“I honestly felt like it was never going to go away. The doctor told me it was 100 day cough, so I was counting the days while Googling to see if there was anything that could help. I tried everything, you name it, I tried it, and nothing worked. It came to 120 days and I couldn’t understand why it wasn’t gone. I then researched and found that babies take longer to get over whooping cough.”
Fern’s Story – Whooping Cough
Fortunately, the cough doesn’t typically last that long if you are vaccinated and still get pertussis.
Which disease was known as “the Strangling Angel?”
“The breathing became much more difficult, with a kind of rattling stertor, as if the patient was actually strangling, the voice being exceeding hoarse and hollow, exactly resembling that from venereal ulcers in the fauces. This noise, in speaking and breathing, was so peculiar, that any person in the least conversant with the disease might easily know it by this odd noise; from whence, indeed, the Spanish physicians gave it the name of garrotillo, expressing the noise such make as are strangling with a rope.”
Edward Headlam Greenhow on Diphtheria
How about “The Crippler?”
Polio, also known as infantile paralysis, was known as “The Crippler.”
The “Speckled Monster?”
Even mild smallpox, as depicted on this WHO Smallpox Recognition Card, included flu like symptoms, a few weeks of pustules, and then waiting for the lesions to scab over…
We forget these names, because we don’t see these diseases anymore.
“…for those trained in pediatrics in the 1970s, Hib (Haemophilus influenzae type b) was a horror.”
It’s easy to be anti-vaccine when you are hiding in the herd. You don’t get vaccinated and you don’t vaccinate your kids, and instead, you simply rely on the fact that everyone else around you is vaccinated to protect you from vaccine-preventable diseases.
Would you vaccinate your high-risk child? Photo by Janko Ferlic.
Of course, this is a terrible strategy, as we are seeing with the increase in cases of measles and pertussis, etc. It is much better to learn about the importance and safety of vaccines, get fully vaccinated, and stop these outbreaks.
But as they continue to tell you that vaccines don’t work, how about asking what they would do in these ten high-risk situations?
Amazingly, some folks continue to try and justify skipping vaccines and accept the risk of disease, even when that risk is much higher than usual and they could be putting their child’s life in immediate danger!
How will you do with our quiz?
Would you choose to vaccinate in these situations?
1. Baby born to mother with hepatitis B.
You are pregnant and have chronic hepatitis B (positive for both HBsAg and HBeAg). Should your newborn baby get a hepatitis B shot and HBIG?
Background information:
Many anti-vaccine experts tell parents to skip their baby’s hepatitis B shot, saying it is dangerous, not necessary, or doesn’t work (typical anti-vax myths and misinformation).
However, it is well known that:
from 10 (HBeAg negative) to 90% (HBeAg positive) of infants who are born to a mother with chronic hepatitis B will become infected
90% of infants who get hepatitis B from their mother at birth develop chronic infections
25% of people with chronic hepatitis B infections die from liver failure and liver cancer
use of hepatitis B immune globulin (HBIG) and hepatitis B vaccine series greatly decreases a newborn’s risk of developing a hepatitis B infection (perinatal transmission of hepatitis B), especially if HBIG and the first hepatitis B shot is given within 12 hours of the baby being born
Would your newborn baby get a hepatitis B shot and HBIG?
2. Your child is bitten by a rabid dog.
Your toddler is bitten by a dog that is almost certainly rabid. Several wild animals in the area have been found to be rabid recently and the usual playful and well-mannered dog was acting strangely and died a few hours later. The dog was not vaccinated against rabies and unfortunately, the owners, fearing they would get in trouble, disappeared with the dead dog, so it can’t be quarantined. Should your child get a rabies shot?
Background information:
Although now uncommon in dogs, rabies still occurs in wild animals, including raccoons, skunks, bats, and foxes. These animals can then expose and infect unvaccinated dogs, cats, and ferrets, etc.
To help prevent rabies, which is not usually treatable, in addition to immediately cleaning the wound, people should get human rabies immune globulin (RIG) and rabies vaccine.
The rabies vaccine is given as a series of four doses on the day of exposure to the animal with suspected rabies and then again on days 3, 7, and 14.
Although rare in the United States, at least 1 to 3 people do still die of rabies each year. The rabies vaccine series and rabies immune globulin are preventative, however, without them, rabies is almost always fatal once you develop symptoms. A few people have survived with a new treatment, the Milwaukee protocol, without getting rabies shots, but many more have failed the treatment and have died.
You are traveling to the Romania to see family with your 9-month-old baby. Neither of you have had the measles vaccine. Should you both get vaccinated before making the trip?
Although the first MMR vaccine is routinely given when children are 12 months old, it is now recommended that infants get vaccinated as early as age six months if they will be traveling out of the country.
Since the endemic spread of measles was stopped in 2000, almost all cases are now linked to unvaccinated travelers, some of whom start very large outbreaks that are hard to contain.
