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DTaP: diphtheria, tetanus and acellular pertussis

These three illnesses are among the worst known to man. Diphtheria was particularly dreaded. It had a very high case fatality rate and would strike otherwise healthy children.

Case History of Diphtheria

The Spencer and Katrina Trask family of Saratoga and Brooklyn NY. During the month of March 1891, three of the surviving four children, and their mother contracted diphtheria. Their mother Katrina contracted the illness first and was on her deathbed. The kids were allowed into the sick room to say goodbye. She survived but the three children died, and she always blamed herself for letting them in her sick room. In fact, the illness was probably contracted from someone in the house who was an immune carrier. Diphtheria used to strike rich and poor. During the turn of the 20th century, the children of doctors had a particularly high death rate from diphtheria even though they didn’t live in the crowded conditions of the urban poor. Even with today’s antibiotics, diphtheria can be deadly. Besides suffocation, it can cause cardiac arrhythmia. In many underdeveloped countries, and when public health networks break down, many children go without vaccination. In developed countries, doctors have probably never seen a case of diphtheria and would treat the patient as if they had a bad case of tonsillitis, instead of the potentially fatal disease.

Tetanus

This has been a dreaded killer, striking active, healthy people. At the turn of the 20th century, it was common to know someone who had died of tetanus, especially among pioneer children, manual workers and soldiers. Tetanus is still a big killer of newborns in the third world, if mud or cow manure is applied to the umbilical cord.

Case History of Tetanus

John Roebling, the designer of the Brooklyn Bridge, died of tetanus acquired from a foot injury sustained while observing the building of the bridge in the late l800’s, before the tetanus vaccine was developed. A hundred years later, a 30 year old woman who lived about a mile away from the bridge died of tetanus in the local hospital. She had been born in another country but immigrated to the US when she was 12 and had no accent. When she was hospitalized with early symptoms of tetanus, no one suspected tetanus because she had no accent and every one assumed she was vaccinated. None of the doctors had ever seen a case of tetanus. The diagnosis was made by a nurse from the Philippines. Despite admission to the ICU, the woman died.

Pertussis

Otherwise known as whooping cough, is a horrible disease, especially for infants and young children. It causes spasmodic coughing that can last for months, (the Chinese word for whooping cough means 100 day cough). In the days before pertussis vaccine, parents dreaded whooping cough. The cough spasms could be so severe that a young child would turn blue. Infants would lanquish from coughing so much they couldn’t eat. Older children, adolescents and teens, and adults with whooping cough get a dramatic cough, but are not as sick. When a person is vaccinated against pertussis, they might still have a cough, but not be sick enough to stay home from school or work.

Case History of Pertussis

A family of five in which the mother and one of the three school aged children developed a cough. The mother, who brought the coughing child to the office had a severe cough herself. Her cough was so dramatic that a pertussis culture was sent on the child, whose cough was deep, but not severe. A blood specimen for pertussis antibodies was drawn on the mother, whose cough was worse than the child’s. Both the sputum culture of the child, and the mother’s blood test were positive. The child, who had been vaccinated as an infant, had a cough, but had not missed school. The other two children in the family, also vaccinated, and the father were not sick at all. Situations like this illustrate how pertussis circulates in the community, even though the vaccine stops or minimizes the chance of getting full fledged whooping cough.