Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: SUNDAY, March 19, 1995                   TAG: 9503200051
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A-14   EDITION: METRO 
SOURCE: Associated Press
DATELINE: WASHINGTON                                LENGTH: Medium

AS OLD CHILDHOOD ILLNESSES FALL, NEW ONES TAKE STAGE

Smallpox has disappeared. Polio is almost gone. Rare are diphtheria, cholera and tetanus. Measles are under control, as are mumps and whooping cough.

Now, chickenpox - a so-called nuisance illness that sometimes kills - is on the run. The Food and Drug Administration last week approved a new chickenpox vaccine, adding it to the arsenal of shots that ward off childhood diseases.

Chickenpox infected 134,722 Americans in 1993, the last year for which figures are available. About 9,000 were hospitalized and 90 died. Those numbers will drop, experts say, when the use of a vaccine called Varivax becomes common.

Such advances over the past half-century have cleared from the American landscape diseases that once made childhood a perilous time.

Smallpox was still feared in 1945. The last reported U.S. case was in 1949. Now, the disease has been wiped out worldwide.

The year the polio vaccine was introduced, 1955, there were 30,000 reported cases. A decade later, the number dropped below 80. The last reported American case of the disease from a ``wild'' source was in 1983, and The World Health Organization expects polio to join smallpox as one of the conquered diseases within 10 years.

Dr. Neal Halsey, a professor of medicine at Johns Hopkins University and an expert on public health history, said red measles, or rubeola, was so common in the 1940s that 98 percent of the population got it in childhood. About five patients in a thousand died of it and 3 percent to 10 percent had lifelong effects, such as deafness or mental retardation. ``Now, we really do have it under control,'' he said.

Measles vaccine became available in 1963. That year, there were almost 400,000 cases in the United States. By 1993, there were 312.

Mumps vaccine came out in 1971, but control has been less successful. ``There were almost universal schools laws against measles, but not for mumps,'' Halsey said. ``The effort has not been as rigorous.'' In 1971, there were 124,000 U.S. cases. In 1993, there were fewer than 1,700.

Diphtheria, the ``D'' in childhood DPT shots, has virtually disappeared. Fifty years ago, there were more than 18,000 cases in a U.S. population about half the size it is now. In 1993, there were none.

Tetanus, the ``T'' in DPT, is absent from U.S. children but strikes about 50 adults a year who have failed to get booster shots.

Control of pertussis - the ``P'' in DPT - has been less successful, partly because of side effects from some early vaccines, Halsey said. But new vaccines give up to 90 percent protection. Cases of pertussis, or whooping cough, routinely numbered more than 100,000 in the 1940s. In 1993, there were 6,500.

In 1940, the death rate for children ages 1 to 4 was 289.6 per 100,000. In 1993, it was 43.6 per 100,000. For ages 5 to 14, the 1940 death rate was 103 per 100,000. In 1993, it was 22.5 per 100,000.

But death comes in a different guise. In 1940, infectious disease was the most frequent cause of childhood death. In the 1990s, accidents, homicides and suicides are the top killers. AIDS, a disease not known until the 1980s, is a leading cause of death among the young. And tuberculosis, once battled with effective drugs, has developed a new virulent strain and is on the march.