Why Are Babies Dying of Old-Fashioned Whooping Cough? It’s not just the fault of parents who don’t vaccinate their kids.
In the past few years, diseases that vaccines are expected to prevent have flared across the country. Whooping cough killed 10 babies in California in 2010 and the next year measles sickened 21 people in an outbreak in Minnesota. Now this year, measles has struck 14 in Indiana, causing terror along the way with reports that one infected person had visited Super Bowl village. And whooping cough is on track to infect more people in the United States than it has in 50 years.
You can lay much of the blame for the measles outbreaks on the alarming number of parents who don’t vaccinate their kids. Both the Minnesota and Indiana measles episodes were traced to unimmunized people who had picked the disease up abroad and then spread it to others, many of whom were also unvaccinated (or unsure), according to the Centers for Disease Control and Prevention.
But the story of the whooping-cough outbreaks is more complex, with multiple—and unexpected—sources of risk. To be sure, the illness has struck unimmunized children. But the biggest problem is that the current vaccine wears off faster than researchers anticipated. So substantial numbers of vaccinated children are getting the disease. And since adults are supposed to get a booster, and many haven’t, they’re also vulnerable, even if they got all their shots as kids. The vaccine refusers aren’t helping, but the current epidemic is bigger than they are. Advertisement
In the bad old days, whooping cough, like measles, infected nearly all children, often causing terrible sickness or even death (listen to the characteristic cough, especially harrowing in babies). It was with the advent of a vaccine for whooping cough, created in the 1940s, that the number of deaths plummeted. Known as DPT (it protects against diphtheria and tetanus as well as pertussis, the scientific name for whooping cough) the 1940s formulation also, however, caused serious side effects—perhaps more so than other childhood vaccines. Many kids developed fevers, some high, and a small number had seizures.
The side effects gave rise to legitimate concern—and also to fear mongering. In 1982, a Washington, D.C., television station broadcast particularly irresponsible “claims of vaccine-induced brain damage, mental retardation and permanent neurological damage,” as Seth Mnookin relates, and debunks, in his superb book, The Panic Virus. The anti-vax movement didn’t need to hear more.* The infamous vaccine skeptic Barbara Loe Fisher became active in the wake of the broadcast, convinced that DPT had caused her son’s developmental problems.
So under intense pressure, researchers set about making a vaccine with fewer side effects. In the late 1990s, the Food and Drug Administration approved a new formulation, called DTaP, for babies and children. Before this, the vaccine used dead whole cells of pertussis to stimulate kids’ immune systems. Now the newer version deployed only a few selected compounds, not cells. The good news is that it hasn’t caused as many side effects. Early clinical trials suggested that this newer, acellular vaccine was also highly effective.
But as Tom Clark, a pertussis expert at the CDC, told me, the studies fell short. They tended not to follow children for a long enough time. Or they defined cases in a way that missed milder infections. As a result, the studies missed a dire fact: The new vaccine doesn’t actually work for as long as the old one.
Now we’re feeling the painful effects. During the 2010 whooping-cough outbreak in California, the largest number of cases, age-wise, were infants under the age of 1. But a notable spike was also seen in kids aged 7 to 10, most of whom had received all of the recommended shots—at 2 months, 4 months, 6 months, 2 to 3 years, and 4 to 6 years of age. These kids were supposed to be safe. What’s more, their risk seemed to increase with age, with the 10-year-olds most likely to get sick. When the CDC picked up that pattern, it “leapt out at us,” Clark says. These were kids who hadn’t received any doses of the old, whole-cell vaccine, which had been phased out completely by 2000. So the uptick strongly suggested that the acellular vaccine’s effects were wearing off year-by-year as the kids got older—long before anyone had anticipated.
Data from this year’s epidemic tell a similar story: Check out this graph showing how the number of whooping-cough cases across the country climbs with age in 7- to 10-year-olds. (Kids receive a booster shot at age 11 to 12, and that helps; still, today’s 13- and 14-year-olds, who may have received only acellular vaccine, are also more likely to get the disease.)
That’s the trouble with the current vaccine. Now here’s how parents who don’t give it to their kids, quite apart from those flaws, are making things worse for all of us. Unimmunized children are simply more likely to get the disease than their vaccinated peers, even with the limitations of the current formulation. And when they do, they are more apt to develop severe symptoms that last longer. This means they’re more likely to pass the disease on to others, including infants, who are at greater risk of dying. Nationally, the anti-vaxers may not be responsible for most of the cases in the spate of recent outbreaks. But that’s mainly because they make up a small fraction of the population.
In the long run, the most important step is a better vaccine. Researchers might add more of the components found in the old one, and try to create long-lasting effectiveness while skirting the old side effects. But that could take a while. The scientific challenges particular to a whooping-cough vaccine are daunting. Unlike measles (or rubella or varicella), pertussis mainly infects the respiratory tract rather than invading the bloodstream. So giving someone a shot intended to produce circulating antibodies, as other vaccines do, may not work as well, because that’s not where the pathogen is mainly found, as Sarah Long, chief of the section of infectious diseases at St. Christopher’s Hospital for Children in Philadelphia, explained to me.
