The world before vaccines is a world we can not afford to forget.

Like most American children of my generation, I aligned with my classmates in the mid-1950s to receive the first polio vaccine, resulting in 15,000 cases of paralysis and 1,900 deaths a year in the United States. , mainly in children. Similarly, we aligned ourselves with the smallpox vaccine, which still caused millions of deaths each year worldwide. Since then, I have continued to update my vaccines, including some exotic vaccines for National Geographic missions abroad, including vaccines for anthrax, rabies, Japanese encephalitis, typhoid, and yellow fever.

Growing up in the shadow of polio (my uncle was all his life on crutches) and getting to know measles (I was part of the peak year before vaccination in 1958 , with 763,093 other young Americans), I gladly rolled up my sleeves for any vaccine recommended by my doctor and the US Centers for Disease Control and Prevention, with an additional contribution for overseas travel from the CDC Yellow Book. I am deeply grateful to the vaccines for keeping me alive and healthy, as well as helping me get out of the field as healthy as when I left.

One of the results of this desire, however, is that I suffer, like most people, from a famous Catch-22: vaccines protect us from diseases, then make us forget the diseases they save us. Once the threat seems to have disappeared from our lives, we become lax. Or worse, we take other things to fear. Thus, some well-intentioned parents avoid vaccinating their children, fearing that the MMR vaccine (against measles, mumps and rubella) will cause autism. It does not matter that independent scientific studies have repeatedly demonstrated that such a link does not exist, most recently in a study of 657 000 children in Denmark. (Discover the strange story of vaccines.)

This irrational fear explains why the United States has recorded nearly 1,200 cases of measles since the beginning of the year, nearly two decades after public health officials proudly declared it eliminated. About 124 of the victims, mostly children, were hospitalized, including 64 with complications such as pneumonia and encephalitis, which can lead to brain damage or death.

And yet, autism may still seem to be a bigger threat than measles, if only because it appears in countless TV shows and movies such as Rain Man and Gilbert Grape. During this time, you are more likely to get measles in the movies than to see the disease on the screen.

And so, parents forget, or more likely never knew, that 33 out of every 100,000 people who had actual measles had mental retardation or damage to the central nervous system. (This is in addition to those who have died.)

They forget that a rubella outbreak in the early 1960s resulted in the birth of 20,000 children with brain damage, including autism, and other congenital anomalies.

They forget that before being eradicated by a vaccine in the 1970s, smallpox had left many survivors blind, mutilated or damaged to the brain. (Find out how the smallpox vaccine was invented.)

One of the remedies for this trap is to make a conscious effort to remember the world before vaccines. The dca, for example, is a recurring but somewhat confusing element on my vaccination card. (Children receive a slightly different formulation called DTaP.) The "T" is for tetanus and the "P" for whooping cough or whooping cough. But I was totally ignorant of the "D" of diphtheria.

Even doctors now tend to know the disease only from textbooks. But before the development of an effective vaccine in the early 1940s, diphtheria was one of the great terrors of childhood. He killed more than 3,000 young Americans a year in the mid-1930s while my parents were in high school. Once again, he kills children in Venezuela, Yemen and other areas where social and political upheavals have disrupted the distribution of the vaccine.

Among the other symptoms, diphtheria produces a gray membrane of dead cells in the throat that can block the child's trachea and cause death by suffocation. Hence one of his nicknames: "The Strangler Angel".

New England, where I live, was one of the most deadly epidemics of the 1730s and 40s, "the most horrific epidemic of childhood sickness in American history," according to one historian. The widespread idea that he had been sent by God to punish sinful behavior made it all the more horrible. Or as a verse of 1738 warned boys and girls to behave badly:

As soon as death has stopped your breath,

Your souls must then appear

Before the Judge of Speed ​​and Death,

The sentence over there to hear. //

From there, without delay,

You must be Doom'd to,

A terrible hell, where dwell the devils,

Diphtheria was terrifying, not only because she could kill at a lightning speed, but also because she could play hopscotch so easily from one child to the other because of coughing and sneezing that she induced. Some families may also have accidentally precipitated death by lining up children to kiss a dying brother or sister bye. The results are still visible in our local cemeteries.

