My Pertussis Paranoia

Once upon a time I was a professional who went to work every day with a jacket and a little floppy tie. I did battle with second order differential equations, multiple computers with various quirks (like the VAX), varying data for parameter studies and working in a large bullpen room full of engineers like myself. That was back when I was intelligent, before I had kids. Little did I know what I was to expect.

I was and still am an avid newspaper reader, so I remember seeing news reports of a rise of pertussis. By using my library’s database I found some samples from what was then the afternoon newspaper (the online search at the newspaper’s website only goes back to 1990):

WHOOPING COUGH RISES THIS YEAR IN COUNTY
THE SEATTLE TIMES – Friday, May 23, 1986
Author: CHARLES E. BROWN

Pertussis, more commonly known as whooping cough, is on the rise in King County, with more cases reported so far this year than for all of 1985.

At least 20 cases of pertussis have been reported to the Seattle-King County Health Department since the start of 1986, compared with just two cases reported during the first five months of last year and only 19 cases for the entire year, said Dr. Jesse Tapp, the health department’s communicable disease control officer.

“It’s not what we call an epidemic at this point, but we’re edging up into the range where we could be on the threshold of an epidemic,” Tapp said.

… and …

OFFICIALS SEE MORE WHOOPING COUGH – MOST IN CHILDREN WITHOUT SHOTS
THE SEATTLE TIMES – Thursday, June 5, 1986
Author: WARREN KING
A whooping-cough outbreak in King County is continuing, and health officials are concerned because nearly three-fourths of the 22 cases have been in unimmunized children.


More than half of the whooping-cough, or pertussis, cases have occurred in the past two months, and two of the children were hospitalized. Only 19 cases were reported in 1985. Usually only 10 to 20 cases are reported here for the entire year, although there was a major epidemic two years ago.

Boase said most of the parents of the 16 unimmunized children who got the potentially deadly disease expressed fear of the vaccine, commonly called the DPT shot _ for diphtheria, pertussis and tetanus.

During the past three years, the risks of the pertussis vaccine have received wide publicity, including three nationally broadcast television shows devoted to the subject.


In the current King County outbreak, 12 of the children were under 6 months old, the most dangerous age for the disease because the respiratory systems are not fully developed. Nine of those children had not yet received any vaccine.

Seven older children _ up to 13 years old _ had not received any DPT shots. The others had at least part of the series. The vaccine is not effective 10 percent of the time.


Bolding and italics added by me, see more information on those media reports here.

There was even talk in the office about the issue with the DPT vaccine. One gentleman I worked with became convinced due to the news coverage that his adult daughter’s seizures were related to the vaccine.

I must confess I was beginning to believe it. I tried to consult my brand new copy of the American Medical Association Family Guide, and got very little help. They just said that there was an effective vaccine for pertussis.

Then there was more news, just about the time I got pregnant:

CHILDHOOD DISEASES ARE BACK ON THE RISE – CASES OF MEASLES AND MUMPS INCREASE AS VACCINATIONS DROP
THE SEATTLE TIMES – Sunday, January 3, 1988
Author: WASHINGTON POST
WASHINGTON _ Cases of measles, mumps and whooping cough have risen steadily over the last several years while the percentage of young children receiving vaccines has dropped.

Public health officials have become worried that if the trend continues, childhood diseases that are now considered minor problems in the United States could return in force.

Health experts say that diminished federal funds have been responsible for at least part of the problem. As funds have been cut during the past five years, it has become increasingly difficult for poorer children to gain access to vaccines.
….

The issue was not so much of the media attention to the vaccine injury issues, but to actually getting kids the vaccines.

In September of 1988 I had a long hard labor and gave birth to a healthy baby boy. That is until two days later when he started to have ongoing neonatal seizures and was taken to the children’s hospital NICU across town. Fortunately he responded to the Phenobarbital, and was transferred to the intermediate infant care unit.

But due to the issues brought up in the previous years about the pertussis part of the vaccine, his doctor recommended that he only receive the DT vaccine.

I do not remember how I managed to cobble together that he was in danger because of the lack of pertussis vaccine. I know I only worried because he had not received the vaccine, I know that I did not know even he had been vaccinated he would only be partially protected. My doctor may have mentioned it. It may have come up in the prenatal class at the hospital (where all sorts of issues were discussed). Or one of the more cognizant moms at the mom/baby group I went to might have mentioned it. Or even the trained facilitator of that group might have mentioned it (it was an organized program for new parents).

Whatever the reason, I knew he depended on herd immunity. So I did ask if any of the children he came into contact with were vaccinated. I only encountered one mother who snootily said she did not vaccinate at a new mom/baby group I was checking out. Her attitude really bugged me, and I never bothered to go back to that group.

