Immunization: Your First and Last Defense at TEOTWAWKI, by Philip J. Goscienski, M.D.

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If the nation’s infrastructure should crumble at TEOTWAWKI more than two centuries of medical advances in immunology will go down with it. The loss of the power grid in a massive solar flare or EMP will eliminate our capacity to make vaccines that protect us against serious, often fatal illnesses. The physicians who survive will face infectious diseases that they have never seen because they have been eliminated by vaccines.

Survivalblog readers are aware of the need to stock up on beans, Band-Aids and bullets but it is vital to acquire a supply of immune substances within the body. We may eventually run out of the three Bs but the protection provided by vaccines can last for years, perhaps a lifetime.

A SHTF scenario can take many forms, will probably affect various parts of the globe differently and the degree of recovery will depend on factors that are at present unpredictable. An example of how it might affect a vaccine-preventable disease occurred when the Soviet Union collapsed in 1991. Some regions of that country have always suffered from health standards that are quite low compared to most Western nations. Diphtheria, a disease that has been virtually absent in the United States since the middle of the 20th century was not unknown in the USSR. There were 839 cases of diphtheria reported there in 1989, two years before the implosion of the communist way of life. When the country fell apart so did their public health system. There were no funds for vaccines, including the one for diphtheria. The bacteria that cause diphtheria are always circulating within the population. The vaccine – the D in the DPT vaccine that children usually receive during the first 6 months of life – protects against a toxin produced by the germ and has no effect on the bacterium itself. As the unimmunized population grew so did the incidence of diphtheria. In 1994 50,000 persons developed the disease and 1,700 died. By the time a massive immunization program brought the epidemic under control more than 157,000 cases had been recorded and more than 5,000 persons died. Those numbers may not have told the whole story, since record-keeping also suffered during the years that followed the collapse.

This example explains why immunizations must continue even when the diseases that they protect us against have been nearly eliminated. Nearly is the key word. With the exception of smallpox, every other vaccine-controlled virus or bacterium lurks within every population group on the planet, suppressed but not eliminated. In order to maintain low levels of disease it is necessary to immunize 85 or 90 percent of the population. This is known as herd immunity, wherein there are so few susceptible individuals that outbreaks of disease are unlikely. At TEOTWAWKI herd immunity will diminish rapidly and the diseases that our great-grandparents feared will return in epidemic form. To put this in perspective the list below shows the average number of cases that occurred every year in the United States prior to the vaccine for that disease and the number that occurred annually within approximately five years after a vaccine’s introduction.

Pre-vaccine                             Disease                                               Post-vaccine

48,000                                       Smallpox                                                     0
175,000                                    Diphtheria                                                    2
16,000                                      Paralytic polio                                             0
500,000                                    Measles                                                     116*
150,000                                    Mumps                                                     266*
48,000                                       Rubella (German measles)                       23*
800                                            Congenital rubella                                        3*
20,000                                       Hemophilus meningitis, epiglottitis       181
150,000                                    Pertussis (Whooping cough)                    7,500

* – Many of these victims came here from countries with low immunization rates. Some belong to communities that do not immunize children based on religious beliefs. A growing number represents children of parents who refuse immunization.

A graph originally from the Centers for Disease Control and Prevention web site shows the dramatic decline in the incidence of measles that followed introduction of an effective measles vaccine. Nearly identical declines have followed for vaccines such as mumps, rubella, polio and Hemophilus.

There was a surprising surge in the incidence of measles during the period 1989-1991. Subsequent analysis revealed that nearly half of the cases were in preschool children and that vaccine coverage was low in this group. Ninety percent of victims that died had not received the measles vaccine. There was an increased susceptibility among infants below the age of one year who were born to mothers whose immunity occurred from having received the measles vaccine, not natural infection.

