Comparing effectiveness of two types of pertussis vaccines
Over the past year or so, there have been several outbreaks of whooping cough (Bordetella pertussis), including one that reached epidemic levels in Washington state, which has been considered one of the worst pertussis outbreaks in the USA during the past several decades. The disease lead to 18 infant deaths from whooping cough during 2012.
The original DTP vaccine (diphtheria, tetanus and pertussis) became available in the USA in 1948 and was critical to dropping the number of cases of whooping cough from 260,000 in 1934 to less than a few thousand per year in the 1990′s. The original vaccine contained what was called “whole-cell” pertussis, which includes all of the antigens of the pertussis bacterium, partially because it wasn’t understood (and to some extent still not fully understood) which antigens on the bacteria actually induce the proper immune response to have the body destroy a pertussis infection.
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Whooping cough update: outbreak in Montana continues
The Montana Department of Health has reported (pdf) that as of November 15, 2012, a whooping cough (Bordetella pertussis) outbreak has reached over 500 cases since the beginning of the year, compared to only 129 cases during the same time period in 2011. As of November 15, 33 cases of pertussis were found in infants of less than one year of age. Of these, four have been hospitalized. Because Montana is has a small population (about 1 million people), the overall incidence rate year to date is 50.5 pertussis cases per 100,000 Montana residents.
This past spring, there was a pertussis outbreak in several Montana counties, but it seemed to abate during the summer. The Department of Health is reporting that Flathead county, a northern county that borders Canada, is currently struggling to contain an outbreak in five school districts. “Since the beginning of October, we have 35 cases,” said Community Health Services Director for Flathead County Jody White. “Usually we won’t even see 35 in a year, so it is definitely unusual to have this many.”
CDC recommends pertussis vaccination for all pregnant women
On October 24, 2012, the Centers for Disease Control and Prevention recommended that “providers of prenatal care implement a Tdap immunization (Tdap or DTaP vaccine) program for all pregnant women. Health-care personnel should administer a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. If not administered during pregnancy, Tdap should be administered immediately postpartum.” This recommendation is based upon the Advisory Committee on Immunization Practices (ACIP), a group of medical and public health experts that develops recommendations on how to use vaccines to control diseases in the United States, guidelines, published Fall 2011, for whooping cough(Bordetella pertussis).
ACIP reviewed published and unpublished data from VAERS, Sanofi Pasteur (Adacel) and GlaxoSmithKline (Boostrix) pregnancy registries, and two small studies here and here. ACIP concluded “that available data from these studies did not suggest any elevated frequency or unusual patterns of adverse events in pregnant women who received Tdap and that the few serious adverse events reported were unlikely to have been caused by the vaccine.” In addition, both tetanus and diphtheria toxoids (together) and tetanus toxoid (alone) vaccines have been used worldwide in pregnant women to prevent neonatal tetanus without negative effects. The ACIP concluded that administration of the pertussis vaccine after 20 weeks of pregnancy was preferred to minimize any risk of a low percentage adverse event.
According to the CDC, only about 3% of pregnant women receive the vaccination. However, the CDC believes if the new recommendations are implemented, there would be a 33 percent reduction in cases, a 38 percent reduction in hospitalizations and a 49 percent reduction in deaths from whooping cough.
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Key citations:
- Centers for Disease Control and Prevention. CDC Advisory Committee for Immunization Practices Recommends Tdap Immunization for Pregnant Women. October 24, 2012.
- Centers for Disease Control and Prevention (CDC). Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate having close contact with an infant aged <12 months — Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly Rep. 2011 Oct 21;60(41):1424-6. PubMed PMID: 22012116.
- Czeizel AE, Rockenbauer M. Tetanus toxoid and congenital abnormalities. Int J Gynaecol Obstet. 1999 Mar;64(3):253-8. PubMed PMID: 10366047.
- Gall SA, Myers J, Pichichero M. Maternal immunization with tetanus-diphtheria-pertussis vaccine: effect on maternal and neonatal serum antibody levels. Am J Obstet Gynecol. 2011 Apr;204(4):334.e1-5. Epub 2011 Jan 26. PubMed PMID: 21272845.
