Vaccines and me (and you?)

[carbonel]

redbird had a post about looking up her history of childhood vaccines. I don't have any documentation, but I have memories. I'm reposting my comment (slightly edited) for archival purposes, and am happy to have other people post about their experiences/memories/whatever here.

I was born toward the end of the baby boom (1956). I am just old enough that the MMR wasn't available when I was a child, though it must have been right on the edge, since I believe my youngest brother (born in 1960) was able to take advantage of it. I had a nasty case of measles, and I also had mumps and chicken pox. My mother sent me to stay with a friend who had rubella, but I didn't come down with it. In college, I had a rubella titer drawn -- apparently the vaccine was scarce enough that they only wanted to use it on people who really needed it, and it was easy to have a subclinical case -- and the result came back as ambiguous, so I didn't get it.

I had all the other standard childhood vaccines, including smallpox (I have the scar), DTP, and polio. There were a couple of rounds of the oral vaccine (in a sugar syrup), and then the injections later, which I was rather indignant about. It occurs to me that the polio vaccine in sugar must have been part of a community program, because we went to a church and stood in line to get it instead of the usual doctor's office visit.

When I went to Kenya a few years ago, I had to have yellow fever vaccine, and the travel clinic ended up giving me a bunch of others: polio (again), rubella, and Hepatitis C are the ones I remember for sure, plus oral typhoid and malaria prophylaxis.

I had the shingles vaccine (both of them) recently. No one said anything to me about scarcity, and I'm heard enough about shingles that I'm happy to up my chances of avoiding it.

I've asked about a TB vaccine, because I was apparently exposed to it sometime during nursing school, and started reacting positively to standard TB tests at that point. I had to take a year's worth of prophylactic (isoniazad, IIRC), and when I was working as a nurse, had to have periodic chest x-rays to prove I didn't have TB. But apparently there isn't anything generally available.

I make sure to keep my tetanus booster up to date, because I engage in high-risk activity for that particular disease -- I work with raw sheep fleece in the presence of pointy objects. Everything else I'm a lot more casual about.

Comments

[dreamshark]

My childhood history is much like yours, but without the mumps. I got all the vaccinations that were available then: smallpox, DTP, and polio. I had chicken pox and measles (both of which I remember) and I my mother told me I had rubella (although I don't remember that).

I also had scarlet fever, at an odd moment in medical history. As I'm sure you know, scarlet fever is just untreated strep throat. Now that every bad sore throat gets screened and treated with antibiotics, it almost never progresses to the rash stage and beyond. When I was in 1st grade, penicillin was available but the screening protocol wasn't really in place yet. As soon as it was obvious that I had scarlet fever I was immediately treated with penicillin. But because people were still so scared of it, I was kept out of school for 6 weeks (despite not being all that sick) and the doctor MADE DAILY HOUSE CALLS to give me my penicillin shots because it was considered too dangerous to the public to let me out of the house.

Since I grew up at a time when EVERYBODY got measles it's odd to hear it described as a killer disease. Clearly it can be, especially in populations with no genetic immunity. Wasn't that the disease that wiped out a large percentage of native Hawaiians? I was in my teens when I had it and remember being quite sick and miserable. It is a nasty disease and should be vaccinated against. It's just odd to hear it described routinely as a "lethal disease" when it was such a common experience in my youth.

I remember NOT getting mumps. Some or all of my siblings got it when I was in my teens and my mom made a point of quarantining the sick ones as much as possible to protect me (and possibly my Dad). I assume that was because she was well aware that adults get sicker with mumps than kids. And sure enough, SHE got mumps and was sicker than I have ever seen her. It was scary - she had a high fever for days and actually lost a lot of hair, just like Victorians with brain fever. So I am still scared of mumps. If that disease makes a recurrence like measles is doing, I am for sure getting an MMR.

I've never been anywhere overseas that required vaccinations. Occasionally I remember to renew my DTP; I think it's up to date. I have been tested for TB a couple of times and it's always been negative. I'm surprised to hear that you can react positively to TB for years without ever having had it. Huh. Glad your immune system protected you there. I don't consider myself at high risk for shingles because my immune system is the exact opposite of depressed, but I did finally get a shingles shot after my younger sister got it. I think I only had one shot, and don't recall being told that I needed a second one. Were the two types of vaccination: one that required two shots and one that didn't?

[redbird]

I think they're emphasizing that measles can kill because a lot of people are assuming, and repeating, that it's trivial: that "childhood disease" means "harmless" rather than "most people will get it in childhood, most of those will survive, but they may be miserable for weeks." To paraphrase one of the medical bloggers I read, 1 fatality per thousand cases sounds like an insignificant percentage, unless that one is your child.