Would you both get vaccinated before making the trip?
4. Tetanus shot.
Your unvaccinated teen gets a very deep puncture wound while doing yard work. A few hours later, your neighbor comes by to give you an update on his wife who has been in the hospital all week. She has been diagnosed with tetanus. She had gotten sick after going yard work in the same area and has been moved to the ICU. Do you get him a tetanus shot?
Background information:
Most children get vaccinated against tetanus when they receive the 4 dose primary DTaP series, the DTaP booster at age 4-6 years, and the Tdap booster at age 11-12 years.
Unlike most other vaccine-preventable diseases, tetanus is not contagious. The spores of tetanus bacteria (Clostridium tetani) are instead found in the soil and in the intestines and feces of many animals, including dogs, cats, and horses, etc.
Although the tetanus spores are common in soil, they need low oxygen conditions to germinate. That’s why you aren’t at risk for tetanus every time your hands get dirty. A puncture wound creates the perfect conditions for tetanus though, especially a deep wound, as it will be hard to clean out the tiny tetanus spores, and there won’t be much oxygen at the inner parts of the wound.
These types of deep wounds that are associated with tetanus infections might including stepping on a nail, getting poked by a splinter or thorn, and animal bites, etc. Keep in mind that some of these things, like a cat bite, might put you at risk because you simply had dirt/tetanus spores on your skin, which get pushed deep into the wound when the cat bites you.
Symptoms of tetanus typically develop after about 8 days and might include classic lockjaw, neck stiffness, trouble swallowing, muscle spasms, and difficulty breathing. Even with treatment, tetanus is fatal in about 11% of people and recovery takes months.
Would you get your teen a tetanus shot?
5. Cocooning to protect baby from pertussis.
Both of your unvaccinated teens go to school with a personal belief vaccine exemption. You are due in a few months and are a little concerned about the new baby because there have been outbreaks of pertussis in the community, especially at their highschool. Should everyone in the family get a Tdap shot?
Background information:
Pertussis, or whooping cough, classically causes a cough that can last for weeks to months.
While often mild in teens and adults, pertussis can be life-threatening in newborns and infants. In fact, it is young children who often develop the classic high-pitched whooping sound as they try to breath after a long coughing fit.
In a recent outbreak of pertussis in California, 10 infants died. Almost all were less than 2 months old.
Since infants aren’t protected until they get at least three doses of a pertussis vaccine, usually at age 6 months, experts recommend a cocooning strategy to protect newborns and young infants from pertussis. With cocooning, all children, teens, and adults who will be around the baby are vaccinated against pertussis (and other vaccine-preventable diseases), so that they can’t catch pertussis and bring it home.
There is even evidence that a pregnancy dose of Tdap can help protect infants even more than waiting until after the baby is born to get a Tdap shot.
Would everyone in your family get a Tdap shot?
6. Nephew is getting chemotherapy.
Your nephew was just diagnosed with leukemia and is going to start chemotherapy. Your kids have never been vaccinated against chicken pox and haven’t had the disease either. Your brother asks that you get them vaccinated, since they are around their cousin very often and he doesn’t want to put him at risk.
Do you get your kids vaccinated with the chicken pox vaccine?
Background information:
Kids with cancer who are getting chemotherapy become very vulnerable to most vaccine-preventable diseases, whether it is measles, flu, or chicken pox.
According to the Immune Deficiency Foundation, “We want to create a ‘protective cocoon’ of immunized persons surrounding patients with primary immunodeficiency diseases so that they have less chance of being exposed to a potentially serious infection like influenza.”
Would your get your kids vaccinated with the chicken pox vaccine?
7. Outbreak of meningococcemia at your kid’s college.
Your child has just gone off to college. There is an outbreak of meningococcemia in her dorm (8 cases already). It is the strain that is included in the Menactra and Menveo vaccines, although she has not been vaccinated. Do you encourage her to get vaccinated?
Background information: Neisseria meningitidis is a bacteria that can cause bacterial meningitis and sepsis (meningococcemia).
Depending on the type, it can occur either in teens and young adults (serogroups B, C, and Y) or infants (serogroup B).
Although not nearly as common as some other vaccine-preventable diseases, like measles or pertussis, it is one of the more deadly. Meningococcemia is fatal in up to 40% of cases and up to 20% of children and teens who survive a meningococcal infection might have hearing loss, loss of one or more limbs, or neurologic damage.
Meningococcal vaccines are available (Menactra and Menveo) and routinely given to older children and teens to help prevent meningococcal infections (serogroups A, C, Y and W-135). Other vaccines, Bexasero and Trumenba, protect against serogroup B and are recommended for high risk kids and anyone else who wants to decrease their risk of getting Men B disease.
Would you encourage her to get vaccinated against meningococcemia?
