by Sharon Humiston, MD, MPH


IT'S-PERSONAL-AS-WE-SEE-IT-SHARON-HUMISTONWhen my Dad was growing up, one of his brothers died of an infection that would not have killed a child today.

Obviously, having his brother die affected him so he sometimes invited us to imagine what it would be like to grow up in the days when children were helpless against serious infections and what it would be like as a parent to worry that your child’s fever or sore throat would transform from an inconvenience to a nightmare, leading to your child’s death. Unthinkable.

I was a history major in college and found the role of microbes on the course of human events to be impressive.

All this seems very cerebral, however, compared to my experience in the pediatric emergency department (ED). There is no one who is a more passionate proponent of Hib vaccine than I am after having my years in the ED.

By the time I was a pediatric resident, smallpox had been eradicated, diphtheria was “merely historical,” and polio was exceedingly rare, but there was no Hib vaccine yet, so this disease was still around to terrorize us.

I remember lots of patients with infection of the cheek (buccal cellulitis) and one boy who had Hib infection in his bones (osteomyelitis) and the antibiotics were not working well, so he ended up with a very prolonged hospital stay, which was not doing good things for him psychologically. But these weren’t scary.

The scary ones were the infants who came in with meningitis—either limp or screaming frantically. The medical word for that kind of inconsolable screaming is “irritability,” but that always seemed such a mild expression, when in fact you could hear these babies screaming from across the ED, screaming like they were being dragged to hell.

But the very worst cases were the children with epiglottitis. The epiglottis is a flap of tissue that perches like a guard at the entrance of the voice box and the airway. The job of the epiglottis is, in fact, to guard the opening between the vocal cords so nothing “goes down the wrong pipe.”

When children got Hib epiglottitis, the epiglottis would swell, making it so that nothing got down the wind pipe . . . not even air.

Back in the day, I was pretty good at intubating kids, that is, putting a small breathing tube between the vocal cords and into the airway so we could make sure oxygen was getting in. But accomplishing this for a child with epiglottitis had a much higher level of difficulty.

Intubations for other diseases were like shooting a hockey goal with a normal goalie—not easy, but doable.

Intubations for a child with Hib epiglottitis were like shooting a hockey goal when King Kong was the goalie. We would have to call in subspecialists to put in a surgical airway. Yikes, how terrifying for the child, the parents, not to mention the ED personnel.

And then the vaccine was invented, and physicians hurried to give it to infants, and Hib disease simply disappeared. It felt like a miracle. That’s how it felt—just “poof.”

[I can’t help but think, wouldn’t it be beautiful if gynecologists and other surgeons were saying that about HPV-associated cancers 20 years from now? “It felt like a miracle…just “poof” and all these cancers were gone.”]

You ask about the value of vaccinations—I have seen it first hand. Ask any middle-aged pediatric emergency medicine doctor about the “good old days.” I think you will find that most are in awe of vaccines.