The intern’s hand had a slight tremor as the needle neared the 12-month-old’s spine. It was midnight, in a quiet corner of a busy pediatric ward. “Baby T” was being held still by the intern’s teacher, a well-respected infectious disease specialist, adding to the intern’s stress. In 1979, I was a medical student doing my first night of pediatric call. The attending physician quietly reassured the intern saying, “at this point you are much more practiced at this than I am.”
The intern proceeded to competently complete the lumbar puncture. At the time, our supervising physician’s kind words and her gender were both rare for medical training at Duke University. I thought she was just being kind, but I quickly realized that she was accurately describing the reality of pediatric care during a time when most of our current childhood vaccines were not yet available.
The baby did turn out to have Haemophilus Influenza type B bacterial meningitis. I quickly learned that invasive H. flu bacterial infection was an all too common and devastating disease, especially in young children. The best a physician in 1980 could do against H. flu was to diagnose it early and treat aggressively with antibiotics. Any child under the age of two who had a fever over 102 degrees without an obvious source required a septic work up. This involved a blood draw for a white cell count and blood culture. If the cell count was worrisome, that child needed a lumbar puncture and usually had to be admitted to the hospital for IV antibiotics. During medical school and my family medicine residency, any night covering the pediatric ER would involve several children with possible H. Flu infection and usually at least one lumbar puncture.
By age five, most children were colonized with H. flu and not at risk for severe infection, but it was those under two who suffered the worst consequences. During this pre-vaccine era, H. flu was the leading cause of invasive childhood diseases like meningitis, pneumonia and epiglottitis and the incidence of invasive disease was one case per 200 children.
Meningitis had a 3% to 6% fatality rate and 30% of those infected were left with permanent injury, primarily brain damage or hearing loss. At the time, H. flu was the leading cause of intellectual disability which occurred in children after birth. I admitted Baby T a couple of years later for another issue and was sad to see that she did have an intellectual disability due to the hydrocephalus she developed from her infection.
Research for the H. flu immunization took decades with scientists at numerous labs carefully determining a safe way to protect children. Their research was published in reputable medical journals and peer-reviewed by independent physicians. By the late 1980s, the conjugate Hib vaccine we use today was licensed and within a few years the rate of invasive H. flu infection dropped 99%. Now the Hib vaccine is part of the standard vaccination protocol starting at two months old.
This is just one example of a serious disease which used to cause injury and death, which vaccines now almost totally prevent. Each vaccine we recommend for children has a similar story of overcoming a devastating infection. Scientists have spent decades researching the safest way to protect our children. Unfortunately, vaccines have become part of the culture wars and some, including our Secretary of Health and Human Services, are using poorly documented “studies” with no peer review or adequate scientific standards, to question the value of childhood vaccination.
Dedicated and experienced scientists and physicians have been fired from the CDC and decisions about future vaccine coverage are being made by anti-vax devotees. In my over 40 years as a family physician, I was honored to care for many families. Parents universally wanted to make good decisions to keep their children healthy and safe. It is maddening that parents are now being bombarded by “junk” science scaring them away from immunizations which have saved millions.
This is not to say that any vaccine is perfect (though the Hib vaccine comes mighty close to that), but overwhelmingly, vaccines do far more good than harm. As a physician, I am proud that professional groups like the American Academy of Pediatrics and the American Academy of Family Physicians are still giving reliable advice regarding immunizations and would encourage all of us, especially parents, to trust the science.
Elizabeth Clardy is a semi-retired family physician living in Concord.