In last week’s entry, I covered what I see as the poor state of science addressing vaccine-autism risk. While this drew a few opponents in the discussion, for the most part there were a fair number of proponents of the idea as well. In any case, there’s certainly a lot of passionate argument on both sides and understandably so given the seriousness of the topic.

So for this week’s post, I thought I’d introduce readers to what life was like before vaccines, a life with the diseases that these childhood inoculations suppress. This is vitally important information for parents to know because when one speaks of foregoing vaccination, this doesn’t come without risk. So I welcome you to the:

Pre-vaccination Era

In 1750, only approximately 15% of the population lived in urban areas, but by 1860 that number boomed to 80%. With life in such close quarters came the opportunity for contagions to run rampant. Some diseases were directly propagated by unsanitary conditions, e.g., feces-contaminated water sources. For instance, cholera, due to infection by the bacterium, Vibrio cholerae, produces violent vomiting and diarrhea, ultimately leading to severe dehydration and possible death if left untreated. In 1st world countries, antibiotics and fluids (oral or intravenous) are usually used to treat the infrequent disease, but in poorer countries where antibiotics are not readily available and the disease is sadly much more common, cholera vaccines offer a relative period of immunity for approximately two years. Vaccination reduces risk of mortality by 50% within the first year following application [1]. Young children, 2-4 years of age, are particularly vulnerable to the deadliness of cholera.

The above is an image taken of patients from a cholera outbreak in Zimbabwe in 2009.

But what about diseases that arise simply from close contact, ones which we might still see in communities today?

Hepatitis B. In its acute form, this virus causes liver inflammation, vomiting, jaundice, and rarely death. For those for whom the illness is not fatal, they are termed “carriers.” In later life, these people can develop cirrhosis, as well as a very serious and poorly treatable form of liver cancer. HepB is a DNA virus able to reverse transcribe itself into an RNA intermediate, which then inserts itself into the genome of liver cells. The virus is spread primarily through contact of bodily fluids. Because of this, most people tend to think of it as relating to sex (or drug abuse) and so have questioned why in the world this would be one of the first inoculations given to an infant. But for those mothers who are HepB+, they are able to pass the disease to the infant during natural labor as the child passes through the birth canal and swallows vaginal fluid. (This is one of the primary ways infants receive their necessary slew of intestinal microbiota imperative for development of the GI tract and proper digestion.) Depending on the form of HepB, the child has a 20-90% risk of infection. With early inoculation, that risk of infection drops dramatically to approximately 5-10% [2].

Rotavirus. The rotavirus is a double-stranded RNA and houses 11 genes which code for RNA and proteins. The primary symptoms of infection are severe diarrhea, vomiting, and fever, an illness which leads to about 50% of diarrhea-related hospitalizations of infants and children each year. Before inoculations for RV in the US, per year the infection caused 2.7 million cases of gastroenteritis, 60,000 hospitalizations, and 37 deaths [3]. Because this RNA virus has a long life outside its host (9-19 days) and most of the typical sanitary measures against bacteria and parasites are ineffective, rates of infection are fairly stable worldwide, excepting in those countries which utilize vaccination as a preventative [4].

Diphtheria. In the curious case of Corynebacterium diphtheriae, the bacterium itself does not produce the toxin which causes the well-known symptoms of the disease. Instead, the bacterium must first be infected with the prophage DNA virus, beta phage. This virus inserts itself into the bacterium’s genome and subsequently triggers the production of the diphtheria toxin. Symptoms of the virulent infection include sore throat, coughing, fever, pseudomembranes within the sinuses, bloody nasal discharge, difficulty breathing and swallowing, and severely swollen lymph nodes (lymphadenopathy). Other symptoms can include myocarditis, which is inflammation of the heart muscle which occurs in approximately 20% of cases, and peripheral neuropathy, or damage to the peripheral nerves of the body which occurs in about 10%.

Above is the characteristic “bull neck” that typifies lymphadenopathy in diphtheria infection.

Pertussis. Commonly known as “whooping cough” and “the 100 days cough”, pertussis is caused by infection from the bacterium, Bordetella pertussis. The disease is typified by severe coughing fits, which include the paraxysmal (worsening) cough, followed by the high-pitched inhalation or “whoop”, and then usually vomiting. While most adults recover from the infection without permanent complications, morbidity and mortality rates are highest amongst infants. The CDC reports that about half of infants affected require hospitalization. 1 in 4 develop pneumonia, 1-2 in 100 develop convulsions, 2 out of 3 develop apnea, 1 in 300 will develop some form of encephalopathy, and 1 in 100 will die.

Tetanus. The bacterium which produces the neurotoxin, tetanospasmin, goes by the full name Clostridium tetani. Infection usually occurs through contamination of an open wound. Rusty metal objects have most frequently been associated with contamination, although it is not the rust per se which promotes infection but rather that rusty metal objects afford the bacterium an ideal environment for protecting its endospores. The toxin can spread and attack nerves within the spinal cord and neuromuscular junctions, preventing the communication of nerve and muscle, leading to sudden sporadic severe muscle spasms. The heart thankfully is exempt from these effects. Symptoms of the condition include jaw, neck, abdominal, and other body spasms, as well as difficulty swallowing, fever, sweating, elevated blood pressure, and rapid heart rate. In the past, mortality rates have reportedly ranged from 43-73%.