For now, then, the best plan is to double down with the vaccine we have. CDC guidelines give physicians a window for administering whooping-cough shots to children: They can give the first one at six weeks instead of the standard 2 months. They can also offer the 11- to 12-year-old a booster at age 10. This might be a good idea in areas with high levels of disease, says Long. (Protect the 10-year-olds!) Experts might also consider an updated schedule involving more booster shots, though Clark cautions that’s premature. The CDC advises pregnant women to get the vaccine, preferably in the third trimester, so that some antibodies will cross the placenta and continue to circulate in the newborn. Also, since babies are most likely to get pertussis at home, anyone in contact with a newborn, including grandparents and caregivers, should be immunized. (A smart New York law now requires hospitals to recommend the vaccine to new parents.) But with so much whooping cough in the air, no adult should go without the recommended booster (which for adolescents and adults is called Tdap). Only about 10 percent have done so currently, which is a far cry from herd immunity.
Like it or not, you are part of this herd. So if you haven’t gotten around to the shot, click here or here, and do it now. Seriously.
I want to say that I was given a booster when I was in the hospital giving birth to my DD but I honestly can't recall. At the very least I will call my current doctor to see if I've had a booster since I started seeing her six years ago.
This is why I don't get why adults don't have a pcp and go to check ups when they aren't sick. That is when they catch things like missing boosters!
I've always gotten an annual physical and not one of my various doctors has ever mentioned a booster of any kind. Any booster I've gotten has been at my request.
Thank you for posting this. When I had Em in April, I was given DTap before discharge and my husband was told that he needed to either go to his pcp or to the pharmacy and get the shot.
This is why I don't get why adults don't have a pcp and go to check ups when they aren't sick. That is when they catch things like missing boosters!
I've always gotten an annual physical and not one of my various doctors has ever mentioned a booster of any kind. Any booster I've gotten has been at my request.
I would love to have a PCP. I joke with the doc at urgent care that he's my PCP. Everytime I call the doc that is supposedly my PCP I can't be seen for weeks which is no good if I'm wheezing.
I was offered a booster when DS3 was born in 2008.
I've always gotten an annual physical and not one of my various doctors has ever mentioned a booster of any kind. Any booster I've gotten has been at my request.
I would love to have a PCP. I joke with the doc at urgent care that he's my PCP. Everytime I call the doc that is supposedly my PCP I can't be seen for weeks which is no good if I'm wheezing.
I was offered a booster when DS3 was born in 2008.
Why on earth does it take you so long to see your PCP? Mine always sees me the day of if I call up sick.
I would love to have a PCP. I joke with the doc at urgent care that he's my PCP. Everytime I call the doc that is supposedly my PCP I can't be seen for weeks which is no good if I'm wheezing.
I was offered a booster when DS3 was born in 2008.
Why on earth does it take you so long to see your PCP? Mine always sees me the day of if I call up sick.
My only answer is fvcking Vanderbilt central booking.
DH had a mole last summer. He called and Vandy said they could see him in October. I called back and ripped a new one and he got in 6 days later, but if I call and say I'm wheezing they tell me to go to the walk in.
We were both offered to update our vaccination in the hospital. I freaking hate this because I have a 3 month old and I have been paranoid about it all summer.
Post by EloiseWeenie on Sept 6, 2012 7:15:33 GMT -5
I had mine in the hospital before I was discharged, when I had Amelia. While pregnant, my OB told my H to go get one from the health dept, and he also encouraged us to ask our parents (who live out of state) to get the booster.
When my mom was getting her physical last year, her PCP asked specifically if she had grandchildren. When she told her Dr she did (plus the one on the way), her Dr said she and my dad had to get the booster. They were planning on getting it anyway, but that helped things go a little faster.
Post by lyssbobiss, Command, B613 on Sept 6, 2012 7:32:18 GMT -5
I wish more doctors pushed the booster. We hadn't heard anything about it until my stepdad came down with it a few years ago, and then we were told by THAT doctor that everyone needs to get a booster. Why isn't this more widely known?
"This prick is asking for someone here to bring him to task Somebody give me some dirt on this vacuous mass so we can at last unmask him I'll pull the trigger on it, someone load the gun and cock it While we were all watching, he got Washington in his pocket."
I received mine the day of discharge with Max. H went to the health department and got his. Both of my parents went to their PCP to get it- but no one ever mentioned it to them, or my H. I decided to tell them they had to get it. My OB didn't even mention it until I asked- and then we all almost forgot about it, until the nurse was going through my discharge paperwork and said "And your Tdap might hurt...wait! You haven't gotten it!"
I wish more doctors pushed the booster. We hadn't heard anything about it until my stepdad came down with it a few years ago, and then we were told by THAT doctor that everyone needs to get a booster. Why isn't this more widely known?