8. Cochlear implants.
Your preschooler has just received cochlear implants. Should he get the Prevnar and Pneumovax vaccines?
Background information:
Cochlear implants can put your child at increased risk for bacterial meningitis caused by the Streptococcus pneumoniae bacteria (pneumococcus).
Would he get vaccinated with Prevnar and Pneumovax, as he is no at high risk for pneumococcal disease?
9. Splenectomy
Your child is going to have his spleen removed to prevent complications of hereditary spherocytosis. Should he get the meningococcal and pneumococcal vaccines first?
Background information:
Without a spleen, kids are at risk for many bacterial infections, including severe infections caused by Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.
In addition to their routine vaccines, kids with asplenia might need Menveo or Menactra, Bexsero or Trumenba (Men B), and Pneumovax 23.
Would your child get these vaccines that are recommended for kids with asplenia?
10. Ebola
Ebola is returning, but this time an experimental vaccine is available.
Background information:
There were nearly 30,000 cases and just over 11,000 deaths during the 2014-16 Ebola outbreak in West Africa.
You are in an area that is seeing an increasing number of Ebola cases and there is still no treatment for this deadly disease. An experimental vaccine is being offered.
Do you get the vaccine?
How Anti-Vaccine Are You?
It’s easy to be anti-vaccine when you are hiding in the herd – seemingly protected by all of the vaccinated people around you.
Most people aren’t overly worried about rabies these days, at least not in the United States.
In the mid-1950s, rabies control programs began to get more and more dogs vaccinated against rabies.
Is that because rabies isn’t around anymore?
Of course not. It is because a rabies vaccine has long been available both to prevent our pets from getting rabies from wild animals and to protect us if we are ever bitten by an animal that might have rabies.
Hopefully, especially after the recent rabies death of the 6-year-old in Florida, everyone understands that rabies is still around.
When Was the Last Time Someone Died from Being Bitten by a Rabid Dog in the United States?
Since 2008, at least 21 people have died of rabies in the United States, mostly after getting exposed to rabid bats.
There were more than a few exposures from dogs with rabies too. In fact, the last rabies death after a dog bite was not very long ago – it was in May 2017.
Exposure to rabid dogs typically happened while the person was out of the United States.
Does that mean that something isn’t working with our rabies prevention plans?
When you take a closer look at the statistics about rabies deaths after dog bites, it becomes clear where the problem is.
“In 1950, for example, 4,979 cases of rabies were reported among dogs, and 18 cases were reported among humans. Between 1980 and 1997, 95 to 247 cases were reported each year among dogs, and on average only two human cases were reported each year in which rabies was attributable to variants of the virus associated with indigenous dogs . Thus, the likelihood of human exposure to a rabid domestic animal in the United States has decreased greatly.”
Human Rabies Prevention – United States, 1999 Recommendations of the Advisory Committee on Immunization Practices (ACIP)
Most rabies deaths in the United States from dogs occur in people who get bitten while they are traveling outside the country.
So when was the last human rabies death from a rabid domestic dog in the United States?
A 7-year-old girl died after she was bitten by a rabid dog in Texas in June 1979. Before that, in 1968, a 13-year-old boy died after getting bit by a rabid dog in Kansas.
That’s a long time ago.
Does that mean the rabies vaccine isn’t necessary anymore?
Rabies Vaccines Work
Of course not! That means the rabies vaccines works!
Two Indonesian boys proudly show off their puppy and her vaccination record. Photo by the rabiesalliance.org.
There are two reasons that we don’t see human rabies deaths from dog bites in the United States anymore, unless the bites occur in another country:
Most of us vaccinate our pets – fewer dogs and cats with rabies means that there are fewer chances for us to get bit and get rabies.
Most folks get proper treatment if they are exposed to an animal that could possibly have rabies, whether it is an unvaccinated dog or cat, or a raccoon, skunk, fox, coyote, or bat. In fact, about 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year.
If you don’t believe this, just look back at what rabies was like in the pre-vaccine era, when dogs and cats would get rabies, and so would their owners. In the early 1960s and 1950s, rabies deaths from dog bites were more common, about 10 each year.
“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”
CDC on Rabies in the U.S.
To understand just why rabies vaccines still so necessary, you can also look at what is still happening around the world where rabies vaccines aren’t used as commonly as they are in more industrialized countries.
“Despite substantial gains in tackling this neglected disease, more than 20,000 people still die from rabies every year, mostly in Asia and Africa.”
Schneider et al on Substantial reductions in rabies, but still a lot to be done
In addition to the deaths from folks traveling outside the United States, there are many more rabies deaths in people, mostly children, who live in areas where rabies is still endemic.
Hopefully these deaths will end soon too, as experts from WHO, Food and Agriculture Organization (FAO), International Organisation for Animal Health (OIE) and the Global Alliance for Rabies Control (GARC) work together in the United Against Rabies collaboration to achieve “Zero human Rabies deaths by 2030.”