A case of neonatal tetanus in which the infant’s muscles are contracting in an opisthotonos (arched from head-to-foot) formation.

Tuberculosis. Tuberculosis is a disease which generally targets the lungs and is caused by various strains of mycobacterium, most commonly Mycobacterium tuberculosis. Symptoms include chronic cough with bloody mucus, fever, sweats, and weight loss, the latter inspiring the classic term “consumption.” Most people infected with TB are asymptomatic, however approximately 1 in 10 infected people develop the full condition, ultimately killing about half. Despite its control in 1st world countries, TB is still nevertheless very common, hence the importance of vaccination. Today, TB is considered a global pandemic, killing one person every twenty-five minutes.

Above you can see the severe “consumption” of a boy infected with TB.

Rubella. Rubella, also known as “German Measles,” is a single-strand RNA virus whose incubation period lasts approximately 2-3 weeks. In children and adults, the infection usually has a mild presentation including flu-like symptoms (fever, joint aches, swollen lymph nodes, etc.), with the addition of the characteristic red rash. However, infection during pregnancy can lead to spontaneous abortion or, in those infants who make it to term, Congenital Rubella Syndrome (CRS). Symptoms of CRS can include heart defects, blindness, deafness, and mental retardation. Chess et al. (1977) and Brown et al. (2001) have also found increased incidence of autism and schizophrenia in those with CRS respectively. Though risk decreases postnatally, infants still serve as potential carriers to other children and pregnant women, hence the importance of disease prevention.

Measles. Measles is a highly contagious Morbillivirus, a single-stranded RNA virus. Symptoms of infection include runny nose, cough, fever, and a generalized rash. Severe complications can include pneumonia, ear infection, corneal ulcers which can lead to scarring, and encephalitis or inflammation of the brain. Deaths attributed to measles occur at approximately 3 per 1,000 infected within the US, although immunocompromised individuals exhibit much higher rates of fatality [5].

The measles rash.

Mumps. Mumps is a form of Rubulavirus, a single-stranded RNA which comes from the same family, Paramyxovirus, as measles. Prior to the development of a vaccine, mumps was a very common childhood disease. It typically presents with glandular swelling, particularly of the parotid (salivary) gland, although a minority of pubertal and postpubertal males infected will also present with inflammation of the testicles. Infertility and subfertility can sometimes follow. Though extremely rare, mumps is the leading cause of viral meningioencephalitis, which is a virally-induced inflammation of the brain and meninges [6]. Other rare complications can include inflammation of the breasts or ovaries in pubertal and postpubertal females, and deafness [7].

A girl with swollen salivary glands typical of mumps infection.

According to research, in 1860 childhood mortality for white nonhispanics is estimated at approximately 181 per 1,000 births (18%). By the year 2000, childhood deaths are estimated at 6 per 1,000 (0.6%) in white nonhispanics and 14 per 1,000 (1.4%) in African Americans. While improvement in sanitary conditions had drastically improved these odds, much of the reduction in childhood mortality can be attributed to the control of infectious and parasitic diseases such as pneumonia, tuberculosis, GI infections, small pox, diphtheria, and typhoid fever [8].

While I maintain the viewpoint that safety research into autism-vaccine risk is currently inadequate, I’ve also written this post to highlight what we may be risking by precipitously foregoing childhood vaccinations altogether. Autism can prove an extraordinary challenge for some families, and the desperation to find a cause and if not cure one’s own child then at least prevent future occurrences for other children is understandable. But some of these diseases which vaccinations are meant to prevent are truly horrible. We need to remember that. When we’re promoting the dissolution of vaccine use for fear of promoting occurrence of a condition like autism, we need to remember the long list of deadly and debilitating conditions we may be substituting in its place.

As a parent, just imagine what it must’ve been like in the 19th century: 1 out of every 5 children died from some sort of infectious disease. Most parents could expect to lose at least one of their children before the child reached age 10. Therefore there is a good reason so much emphasis has been placed on the importance of vaccination. It doesn’t mean that one needs to accept the status quo without question, but for any person who convinces him- or herself that our world would be better off without inoculation has never lived in a society without them.

1 out of every 5 children: dead. Those numbers are unreal to anyone living in a 1st world country today. But this is our history and it’s the circumstances in which all our ancestors undoubtedly lived. I know mine did. I can look back through the generations of my family tree and see the number of childhood deaths that have littered each subsequently older generation, sometimes as many as 3 or 4 children out of 10 who passed away from one cause or another. One-year-olds, two-year-olds, three-year-olds, gone.

Our current age has bred in us distrust of medical establishment. But before we allow our fears to carry us away completely, we need to stop and consider what we’re risking. Look at the images above one more time, re-read the death rates, and just think.

claimtoken-513dec7919702

claimtoken-513def1e76e77