Before Vaccines

The current issue of The Medical Letter includes an article on this year’s influenza vaccine, which reminds me how crazy the world has become. The temperature went up to 108 degrees in Paris, and young women with PhDs are refusing to vaccinate their children, and not just against flu. Well, flu can be scary; the CDC estimates that it killed more than 57,000 people in the US during the 2018/2019 season, including more than 100 children. I believe that’s more than died in auto accidents and close to the number killed by guns. I remember during my training a 30-year-old policeman and a 50-year-old medical school professor dying from flu – just plain flu. The vaccine isn’t 100% effective, but it will save lives.

Of course, the anti-vaxxers aren’t just endangering their own children; they’re also endangering everyone else’s by weakening herd immunity. I have some personal experience with a disease that vaccine-induced herd immunity has just about done away with. I was 9 years old in summer camp. A febrile illness resolved after a few days, but recurred after a week or two, this time with a stiff neck. I was taken to a hospital in Troy, NY, which had a communicable disease unit. I have forgotten the spinal tap I must have had, but I remember being given a glass of water with a straw and finding that I couldn’t suck the straw. During the next few days, I also became unable to swallow or close my eyes; IV’s kept me hydrated and I slept with my eyes open. Bulbar polio carried an 80% mortality rate, but survivors generally had much less disability than patients whose limbs were affected.

In medical school when I studied neuroanatomy, I was able to estimate the distance between the nuclei of the facial, glossopharyngeal, and oculomotor cranial nerves and the respiratory center. It was very close. The first polio vaccine became available when I was in medical school, and I was surprised to learn that I was not immune, because there are 3 types of poliovirus, and I had only been infected by one. I was happy to be vaccinated.

Measles is another vaccine-preventable disease that I experienced, this time as a physician. I was serving as a pediatrician in the US Army in the then largest American community outside the continental US in Kaiserslautern, Germany, just before measles vaccine became available. Measles is highly transmissible anyway, but when you have 20,000 people shopping in one store, it spreads like a forest fire. I used to go to the PX and see children with a rash sitting on the backs of shopping carts, and when they opened their mouths to cough, I could see Koplik spots on their buccal mucosa.

Before the vaccine, according to the CDC, 3-4 million cases of measles and 500 deaths from the disease occurred annually in the US. When a resurgence of the disease occurred in 1989-1991, the mortality rate rose to 2.2/1000 cases. Pneumonia accounted for about 60% of the deaths. Encephalitis, which occurs in about 0.1% of cases, has a fatality rate of about 15% and causes significant neurologic damage in about 25% of patients. The first patient assigned to me as an intern had measles encephalitis, which she survived, but she was not the same child anymore.

Varicella is not usually a killer, but I remember a pregnant young woman with varicella who died suddenly on our infectious disease ward. And in the emergency room of another hospital, I saw a toddler with a high fever, a typical varicella rash, and petechiae scattered throughout the papules and vesicles of chicken pox. We suspected thrombocytopenia, which is a known complication of varicella, but when the routine blood work came back, we learned that the white cell differential was unreadable because the cells were riddled with the gram-negative diplococci of Neisseria meningitidis. We had already started antibiotics, but it was too late.

I remember how crowded the polio clinics were at Children’s Hospital in Boston, where orthopedic surgeons did their best to help the crippled children. And there is nothing worse than attending the autopsy of a child. I doubt that most anti-vaxxers will listen to me or others like me who remember what these diseases, all preventable now with harmless injections of safe vaccines, can do to a beautiful, healthy child. But I hope that some will.

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  1. Steven A. Wahls, MD, FAAFP says:

    Mark, as much as I agree about the benefits of vaccination, I take issue with your categorization of thoughtful, concerned human beings as “anti-vaxxers”. Like other examples with which we are both familiar, such terms are used pejoratively to marginalize those with whom the author disagrees, shutting down reasonable academic discussion.

    I hope that you, as a professional and one of my colleagues, would treat all our patients with the compassion and understanding they deserve to build alliances, regardless of whether they agree with you.

    • Janaki Kuruppu MD says:

      I think that the term “anti-vaxxer” is used by those who hold these beliefs, not just as a disparaging label by those of us who think they are misguided. doing a quick search on the term, I came across a couple of links to articles of former anti-vaxxers who are now proponents of vaccination. The “bubble” that anti-vaxxers live in seems to be the biggest problem, but by these two examples, it seems like it’s possible to break through the misinformation. the one I’ve linked to is the more coherent of the two that I read.

      however, from another article, clearly the term can be seen as derogatory by some: “I read a tweet from a fellow health reporter this morning who said an anti-vaxxer had emailed her to insist she be (in her eyes more accurately) referred to as an “anti-toxxer” instead.” (

  2. paul gitlin says:

    Thank you

  3. R N Capper says:

    Tragic stories. Thanks for relating your experiences. Moreover, recognizing your superb contributions to the Medical Letter, among other things, I’m happy that you survived bulbar polio. I had both varicella and measles with uneventful recoveries. I remember receiving the Salk vaccine in the early 1950’s, and every vaccine since, except for Gardisil.

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