Wednesday, March 9, 2011

Vaccinations: Is death the only motivator that works to promote immunization?

A recent conversation with my nurse and regular debating partner highlighted the passion that people have about vaccinations.

We were finishing up clinic and the topic of HPV came up.

(Now, don't be surprised. This issue is something that we deal with almost every hour of every day.)

There is a vaccination now for certain subtypes of HPV, which not only cause genital warts but also can lead to cancer in women and men.

Cervical cancer particularly is an epidemic disease among young women. And the "abnormal Pap smear" has become as frequent as many common diseases.

Women infected with the virus can develop dysplasia (atypical, precancerous cells) of the cervix which if not recognized and treated can lead to both a superficial and invasive malignancy.

The dysplasia needs to be treated with painful procedures like cryosurgery, or a cone biopsy where the affected tissue is surgically removed, to the possibility of a hysterectomy.

Aside from the fact that the vaccination is really directed to young women, it is clear that young men are also parties to the transmission of the virus. And, there is a cancer risk in men as HPV can lead to not just cometic genital warts, but also to penile cancer.

My nurse was adamant about her son not having the vaccination.

She is certainly entitled to her opinion and it's a common thought among many young parents these days.

Plus, lets face it, men serve as reservoirs of the disease for women.

So, why does she have such a strong opinion?

I mentioned this discussion to my father who in less than a month will be 91. He couldn't grasp why someone would ever turn down a vaccination.

His opinion is grounded in growing up where epidemic infections were a regular cause of death for young adults, including his family and friends.

"I can remember when my cousin died of polio. We burned all of her bed clothes and put phenol around the house," he told me.

"Then we buried her."

So what happened when the vaccine came about I asked?

"We lined up downtown at the community center. Everyone in town."

"No one felt like the government was forcing them to get vaccinated? Did anyone refuse?"

"I can't remember anyone who didn't want it. I mean, almost everyone had lost a member of their family, or a child. You didn't have to see many people in a wheel chair or an iron lung to put the fear of God in you about polio."

So that's the culture that I grew up in. My parents used every opportunity to have me punctured by a hypodermic to keep me from dying of polio, and lock jaw (tetanus), two kinds of measles, and whooping cough.

They must have also wanted to continue the blood line too because mumps was also put "at bay" and my testicles protected with a series of injections.

So maybe death is the big motivator for vaccination.

If you look at college campuses now almost all of them have been affected by meningitis. Students have died of the disease so frequently in the past few years and it is so contagious that most schools require vaccination before you can gain admittance.

I remember the first patient I ever admitted to the ICU as an intern almost 18 years ago now.

She was a 24-year old waitress at one of the Dallas cowboy bars. You know the drill: fever, chills, altered mental status, and finally collapse in the ER.

She got the finest treatment a major tertiary center could offer. But she still descended to the brink of death.

There was a ventilator, multiple consultants, loads of IV antibiotics, and plenty of hand holding from a pimple faced intern who saw someone younger than him dying.

There was no vaccination for meningitis in those days. We gowned and gloved when we took care of her. And we all took prophylactic antibiotics lest we succumb to the same fate.

And we waited, and yes, I prayed for her.

It's not that I just didn't want to strike out at my first bat with a patient in the ICU.

I met her family, her boyfriend, and friends. I got to know her.

And thankfully I witnessed her get better. It took the better part of a month, but we were able to give her the hospital equivalent of the perp-walk in a wheel chair to the front door with balloons, plants, and the to go bag containing the pink ice pitcher give-away from the hospital room.

But for the other diseases nobody dies.

Does this decrease motivation for vaccination?

It probably does. I can assure you my children will be vaccinated against meningitis.

Chicken pox maybe is an exception. Public health officials were successful in convincing parents in our state to require this for elementary school attendance.

I would like to think that it was because chicken pox can lead to devastating scars in children and to permanent pain in adults when it reappears as shingles.

More likely, the primary concern was the missed school days for the kids and missed work for the parents.

But today most parents line their kids up for chicken pox and also hepatitis B vaccinations without much consternation.

Oh, but not for the HPV vaccine.

It may be the social stigma of the disease, or the fact that their children either shouldn't be or won't be doing anything to put them at risk for the disease.

I even still the absurd argument I hear about the birth control pill: that it might promote promiscuity.

My opinion is no doubt clouded by practicing every day at a major urban metropolitan hospital. What I see is real world. But it may not be your world.

I guess I grew up with the values from my father. If modern medicine can protect children or adults from ailments or infirmities then I am easy to buy in.

Whether its small pox or HPV, I support vaccination and elimination of these diseases from the society I call home.

I no longer have to see someone die to become a cheerleader.

- Posted using BlogPress from my iPad

Location:Milwaukee, Wisconsin

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