The Journey to the Pediatric Intensive Care Unit Following Vaccine Refusal

Background: Vaccines are the most effective public health interventions against many vaccine-preventable diseases. In recent years, the number of parents refusing recommended childhood vaccination increased significantly. The concept of increasing vaccine refusal has emerged in the world in the 1990s and in Turkey in the beginning of 2010. Here, we report a clinical case of an infant with severe pertussis with vaccine-refusing parents.

Case Presentation: A 13 months-old girl was admitted to emergency department with a 10-day history of cough, which was gradually progressive. She was diagnosed with viral upper respiratory tract infection in another hospital. On examination, body temperature was 38.2^c, oropharynx was hyperemic and bilateral crackles were detected by lung auscultation. The remaining findings on her physical examinations were normal. Laboratory investigations showed the following results: WBC: 66.900/mm3 (80% lymphocyte), CRP negative, ESR 19mm/h, blood biochemistry, liver and kidney function tests were normal. Bilateral infiltrations were seen on chest radiography. Patient was diagnosed with pneumonia, and treated with intravenous ceftriaxone. Pertussis was suspected because of the infant`s persistent cyanotic cough and apnea, intravenous clarithromycin was added to antibiotherapy. Two days later, her WBC count had increased to 79.800/mm3 (85% lymphocyte). No tumor cells was detected in peripheral blood smear. She was transferred to the pediatric intensive care unit with, generalized tonic seizure after coughing. Brain computed tomography examinations and EEG were normal. The culture of nasopharyngeal secretions and polymerase chain reaction (PCR) were both positive for B. Pertussis. During his follow-ups, on 14th day of hospitalization, her WBC count gradually dropped, physical examination was normal and she was discharged from the hospital. The patient had been given all the missing vaccinations in the follow-up after discharge of the baby as a convinced family vaccination after discussing her illness with her parents and explaining all the facts of the event.

Conclusion: Children of parents who refuse immunizations are at increased risk of in for vaccine-preventable diseases. Vaccine refusal also increases the risk for the whole community. All parents should be informed about the benefits of vaccination and risk of severe infection deseases.