Pre-immunisation - Ireland in the bad old days

  • Deborah Condon

Measles, tuberculosis, rubella, polio - just some of diseases that at one time or another, blighted Ireland. However, today, thanks to national immunisation schemes, parents are in the unique position of being able to offer protection to their children from these debilitating illnesses, something that previous generations simply could not do.

And yet, some parents choose not to have their children vaccinated. From fears about possible side-effects to simply not getting around to doing it, the reality is that parents who opt not to have their children vaccinated are putting them, and others, at risk of contracting a potentially serious illness.

However, it is easy to forget how serious some of these illnesses can be and that is thanks largely to immunisation schemes. Maybe it is a victim of its own success - many people today either cannot imagine the horror of their child being diagnosed with a disease such as polio, nor do many realise how serious a common illness such as measles can be. The importance of immunisation may be lost on them.

According to Prof Denis Gill, a consultant paediatric nephrologist and chairperson of the National Immunisation Advisory Committee 2010 - 2011, the facts are simple.

"If you have 100% vaccine uptake, you get disease eradication. If you have 90-95% uptake, you get disease elimination. Greater than 80% uptake gives you disease control, but less than 70% uptake means that outbreaks and mini-epidemics are possible," he tells Irishhealth.com.

He points out that in the mid-1940s in Ireland, about 500 children died every year of vaccine preventable diseases, such as measles, whooping cough, diphtheria, tuberculosis and polio. Today's death rate figure for these illnesses is zero.

"Communist counties had 100% vaccine uptake. After the fall of communism in 1990 - 1995, vaccination rates fell dramatically and there were outbreaks of diphtheria and polio, neither of which had been seen for decades in Russia. Should vaccine rates fall to less than 70% in Ireland, there will certainly be outbreaks of measles and pertussis (whooping cough)," Prof Gill insists.

He notes that Ireland had epidemics of whooping cough in the 1970s following a 'scare' about that vaccine.

Meanwhile, many countries' MMR (measles mumps rubella) uptake rates are still feeling the repercussions of a scare arising from Dr Andrew Wakefield's 1998 study, which (falsely) claimed to have linked that vaccine to autism.

Published in the highly respected medical journal, The Lancet, the study was later found to be fundamentally flawed. A subsequent investigation by the UK medical regulator found Dr Wakefield acted unethically and did not have the relevant qualifications for carrying out the tests required. He was subsequently struck off as a doctor.

Yet despite numerous other studies finding no such link between the MMR and autism, some parents still remain concerned and have called for the introduction of three single vaccines to replace the MMR.

Current MMR uptake levels in Ireland meanwhile remain below the recommended 95%.

Prof Gill notes that measles in Ireland pre-1980 caused the following:
- One in 10 cases suffered a complication
- One in 100 cases were hospitalised
- One in 1,000 cases got encephalitis (inflammation of the brain)
- Between one in 1,000 and one in 10,000 died.

"If measles affected every child in Ireland today, we could expect between 10 and 50 child deaths each year," Prof Gill adds.

Maybe some parents believe that with medical advances today, their child, if affected by one of these illnesses, will not be seriously harmed. Or they are simply unaware of the potential devastation that some ‘past' illnesses could cause.

Joan Bradley was four years old when she was diagnosed with polio in 1942. Now in her 70s, she paints a stark picture of what it is like to contract this disease.

"You cannot explain the devastation of polio. You are left disabled for life," she tells Irishhealth.com.

Polio is an infectious disease caused by a virus. It can strike at any age, but affects mainly children under the age of five. The disease can cause paralysis, which is almost always irreversible. In the most severe cases, polio can cause the breathing and swallowing muscles to paralyse, leading to death by asphyxiation.

Polio was a very common disease in Ireland in the 1950s. In 1957, the first polio vaccine was introduced here and by the mid-1960s, few cases were being reported. Europe was declared polio-free in 2002 because of extensive vaccination programmes over many years.

Today, the disease remains endemic in just four countries - India, Pakistan, Afghanistan and Nigeria, down from 125 countries in 1988. However, according to the World Health Organisation (WHO), ‘as long as a single child remains infected, children in all countries are at risk of contracting polio. In 2009-2010, 23 previously polio-free countries were re-infected due to imports of the virus'.