Infants who are born to mothers who have experienced natural measles receive protective antibody through the placenta and they are relatively immune to the disease for about one year. That’s why children do not receive the MMR (Measles-Mumps-Rubella) vaccine until they reach the age of 12 to 15 months. If the vaccine is given before maternally-derived antibody has fallen to very low levels, the vaccine will not “take.” However, women who were born before the introduction of the measles vaccine in 1963, and therefore might have had measles, are almost all beyond childbearing age. Just about all mothers who give birth today have had the measles vaccine, not the natural disease, and their infants do not have year-long immunity. If an outbreak of measles were to occur today, pediatricians are encouraged to give the MMR vaccine to children older than 9 months or even earlier. That option will not be available when the SHTF and no vaccine is available.

There are several reasons for the seemingly high number of victims of pertussis even though a vaccine is available. The responsible organism maintains a constant reservoir within the community. The illness that it causes in adults resembles bronchitis and it is not recognized as whooping cough. Infected adults can spread the disease to very young infants whose immunity is poor. That lack of immunity is partly because their mothers have never had the disease and cannot transmit protection across the placenta or via breast milk. Although immunization for pertussis begins at about 6 weeks the vaccine does not confer protection until at least two, usually three doses have been given. Unfortunately, infants under the age of one year develop the characteristic illness known as whooping cough. Although the mortality rate is low, about 1 percent, the disease is agonizingly painful and often causes seizures.  

A disaster that takes down the grid for a prolonged period will have a severe effect on vaccine production, distribution and administration. Each of these elements will be affected by loss of the cold chain when refrigeration systems are no longer operable. It is the unreliability of the cold chain that challenges immunization programs in the developing world.

Making a vaccine is impossible without refrigeration and freezer capability. Many vaccines must be held at low temperatures from the final step of manufacture throughout the delivery to destination clinics or physicians’ offices. Even recently there have been instances of vaccine failure because vaccines were stored in areas of a refrigerator such as a door shelf, where the difference of only a few degrees eliminated their potency. Vaccines that are now being stored in refrigerators and freezers of pharmaceutical warehouses and pharmacies will become worthless when the grid goes down and backup generators run out of fuel.

Nature provides the most effective vaccines but they come at a frightful price. Those who survived smallpox never had to fear the disease again but 30 percent of its victims did not survive. Smallpox was eradicated from the planet because late in the 18th century an astute physician overheard dairymaids comment that they were unafraid of contracting smallpox because they had developed cowpox in the course of their milking chores. Edward Jenner inoculated fluid from cowpox lesions into the skin of his gardener’s son. The child did not become ill upon later inoculation with fluid taken from a smallpox victim.

Sometimes nature’s vaccines are gentle. During outbreaks of paralytic polio in the first half of the 20th century physicians noted that the disease affected children of the wealthy at higher rates than children of the poorer classes. Sanitation among the latter was often marginal and allowed exposure to germs within human waste. These included viruses that were similar to the poliovirus but that caused only mild illness, if any. Infection with these sewage-borne enteroviruses stimulated the production of antibodies that could block infection with the related poliovirus.

Vaccination causes an artificial disease that is mild or without any symptoms at all but protection from subsequent exposure to the natural disease may not last for a lifetime. For various reasons the antibodies that develop after vaccination gradually decline, making it necessary to give one or more booster doses. For instance, boosters are recommended for all the disease noted in the comparison table above. (Hemophilus may be an exception but it is a relatively new vaccine. Healthy adults rarely develop meningitis or other life-threatening diseases caused by Hemophilus.)  Childhood immunization against diphtheria and tetanus can last for many decades but persons over the age of 50 should have a booster shot. As in the post-collapse Soviet Union, diphtheria may become widespread in TEOTWAWKI. Tetanus will be a greater threat when survivors return to an agrarian lifestyle. The dreaded “lockjaw” will become more common than it is today and there will be no treatment.

There is a little good news for persons who have been immunized prior to the loss of vaccines in the future. Later exposure to a wild virus during TEOTWAWKI may provide nature’s own booster effect. This phenomenon has not been studied extensively and will not apply to every microorganism. It’s another compelling reason, however, to take advantage of all the opportunities for immunization that are available. Even if a vaccine does not completely prevent disease, which occurs in about half the patients who receive the shingles (zoster) vaccine for example, the subsequent illness is milder and is much less likely to produce severe complications.

