Saturday, May 12, 2018

Germ Warfare

Drawings by Suzanne Dunaway
One day late in 1969, in a back office of Creedmoor psychiatric hospital in Queens, I hiked up my skirt and pulled down my tights. My boss Dr. Gideon Seaman, knowing I would soon be taking off for eight months in Europe, had brought along a huge syringe of gamma globulin and shot that horse dose of protective antibodies into the front of my thigh as I stood in front of him. I fell back onto a chair, passed out from the pain.

What country was he protecting me against? Italy. Why? Because, he said, it’s crawling with hepatitis. The locals would pick up the “infectious” A variety from eating their beloved mussels and clams – they were harvested from polluted waters and cooked, if at all, too briefly to kill any lurking viruses. The “serum” B kind they picked up from mothers as mere tots, preparing them to pass it on as adults through needles and sex; any guy I might pick up would likely have been infected since he was four. (If medical science had known about the C kind of hepatitis at the time – it didn’t – it would have also known that too was big in Italy.)

Today the shoe is on the other foot. Americans are much likelier than Italians to die of infections, mostly because of poor access to health care – not to speak of Italy’s conversion to farmed rather than wild shellfish. Former sins have left their mark on Italy, though, in that several key vaccines reached here decades after they became standard in the States. More cases of measles and congenital German measles are reported in Italy than in any other Western European country, with the number skyrocketing between 2016 and 2017 thanks to a know-nothing “No Vax” movement. And things may get worse: the measles vaccination rate for Italian toddlers fell steadily between 2010 and 2016.

My world-hopping clients often need to attend public travel clinics, which have a monopoly on vaccines against yellow fever and Japanese encephalitis. For decades this was a piece of cake: I wrote a prescription and an address, the patient showed up at the clinic any weekday between 9 and 12, and walked out a half hour later ten dollars poorer, with wisps of cotton taped to their arms. It was a poster child for public medicine. Now the party’s over – in 2013 my beloved vaccinators simultaneously started requiring appointments and stopped answering the phone.

Let me close with the strange case of tetanus. There are 400,000 horses in Italy and they are often healthy carriers of tetanus spores, including the ones you see roving the streets of Rome or Florence with police on their backs. Many of these healthy-looking animals gaily deposit manure laced with tetanus spores on the pavement, manure that then patiently waits for a passer-by to get injured so the spores can enter the body, wake up, and multiply. Italians now over fifty weren’t vaccinated as children, nor were most immigrants, so plenty of the people who show up in Italian Emergency Rooms with contaminated wounds should by rights receive not just a tetanus booster but also a shot of antiserum – a type of immune globulin hyper-packed with tetanus antibodies.

But as far as I know that antiserum has never once been administered, in any Rome hospital, to a single patient of mine. Emergency Room physicians go to great lengths to avoid giving it. They’ll tell patients that antiserum is no good two days after the injury (nope – it works even after three weeks). They’ll branish consent forms that claim it can transmit AIDS (possible in theory but nonexistent in practice). They’ll say tetanus was eradicated long ago (would that it were). Why those docs put up so much resistance is a mystery but it may be merely that the hospitals don’t keep the perishable antiserum in stock. An Italian team that studied tetanus prophylaxis in Naples’s public hospitals just a few years ago concluded, “Only 1.5% of the physicians correctly adhere to guidelines.” The upshot? More than a third of the cases of tetanus in the European Union occur in Italy, with 60 fatalities a year. So be forewarned: odd though it may sound for an otherwise proudly developed nation, Italy is one of those countries where you’ll want to make sure your tetanus vaccinations are up to date.
(This post is being published simultaneously as a Bedside Manners column in The American In Italia.)

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  1. Oh dear! Should I have a tetanus shot???

  2. ummm, didn't I give you the whole series back in Via Balbo? I remember at least trying!

  3. Amalie R. RothschildMay 13, 2018 at 4:21 PM

    I'd like to suggest all Italian residents who either haven't ever had a tetanus vaccine, or a booster in over 20 years, to get one. A very dear friend of mine in Rome who wasn't diagnosed in time died at 83 after getting a cut while away for a weekend on Ponza. She was healthy, vigorous and dismissed it as a scratch. Better safe than sorry. One never knows.

  4. ...I once had a patient who'd had tetanus as a child in the 1930s, before antibiotics were invented. Amazingly, she survived.

  5. Here’s a story you might like. A friend of mine’s husband was a young doctor, a couple of years out of medical school, back in the 70s. He was actually quite conscientious as a doctor, and unlike most, as a student he waited in long lines of other students for “esercitazioni” where the professor had them, one by one, listen to an actual heart. They were not obligatory, and it was a sign of his conscientiousness that he went to all of them! I was at their house one night and he took out a can of peaches that he wanted to eat. I said “NO! Are you crazy? Don't eat that! The can is bulgeing, you could get botulism - botulismo!”
    He guffawed - "Botulismo!!! HA HA HA What's botulismo?"
    I said, “It’s something that can develop in canned food and even a drop can kill you. To be safe you have to boil it in an open pan for several minutes. Go look it up in your medical books,” and he did.
    He came back shocked – “It really does exist!”
    Imagine, this guy was doing emergency room shifts. I could picture the sad scenario: someone coming in with botulism and him saying he must have a colpo di freddo allo stomaco!

    1. Italian medical training is REALLY hit-and-miss...

    2. i find when it misses, the doctors often fill in with their mothers' advice: mangiare in bianco, evitare colpi di freddo....