Love and Fear and Vaccines

I am old. Not very old, but old enough to remember a time before many of the vaccines we currently have to prevent life-threatening diseases were developed. The only vaccines I got as a kid were against diphtheria, tetanus, pertussis (aka whooping cough), polio, and smallpox (and yes, I still have a faint scar on my shoulder to prove it).

I am old enough to have had measles (2ndgrade), mumps (4thgrade), and chicken pox (5thgrade). I remember each vividly. I remember having to be in a dark room because the light hurt my eyes when I had measles. I remember my neck being so swollen from the mumps that, not only did I look like a miserable chipmunk, but I had such a hard time swallowing not just solids but even fluids that I was in danger of becoming dehydrated. I remember being so intensely itchy from chicken pox that my mom had to keep slathering me with calamine lotion, I couldn’t sleep, and I had to wear socks on my hands to keep from scratching the pox and the scabs until they bled. In fact I did pick one ripe scab off the left side of the bridge of my nose that left a pit there for years. It only became less obvious over the years as I started wearing glasses, and the left side pad for the glasses flattered out the skin on that side of my nose.

Each of these exquisitely infectious diseases lasted about two weeks, and they tore through our house like a tornado, infecting all the Haller kids at the same time. I honestly don’t know how my mom survived it all. We all did, but many kids did not.

Back in the 1960s before there were vaccines against these infections, they were called “childhood diseases.” This was not because they were minor. It’s because they were inevitable. Back then about a million kids a year came down with measles, and the numbers for mumps and chicken pox were also very high. And the fact is that many kids had complications from these viral infections. For measles this includes pneumonia, corneal ulcerations leading to permanent blindness, and infection of the brain and spinal cord leading to permanent brain damage and even death. In fact when 1,000,000 kids have measles, at least 1000 of them will die of it.

During the course of my career, I have seen the introduction of vaccines against hemophilus, pneumococcus, meningococcus, rotavirus, HPV, hepatitis B, and hepatitis A. Before the introduction of these vaccines, all too often I had the grim task of telling parents that their child was going to spend a long time in the hospital or was going to be permanently disabled or had died because of one of these infections. It has been such a joy for me to see that so many of these diseases are now virtually gone. I know, without a shadow of a doubt, that there are healthy, happy kids who come to my office now who, if these vaccines did not exist, would be disabled or dead. I don’t know which ones, but I do know that they are here now because they got their immunizations.

If you are a parent who is hesitant about vaccinating your child, I know that you are asking these questions because you love your child and are scared about their safety. I get it. To become a parent is to fall into love and into fear in ways you never imagined.

So my goal here is not to scare you. You are already scared. My goal is to help you find an appropriate target for your fear.

I am deathly afraid of these diseases. And I am afraid that kids will end up admitted to Cardinal Glennon with an infection that could have been prevented with a vaccine, that they will have a bad outcome, and that the parents will never be able to forgive themselves.

Some years ago, I did have a baby admitted on my inpatient service with pertussis. I’ll call her Sally. Sally was 5 months old, and her parents had not vaccinated her because of “some scary stuff” they had read “on the internet” and on the advice of a non-physician health provider. This baby was very sick. Pertussis is called “whooping cough” because it causes the throat to become so intensely irritated that, when a person coughs, they can’t stop. They go cough-cough- cough-cough-cough-cough-cough-cough-cough-cough-cough-cough- cough-cough… until they run out of air, sometimes turning blue from lack of oxygen. At this point, the baby violently pulls in air through a narrowed, ragged, painful windpipe in a loud, desperate “WHOOOOP!!!” This baby’s coughing was so brutal that she had to be taken to the Pediatric Intensive Care Unit where she had to be sedated and had a tube put down her throat to allow her to breathe. Sally was in the PICU for four days before she was able to come back out to a normal room where we followed her for a day to assure she could breathe and eat safely before going home. When they did go home, Sally’s mother, after many sleepless nights, told me with tears in her eyes, “Please tell everyone to get their babies their shots. If telling our story helps, please go ahead. Dr. Haller, no one should ever have to go through what we went through.”

For many years as a faculty member of the Saint Louis University School of Medicine, I was able to tell medical students and pediatric residents about these diseases in an historical context. Now, sadly, many of them are starting to see these diseases for themselves.

One thing I know is that, the first time in their education or their career that a doctor sees a disease, this is the case they will remember for the rest of their life.

When I was a medical student at Creighton University in Omaha, I spent the summer between my first and second years in Beatrice, Nebraska, doing an 8-week rural externship. I spent half that time at what was then called the Nebraska State Home for the Mentally Retarded. I remember a teenage girl there who was profoundly disabled. She had a very severe form of Neurofibromatosis. Neurofibromatosis, then usually called Von Recklinghausen’s disease, is characterized by having six or more light brown dermatological spots (“café au lait spots”), at least two neurofibromas (benign nerve-sheath tumors that can result in a range of symptoms from physical disfiguration and pain to cognitive disability), at least two growths on the eye’s iris, and abnormal growth of the spine (scoliosis). This girl had all of this in abundance. I remember one neurofibroma on a wrist which was so large it caused her hand to be misshapen and useless. She had multiple other bumps and lumps and was covered in café au lait spots. She was non-verbal and was unable to engage in everyday self-care activities like eating and dressing herself.

Neurofibromatosis is essentially an autosomal dominant genetic disorder of variable expression. “Autosomal dominant” means that if one parent has it, the chances are 50–50 that any child of theirs will have it. “Variable expression” means that it can be more or less severe in each individual who inherits the gene. One weekend this girl’s family came to visit: mom, dad, and her eight siblings. I didn’t do exams on them, but mom had some noticeable café au lait spots and a few small, barely noticeable swellings which were consistent with neurofibromas. She seemed otherwise healthy and intellectually intact. Dad was unaffected. Of the eight siblings, four had noticeable signs of neurofibromatosis of varying severity. So neurofibromatosis: autosomal dominant, variable expression. Right there in front of my eyes.

Why am I telling you this here? I saw this family over four decades ago. They were the first time in my medical life that I saw real people affected by this real disease. Every time I have seen neurofibromatosis since then, I have thought of them standing in a line, mom with, dad, without, five kids with, four without. They still stick in my mind, and they always will.

We have the power to conquer many infectious diseases. I hope that we will soon have the power to conquer more. I know that you love your kids. I know you don’t want your kid to be remembered in 2071 by a physician nearing retirement as “that kid I saw as a third year medical student back in 2019 who died of measles encephalitis.”

We all want the same thing. We want your kids to be happy and healthy. We want your kids to be, frankly, unmemorable to their doctor — in a good way — because they come in so infrequently because you, their parent, were brave enough to do what might seem scary right now.

Believe me. There are fears that you do not know and that you do not want to face. Please talk to your pediatrician or family practitioner or health department worker. We are here to help you name your fears, face your fears, and prevent our worst fears from coming true.