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Effectiveness of pertussis vaccines–science vs. lies

Infographic about whooping cough risks for babies.

Infographic about whooping cough risks for babies.

Update of an article published on 7 September 2012.

Over the past few months I have written extensively about several whooping cough (Bordetella pertussis) outbreaks which had reached epidemic levels in areas like the Washington state, and has been considered one of the worst outbreaks in the USA during the past several decades. The outbreak has lead to several deaths here in the USA and in other countries such as the UK. Of course, these outbreaks and epidemics have lead to the “blame game” from the antivaccination gang, because they have claimed that since A) most kids are vaccinated, and B) we’re having this outbreak then C) either the vaccines are useless or are actually the cause of the outbreak. Seriously. They blame the vaccines.

So I decided to search the internet to find the most popular vaccine denialist arguments regarding pertussis vaccinations, and deconstruct and debunk them. Hopefully, it will be a useful tool for you when you’re engaging a ridiculous argument with one of those antivaccinationists. Of course, I could use the information too.

First, let’s start with Joe Mercola, one of the leading propagandists of the antivaccination movement, who decided to misinterpret data, probably intentionally, to condemn the use of the pertussis vaccine (DTaP or Tdap) because of 2010 whooping cough outbreak in California. Here’s what Mercola, the amateur and ignorant immunologist, had to say about that:

In fact, the study showed that 81 percent of 2010 California whooping cough cases in people under the age of 18 occurred in those who were fully up to date on the whooping cough vaccine. Eleven percent had received at least one shot, but not the entire recommended series, and only eight percent of those stricken were unvaccinated.

That “only 8% of those stricken were unvaccinated” has been repeated over and over again by the vaccine denialists as proof that being vaccinated is more dangerous than not being vaccinated. Now Mercola is referencing this 2012 study published in Clinical Infectious Diseases. Or should I say “misreferencing.” Because, as Orac said in Joe Mercola attacks vaccinations again. Film at 11., “Needless to say (but I’m going to say it anyway), Mercola is being disingenuous here. For one thing, the authors stated quite clearly: ‘In reviewing cases confirmed at our medical center during this outbreak, we noted effective protection of younger children.’” Once again, I guess if the vaccine denialists lack evidence, then invent evidence it if necessary. That’s why some of us in the pro-science world have started referring to antivaccination lunatics as “lying liars who lie.”

In fact the authors of the Clinical Infectious Diseases study concluded that:

In the case of the recent California epidemic, it appears that the effectiveness of the current vaccine schedule, when paired with the imperfect vaccination rate, may be insufficient to prevent an epidemic. Earlier vaccine booster doses may be required to provide adequate herd immunity, absent an increase in vaccination rate, efficacy, or durability. Earlier booster doses could prevent immunity from waning, and address disease in the 8-12 age group.

Let’s make this clear as possible–this study is completely and intentionally misinterpreted by Mercola. In fact, the vaccine still works, but the immunity from it wanes sooner than expected, and that this area of California doesn’t have a high enough rate of vaccination to prevent epidemics. Moreover, the authors of the study recommend that the CDC and FDA should change the vaccination schedule to provide earlier boosters to protect older children and teenagers (and I would contend adults).  This is how science works, get the evidence, revise the hypothesis, and retest the hypothesis, then come to a new and improved scientific consensus. 

Just in case you think I’m inventing this stuff, another study in the Journal of Pediatrics, published in May 2012, came to  essentially the same conclusion: it found an increase in pertussis among children aged 7-10 years who had completed the DTaP immunization but who had not yet received the Tdap booster recommended at age 11-12 years, along with a concomitant decrease in cases among adolescents from ages 11 to 14. The study concluded that preadolescents are subject to waning immunity with the current schedule but that the adolescent Tdap dose is effective in protecting younger adolescents.