Because it has an animal reservoir, the rabies virus will likely always be around, and won’t be eradicated like smallpox, but hopefully we can one day control rabies by having fewer rabies exposures (vaccinate more of our pets) and we can eliminate dog-transmitted rabies deaths.
We won’t get there if folks continue to push myths and propaganda about rabies and the rabies vaccine.
What to Know About Controlling Rabies and Rabies Deaths
It has been a long time since someone in the United States died with rabies from a domestic dog bite, but that is simply a testament to the fact that vaccines work.
More on Controlling Rabies and Rabies Deaths
Human Rabies in the United States, 1960 to 1979: Epidemiology, Diagnosis,
Tragically, most folks know that they do because of the story of the unvaccinated 6-year-old boy in Florida who died after being exposed to a rapid bat earlier this year.
Unlike most other vaccine-preventable diseases though, unless you are at high risk for getting rabies, you don’t typically get the rabies vaccine unless you have already been exposed to rabies.
How does one get exposed to rabies?
Now that most people get their pets vaccinated against rabies, these exposures typically come from wild animals, including:
raccoons
skunks
foxes
coyotes
bats
While any mammal can be susceptible to rabies, small mammals, including squirrels, rats, mice, hamsters, guinea pigs, gerbils, chipmunks, rabbits, and hares, rarely get rabies and aren’t usually thought to be a risk for humans.
Your other pets, including dogs, cats, and ferrets, are though. They should be vaccinated against rabies. As should other domestic animals, including cows, goats, sheep, and horses.
To avoid rabies, teach your kids to avoid wild animals. Photo by Emilie Chen (CC BY-ND 2.0)
It is also important to teach your kids to avoid wild animals. While most kids won’t go out of their way to pet a coyote, they might try to feed a racoon or skunk, and they might pick up a bat they find on the ground.
Kids should also avoid cats and dogs that they don’t know. Your kids should not just walk up and pet unfamiliar dogs and cats.
What to Do If Your Child Is Exposed to Rabies
Unfortunately, you won’t always know if an animal has rabies, although an animal acting strangely can be a tip off that they might have rabies.
Never touch a bat that you find on the ground during the day, as it might have rabies. Photo by Radu Privantu (CC BY 2.0)
That bat your kids found on the ground could definitely have rabies, especially if they found it during the day. And the bat doesn’t even have to obviously bite your child. For example, if you find a sick or dead bat in your child’s room in the morning when he wakes up, you should consider that a possible exposure to rabies.
Many other exposures happen when kids are bitten by stray cats or dogs.
What do you do?
According to the CDC, if your child is bitten by any animal or has any possible exposure to rabies, you should:
immediately wash the wound well with soap and water, also using a povidone-iodine solution (Betadine Antiseptic Solution) to irrigate the wound if it is available
see a healthcare provider
call your local animal control for help in capturing the animal for observation or rabies testing
Animal control can also help in verifying a pet’s rabies vaccination status if your child was bitten by a neighborhood cat or dog.
“A healthy domestic dog, cat, or ferret that bites a person should be confined and observed for 10 days. Those that remain alive and healthy 10 days after a bite would not have been shedding rabies virus in their saliva and would not have been infectious at the time of the bite.”
CDC on Human Rabies Prevention — United States, 2008
In general, unless they already appear rabid, dogs, cats, and ferrets can be quarantined and observed for 10 days to see if they develop signs of rabies before your child begins post-exposure prophylaxis.
Other animals, including skunks, raccoons, foxes, coyotes, and bats should be considered rabid, with a quick start of post-exposure prophylaxis, unless the animal can be quickly tested (brain material) for rabies. And of course, you would be more considered about rabies if the animal was acting strangely, looked sick, or if it was an unprovoked attack.
What if you can’t find or capture the animal?
Depending on the circumstances, your pediatrician, with the help of your local or state health department, can determine if your child needs rabies post-exposure prophylaxis with rabies immune globulin and a 4 dose series of the rabies vaccine over 2 weeks.
“The number of rabies-related human deaths in the United States has declined from more than 100 annually at the turn of the century to one or two per year in the 1990’s. Modern day prophylaxis has proven nearly 100% successful.”
CDC on Rabies in the U.S.
About 40,000 to 50,000 people in the United States get rabies post-exposure prophylaxis each year. That works to keep the number of rabies cases and rabies deaths in people very low.
And it is not probably not at the top of your list of things to think about at a time like this, but animal bites can also be a risk for tetanus. Make sure your child doesn’t need a tetanus shot.
What to Know About Getting Exposed to Rabies
Keep your kids safe from rabies by vaccinating your pets and teaching them to avoid wild animals, but also know what to do if your child is exposed to rabies.
