July 15th, 2010
I have a freakishly large Golden Retriever named Ozzy. He performs some important household chores like waking me up at 6am every day, pre-rinsing the dishes in the dishwasher and destroying any rogue tennis balls that might be laying around the house. He’s two, now, which for a Golden means that he’s still really energetic. If I don’t find time to let him do what he was bred to do, run around like crazy chasing stuff then bringing it back to me, he will start to act out.
The immune system of an allergic person is sort of like Ozzy. It’s designed to to a specific job and do it well and when it isn’t presented with the chance to do that job, it will find something else to do. The part of the immune system that is responsible for allergies is really designed to fight off parasites. We don’t have a big parasite problem is the Western world anymore, but we do have a huge, and growing, allergy problem. One theory as to why allergies are becoming more common states that since the parasite arm of the immune system is not required to do its job much anymore, it goes looking for something else to do. What it finds, instead of parasites, is pollens, dust mites, peanuts, and the rest of the common allergens. It incorrectly senses that these things are potentially harmful and it sets up a reaction to get rid of them. That reaction causes the symptoms experienced by allergy sufferers.
Some people have taken this theory as far as infecting themselves with hookworms to see if it improves their allergies and there are anecdotal reports of this process working. Usually these reports come directly from the people selling the worms, however. There is serious research into this treatment going on at present and the results should interesting. For now, though, we’ll stick to antihistamines, nasal steroid sprays, and immunotherapy.
July 12th, 2010
California is in the midst of its worst whooping cough outbreak in 50 years. Before a vaccine was available, whooping cough killed around 5000 Americans a year, mostly infants. Add to that the substantial morbidity it caused and whooping cough was a major public health issue. When the whooping cough vaccine became available in the 1940’s, the number of cases declined precipitously. Since the 1980’s, however, the number of whooping cough cases has been on the rise.
Whooping cough is not a trivial disease. It is caused by a bacteria called Bordetella pertussis that infects the lungs. Apart from the small mortality risk, the two things that make whooping cough so bad are the intensity of the disease and the duration. The “whoop” in whooping cough refers to the characteristic noise made when its sufferers cough. It has also been referred to as a bark, honk, or seal-like noise. The cough is so severe that it is not uncommon for sufferers to cough until they vomit or crack ribs. Whooping cough is also known as the “100-day cough”. After the acute illness subsides, the cough can linger for months.
Back to California. A recent NY Times article illustrates some of the reasons for the return of this old foe. It highlights Marin County, a wealthy bay area enclave that is home to 0.5% of the states’ population, but 15% of the states’ whooping cough cases. In Marin county, 13% of infants and children remain unvaccinated, the 7th highest rate in the state. It is this lack of vaccination that allows diseases like whooping cough to gain a foothold in a community.
I’ve said it before in this blog, but it bears repeating: vaccines may be the most important public health advance in the history of mankind and that is not hyperbole. In order for them to be maximally effective, to achieve herd immunity, they need to be used universally. Some vaccines are better than others, but they are all better than nothing. The risks of vaccination are negligible, especially when compared with the risk of not vaccinating.
Finally, when considering not vaccinating your child, remember that you are not only putting your child at risk, but you are also increasing the risk for every other individual in the community.
