On June 11, it was reported that the recent outbreak of whooping cough (Bordetella pertussis) in Johnson County, Kansas, has grown by 65 cases to a total of 175 cases since the beginning of the year. The Johnson County health department has issued a warning (pdf) about the outbreak, requesting that children and adults get the vaccine and to be aware of symptoms. To prevent the spread of the disease, the health department is requesting that people who are being treated for the disease with antibiotics stay home for 5 days, and those we are refusing to be treated, stay home for 3 weeks. Continue reading “Whooping cough: Kansas outbreak grows (update)”
Over the past few weeks, I’ve discussed numerous outbreaks of whooping cough, or Bordetella pertussis (or just pertussis) throughout the US, Canada, England and Australia. For those individuals who think that whooping cough has either disappeared or is not dangerous, well, it’s time to disabuse anyone of that particular notion.
2012 (the year, not the silly Mayan Calendar) pertussis outbreaks
- Kansas–111 cases
- Idaho–1 child died
- New Mexico–1 child died
- Washington state–over 1100 cases
- Montana–outbreak in Flathead and Kalispell counties
- British Columbia–250 cases in 2012
- Illinois–over 1100 cases in 2011
- South Florida–new outbreak in Ft. Lauderdale
- Wisconsin–over 100 cases in a small area
- Australia–38,000 cases
- England–655 cases
These are just the more notable outbreaks. According to the CDC, there were over 27,000 whooping cough cases in the US in 2010 (and that number is going to be small compared to 2012’s numbers). And, worldwide, there are 30-50 million cases of pertussis and about 300,000 deaths per year. It is not a disease to be treated lightly.
Risks from whooping cough (all stats are from the Centers for Disease Control and Prevention)
Of infants younger than 1 year of age who get pertussis, more than half must be hospitalized. The younger the infant, the more likely treatment in the hospital will be needed. Of those infants who are hospitalized with pertussis about:
- 1 in 5 get pneumonia (lung infection)
- 1 in 100 will have convulsions (violent, uncontrolled shaking)
- Half will have apnea (slowed or stopped breathing)
- 1 in 300 will have encephalopathy (disease of the brain)
- 1 in 100 will die
Teens and adults can also get complications from pertussis, though they are usually less serious than in children, especially if they had been vaccinated. Usually, complications in this age group are often caused by the cough itself. In one study, less than 5% of teens and adults with pertussis were hospitalized. Pneumonia (lung infection) was diagnosed in 2% of those patients. The most common complications in another study of adults with pertussis were:
- Weight loss (33%)
- Loss of bladder control (28%)
- Passing out (6%)
- Rib fractures from severe coughing (4%)
So if anyone thinks this is an innocuous disease, well they’d be wrong. It’s not without serious consequences, up to and including death.
It makes you wonder why there isn’t something we could do about this disease. You’d think that science would be able to prevent it. Oh wait, there is a way, and it’s called a vaccine. The DTaP vaccine (for diphtheria, tetanus and pertussis) is the way to prevent whooping cough (and diphtheria and tetanus, both dangerous in their own right).
The vaccine is over 85% effective in preventing a serious infectious disease. Since the introduction of the vaccine, diphtheria and tetanus cases have dropped by 99%. And whooping cough has dropped by 92%. And even then, people don’t want to vaccinate their kids. But why?
Antivaccine lunatics think that vaccines are harmful
- All medical procedures, whether taking an over-the-counter pain reliever or having surgery to remove a tumor, has some amount of risk or side-effects. For the DTaP vaccine, there are some side effects, mostly minor, and even those may not be a result of the vaccine itself.
- An extremely large study, with over 13,000 patients, it can find even small effects, “found no evidence for an increased risk for neurologic, hematologic, allergic events, or new onset of chronic illnesses among adolescents vaccinated with Tdap.”
- In a Korean clinical trial, published in a high impact peer-reviewed journal, found that “No serious adverse effects were noted, and most adverse effects resolved without treatment. The immunogenicity against each antigen was high in patients who were interchangeably vaccinated for DTaP.”
There are a lot more, but those are the most recent, and pretty much shut the door on the old “vaccines cause XYZ” myth.
