Why we vaccinate–to protect our children from pertussis

 

tdap-mother-pertussis

During this past week, a 25 day old baby in Santa Barbara, CA died from pertussis, commonly known as whooping cough (caused by the Bordetella pertussis bacteria). The disease can be easily prevented by the DTaP or Tdap vaccines (also protect against tetanus and diphtheria), which can be given to infants as early as 6 weeks to 2 months old.

According to the California Department of Public Health, 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 during 2014. Continue reading “Why we vaccinate–to protect our children from pertussis”

2013-14 vaccine uptake in the USA is still high

voices-for-vaccinesDespite the continued social network misinformation about vaccine safety and/or effectiveness, the United States Centers for Disease Control and Prevention (CDC) has reported that the median vaccination coverage, amongst children between the age of 19-35 months was 94.7% for 2 doses of measles, mumps, and rubella (MMR) vaccine; 95.0% for varying local requirements for diphtheria, tetanus toxoid, and acellular pertussis (DTaP) vaccine; and 93.3% for 2 doses of varicella vaccine among those states with a 2-dose requirement.

The median total exemption rate was 1.8%, a difficult number to truly analyze. The CDC reported many issues like some parents get an exemption even after their children are fully or partially vaccinated, some exemptions are used as a matter of convenience because the parents forgot to vaccinated, and some states don’t report exemptions. Moreover, the CDC data indicates up to 15% of exemptions are “medical,” meaning that a child cannot receive a vaccine as a result of an establish medical contraindication.

Although these numbers fall near the 95% vaccination rate goal establish by the CDC’s Health People 2020there is still a concern that clusters of unvaccinated or under-vaccinated children exist in many states and areas. Those locations become susceptible to outbreaks of vaccine-preventable diseases. Moreover, 26 states and DC failed to meet the 95% goal, so the disparity between vaccinated and unvaccinated groups remain large.

The research also shows that there have been no statistically significant changes in either vaccination or exemption rate from 2012-13. This is more statistical support that the antivaccination agenda is not gaining much traction across most of the USA.

Continue reading “2013-14 vaccine uptake in the USA is still high”

Why we vaccinate–so mom will protect her newborn baby

tdap-mother-pertussisOne of the important hypotheses of vaccination is to make sure that all family members or others who may encounter a newborn child be vaccinated, especially since many vaccinations are not indicated for infants for a couple of months after birth–those newborns are very susceptible to vaccine preventable diseases until they themselves are vaccinated with the DTaP vaccine (which also protects against tetanus and diphtheria).

This protective “cocoon,” especially important with whooping cough (Bordetella pertussis), theoretically blocks the transmission of the disease to a newborn by creating a protective circle of vaccinated individuals around the newborn. A teenage sibling could catch the disease and accidentally infect the infant. Pertussis is bad enough for a teenager, but it can be deadly to a baby.

Even though the evidence for cocooning is growing, there are some flaws to the idea that are still being investigated in various parts of the world. One of the concerns is that asymptomatic carriers of pertussis (who have been vaccinated) might transmit the disease through a cocoon. However, scientists have known that the current version of pertussis vaccine, called acellular pertussis, isn’t as effective as it should be, but it is still better than not vaccinating. Much better. But that is a potential hole in the protective cocoon that needs to be understood better through research. Continue reading “Why we vaccinate–so mom will protect her newborn baby”

New York State updates vaccine schedule for children

If we don't vaccinate, wards of iron lungs.
If we don’t vaccinate, wards of iron lungs.

As you may be aware, there was a relatively large measles outbreak in New York City (pdf), hitting 26 individuals according to the New York City Department of Health. Some have stated that the outbreak was small, but compared to the historical average of around 60 measles cases per year for the whole United States, and when it was thought that we had “defeated” measles in the USA, 26 is a surprisingly large number.

New York City also had a 2011-12 outbreak of whooping cough (Bordetella pertussis), which was infecting individuals at nearly 4X the historical rate.

In light of these outbreaks, the New York State Department of Health (DOH) announced that it has updated its immunization requirements for school attendance to meet the revised standards recently published by Advisory Committee on Immunization Practices (ACIP), which is a group of medical and public health experts that have developed vaccine and immunization recommendations to reduce the incidence and prevent disease amongst America’s children. The goal of these recommendations is to reduce the incidence of vaccine preventable diseases.

The new 2014 standards did not add any new vaccines for school entry; however, they did update the number of doses required and the minimum intervals between doses. Generally, ACIP makes several recommendations a year, and state health departments “catch up” with the newest recommendations when they set the standard for the upcoming school year.

According to said Acting State Health Commissioner Howard Zucker, MD, JD, “immunizations protect children from serious childhood diseases, like whooping cough and measles, and have an excellent track record of safety and effectiveness. I encourage parents to talk to their children’s healthcare provider and work with their school’s health services to ensure that all immunizations are up-to-date.”

New School Immunization Requirements

The new requirements, which apply to daycare, head start, nursery, pre-kindergarten and grades kindergarten through 12, represent the best evidence and data available to public health researchers, and is the first update to the New York State requirements in over a decade.

