Immunized

 

Fundamentally, I'm a good sport.  At the request of my son, who anticipates his first child and my first grandchild, I had the pharmacist vaccinate me against pertussis. Being a senior, my form would be a Tdap.  It protects me from tetanus and diphtheria as well as pertussis.  In my long medical career, I've never seen tetanus or diphtheria, in large part because everyone got immunized.  I do not recall ever seeing whooping cough, or pertussis, though I recall rounding with pediatricians as a student or resident where that was a consideration for a sick child.  While I've not encountered this, reliable American data anticipates about 10000 Americans will get pertussis each year.  Tetanus and diphtheria have largely disappeared.  While the bacteria that cause these things remain in the environment, vaccinated, herd, or anamnestic immunity is so high that clinical cases no longer emerge.  

Vaccines have become political.  They shouldn't be.  When I took my mandatory pediatric student rotation in 1976, polio and smallpox had been eradicated.  Kids occasionally got measles, as immunization had become available about ten years earlier.  On History and Physical exams that we wrote on patients of all ages, Usual Childhood Diseases were lumped as a unit, most patients emerging both unscathed and immune.  Mumps, chicken pox, and most importantly bacterial meningitis still cropped up.  Not everyone had a complete recovery, as some kids were left with hearing and cognitive effects.  Adults who got mumps, escaping the childhood form, might develop orchitis, which I have seen, and following my own mumps, inadvertently passed along to my friend's father.  These are conditions with widespread effective recovery, but not entirely harmless.  Polio immunization became available when I entered first grade.  I had a HS classmate with forearm crutches and calf braces,  presumably from polio, others with hearing aids, likely from measles.  As viral disorders, many do not have effective antimicrobial options once an established clinical illness arises.

Adults do not get off scot-free.  I've seen hepatitis, even lived through the era when the different forms of this infection became sorted through diagnostic testing.  Influenza can have severe outbreaks, with some patients who do not survive.  And Covid-19 caused a widespread lethal pandemic.  Shingles devastates older people.  And not all viral illnesses present acutely.  Cervical cancer fell dramatically with the incorporation of Pap Smears to periodic gynecological care.  But the young women who got this, even in its early stages, needed significant, often invasive medical care and future surveillance.  A vaccine to prevent this has reduced morbidity.

So what gives high-profile anti-vaxxers credence?  First, perhaps, is that excessive medical care is a variant of bad medical care.  Were it not for the need to protect a newborn, my Tdap would not have happened.  We stopped immunizing for smallpox when the risk of the vaccine exceeded the likelihood of getting a rare disease.  Polio, diphtheria, and tetanus are devastating but in America do not occur.  Still, even the anti-vaxxers don't seem to object to protecting people from rare diseases that will create great harm to even a few.  Bacterial meningitis, Haemophilus and pneumococcal, I've treated kids with both in a pre-cephalosporin era of Penicillin + Chloramphenicol, is memorable to patients, families, and the hospital staff that cares for those kids.  Nobody wants that to ever happen.  No push-back from the anti-vaxxers.   Hepatitis in adults is another life-shortening condition.  If an employer such as a medical center wants its staff protected, no political resistance to this.  Nor to pneumococcal immunization, as pneumcoccal pneumonia and pneumococcal bactermia can be lethal.  

So we are left with controversy over conditions from which people usually recover, particularly measles but also mumps and chicken pox, and vaccines that fall short of the protections offered by polio, DPT, and pneumococcal immunizations.  I've had Covid-19 while up to date on standard protection. My wife had life-threatening Covid while immunized.  This is not a real good immunization when placed against the tried and true medical advancements of fifty or more years ago.  Still, the medical treatment for established infection also leaves a lot to be desired.  And mass immunization capturing people not likely to incur serious harm from Covid, whether school children or healthy adults, remains a legitimate uncertainty for which properly conducted studies in lieu of public reasonableness policies, or even laws, may be a better public option.

My employer mandated flu vaccines.  Many years ago, I had an adverse local site reaction that kept me out of work for three days.  I went twenty years without voluntary winter immunization, taking my chances as a young healthy adult likely to recover.  And the efficacy of the vaccine from one year to the next falls way short of ideal.  Polio and tetanus are eradicated.  Influenza is not. 

The immunizations that reach the recommended preventions have very infrequent adverse effects.  A sore arm like I had.  Yet it can become political.  People of my era remember photos of President Ford, then also candidate Ford, receiving a Swine Flu injection, with the anticipated bandwagon effect getting other patriotic citizens to make their deltoids available.  Before long, a handful of recipients developed Gillan-Barre paralysis, a devastating condition with variable recovery.  And Swine Flu fizzled as an epidemic illness.  The political concerns today involve people whose wealth or prominence creating credence who believe that too many preschoolers who would have recovered from measles are permanently disadvantaged by vaccine-induced autism.  As Reb Tevye of Broadway reminded us in the 1960's "when you're rich they think you really know."  People with professional expertise, most of whom think the measles immunization prevents disability with little risk to the recipient, get marginalized.  However, the medical majority has its failures, too.  While my class had kids with polio and measles residuals, today's public school students carry Epi-Pens generated by mothers who followed the pediatric guidelines and withheld exposure of their toddlers to peanuts.  There are benefits to exposing youngsters to common allergens, with functional development of beneficial antibodies as the common outcome.  

So my own immunizations have been augmented to help somebody dear to me, if not myself.  No covid this year.  Flu would devastate me.  I got that one.  Don't want to risk pneumococcus.  Polio risk averted at my parents' insistence.  Hepatitis immunization as an employer requirement, paid for by them.  Still taking my chances on Shingles.  Maybe I shouldn't