- Talbot EA, Brown KH, Kirkland KB, Baughman AL, Halperin SA, Broder KR. The safety of immunizing with tetanus-diphtheria-acellular pertussis vaccine (Tdap) less than 2 years following previous tetanus vaccination: Experience during a mass vaccination campaign of healthcare personnel during a respiratory illness outbreak. Vaccine. 2010 Nov 23;28(50):8001-7. Epub 2010 Sep 25. PubMed PMID: 20875487.
Whooping cough update: Colorado outbreak hits 1000 cases
The Colorado Department of Public Health and Environment has reported that as of October 6, 2012, a whooping cough (Bordetella pertussis) outbreak has hit over 1000 cases since the beginning of the year, far exceeding the 5 year average of 2007-2011. The chart below shows the dramatic weekly increases in cases in Colorado since beginning of the year.
Protecting infants from whooping cough by cocooning
Infant being treated for pertussis infection. ©CDC, 2012.
This year, 2012, was one of the worst whooping cough (Bordetella pertussis) outbreaks in the USA for the past 70 years, which included an outright epidemic in Washington state. Some of the reasons for the spread of the disease were a reduced whooping cough (Dtap) vaccination rate and reduced effectiveness of the Dtap (or TDaP) vaccine. Whooping cough is a serious disease, especially to children under the age of one year old, who have not been fully vaccinated. According to the Centers for Disease Control and Prevention, of those infants who are hospitalized with pertussis about:
- 1 in 4 (23%) get pneumonia (lung infection)
- 1 or 2 in 100 (1.6%) will have convulsions (violent, uncontrolled shaking)
- Two thirds (67%) will have apnea (slowed or stopped breathing)
- 1 in 300 (0.4%) will have encephalopathy (disease of the brain)
- 1 or 2 in 100 (1.6%) will die
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Effectiveness of pertussis vaccines–myth vs. reality
Over the past few months I have written extensively about the the current whooping cough (Bordetella pertussis) outbreak which has 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, this outbreak has lead to the blame game from the antivaccination crowd, because they claim 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 (or just read the comments section of my blog) 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.
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Whooping cough: North Carolina reports first infant death in 2012
The North Carolina Department of Health and Human Services has reported North Carolina’s first infant death from whooping cough on August 20, 2012. The child was only 2 months old. “Babies and young children are not fully immunized until they have finished a series of vaccinations, so their only protection against whooping cough is the people around them,” said State Health Director Dr. Laura Gerald. “Anyone who lives with or will be around a baby should be vaccinated.” In other words, someone who was not vaccinated or not fully vaccinated passed the infection to this child.
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Vaccine denialism causes USA’s worst whooping cough epidemic in 70 years
Steven Salzberg, at Forbes Magazine, has reported that the USA is experiencing the worst whooping cough epidemic in 70 years. In addition, the CDC has stated that as of August 4 2012 (pdf), there are 21,000 cases and 10 deaths in the United States from whooping cough(Bordetella pertussis) year-to-date. Wisconsin has the highest rate of infection, while Washington, as I have discussed on a number of occasions, has one of the highest total number of pertussis infections.
Increases in pertussis outbreaks by state from 2011 to 2012.
Whooping cough update: Washington state epidemic hits 3400 cases
The Washington State Department of Health is reporting that as of August 4, 2012, the current whooping cough (Bordetella pertussis) epidemic has hit 3400 cases, over 15X more than the 214 cases reported at the same time last year. The epidemic has finally shown a big drop off in new reports this past week (pdf), although there are concerns that the numbers will increase against this fall as children return to school in the autumn.
Pertussis cases by week 2012 (red) vs 2011 (blue)
According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.
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Whooping cough–UK epidemic leads to 5 infant deaths
According to the Guardian, a total of 2,466 cases of whooping cough (Bordetella pertussis) have been confirmed in the United Kingdom between January and June of 2012, causing the deaths of 5 infants. The UK’s Health Protection Agency (HPA) said that the number of cases is six times larger than the last comparable outbreak in 2008. The government’s vaccination committee is “now considering recommending booster vaccinations for teenagers and pregnant women and has already recommended immunising healthcare workers who treat young children because infants are most at risk.”