But these two studies lead to the Nirvana Fallacy among the vaccine denier crowd–if the pertussis vaccine isn’t perfect, then it’s useless. We’ve already shown that the two studies have provided evidence that we need to adjust the vaccination schedule protect one group of later adolescents but is still effective in other groups of children. And even those with waning effectives were still protected.

Now back to Mercola’s comment about “only eight percent of those stricken were unvaccinated.” I had written that the CDC has determined that around 95% kindergartners are up-to-date with their DTaP vaccine, so the population of those vaccinated against pertussis is obviously larger, and you can expect that given what was discussed above, the raw numbers of those whom were infected would be larger in a vaccinated group, since the vast majority of individuals are vaccinated, though it would be fallacious that being vaccinated was the underlying cause of becoming infected. However, a more detailed analysis of the Washington state epidemic shows exactly how the infection rate breaks out between vaccinated and unvaccinated groups by age group:

  • Ages 5-9 unvaccinated or under vaccinated children are 6 times more likely to become infected with pertussis than fully vaccinated. 
  • Ages 10-13 unvaccinated or under vaccinated are 25 times more likely to become infected with pertussis than fully vaccinated. 
  • Ages 14-18 unvaccinated or under vaccinated  are 6 times more likely to become infected with pertussis than fully vaccinated.

In other words, when you directly compare the likelihood of catching pertussis, it’s still much safer to be fully vaccinated than not. By the way, this is how science works again. Make valid statistical comparisons, not ones that are fallacious. I’m almost ready to categorize antivaccination gangsters as math deniers.

Orac makes one more point in a recent blog post:

…Mercola (claims) that vaccines are “causing dangerous mutations.” While it is possible that the B. pertussis bacteria is developing “resistance” to the vaccine through natural selection, the evidence that it is doing so strikes me as rather weak and preliminary. Even if it were, the answer would be to change the vaccine in order to include the altered antigens. After all, do we decide that antibiotics don’t work when bacteria evolve resistance or that chemotherapy doesn’t work when tumors manage to do the same? That’s a rhetorical question, of course. Some segments of the alt-med world do, but reasonable scientists do not. They work to overcome that resistance.

In a recent article in the New England Journal of Medicine, author James Cherry dismissed the pertussis mutation “hypothesis”:

Finally, we should consider the potential contribution of genetic changes in circulating strains of B. pertussis. It is clear that genetic changes have occurred over time in three B. pertussis antigens — pertussis toxin, pertactin, and fimbriae. In fact, changes in fimbrial agglutinogens related to vaccine use were noted about 50 years ago. Studies in the Netherlands and Australia have suggested that genetic changes have led to vaccine failures, but many people question these findings. If genetic changes had increased the rates of vaccine failure, one would expect to see those effects first in Denmark, which has for the past 15 years used a vaccine with a single pertussis antigen (pertussis toxin toxoid). To date, however, there is no evidence of increased vaccine failure in Denmark.

So, let’s review the real scientific evidence:

  1. The vaccine works, although the effectiveness may wane between boosters. There is no evidence that it has stopped working completely.
  2. The vaccine isn’t perfect. In medicine, perfection is a fallacy pushed by the alt med world. Real science-based medicine is almost always nuanced and honest–there are no absolutes.
  3. Individuals who aren’t vaccinated are up to 25X more likely to contract whooping cough than those who are fully vaccinated.
  4. B. pertussis probably is not mutating to evolve resistance, but the evidence is a bit preliminary. Even if it is, we can develop new vaccines.

 

pertussis-chart-CDC

Chart of whooping cough morbidity from 1922-2010.

There’s one more thing that the vaccination denialists fail to mention. Vaccines work.

This graph illustrates the absolute number of pertussis cases in the USA, which shows a dramatic drop since the introduction of the pertussis vaccine in the mid-40′s. If this graph was converted into per capita, accounting for the nearly 2.5X increase of US population from the 1930′s, the drop would be even more dramatic. In other words, even with the what the antivaccinationists claim as a “bad vaccine”, pertussis is just about wiped out compared to what it was just 70 or 80 years ago. But, as you can see, the slight increase recently means that we have to vigilant, and we have to do some adjustments to the vaccine. Medicine does that all the time. I’m pretty certain that cancer therapies have evolved from 1930 to 2012. And that’s a good thing.

