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Before the age of vaccination

Tuesday, October 31, 2000

This is what life was like in the United States before vaccines were developed to prevent most major childhood illnesses, according to statistics from the Centers for Disease Control and Prevention:

Polio

Before Jonas Salk began testing a polio vaccine in 1952, an average of between 13,000 and 20,000 polio cases of paralytic poliomyelitis were reported yearly (In fact in 1952, the number of polio cases nationally peaked at 58,000).

These annual epidemics often left thousands of people -- mostly children -- in braces, crutches, wheelchairs and iron lungs.

The Salk and Sabin vaccines have eliminated paralytic polio in the Western hemisphere, although as many as 5,000 cases were reported last year in other parts of the world.

Although the broad use of the oral live virus Sabin vaccine resulted in rare but serious cases of vaccine-induced paralytic polio until the late 1990s, new guidelines call for administering four doses of the inactivated Salk vaccine from 2 months to 4 to 6 years, eliminating the risk of vaccine-related polio.

Measles

Before the vaccine, nearly everyone in the United States got measles. There were roughly 3 million to 4 million cases each year, and an average of 450 measles-associated deaths reported annually between 1953 and 1963.

More than 90 percent of people who are not immune will get measles if they are exposed to the virus. No measles cases were reported in Allegheny County in 1999 or 2000.

Hib meningitis

Haemophilus influenzae Type b (Hib) was the most common cause of bacterial meningitis in U.S. infants and children before the vaccine was introduced in December 1987. Hib meningitis killed 600 children each year and left many survivors with deafness, seizures or mental retardation.

This disease was a common, devastating illness as recently as 1990; now, most pediatricians just finishing training have never seen a case.

Pertussis (whooping cough)

Before the vaccine, nearly all children developed whooping cough. Each year, there were 150,000 to 260,000 cases reported, resulting in 9,000 deaths.

Pertussis causes prolonged coughing spells that can last many weeks. These spells can make it difficult for a child to eat, drink and breathe, and younger children can easily become dehydrated. In infants, it can cause pneumonia and lead to brain damage, seizures and mental retardation.

The older pertussis vaccine caused adverse side effects in some people, which prompted passage of the National Childhood Vaccine Injury Act in 1986 and creation of a federal vaccine injury compensation program for people harmed by the whole cell pertussis vaccine. The newer (acellular or DTaP) vaccine has been available since 1991, resulting in fewer mild and moderate adverse reactions compared with the older doses.

Despite the vaccine, there are still a number of pertussis cases reported in Allegheny County each year, with 50 cases reported in both 1998 and 1999 -- the highest in a decade. Only five cases were reported in 1990 and 10 in 1991. As of Oct. 14 this year, 45 cases have been logged, said Guillermo Cole, spokesman for the Allegheny County Health Department.

Rubella (German measles)

While rubella is usually mild in children and adults, up to 90 percent of infants born to mothers infected with rubella during the first trimester of pregnancy will develop congenital rubella syndrome, resulting in heart defects, cataracts, mental retardation and deafness.

In 1964-65, before immunization, 20,000 infants were born with this syndrome. Of these, 11,600 babies were deaf, 3,500 were blind and 1,800 were mentally retarded.

Mumps

Mumps was a major cause of deafness in children, occurring in approximately 1 of every 20,000 cases. Rare conditions such as swelling of the brain, nerves and spinal cord can lead to serious side effects such as paralysis, seizures and fluid in the brain.

There were 212,000 cases of mumps in the United States in 1964. After immunization began in 1967, cases dropped dramatically. There were 606 cases reported in 1998. A second dose of mumps vaccine recently was added to the vaccine schedule to ensure total immunity.

Varicella (chickenpox)

Before licensing of the chickenpox vaccine in 1995, nearly all people in the United States got chickenpox by adulthood. It was responsible for 4 million cases, 11,000 hospitalizations and 100 deaths a year.

Chickenpox is usually mild, but may be severe in some infants, adolescents and adults. Some people who get chickenpox suffer secondary bacterial infections, dehydration, pneumonia and problems with the central nervous system. In addition, only people who have had chickenpox in the past can get shingles, a painful nerve inflammation. There are about 300,000 cases of shingles that occur each year when inactivated chickenpox virus is activated in people who have had varicella.

Hepatitis B

Five percent of Americans -- 1.25 million -- have been infected with hepatitis B virus. Each year, 4,000 to 5,000 of them die from related liver disease.

Infants and children who become infected with hepatitis B are at highest risk of developing lifelong infection. Before the immunization program, 45,000 children became infected with hepatitis B, 12,000 of whom acquired the virus from infected mothers.

The hepatitis B vaccine has been the target of a strong backlash from parents claiming the vaccine is harming more people than health officials will acknowledge.

Armed with federal statistics, foes say the vaccine has caused thousands of "adverse reactions" -- including conditions similar to rheumatoid arthritis and multiple sclerosis. But federal public health officials insist the vaccine is one of the safest and most useful ever devised.

Diphtheria

Diphtheria is caused by poison produced from the bacteria, causing heart and nerve problems. In the 1920s, diphtheria was a major cause of illness and death for U.S. children. The vaccine was developed in 1923. In 1998, only one case of diphtheria was reported in the United States.



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