Fortunately I did not encounter another mother like her for a long time. That was years later on an email listserv I participated on for my son’s disability. But that is another story.

I did have an interesting exchange when my son was a bit older. I was reading a parenting magazine at a kid play center when I saw something about the new DTaP vaccine that was safer, and mentioned it to another mother standing nearby. She responded with a glare saying that pertussis was dangerous for babies, and I should make sure my son was vaccinated. I looked up and said he had a seizure disorder, and I wanted him to get the new vaccine since he was denied the old vaccine. She relaxed and said “Oh, okay!”. So I was not the only one who was paranoid!

He did get finally get vaccinated for pertussis with the Tdap at age eighteen.

As I was looking for historical evidence to back up my fading memory, I decided to check the levels of pertussis in my county. Unfortunately their online data only goes back to 1996, not terribly useful. So I made a table from the CDC Pink Book Appendix G data on pertussis:

CDC Pink Book Appendix G: Pertussis
Year Cases Deaths
1986 4,195 
1987 2,823 
1988 3,450 
1989 4,157  12 
1990 4,570  12 
1991 2,719 
1992 4,083 
1993 6,586 
1994 4,617 
1995 5,137 
1996 7,796 
1997 6,564 
1998 6,279 
1999 7,288 
2000 7,867  12 
2001 7,580  17 
2002 9,771  18 
2003 11,647  11 
2004 25,827  16 
2005 25,616  31 
2006 15,632  NA 
2007 10,454  NA 
2008 10,007  NA 

Did you notice something very scary? While I was reading news stories on the increase of pertussis in the 1980s, they were still at level much lower than in the last eight years!

Paranoia does not even begin to describe what is required now!

I will summarize here: Pertussis is a bacterial infection that even if you get it naturally will not confer total immunity. It is kind of like a strep infection, which can happen more than once. If the natural infection does not give immunity forever, why expect the vaccine to? So it is prudent to get boosters.

Make sure the kids get their boosters. Make sure you, as an adult, get your Tdap boosters.

______________________________________________________________

The rest is just data kvetching, because my county has some really cool Epilog newsletters. Also, I used to do number crunching for a paycheck, so it is something I like to do. Todd W. has expanded on some of my number crunching here, check it out. Though please, bear with me.

I created a table using data extracted from these Epilog Newsletters, where the data only go back to 1996. I then put on the table the percentage of the county cases compared to the CDC numbers. With a population of almost two million in a country with 310 million, the county should have only about 0.6% of the cases. Now look at those percentages:

King County Public Health: Pertussis
Year Cases % of CDC
1996 263  3.4 
1997 204  3.1 
1998 157  2.5 
1999 461  6.3 
2000 207  2.6 
2001 39  0.5 
2002 155  1.6 
2003 282  2.4 
2004 202  0.8 
2005 318  1.2 
2006 106  0.7 
2007 119  1.1 
2008 78  0.8 

Did I mention I live in the uber natural woo combined with uber science nerd bipolar county? Sigh.

To be fair, the numbers on both charts are estimates from those who actually reported the disease. These are actually underestimates. Perhaps I just live in a county with a very vigilant public health department, or where a bunch of folks don’t like vaccines (Hello Vashon Island and an enlightening powerpoint, it really needed some serious editing in the notes… yes, it is an island, but unfortunately there is really good ferry service).

Whatever the reason, only four years show alignment with the national figures (that is anything between 0.5% and 0.8%). The other years show a higher incidence than the national average. This is something a parent who has a child with immune issues should be aware of. It pays to be vigilant. Though it would be easier if there were fewer parents of perfectly healthy children who did not erode herd immunity by skipping vaccines.

12 Responses to My Pertussis Paranoia

  1. Great post, Chris!

    There seems to be widespread misperception, echoed in comments on extremist websites, that undocumented immigrants are to blame for California’s pertussis outbreak. Might make a good topic for a future post.

  2. Chris says:

    Thank you.

    Yes, that is disturbing. Especially in light of the recent report from the California Dept. Of Public Health. Chart #4 shows that the numbers of white children getting pertussis is higher between the ages of seven and eighteen.

    Also, “Hispanic” is not synonymous with undocumented immigrants. There are Hispanic families who have been in California since it was a Spanish colony.

