SIOUX CITY | As a child, Sherry Flansburg sat on the sidelines, watching the other kids at school play kickball, ride the merry-go-round and run.
Now 69 years old, the Chicago Bears and Iowa Hawkeyes fan runs too, in her dreams. When she opens her eyes, the chronic muscle pain, weakness and fatigue that plague her daily set in.
"I don't care if I was running from a pack of mad wolves, I was moving," she said as she sat in her Morningside home, her brown and tan Chihuahua, Tomas, nestled against her leg. "I hate to wake up from those."
The Sioux City woman suffers from post-polio syndrome, a condition that affects survivors years after polio, a contagious viral illness that causes paralysis, difficulty breathing and death. Flansburg's muscles that were affected by the virus gradually weaken and lose their function.
A vaccine developed by American virologist Jonas Salk eradicated polio in the United States by 1979 and has mostly eliminated the disease except in war-torn and developing countries.
Paul Spearman said vaccine-preventable diseases such as polio, measles and mumps could rise again in the United States if a movement against vaccination continues to grow among parents.
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Spearman, chief of infectious disease for Emory University Department of Pediatrics and Children's Healthcare of Atlanta, said a number of small measles outbreaks occur in the United States each year, but 2013, he said, was a particularly bad year for the highly contagious disease that causes a red rash and fever.
According to the U.S. Centers for Disease Control and Prevention, from January through November last year, 175 cases of measles were recorded in the United States that originated during foreign travel. Usually about 60 cases are imported annually.
"It's something that has resulted in increasing cases of vaccine-preventable illnesses for the last several years in the U.S.," Spearman said of the anti-vaccine movement. "That part is very concerning."
The United States saw its worst outbreak of pertussis, or whooping cough, in nearly 50 years in 2012. That year, Iowa recorded 1,736 confirmed and probable cases of the bacterial infection that causes uncontrollable, violent coughing. The Tdap vaccine protects against pertussis.
"With all the cases of pertussis we had last year, there were a couple that chose not to vaccinate," said Tyler Brock, Siouxland District Health Department deputy director. "The rest either were vaccinated or they were undervaccinated." He noted Woodbury County hasn't had a case of measles or mumps in several years.
Lori Parsons, director of the Iowa Immunization Coalition -- an organization that promotes immunization among all Iowans -- said state immunization assessments show an upward trend in medical and religious vaccine exemptions for school-age children. Iowa doesn't allow a philosophical exemption as some other states do.
According to Iowa Department of Public Health data, vaccine exemptions have more than doubled in Woodbury County among K-12 students since 2001. While 99.68 percent of students had immunization certificates, the county tallied 136 medical/religious exemptions during the 2011-2012 school year.
The idea behind vaccination is creating "herd immunity," a situation in which the majority of the population is immune to a disease. Spearman said a high vaccination rate protects infants and those who can't be vaccinated due to medical conditions.
Parsons said parents decide not to immunize for a variety of reasons, including concern over vaccine ingredients and potential side effects.
"Some physicians are willing to write medical exemptions for kids based on their medical history," she said. "A parent can have a document notarized that says for religious reasons my child is not going to be vaccinated. There's no way for us to question religion."
FEAR OF SIDE EFFECTS
On her first birthday, former Sioux City Councilman Brent Hoffman's daughter, Lydia, was immunized against pneumonia, chickenpox, measles, mumps and rubella (MMR), and hepatitis B.
A short time later, she was diagnosed with type 1 diabetes. Hoffman believes the vaccines overwhelmed her immune system and brought on the lifelong condition that causes high blood sugar levels. Based on what happened to his daughter, Hoffman said he won't have his younger son vaccinated. Both children are home-schooled.
"In my opinion, most children should be immunized, but others, such as those with certain genetic indicators or family history, should be especially wary and cautious," he said. "It’s an important decision each parent should make in the best interests of their own child.”
Steven Joyce, a physician with Mercy Medical Center Internal Medicine & Pediatrics, said he has seen his fair share of parents seeking to adjust the national vaccine schedule or omit certain vaccines out of fear of potential side effects, the most common of which are soreness at the injection side and a low-grade fever.
"I don't think I've ever had what you would call a serious adverse reaction," he said.
