He Who Hesitates…

With the Pandemic, no one’s wanted to be in tight spaces with others who might be shedding deadly Coronavirus. California’s Disneyland has been closed because of that concern. Being squeezed into lines and rooms at Disney is unavoidable, to get as many people through the rides as possible- after, all everyone wants their turn to be immersed in the magic. But in 2015, some Disneyland visitors were unlucky enough to also be immersed in measles.

That year an unvaccinated 11 year-old visited the park. The child was infected with measles, not symptomatic yet, but already shedding virus. 110 people caught the virus, most of whom were unvaccinated. 20% had to be hospitalized; luckily, no one died. Like COVID, measles is highly contagious. When an infected child coughs, virus-laden droplets can hang in the air for 2 hours, waiting to be inhaled by others. That makes for lots of exposed people if that cough is in the elevator in the Haunted Mansion- how many people shuffle through that ride in two hours!?

Vaccine hesitancy has been growing in the past twenty years, and is now an issue again with the COVID vaccine roll-out. Parents want their kids to be as safe as possible, and some are confused by competing voices in the media and online about vaccine safety. Medical experts know vaccines are safe and important to prevent deadly infections. However, their voices are sometimes drowned out by anti-vaccine folks who frankly don’t know what they’re talking about.

Vaccines have been around for centuries. Smallpox inoculation began in the 1700s, and has saved millions of lives since. Most vaccines kids get these days have been around for 50 years or more. We have lifetimes of experience with these medicines to know they’re safe.  They’re also the most administered medicines- the vast majority of kids get them. Thus we have plentiful opportunities to detect side-effects.  Finally, vaccines are some of the most studied medicines. Anti-vaccine hysteria has driven some of this research, and any serious worries about safety have been thoroughly investigated. Mission accomplished: vaccines are some of the safest medicines available.  Oh, did I mention they save children’s lives too?

My friend Brent has a sheep farm in Georgia. The farmers around him are mostly older, taciturn types.  Brent got his first COVID vaccination, and tried to talk his colleagues into doing likewise, but they’ve decided to wait and see. To goad one farmer into getting his shot, Brent offered, “How about, if I feel fine after my second shot, you get yours?  Deal?” The farmer replied, “Well, let us know how it goes.”  Note the non-committal response- talk about giving nothing away!

As we mentioned above, small pox inoculation is centuries-old, and we’ve had modern vaccinations for over 50 years. Vaccine hesitancy is that old too. In the 1800s, governments mandating smallpox inoculation met with popular resistance. After all, inoculation meant taking fluid from a cow’s pox blister and scraping it into the skin of a child- doesn’t sound very clean or safe, does it?  The Leicester (England) Demonstration March of 1885 had over 80,000 participants, opposing forced vaccination.

Fast forward to 1998, Dr. Andrew Wakefield published a study that supposedly linked the Measles/Mumps/Rubella (MMR) vaccine to autism in children. Despite the revelation that Wakefield falsified his data and lost is medical license for other ethics violations, the anti-vaccination movement was off and running. Besides bad data interpretation, vaccine hesitancy is also fueled by complacency. In the 1950s when polio was epidemic, killing and crippling thousands of children yearly, people clamored for a vaccine. Now vaccines have been victims of their own success: few parents experience the horror of children dying from vaccine-preventable diseases, and wonder why all these shots matter.

Conspiracy theories have also eroded confidence in experts and vaccination.  Conspiracies are inherently attractive to human thinking (they’re so exciting to contemplate, like UFOs!), and have been grafted onto vaccines. From microchips and DNA manipulation in Coronavirus shots, to good-old-fashioned drug company corruption, conspiracy theories make saving kids from vaccine preventable disease harder.

Rest assured, vaccine makers aren’t dastardly villains poisoning kids for fun and profit. They’re nerds and careerists who live for good data and publishing well-researched papers. They’re nice folks doing good science to save kid’s lives. What more could a parent want for their child?

The Mumps Is Not A Muppet

This week’s guest columnist is Dr. Rati Venkatesh, a Family Practice resident at University Hospital and Clinics here in Lafayette.

This winter we’ve seen nearby outbreaks of Mumps in Arkansas and Texas.  Last week a mother brought her 3 year-old daughter into the Emergency Department worried about just that.  The girl had fever and headache and mom had just heard the news.  Instead the girl turned out to have influenza virus, which causes many of the same symptoms.  But this raised the question: what exactly is the Mumps?

Though it sounds like a muppet character, the mumps is an illness caused by a highly contagious virus.  The classic sign of mumps is swollen parotid glands, which are glands at the back of your cheeks.  When they swell you look like a chipmunk. Mumps usually starts with fever, headache, and maybe vomiting.  Symptoms also include cough, runny nose, poor appetite, muscle aches, and generally feeling run down.  Sure sounds like the flu- no wonder that mom was worried!

The biggest concern about mumps is that in rare cases it can cause encephalitis, or brain infection and swelling.  In teenagers and adults, it can also cause exquisitely painful swelling of testicles or ovaries.  Before the mumps vaccine was invented in 1967, people were understandably scared of this disease. Now with the MMR (Measles/Mumps/Rubella) vaccine, mumps has mostly passed into history books, except for the occasional case.

If there is a nearby outbreak, what do you do?  First, speak to your doctor.  If your child has concerning symptoms, she can order the mumps blood test.  A big clue to whether your child has the mumps is exposure- was your child around someone with mumps? Figuring this out can be tricky, because it can be weeks after exposure before you begin to have symptoms.  Who remembers where they were two weeks ago- it’s tough enough remembering what you had for lunch yesterday!  So usually when it comes to the individual kid, we count on the classic chipmunk-cheeks to make the diagnosis.