Some vaccines do provide lifelong protection. Hepatitis A is a disease that is usually food borne and that will likely increase when municipal sanitation facilities decline or fail in TEOTWAWKI. The incidence of hepatitis B is not likely to increase and may even decline when drug addicts, its common victims, no longer have access to intravenous narcotics. There is no vaccine for hepatitis C. Twinrix® is a vaccine that protects against both hepatitis A and hepatitis B but it requires three doses over a 6-month period. It has virtually no side effects and provides nearly 100 percent protection that will likely last a lifetime. TEOTWAWKI might occur at any time, so don’t delay getting this vaccine. You might not have 6 months to become fully protected.

Most vaccines have side effects but these are so inconsequential compared to the real disease that fear of some kind of reaction is not justified. All vaccines are delivered via a needle. (Oral poliovirus is no longer used in the U.S. because of the occasional occurrence of vaccine-associated paralytic poliomyelitis. The intranasal influenza virus is limited to certain age groups.) Needles obviously can hurt and when even a small amount of fluid is injected into muscle or into the tissue beneath the skin it’s likely that there will be a little pain. The good news is that needle technology has become so sophisticated that sometimes there is no sensation of needle entry at all.

One cannot discuss the subject of childhood immunizations without addressing the issue of vaccine-related autism. Autism Spectrum Disorder affects thousands of children and there is as yet no established cause. More than a dozen studies have shown that there is no connection between vaccines and autism but the fear persists. Much of this is because of Dr. Andrew Wakefield, an English physician whose research on the subject has been declared fraudulent. His published paper was retracted by the journal in which it was published and the British Medical Society has revoked his medical license. He has emigrated to the United States where he continues to promote his theory.

This article is not the proper venue to defend or deny Wakefield’s assertions but there are a couple of points about autism that should be considered.

Childhood vaccines have not contained thimerosol (ethyl mercury), the alleged cause of autism, for more than a decade but the incidence of Autism Spectrum Disorder continues to rise. When Japanese and English parents, fearful of autism, stopped vaccinating their children, diseases such as measles, mumps and pertussis skyrocketed even as the incidence of autism did not slow down but continued to rise. In 1974 there were more than 100,000 cases of pertussis in the United Kingdom. There were 13,000 cases of pertussis in Japan in 1979 and 14 children died. When TEOTWAWKI arrives these effects will be multiplied many fold.

Autism is a terrible affliction but pediatricians like me who have watched the agony of a child suffering from pertussis for a month or more, with multiple episodes of severe breathing difficulty, choking, seizures and finally dying of the disease prefer to look at the benefits of immunizations, not their relatively infrequent and rarely fatal side effects.

Notwithstanding the low incidence of serious problems associated with current vaccines there have been some devastating tragedies directly related to childhood immunization. With modern technology it’s not likely that any of these will ever happen again. I include them for historical perspective. My concern is that in the recovery from TEOTWAWKI the processes for vaccine production will not meet the standards of today, and tragedies like these might occur again.

In 1928, poor quality control resulted in contamination of a batch of diphtheria vaccine with Staphylococcus aureus bacteria and 10 children died. There were no antibiotics in the 1920s and some or all of these children might have survived with penicillin treatment. There will be few or no antibiotics in the years after the SHTF.

In 1930 in what has become known as The Lubeck Disaster a virulent strain of tuberculosis contaminated a batch of tuberculosis vaccine. Of more than 200 infants who developed tuberculosis, all less than 10 days of age, 72 died.

Sometimes administering a vaccine has a terrible outcome because the recipient unknowingly has a serious immune deficiency. When smallpox vaccination was routine, immunodeficient children sometimes died when the usually benign vaccine virus overwhelmed them.

Many older readers of SurvivalBlog will recall the Cutter incident of 1955. Cutter Laboratories, a manufacturer of Salk polio vaccine produced a quantity of virus that had not been adequately inactivated. More than 200 children developed paralytic poliomyelitis either directly or from exposure to an infected sibling or playmate. There were 10 deaths.