[dreamshark]

Yeah, I know why they're doing it. I just think the condensation of that message into "deadly disease" sounds so overblown that it may end up in people just discounting the entire warning, especially for people old enough to remember having measles.

The real danger of measles is not the measles itself, but the chance of a follow-on infection: usually pneumonia or encephalitis. Chances of pneumonia are 5%, which is nothing to mess around with (although usually curable). The chances of encephalitis are extremely low, but the results are devastating. So I absolutely agree that this disease is dangerous and should be vaccinated against. I just wish everything didn't have to be oversimplified into a 2-word phrase to get the message across.

[graydon]

Measles resets your immune system, so you lose existing immunities. They found that out this century and maybe this decade; someone did a statistical analysis of post-vaccination health outcomes and found out measles vaccines have a much greater positive health outcome than just not getting measles, and then they started looking for mechanisms.

The other part is that it's not "one in a thousand dies; everyone else is fine". There are long-term complications, some of which are lethal, and the distribution of the severity of those isn't flat; under five and over twenty are worse.

[dreamshark]

Never heard about the measles immuno-suppressant thing, so I looked it up. Fascinating. I never understood why measles opens the door to something as unrelated as encephalitis, and I suppose that must be how it works. The T-lymphocytes actually reprogram themselves to focus so strongly on fighting the measles that they forget some of their other programming. So maybe the lesson to be learned from that (other than keep vaccinating against measles) is that certain other vaccinations should be repeated post-measles? I hope the research continues, and somebody actually does something useful with the knowledge.

[ethelmay]

Mumps can result in encephalitis as well, as can chicken pox, and I don't think either of those does the immune-reset things. My brother had encephalitis after mumps, fortunately without long-term sequelae.

[naomikritzer]

I was born in 1973, so I was not given the smallpox vaccine, as it was no longer routine (although smallpox was not considered fully eradicated until 1980 -- I just checked -- the last case in the US happened in the 1940s.) I did receive the MMR, the DPT (now replaced by the DTaP, because the old pertussis vaccine had more side effects), and the polio vaccine. I had a case of the chicken pox in elementary school.

My parents were very good about getting us routine health care, so I actually remember getting the MMR booster in high school, when they started recommending a second set of that shot. I was asked if I might be pregnant, which I found hilarious, and when they were done, they said, "there you go! that's the last one you'll ever need!" and I said "didn't you say the same thing the LAST time you gave me this shot?"

In 1993, I spent a semester abroad in Nepal, which meant I needed a whole list of exciting additional vaccinations. That's when I got the Hep B vaccine (now routine for kids, and for adults who work in health care, sleep around, or say to their doctor, "hey, I was thinking about getting the Hep B shot" -- health care providers all get it so if you express any interest in the shot they're generally all for it.) The Hep A vaccine was not yet available in the US; I had to get the gamma globulin, which is a much larger needle and wears off after 3-6 months, depending on how much you got. I got an oral vaccine against typhoid. The most unusual (by far): I got the rabies pre-exposure series. There's a lot of rabies in Nepal, and it's not hard to get more than 24 hours from health care there. I called the program to ask (as it was listed as optional) and they said that on average, they had a student bitten by a dog ever year or two, so I decided it would alleviate some anxiety if I just got that one. There were no side effects to speak of but it's a truly vivid shade of magenta -- I think they mix two vials and the magenta coloring is to let them know they were mixed properly.

Before my trip to rural China in November I got the first Hep A vaccination. More adults should get that one, honestly -- the vast majority of people I know who've gotten Hep A, it's been from eating at a slightly dodgy restaurant, which is something nearly all of us do occasionally.

[naomikritzer]

I also wanted to share my story about pertussis.

In 1997, Ed and I visited our friend Rick, who was living in Hong Kong. Rick was sick; he'd had some sort of virus and it had left him with the most horrifying cough I'd ever heard. At night I'd hear him start coughing and would listen to him, because he'd be coughing so hard he couldn't breath, and he'd finally manage to gasp and then he'd start coughing again. I finally nagged him into seeing a doctor, who diagnosed it as a post-viral cough that was just perpetuating itself and gave him an extremely strong cough syrup.

Years passed. Pertussis started coming back, and one day I watched a video of someone with a pertussis cough and thought, WAIT. WAAAAAAAAAAAAAAAAIT. I e-mailed Rick and said, "...hey, remember that horrifying cough you had?" He did, of course. He promptly looked up videos of the pertussis cough and e-mailed back to say, "yes. This is absolutely, positively what I had. There is not a shadow of doubt in my mind."