How do you get the mumps anyway? Transmission is by respiratory droplets, which means an infected kid coughs and sneezes, or wipes his slimy hands, on his playmates.  The new victims stick those virus-laden droplets on their fingers, into their noses and mouths.

So to prevent mumps, kids should do the things to prevent catching other infectious diseases, like colds and stomach viruses: they should wash their hands.  Frequent hand-washing should be taught and encouraged at home and school.  Hand sanitizer dispensers are readily available in public places, and are a reasonable substitute.  I teach kids to wash hands to the Happy Birthday song- if you wash all surfaces of your hands using the amount of time it takes to sing the song, you’ve done a great job of disinfecting.

Also use disinfectant wipes to clean household and school surfaces.  Those respiratory droplets and their viruses can linger on tables and doorknobs, and contaminate unsuspecting hands that touch them later.  Teach your kids to cough and sneeze into the crook of their elbows- this keeps grubby hands from infecting surfaces too.

If your child gets the mumps, the only treatment is for symptoms- there’s no medicine to make it go away quicker.  Use acetaminophen (Tylenol) or ibuprofen for pain and fever.  The chipmunk cheeks or swollen testicles of mumps can really hurt, so don’t skimp on those medicines!  Ice packs can also soothe these sensitive parts.  Most kids and adults get over mumps in about 2 weeks.  Occasionally children need hospitalization for pain control or IV fluids.  If they get encephalitis, they’ll need intensive care to control brain swelling.

Vaccination is great protection against mumps.  Kids get their first MMR shot at 12 months-old, and the second before kindergarten.  This vaccine is very safe, much safer than the car ride to the doctor’s to get it!  Some get a mild fever a week after vaccination, but serious complications are quite rare.  Like any vaccine, your child is incredibly more likely to catch and be harmed by mumps, than be harmed by the vaccine.

So all concerned moms and dads out there, if your child has flu-like symptoms (cough, fever, headache, fatigue) with swollen cheeks, it might be the mumps!  See your doctor for testing.  But with vaccination, odds are you won’t ever be in this worrisome place.

What The Heck Is Measles Anyway?

It was 5 o’clock, July 2, 1991.  I know the date and time because it was the end of my first 36 hour shift as Chief Resident.  And it was a true 36 hour shift, not a wink of sleep, with sick kids piling into the hospital like we were having a sale.  But finally it was time to sign out to my fellow residents and go home for a quiet supper and some sleep.  Then the Emergency Department called- has anyone up there seen Measles before?

I had.  Two years before, in medical school, I had gone to the Philippines for a month for a course in third-world medicine.  In the Philippines vaccinations are a luxury few can afford and I saw lots of diseases we seldom see in the States-measles included.  I went downstairs to the ED, saw the child, and when he opened his mouth, I saw the blue-white spots on the roof of his mouth that clinch it: he had measles.  I didn’t feel sorry for myself that my well-earned break was put off by one more patient; I was elated.  I made a diagnosis no one else could!

Measles is in the news a lot lately.  We are having an epidemic- lots of kids are getting the disease this year.  Many parents are refusing to get their kids vaccinated because of fears of injury from the vaccine.  Those unvaccinated kids are vulnerable and when they come in contact with someone infected, often someone who has been in another country, they get infected too.

What is the measles?  Measles is a virus that has been with mankind for centuries.  It is a virus that starts off like many cold and flu viruses.  The child starts with a cough, runny nose, and fever.  He might have some red eyes, sore throat, and maybe some vomiting.   Then in about 2 to 3 days a spotty rash develops, and those white spots in the mouth.  The rash starts on the face, then spreads to the torso and then the arms and legs. The whole thing lasts about 10 days before it goes away.

So what is so bad about the measles?  Why all the news, why a vaccine in the first place? Well, the bad news is that the measles can be deadly.  Before the late 20th century, measles was a terror for families.  Lots of kids with measles developed bad complications- pneumonia or encephalitis (brain infection).  Many children died.

It was common and terrible scene in many households.  The parents and doctors could do little for a badly infected child.  There were no IV fluids, no respiratory support, no antibiotics for pneumonia.  All anyone could do was hold the child’s hand and watch helplessly as he slipped away, comatose and struggling to breathe.

As the century progressed, improved nutrition, hygiene, and medical care helped more kids survive. Then in 1963 a vaccine was invented and the world rejoiced- finally children were safe from measles!  But in the span of my lifetime, we in medicine became victims of our own success.  With the near-eradication of measles, the next generations did not learn to fear it.  People began to question- what’s in those shots that you’re putting into my kid?

Then in 1998 there was a study that suggested the measles vaccine caused autism. Since then mountains of evidence have refuted that, and the study itself was found to have fraudulent data.  However, the seeds of doubt were planted.  Some parents won’t get their kids vaccinated and that makes for a chink in the armor of our population’s immunity. Pockets of unvaccinated kids are vulnerable to the measles.  And measles is highly contagious- viral particles can hang in the air up to an hour after the infected, coughing patient has left the room.

Now we doctors are having to re-learn what measles looks like.  We are having to explain over and over the safety of vaccines, and the threat of disease that history has forgotten. So help us, and help your own kids- keep them vaccinated.  Enjoy one of the benefits of modern science and technology- safety from one of the world’s worst illnesses, once thought gone for good, now threatening to come back.