So what can we can conclude here. First, there are more outbreaks of whooping cough because fewer people are getting vaccinated or updating vaccinations. Second, whooping cough can be dangerous to adults and children. Third, DTaP vaccine prevent whooping cough. Fourth, aside from a very few and minor side effects, there is nothing dangerous about the vaccine.
Conclusion: vaccines save lives.
The Baltimore Sun is reporting that Maryland is proposing revised vaccination regulations that would require incoming kindergartners to receive a chicken pox booster vaccination (varicella vaccine). It is also requiring seventh graders to get a booster against tetanus, diphtheria and pertussis, (DTaP vaccine). In addition, Maryland also wants to include a vaccine against Meningococcus, a bacterium that causes meningitis, meningococcemia, septicemia, and rarely carditis, septic arthritis, or pneumonia. The state also wants to increase the requirement for the number of MMR vaccinations for measles, mumps and rubella.
If the proposed changes go into effect, Maryland would be aligned with standards recommended by the Centers for Disease Control and Prevention’s National Advisory Committee on Immunization Practices. To this date, 36 states have adopted such standards. The new guidelines, if adopted, would to into effect in 2014.
According to David Bundy, an assistant professor of pediatrics and childhood adolescence at the Johns Hopkins Children’s Center,
The recommendations for these immunizations are not new nationally, this is just updating the state’s requirement to reflect the existing recommendations. It just makes us all look like we’re in alignment with what we’re doing, and it tightens the safety net at schools for kids who may be missing vaccines.
I’m sure the anti-vaccine crowd will be complaining soon.
- Immunization prevents an estimated 2.5 million deaths every year. Immunization prevents deaths every year in all age groups from diphtheria, tetanus, pertussis (whooping cough), and measles. It is one of the most successful and cost-effective public health interventions.
- More children than ever are being reached with immunization. In 2010, an estimated 109 million children under the age of one were vaccinated with three doses of diphtheria-tetanus-pertussis (DTP3) vaccine. These children are protected against infectious diseases that can have serious consequences like illness, disability or death.
- An estimated 19.3 million children under the age of one did not receive DTP3 vaccine. Seventy percent of these children live in ten countries, and more than half of them live in WHO’s Africa and South-East Asia regions.
- Over 1 million infants and young children die every year from pneumococcal disease and rotavirus diarrhea. A large number of these deaths can be prevented through vaccination.
- Public-private partnerships facilitate the development and introduction of vaccines. For example, a new vaccine which prevents the primary cause of epidemic meningitis in sub-Saharan Africa, meningococcal A, MenAfriVac, was introduced in Burkina Faso, Mali and Niger last year. At the end of 2011. Cameroon, Chad and Nigeria are vaccinating more than 22 million individuals with the vaccine which has the potential to eliminate the leading cause of meningitis epidemics in Africa.
- The supply of influenza vaccines has been significantly expanded. The expansion has been possible as a result of WHO supporting the efforts of vaccine manufacturers to produce and license influenza vaccines in 11 developing countries.
- Global measles mortality has declined by 78%. Global measles mortality has been reduced from an estimated 733 000 deaths in 2000 to 164 000 deaths in 2008, thanks to intensified vaccination campaigns.
- Polio incidence has been reduced by 99%. Since 1988, polio incidence has fallen by 99%, from more than 350 000 cases to 1410 cases in 2010. Only four countries remain endemic – Afghanistan, India, Nigeria and Pakistan – down from more than 125 countries in 1988.
- Annual deaths from neonatal tetanus have fallen. Neonatal tetanus deaths have declined to an estimated 59 000, down from 790 000 deaths in 1988.
- Immunization provides an opportunity to deliver other life-saving measures. Immunization not only protects children from vaccine-preventable diseases. It also serves as an opportunity to deliver other life-saving measures, such as vitamin A supplements to prevent malnutrition, insecticide-treated nets for protection against malaria and deworming medicine for intestinal worms. In addition, the benefits of immunization are increasingly being extended across the life course to include adolescents and adults, providing protection against life-threatening diseases such as influenza, meningitis, and cancers that occur in adulthood.
Has there been a more successful human medical effort in the history of man? No.