Meeting the Devil You Don't Know

Dec 16 2010 Published by under [Medicine&Pharma], Uncategorized

The Bad Boy (click image for source)

This morning I dragged myself out of bed and through the wintery slush to fulfill my teaching attending duties. Approximately once every 18 months, each of the attending physicians in our pediatrics program must sit in on a conference while the residents present a case and work through it. Today's case provided a sense of nostalgia, but not in a good way.

A 15 month-old boy was admitted with a febrile illness, including nausea, vomiting, refusal to walk, and crossed eyes. His exam revealed irritability and a stiff neck, consistent with the diagnosis of meningitis. A spinal tap showed thousand of white blood cells and bacteria - what lay people would call pus.

The bacteria responsible: Haemophilus influenzae.

When I trained in pediatrics, we saw cases of haemophilus meningitis on a regular basis. For today's house staff, this case is very unusual because the incidence has decreased by 99% since the introduction of regular immunizations in 1988, the year I finished training.

Haemophilus meningitis, while curable, can result in permanent hearing loss (20%) or other neurologic problems. Even with antibiotics, 3 to 6% of cases prove fatal.

Turns out one of this child's older siblings had a fever and irritability after a round of vaccination, so the family decided not to allow further vaccinations of any of their children.

Now that they have seen meningitis first-hand, and an early, fairly mild case at that, the kids are all getting their shots.

There are good reasons we have spent loads of time and effort developing immunizations. Biomedical researchers did not target "trivial" diseases. The defeat of Haemophilus meningitis has occurred in my professional lifetime, and it is nothing short of a miracle.

I just hope others who read this will think long and hard before refusing a medical miracle for their own children. I would hate to see another case anytime soon, especially a bad one.

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