a surge in bacterial meningitis each year. Some of the children recovered, but because of how quickly bacterial meningitis took hold of a small child, not many of them did.  And even if they did, they sometimes had hearing deficits because of the large amounts of ototoxic antibiotics we administered.

The Haemophilus influenza (Hib) vaccine was licensed in 1987.  Prior to the availability of this vaccine 20,000 children a year came down with bacterial meningitis caused by Haemophilus influenza (the leading cause of meningitis in children under 5 years of age), and a 1,000 of these children would die. The majority that did survive had permanent disabilities.

Before the Hib vaccine was available we saw epiglottitis.  This was a scary, scary illness that caused the epiglottis to swell.  The child would present with drooling and if not treated promptly with steroids and antibiotics  his breathing would become stridorous (high-pitched breathing) and eventually if left untreated the epiglottis would block off the airway. These patients were brought to the Pediatric ward, sitting up in the gurney, leaning forward and they were frightened and their eyes were wide, pleading silently for help  as every breath was a struggle.  We taped emergency airway equipment to their crib just in case.  According to the Mayo clinic website, epiglottitis is rare today.

Several years ago, I contracted Pertussis.  This is another horrible illness.  The coughing is so intense and painful, ribs can be broken.  According to the CDC website, Pertussis in young children and infants can be fatal.  Cases of pertussis are on the rise.

Finally, another illness which is kept at bay is Rubella (the ‘R’ component of MMR) with vaccinations.  For children, this illness is benign.  For adults, it is not.  Rubella can make adults very ill, with arthralgias and arthritis.  In severe cases it can cause encephalitis.  The scariest thing about Rubella is the effect it can have on the unborn child of a pregnant women in the first trimester of pregnancy.  If a pregnant woman is exposed to Rubella in her first 3 months of pregnancy her child could potentially be born with hearing, vision or developmental disabilities.  This used to be a huge concern when the MMR vaccination was not available, but no one seemed to remember this, when the vaccination rates were high. Unfortunately now it might be something we need to keep in the back of our minds.

With daily updates on the news about additional cases of measles, it is really upsetting to know that much of this could have been prevented. I think back to the children and parents whose lives were forever changed because of bacterial meningitis.  If  the Hib vaccine had been available to their children 30 years ago, those children would have grown up and probably had children of their own, their parents would be grandparents.  But they didn’t have that particular vaccine available to them.

I have been watching the news closely regarding the measles outbreak.   I have also watched the videos of the parents explaining why they have chosen not to vaccinate their children.  I have seen a number of videos where they do they air quotes in reference to these illnesses being so rare.  Illnesses such as Rubella, Pertussis, the cyclical outbreaks of meningitis we used to see starting in November are rare, but not gone.  They are successfully controlled because the majority of the population chooses to vaccinate their children. These diseases are just waiting, hiding on the sidelines, waiting for a crack in the armor.  Measles has found a crack, an entry point, and if more and more parents opt not to vaccinate, those other devastating illnesses that most people are too young to remember will also find a way through – and that will be a crying shame.

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