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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Washington state makes it harder to get an immunization exemption
Paul Offit, MD
After one of the worst whooping cough (Bordetella pertussis) epidemics in 70 years in Washington state, there is some good news. The New York Times has reported that the state, after passing a law that made it more challenging for a parent to get a personal exemption for a vaccination for their children, the exemption rate in Washington state has dropped by 25 percent. This is good news, because until recently Washington state was dead last in the immunization rate, or, if you like exemptions, it was number 1!
In 2011, the state’s legislature passed a law making exemptions a bit more difficult, by requiring parents to actually speak to a healthcare professional about the risks and benefits of vaccinations. That person then must sign off on the exemption. Parents who opted out of state immunization requirements for kindergartners peaked at 7.6 percent in the 2008-2009 school year, setting off alarms among public health experts in the state, according to the New York Times.
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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–effectiveness of pertussis vaccines
This year has been a bad one for whooping cough (Bordetella pertussis) throughout the world. There have been large outbreaks of pertussis in the United States, England and Australia in 2012. There have been some hypotheses as to why it has been happening. For example, there is some speculation that a subtype (or genotype) of pertussis was responsible for the Australian outbreak, but the evidence is complicated and equivocal. I think there is some evidence that the epidemic in Washington state results from the much lower vaccination rates in the area as a result of the anti-vaccination lunacy.
But the story may be much more complicated, and may need a more open discussion amongst those responsible for protecting us from these infectious diseases. These pertussis outbreaks may be a result of the reduced performance of the pertussis vaccine currently being used. The problem with an open discussion regarding the current vaccine is that the vaccine denialists will make an absolute claim that the pertussis vaccine does not work (of course, a complete fabrication, typical of the anti-vaxxers), instead of the more accurate position that the pertussis vaccine might not have the high level of effectiveness that was originally thought. Ironically, the current vaccine, the acellular pertussis version, replaced the older and more effective whole pertussis vaccine because critics believed the older version had too many side effects.
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Whooping cough–Washington state epidemic is very scary thanks to vaccine denialism
The Washington State Department of Health is reporting that, as of July 30 2012, there have been 3,285 cases of whooping cough (Bordetella pertussis) in the state. This compares to just 253 through the same time period in 2011. If you want to be scared, look at it graphically.
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.
(more…) «Whooping cough update: Washington state…»
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.
Real Skeptics get vaccinated
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.
Whooping cough: Washington State lacks funds to fight epidemic
Whooping cough patients per county
The New York Times is reporting that the State of Washington has been hit by a whooping cough (pertussis) epidemic that has hit 1,284 individuals in 2012, 10 times the 128 seen at this point in 2011. At this rate, there could be over 3000 cases by the end of 2012. Of those infected so far in 2012, 86 infants (under age of 1 year) required hospitalization, including 19 of whom were under 2 months. Pertussis immunization, with the DTaP vaccine, does not confer full immunity to the child until the third vaccination at 6 months of age, during which the infant is susceptible to catching the disease from adults with lapsed immunity or other children who are not vaccinated. However, even children with the first vaccination have some immunity, so the infection could be milder than in a child without any vaccination.
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Washington allocates money for whooping cough outbreak
As discussed previously, the state of Washington is experience a relatively large outbreak of whooping cough (Bordetella pertussis), with 1,132 cases of whooping cough so far in 2012, which the state reports as over 10 times higher than what was reported in 2011. The epidemic has caused the hospitalization of 20 children under the age of one. Washington Governor Christine Gregoire released cash from an emergency fund last week to be spent on efforts to contain the epidemic. Gregoire has made $90,000 available to strengthen the public awareness campaign about the need to vaccinate against the highly infectious disease that is also known as pertussis. The state’s Department of Health projects that it will spend approximately $200,000 on the campaign. The state has also sought and received approval to use federal funds to purchase 27,000 doses of pertussis vaccines that will be available for the uninsured.
Idaho infant dies from whooping cough
A nine week old Idaho girl died Friday of complications from whooping cough according to Reuters. She was being treated for the disease at a hospital in Pocatello, Idaho; however, her situation worsened, and she was flown to the University of Utah medical center for further treatment as her condition worsened.
There appears to be a significant outbreak of whooping cough in the Northwest US since the beginning of the year. Washington state has had 1132 cases so far this year, a pace running far ahead of last year, when the state had 961 cases for the whole year. Montana has had nearly 100 cases in 2012, while Idaho has had 31 cases.
According to Emily Simnit, a spokeswoman with the Idaho Department of Health and Welfare, “when you have something as tragic as the death of an infant, it underscores the fact that there are really nasty, severe illnesses that vaccines can prevent.”
The whooping cough immunization is a component of the DPT (diphtheria, pertussis and tetanus) vaccine, which is typically given at the age of 2 months. So the infant probably was not immunized against the disease, and probably got it from an unvaccinated individual, or possibly from someone with lapsed immunity. It could have even been a sibling or another adult. However, there is no indication that the parents were opposed to vaccinating the infant, so this is probably just horrible luck, though the prevalence of the disease in those areas increased the chances of any infant contracting whooping cough.
Idaho and Washington are two of about 20 states that allow for philosophical exemptions to vaccinations. Because of the drop in vaccination rates, herd immunity, where enough people are vaccinated that the disease has little possibility of being transmitted from an infected person to an susceptible one, has probably developed some cracks that allow the diseases to start spreading more quickly.
There are few legitimate reasons to refuse to get vaccinated. There should be medical reasons for not being vaccinated. However, refusing to get children vaccinated because of unscientific, unproven, and ridiculous reasons should stop. Children shouldn’t die of diseases that can be eliminated. One preventable death is unacceptable and unconscionable.
via H5N1: US: Idaho infant dies from whooping cough amid regional outbreak.
State of Washington declares whooping cough epidemic
The Washington State Department of Health has declared a statewide epidemic for whooping cough (Bordetella pertussis). For the first three months of 2012, there have been 640 reported cases of the disease, mostly babies and infants.
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