SIOUX FALLS, S.D. — In the time before widespread vaccination, death often came early.

Devastating infectious diseases ran rampant in America, killing millions of children and leaving others with lifelong health problems. These illnesses were the main reason why nearly 1 in 5 children in 1900 never made it to their fifth birthday.

Over the next century, vaccines virtually wiped out long-feared scourges like polio and measles and drastically reduced the toll of many others. Today, however, some preventable, contagious diseases are making a comeback as vaccine hesitancy pushes immunization rates down. And well-established vaccines are facing suspicion even from public officials, with Robert F. Kennedy Jr., a longtime anti-vaccine activist, running the federal health department.

“This concern, this hesitancy, these questions about vaccines are a consequence of the great success of the vaccines — because they eliminated the diseases,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center. “If you’re not familiar with the disease, you don’t respect or even fear it. And therefore you don’t value the vaccine.”

Anti-vaccine activists even portray the shots as a threat, focusing on the rare risk of side effects while ignoring the far larger risks posed by the diseases themselves — and years of real-world data that experts say proves the vaccines are safe.

Some Americans know the reality of these preventable diseases all too well. For them, news of measles outbreaks and rising whooping cough cases brings back terrible memories of lives forever changed — and a longing to spare others from similar pain.

Rubella: With a mother’s guiding hand, Janith Farnham, 80, helped steer her 60-year-old daughter’s walker through a Sioux Falls art center. They stopped at a painting of a cow wearing a hat.

Janith pointed to the hat, then to her daughter Jacque’s Minnesota Twins cap. Jacque did the same.

“That’s so funny!” Janith said, leaning in close to say the words in sign language too.

Jacque was born with congenital rubella syndrome, which can cause a host of issues including hearing impairment, eye problems, heart defects and intellectual disabilities. There was no vaccine against rubella back then, and Janith contracted the viral illness early in the pregnancy, when she had up to a 90% chance of giving birth to a baby with the syndrome.

Janith recalled knowing “things weren’t right” almost immediately. The baby wouldn’t respond to sounds or look at anything but lights. She didn’t like to be held close. Her tiny heart sounded like it purred — evidence of a problem that required surgery at four months old.

Janith did all she could to help Jacque thrive, sending her to the Colorado School for the Deaf and the Blind and using skills she honed as a special education teacher. She and other parents of children with the syndrome shared insights in a support group.

Meanwhile, the condition kept taking its toll.

As a young adult, Jacque developed diabetes, glaucoma and autistic behaviors. Eventually, arthritis set in.

Today, Jacque lives in an adult residential home a short drive from Janith’s place.

Given what her family has been through, Janith believes younger people are being selfish if they choose not to get their children the MMR shot against measles, mumps and rubella.

“I get angry inside,” she said. “I know what can happen, and I just don’t want anybody else to go through this.”

Measles: More than a half-century has passed, but Patricia Tobin still recalls getting home from work, opening the car door and hearing her mother scream. Inside the house, her little sister Karen lay unconscious on the bathroom floor.

It was 1970, and Karen was 6. She’d contracted measles shortly after Easter. While an early vaccine was available, it wasn’t required for school in Miami where they lived. Karen’s doctor discussed immunizing the first grader, but their mother didn’t share his sense of urgency. Then came a measles outbreak.

Karen — who Tobin described as a “very endearing, sweet child” who would walk around the house singing — became sick. The afternoon she collapsed in the bathroom, Tobin, then 19, called the ambulance.

Karen never regained consciousness.

“She immediately went into a coma and she died of encephalitis,” said Tobin, who stayed at her bedside in the hospital. “We never did get to speak to her again.”

Whooping cough: Every night, Katie Van Tornhout rubs a plaster cast of a tiny foot, a vestige of the daughter she lost to whooping cough at just 37 days old.

Callie Grace was born on Christmas Eve 2009 after Van Tornhout and her husband tried five years for a baby. She was six weeks early but healthy.

“She loved to have her feet rubbed,” said Tornhout, 40, of Lakeville, Indiana. “She was this perfect baby.”

When Callie turned a month old, she began to cough, prompting a visit to the doctor, who didn’t suspect anything serious. By the following night, Callie was doing worse. They went back.

In the waiting room, she became blue and limp in Van Tornhout’s arms. The medical team whisked her away and beat lightly on her back. She took a deep breath and giggled.

Though the giggle was reassuring, the Van Tornhouts went to the ER, where Callie’s skin turned blue again. For a while, medical treatment helped. But at one point she started squirming, and medical staff frantically tried to save her.

“Within minutes,” Van Tornhout said, “she was gone.”

Van Tornhout recalled sitting with her husband and their lifeless baby for four hours, “just talking to her, thinking about what could have been.”

Callie’s viewing was held on her original due date — the same day the Centers for Disease Control and Prevention called to confirm she had pertussis, or whooping cough. She was too young for the Tdap vaccine against it and was exposed to someone who hadn’t gotten their booster shot.

Today, next to the cast of Callie’s foot is an urn with her ashes and a glass curio cabinet filled with mementos like baby shoes.

“My kids to this day will still look up and say, ‘Hey Callie, how are you?’ ” said Van Tornhout, who has four children and a stepson. “She’s part of all of us every day.”

Van Tornhout now advocates for childhood immunization through the nonprofit Vaccinate Your Family.

“It’s up to us as adults to protect our children — like, that’s what a parent’s job is,” Van Tornhout said. “I watched my daughter die from something that was preventable … You don’t want to walk in my shoes.”