The older I get, the more I have come to realize that there is a wide range of quality in doctors, and I cannot rely on my doctor for 100% of the information I need to maintain good health, no matter how good she might be in certain respects. I would think that vaccinations would be part of some sort of basics checklist, but I'm no longer surprised when common sense stuff is bypassed.
Id be so pissed if my PCP didn't keep track of my immunizations! This came up on my local a while back too and a few people said the same thing... that is, to me at least, part of basic care!
Petrussis scares the living shit out of me for the littles. This disease in particular... just terrifying. Im generally such a go with the flow mom but I think this cold-and-flu-season-baby will be kept under lock and key.
I've tried to make this point for awhile, that whooping cough is a bad example of the problems the anti-vaxers cause. Not that it makes them any less dangerous, but this was a problem when I was growing up - in CA at least - long before Jenny McCarthy.
I didn't know about the problems with the new vax though. Great approachable article, and I love the call to action.
Someone on my FB feed (anti-vax) is all up in arms that her Kindergartener has been barred from K until the CDC determines that her WC is no longer contagious.
That's right, she sent her child with WHOOPING COUGH into a public school. And then has the gall to get upset about her perceived persecution.
Someone on my FB feed (anti-vax) is all up in arms that her Kindergartener has been barred from K until the CDC determines that her WC is no longer contagious.
That's right, she sent her child with WHOOPING COUGH into a public school. And then has the gall to get upset about her perceived persecution.
Someone on my FB feed (anti-vax) is all up in arms that her Kindergartener has been barred from K until the CDC determines that her WC is no longer contagious.
That's right, she sent her child with WHOOPING COUGH into a public school. And then has the gall to get upset about her perceived persecution.
Wow I hope you told her that she was an assy ass!
Many people did.
H and I had a chuckle over the irony of her shock at the policies, given how "uneducated" she thinks everyone else is. You'd think she'd have looked at potential consequences in her "research" but I guess she was too busy reading Mercola.
Before I even read this, I just want to say that yesterday, I got a note home from PTS's new school saying that there's already been an incident of Whooping Cough. Two weeks into school and this shit is already starting. It's a 5th grader which is a different campus than the one PTS is on, but FFS, people. I can't send my kid to school with a goddamn almond milk pudding, but someone else can send their kid to school with the walking time bomb that is their lack of vaccinations...
Okay, now I'll read the article. I'm sure it will calm me down.
You raise a good point about unvaxxed kids being allowed to attend school. I'm not sure hw I feel about that.
I've asked all of my potential daycare providers if they are up to date on vaccines. Any that aren't get taken off my list!
Before I even read this, I just want to say that yesterday, I got a note home from PTS's new school saying that there's already been an incident of Whooping Cough. Two weeks into school and this shit is already starting. It's a 5th grader which is a different campus than the one PTS is on, but FFS, people. I can't send my kid to school with a goddamn almond milk pudding, but someone else can send their kid to school with the walking time bomb that is their lack of vaccinations...
Okay, now I'll read the article. I'm sure it will calm me down.
You raise a good point about unvaxxed kids being allowed to attend school. I'm not sure hw I feel about that.
I've asked all of my potential daycare providers if they are up to date on vaccines. Any that aren't get taken off my list!
I feel like they shouldn't be allowed, with the exception of medical contra-indications. It's a public school - their interest is in protecting the children who use it. You don't want to play by the rules, find a private school or homeschool. Unfortunately, any parent can file a philosophical reason for not giving vaccines in my state and have their children be allowed in school.
My SIL is refusing to vaccinate her 9 month old son until he is 3. He isn't currently in daycare but she is a nanny for 2 other kids. SMH. It drives me crazy. So we limit our contact because it's all we can do. DH's family doesn't seem to see a problem with it.
Both my OB/GYN and PCP push the booster. I got my DTAP booster in September of '09 at my annual OB visit. Every time I've had a physical with my PCP, they've brought it up, as well.
My PCP actually suggested that I get this booster at my annual exam about a year ago. She noted that I worked in a school (kids aged 3-18) and said that it would be good. I was thrilled that I had gotten it when we did have a case of one of students coming down with whooping cough last year, plus all my friends are having babies and I know they can't be vaccinated.
You raise a good point about unvaxxed kids being allowed to attend school. I'm not sure hw I feel about that.
I've asked all of my potential daycare providers if they are up to date on vaccines. Any that aren't get taken off my list!
Supposedly to homeschool in TN you still have to register with the county and show proof of vaccination. The vaccination form says if you are exempt your medical doctor has to sign off on it.
My school allows medical and "religious" exemptions. Which makes no sense to me because it's a Catholic school and Catholics don't have an issue with vaccinations. I oppose religious exemptions under any circumstance but they make even less sense at a religious school where presumably the philosophy of the school is in accordance with a specific religion.
Can we talk about the development of a new vaccine, and whether that will actually happen? I mean, the gov. is already giving incentives to drug companies to keep manufacturing the vaccines that they want to drop. Are they really going to be motivated to create a new one?