It wasn't until five-ish years ago they started doing pertussis boosters. I'll just add, for the record, that while I'm happy to blame anti-vaxxers for a lot of disease resurgence, I don't think pertussis is their fault. That resurgence has been caused by two very specific other changes: (a) they switched from DTP to DTaP because the old P caused a lot of adverse reactions. That was a legit change -- the old one caused serious brain damage in like 1/100,000 kids or something like that -- but the acellular pertussis is less effective and wears off more quickly, and it took them a while to start boostering. (b) For decades, if a patient presented with a bad cough, doctors tended to throw some antibiotics at it. There's been a huge push to get them to STOP doing this, because most of these coughs are viral and the antibiotics weren't doing anything other than breeding antibiotic resistance. Again, this was absolutely legit! But a certain percentage of those coughs were subclinical pertussis. A five-day antibiotic course won't help your symptoms any, if it's pertussis, but it WILL make you non-infectious! Those patients are almost never treated with antibiotics now, and pertussis outbreaks are a result.

(Kiera had a very bad cough some years back and I had her tested for pertussis. The test came back ambiguous, so they treated her. It was a bad cough but she was not coughing so hard she had to gasp to catch her breath, the way Rick was -- the range of symptoms for pertussis are a lot larger than people think.)

[dreamshark]

Excellent points. Whooping cough is a terrible disease. It is far more deadly than measles, at least in infants (who are too young to be vaccinated). Mortality rate for infants under 6 months is on the order of 1/100. Since this number is specifically for infants the numbers aren't exactly comparable to the measles mortality numbers I've seen, but it seems fair to say that pertussis can be an order of magnitude more deadly than measles. Not nearly so deadly in adults, but can still lead to pneumonia, which can always result in death. Not to mention the horrifying symptoms your friend experienced.

I didn't know some of the other details you included here; thanks for the info. We seem to share a fascination for medical detail (and are probably boring everybody else reading this). Do you ever wonder if in another parallel dimension you might be a doctor? In any case, I appreciated this long comment. ;-)

[carbonel]

When I was in nursing school, our instructor told us the whooping cough (pertussis) was called that for very good reason, and once we heard the distinctive cough, we would never forget it. It was sufficiently rare at that point that I never did hear an example.

But years later, my mother (also a nurse) diagnosed a case of pertussis on the basis of that particular cough. Not, as you say, that there was a lot to be done except treat it symptomatically, but it meant that the person who had it was pretty much quarantined until he got better.

[dreamshark]

I think I probably had whooping cough, although it was not diagnosed as such. When I was 12 I got a terrible cough that precisely matches this description: I would cough and cough until I was about to pass out from lack of air, then finally get in that whooping gasp at the end. My mother (also trained as a nurse, as well as being old enough to remember whooping cough) took me to the doctor, who diagnosed allergies. This is confusing, because I did and do have respiratory allergies with symptoms that sometimes include a chronic cough and borderline asthma. So I'm not saying the allergy tests were wrong, exactly. But I have never, before or since, had a cough like that whooping one. And frankly, I think my mother was a better diagnostician than most of the doctors I have known.

I had been immunized with the old-fashioned DTP, of course. And as I recall, even the old-fashioned Pertussis vaccine was one of the less effective ones, very dependent on herd immunity.

[sillylilly_bird]

I asked my older sister about it the other day and it turns out that when she was sick with measles, I was sick with chicken pox; I just remembered us being on opposite ends of the couch during the holidays. She was born in '65 and I was born in '69. They figured out at the time that likely due to medical record transfer issues when we moved that she never got the 2nd shot. And I certainly would have caught it from her because she was sick for over a month. I don't know about polio, but I'm careful to keep up to date with TDAP and I'm also vaccinated for rabies [post-exposure treatment, woowoo] and I get the flu shot every year. Haven't done any travel requiring vaccines.

[sillylilly_bird]

A friend of mine had diphtheria a few years ago and she'd had her TDAP a couple years before that. Her throat hurt so bad she literally couldn't swallow and spent a week in the ICU with a grey throat and the head of Infectious Disease touching base with her daily and antitoxin over-nighted from the CDC. There have been fewer than 5 cases in the last decade here in the US. They never figured out how she got it - no travel etc.

[jbru]

I was born in 1967. I remember getting a shot with some kind of air gun. I believe that was the polio vaccine and in my memory I was in school when it was delivered. Kids lined up in the gymnasium to receive it. The person giving it wasn't the normal school nurse.

I also remember getting a sugar cube immunization at some point. Maybe more polio because records didn't carry over from one state we lived in to the next? Or maybe I'm wrong about the immunization through that air gun.

I'm certain I've received the regular course of childhood immunizations. My mom was good about making sure we got those. Got a few tetanus shots through high school after stepping on nails and the like.

