The Right Kind of Smile

The Right Kind of Smile

I think I’m going to start doing a theme on “Get Your Vaccines.” In the third world vaccinations are much less accessible. Even as accessibility improves, education regarding their benefit or availability is also lacking, and decreases the number of people who utilize them. Because vaccines have been available in the US for my entire life I had limited exposure to vaccine-preventable diseases during medical school and residency (a testimony to how well they work).

Training in Asheville, the east coast capitol of all things “alternative,” I had plenty of patients and friends (and colleagues) who were “anti-vaccine.” To be fair, I can completely understand the skepticism and hesitation surrounding vaccines. Most parents are very particular about what goes into their kids. They buy the best and most organic/free range/happy-until-butchered food they can find. They read books (websites) on how to bring up their kid to be happy and well adjusted. They agonize over every little decision and feel really guilty when they let their kids watch TV or play with their phone. So I can understand why they would be suspicious when somebody tells them they need to give their already healthy kid these mysterious shots filled with all kinds of “chemicals” that could have it’s own side effects.

I think the root of the issue is that most people alive today have never seen the diseases that we now vaccinate against- because due to vaccines they are nearly non-existent. Of the 11 or so things my kids have been vaccinated for I’ve only seen 5 in pediatric patients in the US: Rotavirus (diarrhea), Pertussis (Whooping Cough), Meningococcal Meningitis (only once), Chicken Pox and Pneumonia (still very common because there are lots of different strains).

You can’t really tell from the picture, but his face in stuck in that position, and if you use your imagination you tell the spasms are causing a pseudo-smile

Here in Togo many vaccine-preventable illnesses are quite common. Tetanus is one of
them. It is caused by Clostridium Tetani, which lives as a spore in the dirt. When it enters your body the spore wakes up and starts reproducing bacteria, which can cause an infection. The infection itself isn’t anything to write home about. It’s pretty much like any other wound infection, and often your body can eventually overcome the bacteria without antibiotics. Now comes the bad part: As the bacterial cells die they activate a potent toxin that binds to nerve cells which regulate muscle activity. The result is all of those muscles being in a constant state of activation, or tetany (thus the name). One of the classic signs is something called a “sardonic smile” (I’m sure that brings back memories of studying for boards for most of you doctors). I’ve attached a picture of our patient. He obviously doesn’t look happy. At this point in his course any stimulation: a loud voice, lights being turned on, adjusting himself in bed, resulted in an all-out spasm.

The only way to prevent Tetanus, besides living in a bubble, is with the vaccine. This little boy’s father told us that he took him in for prompt treatment after his injury (stepping on something sharp with his foot) and his medical booklet said that he’d received the appropriate treatment at the government health center. It’s hard to know how true all of that is, but what is certain is that he didn’t have the recommended vaccines before his injury- which would have almost certainly prevented him from getting sick.

 

Again it’s hard to tell that he’s happy from my picture, but at least he can open his mouth again!

Fortunately his story ends well! We recognized his illness quickly. We gave him the right
medicines. When the symptoms are severe we give the medicine not only in his iV, but into his spinal fluid as well. He continued to have spasms for several days. Once the toxin damages nerve cells they have to regrow the connections. Sometimes this can take weeks, so he was lucky. The picture shows him opening his mouth. He’s still camera shy, but obviously much more comfortable.

Medical knowledge changes every day. I’m sure you’ve all seen the posters from not that long ago when doctors endorsed cigarettes. Margarine is the healthy and cheap alternative to butter- now it’s on par with pesticides. The reason for this is that we base the things we tell people on the best information that we have, which will always be imperfect. The studies and experiments that we use aren’t always clear, and the balance of evidence for or against something can change…and then change back! Vaccines, however, are not in that category.

Jasper watching us put together our new bed

Right now there is overwhelming evidence to support our current vaccine programs and the schedule we use. Vaccines, like any medicine have side effects. Right now there is no evidence that those side effects (fevers, pain, and rarely febrile seizures) are long lasting. There has been a single study linking vaccines to autism. It was published in a major British medical journal created a huge amount of suspicion about vaccines. There had been lots of other larger and better-designed studies looking for problems associated with vaccines, which did not show a link to autism. When an outlier study like this occurs we pay attention, and try to validate it by doing another similar study or going back through old information to see if the results can be replicated. Years went by and study after study failed to find a similar pattern. Eventually it came to light that the study was funded by lawyers representing families suing vaccine manufacturers. You might be thinking: “Well don’t drug companies fund studies all of the time?” The answer is yes, but those studies don’t get published in major medical journals and are generally taken with a grain of salt. The result was that the study was retracted and the author lost his medical license. Unfortunately, the original story made much bigger headlines than it’s debunking, and that’s what people remember.

 

There is currently no credible evidence linking vaccines and autism. There are thousands of anecdotal stories from parents of children who were “normal” before getting their MMR vaccine; they went to the doctor and got their shots, got sick and were never normal again. I had patients in Asheville who reported very similar stories. Going back to the earlier commentary on paying attention to what goes into your kids, I think it’s logical to suspect vaccines as a culprit in this case. Doctors and researchers have taken this seriously as well, but haven’t found any association. The biggest confounder for the apparent association is that the second dose of the vaccine was traditionally given at 2 years, which is also when serious screening for autism begins. This is a big subject and could fill up much more than you want to read from me, so I’m only going to hit the high points. The increase in autism has increased with increased numbers of vaccines. The same can be said for its correlation with the price of milk or the number of electric vehicles on the roads. Almost certainly the uptick in prevalence is mostly a factor of increased surveillance. The cause of autism is not currently known. For most kids it is probably congenital/genetic. There are other theories that point the finger at environmental exposures (other than vaccines) or infections. One day (maybe even tomorrow) somebody will discover a link between vaccines and autism or something else really bad. If that happens I (and almost certainly whoever takes care of your children) will be paying attention. For now, the most compelling statistic is that vaccines have increased life expectancy in the modern world more than any other thing except for access to clean water.

Now I’ll hop down from my soapbox. I’m thankful that my patient survived and had a quick recovery. I’m thankful that my kids probably won’t have to ever experience what he went through. I’m thankful that my kids probably won’t have to experience a number of other diseases that used to kill tens of thousands of people in the US every year. I’m thankful that most of the world now has access to vaccines that can prevent Tetanus and a variety of other diseases. I’m thankful that I’m able to be here, to treat people’s physical needs as well as share the Gospel.

Thanks again for reading! And for making it possible for us to be here!

 

Bryant