Whooping Cough- Outbreaks Will Be the Norm
Charles, 15 years old, sat in my office last week with his mom and told me about his cough that was now starting it’s third week and would result in episodes of coughing that would eventually turn him blue for as long as 15 seconds as he struggled with a whoop at the end to get air. This was the most classic case of whooping cough (pertussis) I had ever seen. You see babies and young children rarely have the whoop. They just cough and cough, usually for a few weeks but sometimes for months.
At Integrative Pediatrics, I promote the DTap on schedule for infants and the Tdap for those 10 and older as recommended. I promote that all members of the family get the vaccine if they are bringing an infant into the home as infants are at the greatest risk of death, by far. In the USA we have about 15-20 infant deaths from pertussis each year. I suspect that number will go up since we are clearly having a rise in the number of pertussis cases. In 2012, my clinic had a record 20 cases of pertussis, 15 of them in fully vaccinated children, most of them in school age children. Oregon as a whole had a whooping cough epidemic in 2012, with 910 cases, the most seen in a single year since 1953. Most other years I have had zero to 2 cases a year.
The Salem area is currently in the middle of an outbreak. Summer break will help end that. The Statesman Journal reported “The latest case was found at Sprague High School, where four students have been diagnosed with whooping cough. Salem-Keizer School District Superintendent Christy Perry notified parents of the latest case Thursday in a letter. At another Marion County school, six students have been diagnosed with pertussis.” (read more here… ) The Marion County Health Department investigated 11 cases of whooping cough. All students except one were up to date on their vaccines. This has been my experience and the general trend, is that the vaccine is not providing great protection. We need to remember that it is a healthy immune system that protects us from disease. When vaccines boost our already healthy immune system, we have the best protection possible.
In the recent article, “Strategies to Decrease Pertussis Transmission to Infants,” in the journal Pediatrics, they conclude, “Two vaccine strategies have been proposed to protect infants. The first involves vaccinating pregnant women, which directly protects through the passive transfer of pertussis antibodies. The second strategy, cocooning, involves vaccinating parents, caregivers, and other close contacts, which indirectly protects infants from transmission by preventing disease in those in close proximity. The goal of this review was to present and discuss evidence on these 2 strategies. Based on available data, the GPI (Global Pertussis Initiative) recommends vaccination during pregnancy as the primary strategy, given its efficacy, safety, and logistic advantages over a cocoon approach.” (read more here… ) This study did show a 78% decrease in pertussis cases for infants under 3 months whose mothers got the pertussis vaccine while pregnant and a 68% decrease in hospitalizations. There were no deaths reported. Shocking to me is the recommendation to inject a huge dose of neurotoxin aluminum into pregnant moms with no testing of safety. They report only one study, small and only following children to 13 months. Why 13 months? Do they perhaps have data that as the children get older the developmental delays caused by injecting neurotoxins during pregnancy start to show up. None of the Tdap vaccines have been tested in pregnancy. I find this recommendation to be irresponsible, despite the apparent benefits of lowered pertussis cases in infants. Funding of the study was, yes you guessed it,- by the pharmaceutical companies.
The article, “Vaccinated but still getting pertussis,” for those teens getting all acellular Tdap (those vaccinated since 1998) overall Tdap effectiveness was 63.9%. Effectiveness dropped markedly over time from 73% at 12 months after vaccination to 54.9% at 13 to 23 months to 34% at 24 to 47 months. (read more here… ) This lack of effectiveness of the pertussis vaccine appears to be getting worse. 2012 saw the highest number of pertussis cases in the US since 1955- a whopping 48,277.
The article, “Tdap Vaccine Effectiveness in Adolescents During the 2012 Washington State Pertussis Epidemic,” (which you can read here… ) gives the actual data and they conclude that “Tdap protection wanes within 2 to 4 years. Lack of long-term protection after vaccination is likely contributing to increases in pertussis among adolescents.” The MMWR article, “Pertussis Epidemic — Washington, 2012,” (read it here… ) provides the best graphic of the various age groups who were getting pertussis, with most being in the late childhood, early teen years when it seems the pertussis protection wanes. It is possible we will need additional boosters if we are to increase protection, or a new vaccine. I, for one, do not want to see a return to the deadly DPT of the 1950’s to 1980’s.
In another recent article, “A Change in Vaccine Efficacy and Duration of Protection Explains Recent Rises in Pertussis Incidence in the United States,” published April 2015, they highlight the same increase numbers of pertussis already discussed, and they found the acellular DTaP to be 80% effective when compared to the 90% effectiveness of the whole cell DPT. “These results demonstrate that the resurgence in pertussis in the U.S. can be explained by past changes in vaccination policy. However, our findings suggest that the efficacy of the currently-used acellular vaccine is not much lower than that of the whole-cell vaccine, and booster doses may be sufficient to curtail epidemics while vaccine research continues.” (read more here… )
Where do we go from here? If you have a newborn, stay away from sick people and get everyone who will be near that baby vaccinated. I cannot support injecting a huge dose of aluminum during pregnancy. If your child is ill with a cough, have your doctor assess for pertussis early as it is treatable. If you happen to have pertussis, as Charles did, stay away from others, especially infants and the very young.