I contracted chicken pox on the evening of my senior prom. Like others that have got it later in life, it was a miserable experience for a few days.

Since I've travelled to India a few times, I've received vaccines for some of the tropical diseases. My favorite was the typhoid, which is delivered by capsules containing live bacteria, which allowed me to tell people I needed to "go home and take my typhoid."

[carbonel]

I've only once had a shot with that air gun you mention, for the 1976 swine flu outbreak. There was a mass vaccination program, which was also associated with cases of Guillan-Barre syndrome, though there was never a direct causal link.

At the time, I thought that the Star Trek-type injectors were very cool, but it actually hurt as much as (or more than) a standard injection, and my arm was sore for days afterward -- though that was probably a reaction to the vaccine.

[ckd]

Born in 1970 to a family that really believed in immunizations and had health care (Army brat), so I got pretty much the whole spread of what was available then including, so I am told, the smallpox shot because I was just old enough to catch the tail end of those.

I didn't get the chicken pox vaccine, of course, and wound up having it the old fashioned way very unhappily as a twelve year old.

When heading off to college in the 1980s, I got new shots for most of the usual suspects then because my records were lost somewhere in all the moves we'd made since I was a baby (see above note about Army brat) and it was simpler to just get them all so I could attend. That means I've had a two-dose MMR even though it was before the 1989 outbreak made that the standard....

I'm now getting into the Shingrix age range, and should probably get that and the Hep shots at some point. (I'm up to date on Tdap.)

[davidschroth]

I don't remember every childhppd disease I experienced (although I do remember having the mumps at the end of one school year).

I'm pretty sure I encountered the Salk vaccine around 1959, and 1961 seems about right for the Sabin vaccine.

I know I was immunized against smallpox, and I had to get a who;e raft of immunizations before traveling to Russia to add N. to our familt.

[minnehaha]

I am fully immunized against everything including yellow fever and hepatitis(es). I might not have gotten immunized against HPV, but I am not in a transmission population set, either. I also have the WHO document where all of this is recorded, which I bring when traveling to certain places. No one has ever asked to see it, though.

K.

[minnehaha]

Anyone else have their small pox scar on their back?

K.

[carbonel]

Not me. Mine is on my shoulder, though it has faded almost to nothingness.

[dreamshark]

Mine was on the outer side of the upper thigh, below the hip. I don't think I can see it any more, though, so I'm not sure why I even know that. Probably because as a kid it was my only visible scar (so I thought it was kind of cool). And I guess it worked, since I never got smallpox.

[mildred_of_midgard]

Hi, saw you commenting about books in Rachel's most recent post and also findthatbook. :D

When I got my first pertussis vaccine, at a couple months old in 1983, I ran a fever and wouldn't stop crying. Afterward, when I was feeling better, my right leg didn't move for a couple days. The doctor asked my mother if maybe it just hurt, and she said no, I was clearly not in pain, I was just partially paralyzed.

My doctor said I'd had an allergic reaction and that I could never, ever be given another one or I would most likely die.

So neither I nor any of my four younger siblings were vaccinated against pertussis (the doctor said it might be genetic). I never got my booster or anything, and was never considered vaccinated against pertussis. I went around for years answering "Any allergies?" with "Pertussis vaccine" and telling doctors I could never ever be vaccinated against pertussis and had to rely on herd immunity. We got our other vaccines: tetanus, diphtheria, MMR, and when we moved to Japan, tuberculosis, and I think hepatitis. Maybe others that I'm forgetting. Smallpox wasn't a thing any more, and there wasn't a chickenpox vaccine yet. Or a flu shot.

After I became an adult and moved away, there was a pertussis outbreak near where my family was living at the time. My youngest brother, deemed most at risk because he was still in elementary school, got the vaccine. He survived.

A couple years ago, in my 30s, I started studying biology, and I realized that what I had did not sound like an allergic reaction at all. Plus, I read that a lot of kids had similar reactions in the 80s, and two things emerged from that. One, the formula was later changed, and two, the kids who'd had my reaction didn't actually die when they got their follow-up shots.

I talked to my doctor in 2017, and we agreed that my leg was probably not paralyzed. It was probably pain of the "hurts if you move it, fine if you don't" variety, which is consistent with my memories of the tetanus shot as an adult. We agreed I should get the pertussis vaccine and that I would most likely not die.

My doctor: "If I'm wrong, I'm sorry."

Me: "No, if I'm wrong, I'm sorry!"

We were not wrong.

I'm now estranged from my family, but I did send my mother an email letting her know that it was safe for my remaining siblings to get vaccinated. I don't know if anything came of that.