In 1998, the medical journal Lancet published British researcher Andrew Wakefield's study that suggests the MMR vaccine causes autism. Two subsequent studies conducted by the British Health Department found the introduction of the vaccine wasn't responsible for a rise in autism among children. Spearman said there is no proven link between immunization and type 1 diabetes either.
"The parents certainly want to do the best thing for their kids, and I think they get some misinformation about the potential risk of serious consequences of vaccination," he said. "If you collect all the information and look at the studies, that link between vaccine and disease doesn't hold up."
Troy Knight, of Sioux City, picks which vaccines to give his 12-month-old daughter and his two boys, 7 and 8. He avoids immunizing against influenza and chickenpox.
"I don't think any of those are helping. I think they're actually making it worse because they're creating worse types of those viruses and diseases," he said.
Jorge Parada, medical director of the infection control and prevention program at Loyola University Medical System in Chicago, said having large pockets of unvaccinated children will result in vaccine-preventable disease outbreaks.
"It's just a matter of math. The larger the number of people who don't get vaccinated, the greater the risk we're going to have," he said.
Nick Chicoine, a chiropractor at the BAC Clinic of Chiropractic in Sioux City, hasn't been vaccinated.
In 2008, Chicoine, then a 20-year-old student at the University of Northern Iowa, contracted mumps. The contagious disease, which the MMR vaccine protects against, leads to painful swelling of the salivary glands.
"The mumps were horrible. It was basically two weeks of laying in a bed all day," he said. "My immune system was strong enough to fight it off on its own, and now I have lifelong immunity against it."
Chicoine, a critic of immunization, said the topic doesn't come up often in his practice, but when parents do bring up vaccination, he said he encourages them to ask, "What's in the vaccine?" If it was his child, Chicoine said, he wouldn't immunize, citing the presence of aluminum and mercury-containing preservatives.
"My biggest issue with vaccines is when you're vaccinating children under the age of 2. Your blood brain barrier doesn't form until the age of 2," he said. "If you don't have that protection to be able to filter out all these highly toxic heavy metals that are in some of these vaccines, then you're directly affecting the central nervous system."
Parada said thimerosal, a mercury-based additive, was removed from all immunizations except the influenza vaccine, which contains small amounts, in 1999. Studies, he said, haven't shown any proof that thimerosal causes diseases, including autism. After thimerosal was removed, he said, autism diagnoses actually increased.
LIVING WITH POLIO
Spearman calls the creation of vaccines "one of the greatest public health successes" in history, saving 6 million to 9 million lives annually.
"There was tremendous fear of polio," he said. "That's been completely eliminated through vaccination. That's just one example of why vaccines are so important to our country and our world."
Flansburg remembers those days well. Around her 10th birthday, she developed a fever and stiff neck. She felt tired and couldn't take a bite of the coconut cream pie her grandmother had baked her. At the time, she said there were no documented cases of polio near her family's Tiffin, Iowa, home. The disease is most often transmitted through contact with an infected person's stool.
Doctors at the University of Iowa Hospitals and Clinics couldn't do much for Flansburg. She participated in a regimen of stretching and heat therapy. She was eventually moved from isolation to a special polio ward of the hospital, where she shared a room with three other girls. Two of them died, she said.
"One of them got to go home for Christmas and died in an ambulance on the way back," she said. "She couldn't breathe anymore."
Six weeks after she was admitted, Flansburg went home. Her father stretched her limbs multiple times a day and rigged a pulley system to the ceiling above the kitchen table to help his daughter regain muscle strength. The exercises brought both of them to tears.
"They hurt so bad. They were just agonizing," she said. "All of having polio has been painful, even post-polio."
Flansburg said her body never worked well after polio. She wavered from side to side when she walked, fell often and struggled with stairs. Fifteen years ago, she noticed her body getting weaker. She couldn't stir cookie dough, get out of the tub or hang sheets on the clothesline in her backyard. Even rising to her feet from the blue recliner in her living room requires all of Flansburg's arm strength. Given what she's been through, she can't imagine why parents wouldn't vaccinate their children.
"How could you do that to your child?" she asked. "You grew up vaccinated. How could you possibly even take the chance of having a child grow up like me?"