Use the Science-based Vaccine Search Engine.

Key citations:

Comments (16)
  • http://www.vacfacts.info/ Lowell Hubbs

    If Dr Mercola is actually as you said incorrect or lying about the said percentages of fully vaccinated existing in the California pertussis outbreak; then why is Dr. David Witt, an infectious disease specialist at Kaiser Permanente Medical Center in San Rafael, California, and senior author of the study; stating the same exact percentage numbers as Mercola did? And you are still going to claim to that this said study is completely and intentionally misinterpreted by Mercola??? How could that actually be?

    I also noticed that under Results in the abstract it lists vaccine effectiveness was 41%, 24%, and 79% for children aged 2–7 years, 8–12 years, 13–18 years, respectively. That as well does not seem to be real good, nor very impressive. Thus indeed that figure of 81% in the outbreak that were found to be fully vaccinated and up to date, would have likely been quite predicable and probable.

    The average person can not get a full version of the study but just the abstract, and perhaps that would have been indeed helpful to ascertain the real numbers from he study..

    Whooping cough vaccine fades in pre-teens: study

    Excerpts:

    “We have a real belief that the durability (of the vaccine) is not what was imagined,” said Dr. David Witt, an infectious disease specialist at Kaiser Permanente Medical Center in San Rafael, California, and senior author of the study.

    The pertussis vaccine, a five-shot series referred to as DTaP, is recommended for children at ages two-, four-, six- and 18-months, and at four to six years old.

    The CDC recommends that at age 11 or 12 kids get the booster shot called Tdap.

    In early 2010, a spike in cases appeared at Kaiser Permanente in San Rafael, and it was soon determined to be an outbreak of whooping cough — the largest seen in California in more than 50 years.

    Witt had expected to see the illnesses center around unvaccinated kids, knowing they are more vulnerable to the disease.

    “We started dissecting the data. What was very surprising was the majority of cases were in fully vaccinated children. That’s what started catching our attention,” said Witt.

    To figure out just how well the vaccine was working, Witt and his colleagues collected information on every patient who had tested positive for pertussis between March and October, 2010.

    Of the 132 patients under age 18, 81 percent were up to date on recommended whooping cough shots and eight percent had never been vaccinated. The other 11 percent had received at least one shot, but not the complete series.

    The rate of cases for each age, two through 18 years old, peaked among kids in their pre-teens.

    Read more:
    http://www.reuters.com/article/2012/04/03/us-whoopingcough-idUSBRE8320TM20120403

    • Boris Ogon

      Why the fuck did you scurry over to a post that’s been moribund for four months and start talking to yourself when you have plenty of things to attend to at the active comment threads?

      • http://www.vacfacts.info/ Lowell Hubbs

        I made my point very well, Boris, and you know it. You simply can not handle the truth. And tell me this; why is it that you are not making a single mention of the large error that the Skeptical Raptor blog made in publishing this obviously incorrect article that you see above? Are they going to pull it down, in realization of their error in actually being incorrect, and as to the real figure being in fact 81% in the said outbreak that were fully vaccinated? How can you continue to deny this obvious finding and result? You do not tell me where I can choose to reply post and not reply post! Your personal bigotry is all to obvious.

    • Boris Ogon

      The average person can not get a full version of the study but just the abstract

      Wrong, dumbshit.

      • http://www.vacfacts.info/ Lowell Hubbs

        Its not wrong at all. I have no college nor medical library near me, and nor that I can access. I perhaps should rephrase that so it fits your picking at it and personally attacking anger mode a little better. When it a full study is not available from a specific journal, online; many people do not have access to whenever they want it libraries with access to medical journals.

