Pertussis (Whooping Cough)- To Vaccinate or Not?

pertussis2My parents, who are either anti-vaccine or very afraid of the toxins and possible ill-effects of vaccines, will point to the fact that many people who are fully vaccinated still get pertussis.  This is a true statement, but it is lacking in full disclosure.  The fact is, in most outbreaks of pertussis, many of those who get pertussis are vaccinated and many are not, but if you look at the rate of pertussis in the vaccinated group vs unvaccinated group, the advantage is clearly to have been vaccinated. Each time I look at the data, this holds true.  In my practice, I have about 100-200 children whose parents have refused all vaccines, and hence no vaccine for pertussis. I have perhaps 8000 patients that have had the vaccine series and theoretically have protection.  2012 was the worst year in Oregon, and much of the country, for pertussis that we have had in 50 years.  I had seen a handful of cases in the past 20 years and my practice alone saw almost 20 cases of lab confirmed pertussis in 2012. About 5 of these were in unvaccinated children for a rate of 5 in 200 or 1 in 40.  The rate in the vaccinated children was 15 in 8000 for a rate of 1 in 533. In my local experience during the past year, clearly vaccination provides some protection. The evidence shows a patient to be more than 10X more likely to get pertussis if not vaccinated. 

Since pertussis is most dangerous to infants (we had 4 infant deaths in Oregon during the past decade, thankfully none this past year), as a parent, I encourage that you give the pertussis vaccine.  I just would not want to lose an infant to this vaccine preventable disease. 

Since the Dtap (or Tdap if you are over age 7) has at least 330 micrograms of aluminum which is a known neurotoxin, it becomes a judgment call on what to do for your infant.  My experience over the past 5 years of giving the Dtap with the Hib, and not with any other vaccines that contain aluminum (Prevnar and Hep B both have aluminum) has been that I have seen no adverse reactions.  The autism rate in my practice for parents who decline the Hepatitis B for newborns, 2 month olds, and 6 month olds and still give the pertussis, Hib and Prenvar-13 (only one aluminum containing vaccine at a time) has been 1 in 1000 provided they did not have a sibling with autism.  The going rate in the USA and Oregon is now between 1 in 80 and 1 in 100.  The rate of autism for families where one sibling has autism was reported last year as 23% or almost 1 in 4.  If you have an autistic child, we need to have a very frank discussion about risks and benefits of vaccines.  My experience has been 1 in 67, and for this population we are very careful to avoid injecting toxins, eating toxins, and continue to just be as careful as we can possibly be.

As recently published in Pediatrics, that protection from pertussis provided by the vaccine seems to be waning and less than we once thought.

http://pediatrics.aappublications.org/content/early/2013/03/06/peds.2012-1928d.abstract?papetoc

Dr. Paul

 

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