It was the late ‘90s and measles immunization rates had increased to more than 90 percent, thanks to public health efforts in response to an earlier measles outbreak. I snuggled next to my daughter in bed reading “James and the Giant Peach.” On the inside cover of the book was a letter from the author, Roald Dahl, on the importance of vaccines. His 7 year old daughter died from measles encephalitis before there was a vaccine available.
At that time, I was a medical student in Cleveland. I was fortunate that I never saw a case of measles encephalitis. But I did see diseases affecting children that today’s medical residents have not seen, and that I hope they will never see. It was a different world then - one that has changed drastically through the introduction of several vaccines.
Invasive Haemophilus influenzae type b (not to be confused with seasonal influenza) is a bacterial infection known to cause sepsis and meningitis that, prior to widespread use of the vaccine in the late 1980s, sickened approximately 20,000 children in the U.S. each year. More than 1,000 of those children would die. By the time I entered residency, the incidence of severe disease caused by the H. influenzae bacteria had dropped to 261 cases per year, thanks to the introduction of a vaccine.
Despite this significant win, children were still dying from yet another bacteria – Streptococcus pneumoniae, also known as pneumococcus. It was not unheard of to see a young child in our pediatric intensive care unit with pneumococcal meningitis. If the child did not die from the infection within 24-48 hours, the likelihood they would be left with debilitating, irreversible neurologic disease was high. The introduction of the pneumococcal conjugate vaccine in the year 2000 essentially halted these tragic cases.
Rotavirus was another vaccine under development during my residency, for which our son was a phase 3 clinical trial participant. An infant with rotavirus disease would start out with vomiting – upwards of 10-15 times per hour. Shortly thereafter, similar bouts of diarrhea would ensue. And within the span of a few hours, the child would be so severely dehydrated, required significant resuscitation and remained hospitalized for days.
Today’s pediatric residents know these vaccine-preventable diseases as I had known diphtheria and polio – essentially diseases that I had only read about in textbooks.
With the coronavirus pandemic, we have seen plummeting immunization rates. A news release in May 2020 from the California Department of Public Health (CDPH) noted the number of vaccines given to California children ages 0-18 years in April dropped by more than 40 percent compared to April 2019.
It is understandable that families are afraid to visit the doctor’s office, for fear of contracting coronavirus. Doctors’ offices are taking appropriate precautions to keep you safe. Or that families believe vaccines can wait until we get back to some semblance of normalcy and school resumes in person. It takes several weeks for appropriate immunity to develop after receiving a vaccine. And that families may see these vaccine-preventable diseases as a thing of the past, something we don’t really have to worry about. We have seen a resurgence in measles despite the fact it was declared eliminated in the United States in 2000. Many might remember the outbreak that occurred at Disneyland in 2015 and spread to 27 states. That is possible again without diligence in keeping our children’s immunizations up to date.
Although immunization rates have begun to rise over the last few months, they are not yet to the level they should be. Too many of our children remain unprotected against these debilitating and potentially life-threatening diseases that most of today’s young pediatricians have never seen. I strongly urge parents to vaccinate their children now, so that when we do get back together - when our schools and parks are open again - our children are not a statistic in the next non-COVID-19 disease surge.
We wouldn’t send them down the highway without a proper safety belt or out on a bike without a helmet. Let’s not send them back out without every chance against vaccine-preventable diseases.
Dr. Carmela Sosa is a general pediatrician specializing in care for medically complex children. She also serves as associate program director for the Pediatric Residency at Valley Children’s Healthcare, and Medical Director for Primary Care and the Guild’s Center for Community Health.