In Lancaster, Massachusetts, for example, spotted slate headstones apply, like a family, to the graves of six children of Joseph and Rebeckah Mores. Ephraim, aged seven, died June 15, 1740, Hannah, three years, June 17, and Jacob, eleven years later. All three were buried in a grave. Then Cathorign, two, died on June 23 and Rebeckah, six, on June 26. The dying – five children left in just eleven days – took a break long enough to leave a thin net of hope to poor parents. But two months later, on August 22, Lucy, also 14, also died. A few years later, diphtheria or another epidemic disease returned to recover the remaining three Mores children.

Joseph and Rebecca were not alone in their tragedy. Many other parents have also lost all their children because of diphtheria, in one case 12 or 13 members of the same family. (In their stunned grief, parents could not quantify their loss with an exact figure.) On a street less than one kilometer away in Newburyport, Massachusetts, 81 children died in three months over three months, in 1735 Haverhill, Massachusetts, lost half of its children, with 23 families left without children.

Parents are now rarely aware of this grief because our children are protected by vaccines, including Tdap / Tdap. That's why we feel safe when we have smaller families. It is also one of the main reasons why life expectancy at birth in the United States went from 47.3 years in the early 20th century to 76.8 years at the end.

The level of this protection has continued to increase from year to year during our own lives, although the terminology of the recommended vaccines tends to obscure these improvements. For example, no parent has yet lost sleep about something called "Hib", short for "Haemophilus Influenzae Type B," or another pathogen called "rotavirus."

But in its early days in the 1970s, "Hib dominated my home," says vaccinologist Paul Offit, MD. It is a major cause of meningitis, pneumonia and sepsis in children, a systemic blood infection. Children with this bacterial infection entered the emergency room so routinely that the hospital maintained a dark room specially equipped with an aquarium to calm the child while an anesthetist was precipitated and that a surgical team was preparing to operate. The danger, if the child became excited, was that the swollen and inflamed epiglottis would begin to spasm, blocking the trachea-artery.

"I had a lot of very painful conversations with parents when children were suffering from meningitis or sepsis," Offit remembers. "Often, children have permanent hearing loss, intellectual deficits, motor deficits."

Stanley Plotkin, M.D., also a vaccinologist, began in the 1950s. Sixty years later, he still remembers helplessly seeing a child with Hib disease "die under my hands". A tracheostomy – a tube inserted into the trachea through an incision in the trachea – could sometimes help. "But at the time, I was trainee and I did not know how to do a tracheostomy."

Doctors (and parents) starting today do not need to live with this particular memory. An effective vaccine introduced in the 1990s reduced the incidence of Hib disease in the United States by 99%, from 20,000 to 29 cases per year.

Rotavirus is an equally unknown term for most parents. But before, it infected almost all children before the age of five and caused about 40% of severe cases of childhood diarrhea. In the absence of medical treatment, dehydration resulted in between 20 and 60 deaths per year in the United States and 500,000 deaths worldwide.

A rotavirus vaccine became available in the 1990s and, in 2006, the CDC approved a safer version developed by Offit and Plotkin, together with the late H. Fred Clark, a microbiologist and social activist. As a result, rotavirus-induced diarrhea has become rare, preventing between 40,000 and 50,000 hospitalizations each year of American infants and young children. But in 2017, during a rotavirus outbreak in California, a child who had not been vaccinated is still dead, two months before his second birthday.

It is true that vaccinations carry risks, like the rest of the world. They range from commonplace, such as pain at the injection site, to an extremely rare phenomenon, such as a life-threatening allergic reaction. Medical researchers are usually the first to identify and characterize these risks. For example, a 2016 CDC study examined 25.2 million vaccinations over a three-year period and found 33 cases of severe allergic reaction triggered by a vaccine, or 1.3 cases per million doses of vaccine. (This is how the Measels vaccine protects against more than just the ones.)

How should parents think of such a risk? Being a good parent does not mean protecting children from all the medical risks. Instead, it is a matter of judging, with the advice of a doctor, the relative risk. Ask yourself what's worse for my child – the remote risk of an allergic reaction, or the risk of Hib disease, rotavirus, pneumonia or even chickenpox – which, despite its poor reputation, has killed 100 to 150 American children a year before the 1995 approval of an effective vaccine? Even worse, a fictitious link between the MMR vaccine and autism – now considered fraudulent even by the journal in which it was published – or expose your child every day to the possibility of a measles, with all its potentially life-threatening or debilitating consequences?

For my wife and I, the decision has always been to vaccinate our children with the recommended vaccines. We are always worried, as do all parents. But they stayed healthy and we slept well, knowing that we had left behind so many medical terrors of the past.