When a child develops a high fever, seizures, a skin rash or other complication of vaccination there is something that is overlooked. It’s possible that such a severe reaction is an indicator of susceptibility. In other words, if the child had been infected by the wild form of the germ, he or she might have been one of the unfortunate fatalities. A vaccine side effect may reveal who might have been a victim, not a survivor. Perhaps that will be some small consolation to parents who have had to watch their child experience a vaccine-related illness.

As our population ages more of us are losing the immunity that we received either from natural infection or from vaccines. As noted earlier, persons over the age of 50 should receive tetanus and diphtheria boosters. Everyone over the age of 65 should receive the pneumonia (pneumococcus) vaccine because the risk of invasive disease is high among seniors, especially those with a history of smoking or asthma. Boosters at this age will give truly lifelong protection.

The influenza virus kills tens of thousands of people, mostly the elderly, every year. The virus is peculiar in that it undergoes frequent genetic transformation. Adequate protection requires a dose of vaccine every year that is designed for the virus du jour – or perhaps de l’année if my French is correct. It’s extremely important to note that perhaps as many as half of influenza-related deaths are not due to the virus itself but to secondary infection with bacteria such as Staphylococcus aureus. That germ is particularly dangerous to victims of influenza for two reasons. It is a common cause of hospital-acquired infections and current strains are often resistant to most antibiotics. Persons who have received the influenza vaccine are very unlikely to have severe disease if they become infected. They will avoid hospitalization and thus will not be exposed to bacteria that take the lives of nearly 100,000 persons every year.

At this point some readers are thinking “The influenza vaccine gave me the flu.” That’s a common perception and it’s easy to see why, even though it’s not correct. First, the vaccine contains only killed virus, except for one live-virus vaccine that is not the most common one in use. The injection causes a little soreness and sometimes a low-grade fever but nothing else. Some older readers may recall becoming quite ill from vaccines that were used in the 1950s and 1960s. These were what I call “dirty” vaccines whose production was not as refined as today’s methods. They didn’t cause influenza but they certainly made people miserable.

Second, illnesses that are labeled influenza are often caused by other viruses. There are hundreds of candidates and many of them produce the cough, fever, chills, headache and muscle aches that occur in influenza. There are several strains of influenza virus and they produce a wide variety of symptoms, sometimes involving the gastrointestinal tract or nervous system. Only laboratory testing provides an accurate diagnosis.

Another reason for the misperception is that most people wait until an outbreak has been in progress for a few weeks before getting the vaccine. While sitting in the doctor’s waiting room among patients who really do have the flu they are inhaling the virus from the person alongside them. The incubation period of influenza is much shorter than the time the vaccine recipient needs to form protective antibody, so symptoms begin before immunity kicks in.

Bioterrorism is a prospective factor in TEOTWAWKI but it’s not as much of a threat as an EMP or worldwide financial collapse. Even sophisticated bioweapons delivery systems are likely to cause problems in relatively small regions, not globally. Anthrax incidents, though serious and sometimes fatal, are examples. Smallpox is a fearsome threat but the disease is easily identified and we have vaccines and antiviral agents that can limit the damage. Food supplies and water reservoirs are potential targets for bioterrorists but barring destruction of the grid such contamination can be identified and managed.

A worldwide pandemic of influenza or some new infectious disease is always a threat but we have learned a great deal from outbreaks of SARS, avian influenza, Ebola virus and others.

The best recommendation that we can make is to keep your vaccine status up to date. These biological materials are not cheap but it’s possible for anyone at any age to build up their immunity to the maximum possible for less than the cost of most handguns.

There will never be a perfect vaccine and some persons will be the unfortunate victims of a serious complication. To help keep things in perspective, more Americans die in a single week in motorcycle accidents, (average: 80) than die in a year from vaccines. Antivaccine groups will dispute this but history tells us otherwise.

About the author: Philip J. Goscienski, M.D. is a retired pediatric infectious diseases specialist and the author of Health Secrets of the Stone Age, Better Life Publishers, 2005. He has archived more than 425 of his weekly newspaper columns, The Stone Age Doc, at www.stoneagedoc.com

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