8 May

‘Sarah is now seven weeks old,’ Jane said, as she came into my surgery. ‘I thought it was high time I had a chat with you about needles and immunization and all that.’

‘I’m glad you came,’ I said. ‘Take a seat, and let’s talk medi-talk.’

‘Good,’ she replied, settling into one of the comfy seats. I like having comfortable seats for my patients and their relations. It makes them feel more at ease. Gone are those horrid, hard, squeaky old-fashioned things some doctors still harbour in their rooms. They should all be relegated to the rubbish heap, in my opinion. But back to the story…

‘Some weeks ago you mentioned protection from disease, but I’ve been talking around, and everybody seems to have all manner of ideas about it.’

‘You’re partly right, Jane,’ I said. ‘Over the past few years, what was a normal, clear-cut procedure has become a bit blurred. This is unfortunate, but there are several reasons.’

‘What, then, should I believe?’ Jane queried. ‘I am anxious to do the very best for Sarah, but I don’t want to take any unnecessary risks or be foolish about it in any way.’

‘That’s perfectly reasonable too,’ I went on. ‘Let me give you the picture, and try to put everything into perspective.

‘The facts of the situation are that today we have several very effective ways of preventing, almost entirely, several serious diseases which in years gone by have been major killers in our country. The ones I refer to are whooping cough, diphtheria, tetanus and poliomyelitis—polio, for short.

‘But in addition, we can also offer good protection against ordinary measles, mumps, German measles (commonly known as rubella), and a few others that may be indicated in special circumstances.’

‘It seems quite a major undertaking, and certainly an amazing list of good tidings,’ Jane said. ‘But what about these sinister comments I hear? I’ve been told that there are certain risks. Some doctors apparently claim that the risks of certain forms of immunization may be more dangerous than the benefits to be gained.’

Whooping cough

‘I know about the comments you’ve heard, Jane,’ I said. ‘And I’m sorry you’ve had your head filled with these stories. To start with, the most controversial concerns the whooping cough vaccine. In Australia, there has never been much doubt about it and nearly all doctors administer it to babies. It gives extremely good protection against whooping cough, which, until mass immunization started some years ago, was a major killer of babies in the first six months of their life. It’s a terrible disease, and small babies, often at the age of two or three months, simply died from it.

‘Immunization altered all of this, and today we seldom see a case. However, a few years ago in Britain there were several cases of brain damage in babies, supposedly linked to whooping cough vaccines. An awful furore broke out, and lots of people turned against the vaccine, foolishly. This included many mothers with babies who should have been vaccinated, but were not.

‘In the meantime, in Britain the vaccination levels for this disorder have greatly reduced. Now the aftermath is starting to be experienced. There is a growing number of cases of whooping cough in Britain and the death rates will inevitably escalate in the next few years unless there is a prompt revision of this trend— which seems doubtful.’

‘I see what you mean. So you advise that Sarah should have whooping cough vaccine then?’

‘Most definitely,’ I replied. ‘In fact, this matter has been very carefully studied by all the health commissions in Australia, and they are unanimous in their recommendation. I base my opinions and judgement on their opinions, plus the mass of material in the medical journals attesting to its continued safety and value.’

‘That sounds reasonable,’ Jane replied. ‘It’s amazing how a few people with loud voices can dominate the scene with ill-founded ideas.’

‘But that’s the same the world over,’ I answered. Diphtheria

‘What about the other diseases?’ Jane then queried.

‘Diphtheria, for a start. There’s not much doubt about that. It was a terrible killer until recent times, but mass immunization has again knocked it for a loop. I haven’t seen one case of diphtheria in thirty years of doctoring.’

‘That’s not a bad record,’ Jane said.

‘Not bad. And it’s a real tribute to the value of mass immunization. That’s the only reason,’ I added.


‘Tetanus, what about that?’ Jane queried.

