Why we vaccinate–because pertussis kills babies

The California Department of Public Health (CDPH) recently announced that the number of whooping cough (Bordetella pertussis) cases through May 2014 has already exceeded the number in 2013. As of 27 May 2014, the CDPH reported 2,649 cases of pertussis since the beginning of the year. More concerning, there were 800 cases reported in April alone, the highest monthly number since California’s 2010 whooping cough epidemic.

whooping-cough-vaccinated

Whooping cough can be easily prevented by the DTaP or Tdap vaccines (which also protect against tetanus and diphtheria), which can be given to infants as early as 6 weeks to 2 months old.

According to the CDPH, infants who are too young to be fully immunized or those who are not vaccinated are most vulnerable to severe and fatal cases of pertussis. In 2014, 66 of the pertussis hospitalizations cases were children four months of age or younger. Two infants have died of pertussis in California this year.

Of the 2,649 cases so far this year, 83% have occurred in infants and children younger than 18 years of age. Of these children, 8% were younger than 6 months old, and 70% were 7 through 16 years of age. In other words, all children are susceptible to the disease.

The CDPH breakdown by county (pdf) shows a stark and troubling trend:

  • Sonoma County–83.28 (incidence rate per 100,000 residents)
  • Napa County–42.42
  • Marin County–38.30
  • Tehama County–37.83
  • Trinity County–22.32
  • Humboldt County–19.29
  • City of Berkeley–18.24

TDaP-vaccine-vialFor those of you who do not live in California, these are some of the wealthiest, most educated counties in the country, let alone California. Marin County is one of the whitest, wealthiest (a median income over US$113,000), best educated, and most liberal (nearly 75% of the county voted for Barack Obama). Sonoma, Napa, Trinity, Humboldt and Tehama counties, along with the City of Berkeley, are very similar in socioeconomic makeup.

These constitute probably the largest pockets of vaccine denialism, which is demonstrated by the unusually high incidence of pertussis versus the statewide incidence rate of the disease of 6.93. This provides me, at least, with additional evidence that liberals can be as anti-science as right wing fools. Vaccines are safe. Vaccines prevent diseases like pertussis which can kill children. I’m not sure why the parents in these areas miss these basic points, But these pockets of hostility towards vaccines will be ground zero for any future epidemic in other diseases like measles or chickenpox.

As a reminder, the CDPH makes these recommendations about vaccinating against pertussis:

  • Pregnant women receive a pertussis vaccine booster during the third trimester of each pregnancy, even if they’ve received it before.
  • Infants be vaccinated against pertussis as soon as possible. The first dose is recommended at two months of age but can be given as early as 6 weeks of age during pertussis outbreaks. Children need five doses of pertussis vaccine by kindergarten (ages 4-6).
  • California 7th grade students receive the pertussis vaccine booster as required by state law.
  • Adults receive a one-time pertussis vaccine booster, especially if they are in contact with infants or if they are health care workers who may have contact with infants or pregnant women.

These are very similar to CDC recommendations regarding the vaccine.

These two babies would not have died, if they had been vaccinated (along with anyone in close contact) against whooping cough. A simple, effective, extremely safe vaccine. Are parents’ ignorance of scientific facts an excuse for these dead babies? Not in my world, where protecting children from harm should be a primary goal of society.

 

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Why we vaccinate–to protect those children who can’t be vaccinated

One of the most selfish and narcissistic tropes of the antivaccination cult is that “if your child is vaccinated why do you need to worry about mine.” Setting aside the fact that the vaccine denier can make that arrogant statement because most of the community is vaccinated so her children are protected by the herd effect, it ignores the fact that not every child is vaccinated.

queensland-health-minister-geoff-wilsonChildren who are under the age of 3-6 months either have not or just received the DTaP vaccine against whooping cough (Bordetella pertussis), so they are susceptible to adults, teenagers and other children who might be passing along the disease. Moreover, vaccines are not 100% effective (this does not mean that they are 0% effective, just that it’s not perfect), so some people may be vaccinated but still can catch the disease.

But there are also children who cannot be vaccinated for medical reasons, and they are vulnerable to infectious diseases, even the flu. In a recent story, the Brisbane Australia Courier Mail reported about a three year child, Lachlan, who, because of a liver transplant that may leave him immunosuppressed for the rest of his life and unable to get vaccinated, must be protected against those children that might carry diseases that could kill this child. To be clear, because vaccine deniers tend to have no knowledge of real science, this child cannot be vaccinated not because the vaccines would harm him, it’s because his immune system cannot develop the adaptive immune response, so the vaccines are useless.