  • Students entering kindergarten or 6th grade in the 2014-2015 school year will now be required to have two doses of the varicella (chicken pox) vaccine and 3-5 doses of poliomyelitis vaccine. The updated varicella and polio vaccination requirements will be phased in over the next seven years and will be required for all grades by the 2020-2021 school year.
  • For all other required vaccines, students in day care, head start, nursery, pre-kindergarten and grades kindergarten through 12 will be required to have age-appropriate doses in accordance with the ACIP schedule (pdf).
  • A student who is in process is defined as one who has had the first dose of vaccine in all of the required immunization series and has appointments to complete the series in accordance with the ACIP catch up schedule.
  • Students may present proof of immunity by serology (blood test) for the following immunizations: measles, mumps, rubella, hepatitis B, varicella, and poliomyelitis.
  • Medical exemptions to immunizations must be reissued annually. The written exemption must identify the immunization exempted, the medical contraindication for the exemption, and the length of time the immunization is contraindicated. A sample medical exemption form is available one the website.
  • Any child who has been vaccinated according to the ACIP recommendations, which are followed by most health care providers, should not need further vaccinations in order to attend day care or school.
Line of New York City children receiving vaccines during World War II.
Line of New York City children receiving vaccines during World War II.

New York State and City allow for legitimate medical exemptions to some or all of these vaccines, but they require certification and renewal each year. The state and city also allow religious exemptions, but recent court decisions (also here) have empowered school administrators to restrict or disallow those exemptions.

I cannot be sure that the New York State Department of Health was responding to outbreaks of measles and whooping cough to re-examine its  vaccine requirements, but it would make sense. And hopefully it, along with the reduction or elimination of nonsense religious exemptions (there are simply no legitimate anti-vaccine religious groups), will reduce or eliminate outbreaks of vaccine preventable disease.

Use the Science-based Vaccine Search Engine.

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.

 

Visit the Science-based Vaccine Search Engine.

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.

 

Visit the Science-based Vaccine Search Engine.

Refuting another antivaccination lie about the pertussis vaccine

Here we go again. There have been some articles published in peer-reviewed journals which have caused the antivaccination cult to not only misinterpret the data (shocking), but then broadcasting another lie (more shocking) which could lead to lower vaccinations rates.

Smart baboons searching for the pertussis vaccine.
Smart baboons searching for the pertussis vaccine.

According to research, some individuals who have been vaccinated against whooping cough (Bordetella pertussis), with either the DTaP or Tdap vaccine (which also protect against tetanus and diphtheria), remain infected with the pertussis bacteria, although they are asymptomatic. This is been morphed into the internet meme that only those who have been vaccinated carry the disease. Or worse yet, that the vaccine causes the asymptomatic infection. Typical of pseudoscience, the vaccine deniers take a little bit of scientific fact, and mutate it into something that meets their own biases.

First, let me give you a bit of background about the disease and vaccine, so that you can have a bit more context on what we’re discussing. The original DTP vaccine, sometimes called DTwP, 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 (thus wP), 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 adaptive immune response to destroy a pertussis infection. Continue reading “Refuting another antivaccination lie about the pertussis vaccine”

Pertussis vaccine reduced length and severity of whooping cough

Except for the evidence that says it's not a failure.
Except for the evidence that says it’s not a failure.

I know, there are just so many tropes and outright lies pushed by the vaccine deniers, it’s really hard for this writer to keep up with it all. But there’s one that has always bothered me, but I didn’t have quite enough evidence to lustfully debunk in my usual manner.

As has been shown in few studies, the vaccine against whooping cough (Bordetella pertussis), either  DTaP or Tdap (which also protect against tetanus and diphtheria), isn’t as effective in providing long-term protection as our expectations, based on other vaccines. Although the antivaccination cult has misinterpreted and misstated the actual numbers, an analysis of the data from the Washington State pertussis epidemic in 2011-2012 provided us with the following information:

  • 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, not getting the vaccine made it easier to get infected with whooping cough. Continue reading “Pertussis vaccine reduced length and severity of whooping cough”

Why we vaccinate–Austin, TX child dies of whooping cough

WhoopingCough__signAccording to the City of Austin, Texas Department of Health and Human Services, an infant hospitalized with whooping cough (Bordetella pertussis) died recently in hospital. The infant, who was too young to receive the first  pertussis vaccine (DTaP or Tdap), was one of 41 confirmed or probably cases of whooping cough in the city of Austin.

An infant 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

“This is a sad and tragic event,” said Dr. Philip Huang, Medical Director for Austin/Travis County Health and Human Services. “Because the disease can make babies so sick, and they can catch it from anyone around them, they need protection.”  

The Austin Department of Health and Human Services provided the following advice, based on CDC recommendations, to help protect babies from whooping cough:  

  • If you are pregnant, get vaccinated in your third trimester.
  • Surround your baby with vaccinated family members and caregivers.
  • Make sure your baby gets all doses of whooping cough vaccine according to CDC’s recommended schedule.
  • If you or your child experience cold-like symptoms that develop into a severe cough after 1 to 2 weeks contact your healthcare provider immediately.

No child, no infant, should die of a vaccine preventable disease like whooping cough. And to those of you in the antivaccination “movement” who think that these diseases aren’t that dangerous–think again. These diseases kill.

Visit the Science-based Vaccine Search Engine.

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. Continue reading “Effectiveness of pertussis vaccines–science vs. lies”