‘Tetanus is rarely seen in Australia. In fact, there are probably less than twenty deaths annually from this fellow. But it’s bad, bad news if you happen to get it. Awfully painful, and a slow, horribly unattractive way to die. It is a totally preventable disease and should never happen in an advanced country. Protection is readily available to everyone, protection for both children and adults. Tetanus spores are everywhere, especially in soil; that’s why even a thorn prick in the garden is a potential danger. Most cases of tetanus in our country came from small puncture wounds.’

‘Does tetanus cause much trouble in other lands?’ Jane asked.

‘Does it ever!’ I replied. ‘The total number of tragedies isn’t known, but we do know that well over a million die from it each year. The overwhelming majority are in the developing lands of the Third World. At least half—perhaps more—occur in infants under the age of six months, the statistics show.’

‘Phew! That’s terrible,’ Jane said, with a grimace. ‘Now tell me a bit about poliomyelitis. I understand it’s also rife in certain countries.’

‘It is indeed, alive and thriving, and killing off huge numbers of children. Once more, it’s mainly in the Third World countries, where vaccination has barely touched the scene. But since dramatic mass immunization campaigns in this country were started in the mid-1950s, the death rate, and the number of persons left crippled and deformed, has zeroed out. Seeing a new case of polio today is a unique experience. They simply do not happen, and as far as I know there hasn’t been a polio death recorded here for some years.

‘But once again, it will remain this way only as long as the majority of parents have their infants immunized. It’s as simple as that. And simple it is: taking a small amount of syrup from a spoon is easy for a baby. The stuff even tastes pleasant. As well, the government supplies the vaccine free of charge—another plus.’

‘It’s nice to get a free deal occasionally,’ Jane said. ‘It’s even better when it benefits one’s child. That’s good value.’

‘I agree. We often criticize governments, but with immunization campaigns and products, they do an excellent job. Of that, there is no doubt.’


‘Now what’s the bit about measles? Is it really necessary?’

‘It isn’t essential, but there are a significant number of children who do get measles—the ordinary kind—and suffer serious complications, so it’s believed to be worthwhile. Viral encephalitis kills a substantial number of Australian children annually, and for this reason alone it is believed to be worthwhile immunizing all children. In fact, in America they have set themselves a target date, 1982, when they hope to have all their children mass-vaccinated against measles.’

‘What an enormous task,’ Jane said. ‘Will they achieve it?’

‘Who knows,’ I said. ‘They’ve fallen apart with mass campaigns in the past. Remember their swine flu debacle? Nevertheless, when children are involved, public support is often enormous. I hope they succeed—and I hope Australia decides to follow suit. Besides brain damage, the measles virus can cause havoc in the eyes, ears, throat and chest. It’s bad news for many, many children.

‘A single shot is usually administered at the age of 12 months. Before this, the child receives a lot of immunity from the mother, and if given earlier the vaccine may not do its job properly. One needle may be adequate, although in America they talk of booster shots later in the child’s life. Time will ultimately give us the final answer of what is the best long-term course to follow.’

‘Supposing a child is not vaccinated against measles at this time. Can it be done later on?’ Jane asked.

‘It is okay, but most children have acquired immunity to measles by the age of ten. I might add that an enormous number of children have also had an attack well before that age.’


‘Is mumps vaccine given routinely these days?’ was Jane’s next query.

‘No, it’s not. The vaccine has been available for some time—in fact, a few years. But it’s not widely used. However, this changed in 1981 when the National Health and Medical Research Council recommended it be routinely included in immunization programmes for infants. Mumps’ chief complication is its ability to cause an infection in the testes in males or the ovaries in females; in time, this can lead to infertility or sterility in later life. This would be the main reason for administering it. Also many doctors think its chief use may be in places where children are in close community, such as in boarding schools—there has also been talk of using it in army camps, and similar institutions.

‘A single shot is given, in the case of infants at the age of twelve months along with the measles vaccine. In fact, it is possible that a combined measles-mumps vaccine may become available.’


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