Ms Bradley grew up on a farm in Laois. Her initial symptoms were breathing problems and a very bad headache.

"When the doctor came to my house, he tried to lift up my leg but it just wobbled. He left the room and told my mother what he suspected. Maybe a day later, my bladder ceased functioning and I was sent to hospital. I was totally paralysed except for my right hand and my mother was told I would always be a cripple if I lived," she explains.

For Ms Bradley, the Ireland of then was very different to the Ireland of today. The world was at war for the second time, her family did not own a car and the only hospitals that could deal with her illness were in Dublin - the National Children's Hospital on Harcourt Street, which is now incorporated into Tallaght Hospital, and Dr Steevens' Hospital, which closed down in the late 1980s.

Due to the lack of a car and minimal public transport, her mother was not able to visit very often, making the illness an even more terrifying ordeal for a four-year-old.

"I was left lying on my back staring at a white ceiling. No child should be left like that. I used to just stare at the cracks in the ceiling," she remembers.

She also remembers that nurses then ‘were not like they are today'.

"Nurses were the enemy, they scared us. They would tell us that the bogeyman would come and get us or we'd be put into a big black hole if we cried. One day, one of the nurses, realising that I couldn't sleep because I was so scared, said 'don't worry, the bogeyman only takes red-haired boys'. Soon after a red-haired boy joined our ward, but one day he just disappeared. I don't know if he died or was moved. A nurse later said he had gone to another ward, but I didn't believe her."

Ms Bradley could be considered one of the lucky ones, as her paralysis was not permanent. She slowly started to regain some movement and with the aid of a walking frame and calipers - an appliance attached to the legs - she was able to start walking again. Altogether, she spent around a year in hospital.

At home, Ms Bradley taught herself how to read and eventually began school when she was nine years old. She went on to qualify as a radiographer and worked in this field for some years.

However, the effects of the polio were never far away. "I just wasn't able to physically keep up with the job. It got to the point where I had to set my alarm for 6am to take painkillers just so that I'd be able to get out of bed. I was so demoralised and had to give it up."

She then took an office job, 'something I never wanted to do', and spent the next 40 years as a receptionist/telephonist. She is now retired.

Ms Bradley was able to walk without calipers or a stick at one point, however she started to lose her balance a lot so she was back to using walking aids. In the 1990s, she was recommended to get a manual wheelchair and in 2003, she was told to get a power wheelchair 'to save her arms'.

She was using the power wheelchair outside her home only, but two years ago, she was recommended to use it inside her home as well.

"I use it almost all the time now. I can only walk for four minutes at a time without stress," she explains.

She says the disease is extremely painful for her. Her joints seize up and she literally cannot allow anyone to touch her as it is simply too painful. She has also developed sleep apnoea, a potentially life-threatening condition in which breathing is disrupted during sleep. She has to use a breathing mask to aid respiration every night when she sleeps.

However, Ms Bradley is by no means alone. There are currently an estimated 7,500 polio survivors in Ireland and most of them have developed post polio syndrome. The symptoms of this are not age-related and usually occur 20-40 years after the original polio infection. They include:
- Muscle and joint pain
- Respiratory and swallowing difficulties
- Severe intolerance of the cold
- Lack of strength and endurance.

Ms Bradley is one of the founder members of the Post Polio Support Group (PPSG) and the effects of post polio syndrome are an ongoing issue. The group has fought hard to have polio placed on the Long-Term Illness Scheme, but to no avail.

When asked if she supports vaccination, her answer is definitive.

"Yes, I think it is criminal not to."

Prof Gill agrees.

"On health grounds, on disability grounds, on cost-effective grounds, immunisation is a win/win/win situation. Of course it is frustrating when parents deny their children immunisation, allowing their emotions and fears to over-ride reason. But, all the data clearly show that vaccines were among the greatest health advances for children in the 20th century," he says.

Ms Bradley adds that people 'just do not understand' what polio was like.

"I just wanted to be like my two brothers and sister. Inside every child with a disability is a child who just wants to be able to do what other children are doing.

"My mother would ask me if I was tired and I would say 'no mammy', but the tears would be rolling down my face because I was so tired."

For more information on the Post Polio Support Group, click on www.ppsg.ie

To keep track of your children's vaccines, see our unique online Child Vaccination Tracker here

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