His parents, Chris and Nelia Hay, must be extraordinarily vigilant in protecting young Lachlan. Another child, whose parents may listen to the reprehensible Meryl Dorey, may not be vaccinated and pass along the “harmless measles,” which could kill Lachlan. Every sniffle. Every rash. Anything seen on another child must make the Hays stiffen with fear.

And when Lachlan heads off to a school, his parents will probably have to choose a school with extraordinarily high vaccination rates. Not that I would actually recommend this, but Mississippi, which doesn’t allow any vaccine exemptions except medical ones, has a nearly 99% vaccination rate. Lachlan would be safe there from the ignorance of antivaccination lunatics.

Society and political entities evolved to protect the individual citizen (OK, it’s not perfect, but it’s better than the alternative). We vaccinate not only to protect the ones we love, but also to protect the ones we don’t know. Vaccines work, and we have scientific evidence supporting. Vaccines are safer than almost any medical intervention out there, and we have evidence supporting that. To not vaccinate is simply wrong.

 

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Why we vaccinate–protecting babies from pertussis

tdap-vaccineRecently, 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 in the USA during 2012.

The Advisory Committee on Immunization Practices (ACIP) recommends (pdf) that children should get 5 doses of DTaP (the vaccine for (diphtheriatetanus and pertussis), one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. Those children who are not completely vaccinated according to these ACIP recommendations for pertussis are considered to be “undervaccinated.”  Continue reading “Why we vaccinate–protecting babies from pertussis”

Infant in North Carolina dies of whooping cough

whooping-cough-coccoonThe North Carolina Department of Health and Human Services reported that a three-week old child died of whooping cough (Bordetella pertussis) last week.

As the report states, a child cannot be vaccinated with DTaP (the vaccine for diphtheriatetanus and pertussis) until they are about 2 months old. However, because infants are susceptible to whooping cough, all adults, children, friends, relatives, everyone, who is in contact with that child should be vaccinated against pertussis, a process called cocooning.

When an antivaccination militant says “my unvaccinated child won’t hurt your child”, this is where their lies are uncovered. For example, an unvaccinated older child may have whooping cough, and the parent take him or her to a pediatrician for the horrible cough, and that infected child passes it to other children.

In this case, the NC Department of Health and Human Services has not reported how the child may have contracted the deadly disease, so we can only speculate. Continue reading “Infant in North Carolina dies of whooping cough”

Undervaccinating against pertussis puts children and community at risk

whooping_cough-babyOver 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 in the USA during 2012.

The original DTP vaccine (diphtheriatetanus 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. In the late 1990’s, the Advisory Committee on Immunization Practices (ACIP) recommended that the USA switch to the acellular form of the vaccine, known as DTaP (a pediatric vaccine to immunize against diphtheria, tetanus and pertussis) or Tdap (the older children/adult version of same vaccine). Continue reading “Undervaccinating against pertussis puts children and community at risk”

Comparing effectiveness of two types of pertussis vaccines

whooping-cough-cocoonOver 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.  Continue reading “Comparing effectiveness of two types of pertussis vaccines”

Waning whooping cough immunity after DTaP–a new analysis

Protect Your Baby from Whooping Cough.

Despite the fact that over 95% of kindergarteners in the United States are properly vaccinated against whooping cough (Bordetella pertussis) with the DTaP vaccine, there are persistent reports that the rates of whooping cough have risen during the past few years. Several outbreaks, along with an outright epidemic in Washington state, seemed to indicate that the vaccine’s effectiveness is waning faster than expected.

A recently published study in Pediatrics evaluates reports of increased rates of pertussis in the six years after receipt of the fifth (of five) DTaP doses. These reports suggest that waning of immunity to pertussis from DTaP is occurring before the recommended booster age of 11 to 12 years. The researchers tracked more than 400,000 Minnesota and Oregon children using immunization records and state health department whooping cough data. All of those children were born between 1998 and 2003 and received the recommended series of five DTaP shots, the final one usually given at 4-6 years old. Continue reading “Waning whooping cough immunity after DTaP–a new analysis”

Whooping cough vaccine–facts about waning immunity

A new article published this week in the Journal of the American Medical Association (JAMA) by Misegades et al. analyzed a recent whooping cough (Bordetella pertussis) outbreak in California children. Misegades determined that those who had not been vaccinated against the disease were nine times more likely to get pertussis than those who had received the entire five-shot series. However, among children who were fully vaccinated, the longer it had been since their final dose of the DTaP vaccine (which protects against diphtheria, tetanus and pertussis), the higher the risk of contracting whooping cough. This is in line with the decrease in effectiveness of the vaccine that has been discussed here and elsewhere. Continue reading “Whooping cough vaccine–facts about waning immunity”

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.”

Continue reading “Whooping cough update: outbreak in Montana continues”

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.

Vaccines Saves Lives.

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