Wednesday, August 1, 2012

Roll Up Your Sleeve

Once upon a time, summer carried a special dread. Each year, polio paralyzed 13,000 to 20,000 people, and a thousand people died. Images of leather-and-steel leg braces and the very particular horror of an "iron lung" were common. When a polio vaccine appeared, parents hurried children into doctors' offices for injections and later lined them up to get vaccine-soaked sugar cubes on their tongues. Polio, once highly contagious, nearly disappeared and vaccine developer Dr. Jonas Salk became a national hero.

This year will most likely see the worst outbreak in five decades of whooping cough, another disease believed to be a relic of pre-vaccination times. A three-fold increase for the first half of this year has hit Washington, Oregon, Montana and Wyoming, plus at least nine other states, according to the Centers for Disease Control.

A series of five vaccinations starts in early infancy with the last injection at about age 13, but an increasing number of parents have resisted exposing their infants to what seemed a minimal risk of whooping cough. The number of cases has been on the rise since the early 1990s. Current versions of the vaccine are weaker than in the past, which may reduce side effects but may also reduce efficacy.

The harsh reality of public medicine is that vaccination works when nearly an entire population participates. People who are not vaccinated are eight times more likely to get whooping cough than those who are fully vaccinated, and the disease is less serious and far less infectious in the vaccinated. This year's spike in whooping cough reminds us, however, that success over disease is elusive.

Childhood vaccination is not the focus of the CDC's current call for mobilization. Adolescents seem particularly vulnerable to the current increase in infection. Questionable long-term efficacy of the current vaccine, possible changes in the bacteria itself, and better reporting of cases may also be involved. What is important, however, is that whooping cough remains highly contagious, it hits its youngest victims the hardest, sometimes with fatal consequences, and it is preventable.

The solution, as it was with polio and smallpox, is for everyone to be as fully immune as possible. That means we all, adults and adolescents as well, should make an appointment with our doctor or public health provider, roll up our sleeves and take our medicine as part of our common responsibility to protect our most vulnerable.

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