        Actually when first looking at the abstract I did not see initially the link to the full study, and the article should have simply linked to that instead. In fact I do not really have all day and nor the time to be doing all this and additional research, and need to be limiting it.

        I find it it interesting as well that people like you Boris, believe in these clearly false articles, like the one I am commenting on right now; (and that I as well just clearly exposed), but yet you have the twisted audacity call me a dumbshit. Wow. LOL

        • Boris Ogon

          Its not wrong at all. I have no college nor medical library near me, and nor that I can access.

          You say that “the average person can not [sic] get a full version of the study,” I give you a link to the full text, and you say that you weren’t wrong?

          Actually when first looking at the abstract I did not see initially the link to the full study, and the article should have simply linked to that instead.

          It’s Joe Fucking Mercola’s fault that you don’t understand what the words “full text” mean? But wait, you just said that you weren’t wrong to start with.

          In fact I do not really have all day and nor the time to be doing all this and additional research, and need to be limiting it.

          No, Lodwill, the problem is that you can’t understand it. Your “research,” as you’ve amply demonstrated, is collecting links to stupid things on random blogs so that you can barf them back up and declare victory. You couldn’t reason your way out of a wet paper bag, which is why you’re stuck pretending that you “evaluate papers” and just run the fuck away when, for no discernible reason, you complain that you can’t look at one and then have it served to you on a silver fucking platter.

          I find it it interesting as well that people like you Boris, believe in these clearly false articles, like the one I am commenting on right now; (and that I as well just clearly exposed), but yet you have the twisted audacity call me a dumbshit. Wow. LOL

          Then why the fuck were you using the abstract for support?

          • http://www.vacfacts.info/ Lowell Hubbs

            It is as simple as this it was very late, and I had been online with this for hours. I was tired and trying to hurry and simply did not see the full study link, which normally I am sure I likely would have. That happening has absolutely no bearing whatsoever on the finding that I made, and nor the accuracy and truth of and in that finding. But just look at all the attacking and irrelevant garbage you have replied with above.

            And yet not once have you made any reference nor address of this matter regarding the fact that this above article is obviously and clearly false information about Dr Mercola’s claimed to statements. I think that is beyond pathetic. You people really know how to show your true colors don’t you, and what you actually made of. And here is a clue, no one any longer even needs the abstract nor the full study for support, when the author of the study quite clearly and obviously has backed what Dr Mercola stated in regard to that 81% vaccinated figure. You people simply refuse to be wrong. They obviously need to pull this false information filled article down.

  • http://www.vacfacts.info/ Lowell Hubbs

    What is amazing is that everyone here seems to continue to ignore the study that Judy Harvey presented with, as if it holds no real significance. How many times have we seen it stated that parents, caregivers and anyone around an infant or young child not old enough to be vaccinated needs to be vaccinated for pertussis. Then they even go so far as to rant with guilt trips about being unconcerned with saving the lives of infants and young children. The message remains to be get vaccinated to protect those to young to be or unable to be vaccinated. Fear mongering and guilt is what they have pushed. And lets not forget the you will weaken the needed vaccine derived herd immunity percentage if you don’t get vaccinated trip; and which basically as well this study does of course not entirely disregard, puts a few holes in that vaccine derived herd immunity concept.

    My question is this. If the vaccine promoters claim as they have to being the purveyors of the needed science; then why was this said and needed study not done long ago; actually decades ago? As well when will they do a similar study in regard to all of the currently used vaccines? Why is not currently knowing the outcome of such a study, not important enough to actually do them? I think that the answer is that they really do not want to know the outcome of such significant studies.

    • Boris Ogon

      What is amazing is that everyone here seems to continue to ignore the study that Judy Harvey presented with

      What are you talking about? The mischaracterization of the baboon study along with the howlingly wrong statement “children who get whooping cough naturally are immune for life”?

      This is a four month old post, Lodwill. There is no “everyone here.”

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