In Favor of Inoculations

The fear of vaccinations is as old as vaccinations themselves. As swine flu rages, now is a good time to clear up some myths

Dr. Avi Itzhaki
Dr. Avi Itzhaki

A young man was admitted to my hospital a few weeks ago. He does not smoke, he runs 10 kilometers a few times a week, and he did not have any pre-existing illnesses. In the emergency room he was diagnosed with flu symptoms, and tests confirmed he had swine flu, H1N1. He was hospitalized in a ward for influenza patients.

During his first hours there, his condition deteriorated. He came down with aggressive pneumonia, the oxygen saturation in his blood dropped, and his blood pressure dropped as well. He was transferred to the intensive care department, where he received anti-virals and antibiotics. His youth, his good health and the quick, effective treatment worked to his advantage, and he recovered.

People who caught smallpox in the 18th century were not so lucky. The virus killed many people, until an English doctor name Edward Jenner found a vaccine. He noticed that milkmaids had welts on their hands that were caused by cowpox, and that the women were immune to smallpox.

On May 14, 1776, Jenner took tissue from welts on a milkmaid's hands, and put it into a scratch on the arm of an 8-year-old child named James Phipps. He later injected Phipps with smallpox, but the boy stayed healthy - he was immune.

During the subsequent years, Jenner's method was used to inoculate millions of people, thus freeing humanity from one its bitterest enemies. The smallpox virus, which had been killing humans since the beginning of history, was wiped out.

Over the past 200 years, there has been a tremendous improvement in public health: Infant mortality has decreased, and life expectancy has increased. Some believe this improvement is due to inventions including antibiotics and anesthetics. The two most important factors have been the provision of clean drinking water, and immunizations.

Various bacteria and viruses that blighted the human race for tens of thousands of years virtually disappeared after inoculations were developed. The polio virus, which was the scourge of mothers until the middle of the 20th century, disappeared from most countries after an immunization was developed in the 1950s.

Then there's the clostridium bacterium, which enters the body through sores and releases a toxin that causes tetanus, which causes a painful death. Today this is a very rare illness, thanks to a vaccine. Rabies is caused by a virus that is transferred by animal bites, and injures the central nervous system. An inoculation in time prevents illness and death. Pneumonia, a common cause of death among the elderly, can also be prevented by an immunization. The fatal disease spinal meningitis also can be prevented by an inoculation.

Childhood diseases like chicken pox, whooping cough, measles, German measles and mumps have almost become history, thanks to immunizations. These diseases break out only among groups that do not immunize their children. Travelers get inoculated against viruses transmitted by mosquitoes, such as yellow fever in Africa and South America, and Japanese B encephalitis in East Asia.

The human papillomavirus (HPV), which is sexually transmitted, can cause cancerous cells in the cervical mucus membrane. This infection can be prevented by inoculating young girls.

What happens when we do not have immunizations at our disposal? Malaria, AIDS and tuberculosis kill millions of people around the world. The existing treatments for these diseases are decreasing the mortality rate, but they are hardly affecting the morbidity rate.

As immunizations began to appear, so did the fear of immunizations. By the 18th century, rumors began of terrible side effects caused by Jenner's new inoculation. A cartoon from that period shows Edward Jenner surrounded by people sprouting cow body parts.

The drawing would be funny, were it not for the fact that to this day, we have made no progress. One naive letter, cast up from the depths of the Internet, describing ostensible side effects of the swine flu immunization has sufficed to conjure primordial fears. Scores of learned individuals armed with reasoned, factual explanations have not managed to fight the anxiety. Fear of the new inoculation has itself become an epidemic spreading along with the H1N1 virus.

Every week, millions of people around the world come down with this flu, thousands are hospitalized because of complications, some of them need respiratory support in intensive care units and a few even die. These facts do not deter the immunization opponents, who continue to recommend all sorts of alternatives - from charged water molecules (homeopathy) to replacing mezuzahs. They make claims against various ingredients in the inoculation that boost the immune system or keep the inoculation uncontaminated. They are spreading hallucinatory conspiracy theories and posting scary films on YouTube. They are not impressed by the fact that there is no serious research supporting their claims.

In 1918-1919, Spanish influenza killed 50 million people. The outbreak had three waves. The first was in March, the second in the fall and the winter. A third, smaller wave came in spring of 1919. Most of the deaths were during the second wave.

We are now in the second wave of the current epidemic, and we have at our disposal an effective inoculation. We feared that the pandemic would be as violent as the Spanish flu, but at this stage luck appears to be on our side. The mortality rate is far lower than was predicted.

Nonetheless, it must be remembered that the current epidemic is causing a great deal of morbidity. Millions of patients are confined to their homes with fevers and respiratory problems. It is important to remember that unlike the "seasonal" flu, swine flu is causing deaths mostly among young, healthy, active people. To date, 7,000 people around the world have died from the flu virus. I am convinced that each and every one would have been eager to get the inoculation had they been able. Unfortunately, in the first months of the epidemic, an immunization did not exist yet. The generation that of 1918 would also have stood in line for an inoculation, had there been one.

Although more than 220 years have passed since Jenner's experiment, it is still necessary to explain the importance of immunizations and inoculating a population against a pandemic. As Albert Einstein said, "Two things are infinite: the universe and human stupidity, and I'm not sure about the universe."

The author is a specialist in infectious diseases at Assaf Harofeh Medical Center.



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