When Pediatrics Got Boring

It was 1990, my second year of residency.  I was in Emergency seeing a boy with swollen left eyelids.  I explained to his mom that he could have an infection that sometimes spreads into the eye socket, and the boy "might need a CT scan to see behind the eye." As I was talking, I pried open the boy's eyelids to examine the eye itself and had one of those "Whoa!" moments: the eyelids themselves weren't swollen, they were puffed out because the boy's eyeball was sticking out of the eye socket; pushed out by infection. "He definitely needs a CT," I corrected, not skipping a beat, "and possibly surgery to clean out the infection." This condition is called orbital cellulitis, and was quite common due to the bacteria Hemophilus Influenza (a.k.a. "H. Flu," and no relation to the viral Influenza we get "flu shots" for).  But that year of my residency, the vaccine against H. Flu came out.  Vaccines had already existed against some viruses and a few bacteria like tetanus, but H. Flu was different, and required a pharmaceutical breakthrough.  That same breakthrough enabled invention of vaccines against Pneumococcus and Meningococcus, two other bad bacteria that caused lots of meningitis, blood infections, and pneumonia. In the 26 years since, pediatrics has gotten, well, kinda boring.  Wards that used to be filled with sick and dying children infected by these bacteria, emptied out. You could almost hear the crickets chirping.  Which is great for kids.  However, the success of these vaccines and their predecessors- measles, diphtheria, pertussis, etc- has led to complacence about their need. Everyone used to know of a child who died or had brain damage from one of these diseases.  But now, "out of sight, out of mind." A recent poll of parents who don't get their child vaccinated has revealed this false sense of security.  Many parents are afraid that vaccines are dangerous, but now even more think that they are just plain unnecessary.  But the scientific fact is that vaccines are safe, safer than riding in cars.  They may seem unnecessary just like seat belts might seem unnecessary when you're just driving around-  right up until you get in a crash. When kids get lacerations and need stitches, we always check if they are up-to-date on tetanus.  If they're not vaccinated, we ask the parents to allow a tetanus shot. Tetanus infects deep wounds, and is deadly.  If parents are reluctant, I tell them about my experience in the Philippines. In medical school I spent a month there, where for many, vaccines are an unaffordable luxury.  During that time I saw two kids die of tetanus- one teenager who stepped on a needle, one newborn who had her umbilical cord painted with some concoction by a village healer.  Tetanus is also called Lockjaw because it causes muscles to freeze up, including the jaw and chest muscles used for breathing.  When those lock up, the child slowly dies of asphyxiation. Despite pediatricians' recommendations, some parents won't get their kids vaccinated. Some think they're unnecessary, like we discussed above. They've been lulled into complacency, since they don't know anyone whose died of the diseases we vaccinate against (see how that worked?). Some worry that vaccines are dangerous.  They hear vaccines cause autism, or contain poisons.  There are even internet sites which claim vaccination is a money-making conspiracy between drug companies and doctors.  I've had moms whisper to me, "What's really the truth about vaccines?" like it's a big secret. The truth is vaccines are simply a modern technology, like cars and cell phones, and everyone seems comfortable with those.  Vaccines have been extensively studied and tested for safety.  In fact, vaccines are safer than riding in cars, and we certainly know more about vaccine safety than we do about cell phones! It's frustrating for pediatricians trying to convince these parents otherwise. There's a psychological phenomenon called cognitive dissonance, wherein if someone has a set belief, no amount of facts will sway that belief.  This phenomenon explains why people support political candidates despite data, or the candidate's own past words, that highlight that candidate's insincerity.  If you're pulling your hair out because your political opposites just won't see reason, that's how pediatricians feel when discussing vaccines. So give your pediatrician a break- get your kids vaccinated.  Oh, and you also might save their lives.