Also according to the article, Mary Ramsay, the HPA’s head of immunization, said: “We are working closely with the Department of Health’s Joint Committee of Vaccination and Immunization to consider the most effective ways to tackle the ongoing outbreak. The committee is reviewing a number of options, including the introduction of a booster dose in teenagers and offering whooping cough vaccination to pregnant women. In the meantime we are actively reviewing our cases to see what interventions could have the quickest impact on the spread.”
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Whooping cough update: Washington state epidemic exceeds 2800 cases
The Washington State Department of Health has reported (pdf) that the current whooping cough (Bordetella pertussis) epidemic has hit 2883 cases, over 10X more than the 210 cases reported at the same time last year. The epidemic seems to have peaked a few weeks ago, although concerns will remain as children return to school in the autumn.
According to the Centers for Disease Control and Prevention, pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.
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Whooping cough: Washington state epidemic exceeds 2600 cases
The Washington State Department of Health is reporting that there are 2647 confirmed cases of whooping cough (Bordetella pertussis) as of June 23, 2012. This number compares to only 187 cases during the same period in 2011. The epidemic has stricken 31 out of 39 counties (pdf) in the state with Skagit County having the highest number at 508 confirmed cases.
According to the Centers for Disease Control and Prevention, Pertussis (whooping cough) can cause serious illness in infants, children and adults. The disease usually starts with cold-like symptoms and maybe a mild cough or fever. After 1 to 2 weeks, severe coughing can begin. Unlike the common cold, pertussis can become a series of coughing fits that continues for weeks. In infants, the cough can be minimal or not even there. Infants may have a symptom known as “apnea.” Apnea is a pause in the child’s breathing pattern. Pertussis is most dangerous for babies. More than half of infants younger than 1 year of age who get the disease must be hospitalized. Approximately 1-2% of infants who are hospitalized from pertussis will die.
Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud “whooping” sound. This extreme coughing can cause you to throw up and be very tired. The “whoop” is often not there and the infection is generally milder (less severe) in teens and adults, especially those who have been vaccinated.
Whooping cough can be easily prevented with the Tdap or DTaP vaccine. The problem is that infants are not initially vaccinated until they are 2 months old, and are not fully immunized until they’re 6 months old, so they are susceptible to adults who may be infected. Adults may have lapsed immunity or may have not been vaccinated.
It’s unknown why the epidemic in Washington state has grown so fast and so large, but it may be that there is a pool of anti-vaccine sentiment in the area.
Vaccines save lives.
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Most real scientific skeptics, in contrast to pseudoskeptics who ignore evidence to believe whatever fits their view of the world, support vaccinations. In fact, the skeptic community doesn’t just talk about how vaccinations save lives, but they actually practice what they proclaim. Very loudly at times.
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Whooping cough: Washington state surpasses 2,000 cases
As mentioned in previous posts, the state of Washington is being hit hard by a whooping cough (Bordetella pertussis) epidemic since the beginning of 2012. As of today, over 2000 cases of pertussis have been reported, nearly a 12-fold increase over 2011. In fact, the outbreak is the largest for pertussis since the 1940′s before the whooping cough vaccine was widely available.
According to Mary Selecky, Washington state’s Secretary of Health,
“We’re asking everyone to double-check with their health care provider to make sure they’re up-to-date on vaccinations. Our reported case count has climbed above 2,000 already with half of the year to go. It’s vital that teens and adults get the Tdap booster. Actually, our little babies are in the most danger. When they get a coughing fit, their throats close up on them, which is why they turn blue.”
The state has ordered over 27,000 doses of the Tdap vaccine (almost the same as DTaP vaccine, just different brand name), for lower income residents. Over 82,000 adult residents of the state have been vaccinated. Infected adults are the largest risk group for transmitting pertussis to infants who have not been vaccinated yet, or whose parents refuse to vaccinate them.
Washington state is attacking this outbreak with all of their resources including massive vaccination effort. Because, vaccines save lives. Period.
via Washington state surpasses 2,000 pertussis cases | Vaccine News Daily.