  3. Doug C. says:

    Not sure of the advantages of immunizing at age 18.
    Almost everyone has had natural pertussis by that age, according antibody studies of college students.
    After age 5 or 6, it is normally just a “coughing spell” that goes undiagnosed.
    It can be dangerous if a baby, especially a small baby under 6 months or so, catches it. That’s what causes most of any fatalities. This is true regardless of whether or not someone vaccinates, because any vaccinated immunity at less than 6 months will quite likely not be anything near complete.
    In my opinion, a good strategy–again, whether you vaccinate or not–is to limit contacts when your baby is small, and especially avoid anyone with a cough. A lot of traditional cultures have a kind of an “isolation ettiquette” for moms and babies when babies are small, maybe for this reason.
    The writer suggests regular pertussis boosters for everyone as a means to stamp out pertussis, but it is a tough proposition. The vaccinated immunity is not 100 percent effective, and it disappears after about 5 years. That would require boosters for everyone every 4 years or so for life. That’s a lot of extra jabs and a lot of extra potential side effects. It’s rather hard to weigh the risks and benefits of that, especially because the effects of such an intense regimen are unknown.
    I think vaccinations can be great for quite a few purposes, but there is such a thing as overdoing anything. IMO, true evidence-based parenting would seek to compare health of vaccinated and unvaccinated groups before presenting the idea of even more vaccines.

  4. Julie says:

    Doug, your own comments give the very reasons that the booster shot is a good idea.

    Immunity wears off, so you need the booster. And if symptoms aren’t severe in adults, it would be easy for an infected adult to come into contact, unknowingly, with a newborn. In Los Angeles, there was a case of a woman who gave her own baby pertussis. The mother herself did not know that she was infected. The baby died at 17 days old. How could the baby have avoided his own mother?

  5. Chris says:

    Doug C., the reason to give it to the 18 year old was to increase herd immunity, and prevent him from getting pertussis. He has a severe genetic heart condition, the strain from severe coughing could be very dangerous. The “coughing spell” is not minor (pertussis is also known as the 100 day cough for a reason). He also gets a flu vaccine each year, plus prophylactic antibiotics before dental appointments.

    IMO, true evidence-based parenting would seek to compare health of vaccinated and unvaccinated groups before presenting the idea of even more vaccines.

    That has been done in the several epidemiological studies carried out in several countries. See the extensive list starting here. Those studies were also done in the infamous Willowbrook School from the 1950s until they were shut down for ethical reasons in the 1970s.

    If you are pushing the “vax/unvax” double blinded idea pushed by certain websites, please share how you would protect the placebo arm of the study from getting the actual diseases like pertussis. And how to protect their younger siblings.

  6. Doug C. says:

    In reply to questions and comments by Julie and Chris:

    1. My suggestion for protecting the most vulnerable portion of population (i.e. small infants) was the traditional method of “isolation ettiquette” for the mom and kid. Please keep in mind that the vaccines hardly (if at all) protect this population anyway.

    2. In the case of an 18-year-old with heart condition, might be good to do antibody test to see if he’s already had pertussis before one gives the vaccine. Seems that most 18-year-olds have already had it in an undiagnosed manner (it is hardly the “100-day-cough” in typical adult form, I believe). Obviously too that there are many sources of cough, not just pertussis. To avoid these in general requires lots of hygienic diligence and avoidance of ill people.

    3. The strategy of giving boosters to some individuals such as this young man might be an OK one, but as a general practice in the population, it is very questionable.

    4. Regarding vaccine safety studies: The list of studies Julie sent, which I looked at with interest, seemed all to be the standard short-term side-effect studies, and I could not find studies there comparing general health/morbidity/mortality of fully vaccinated vs fully unvaccinated populations. That’s a really interesting question to be answered, and since kids now are getting so many more vaccines than in the 1950s, any study that old would have little relevance. If you know of some specific modern studies like that, I’d be very interested in reading them. Regarding protecting “placebo arm” of such studies: as I understand it there are relatively large numbers of willingly unvaccinated individuals in this country alone, so protecting them is a moot point. They have freely chosen either no protection or alternative protection, many would probably willingly take part in controlled studies, and it’s quite likely that many hospitals and schools already have potentially cogent data on them.

  7. Chris says:

    Okay, Doug C.:

    1. Of course we know that infants are not fully protected by the vaccines. That is why herd immunity must be strengthened. Vaccination does make a difference. Your isolation method is not practical because it neglects the needs of older children, and denies the baby access to regular medical care for a year. If you know where this is presently being practiced in a developed country, please provide a link to the description.

    2. If that child had had pertussis, he would probably be dead. Even getting pertussis only confers immunity from four to ten (if you are lucky twenty years). So how is getting an expensive blood test every few years cost effective compared to the Tdap, and better yet: protective. Provide some evidence that your solution is actually used anywhere, and it is effective. Plus, how does that work for tetanus? Do you not bother to get tetanus boosters?

    3. Please provide some evidence for that statement. Please show us the epidemiological studies that indicate herd immunity is not useful. I am sorry but I cannot accept argument by assertion.

    4. You are moving goal posts. Also, you should be reminded that in the 1950s more kids were actually getting sick from measles, mumps, rubella, Hib and polio. There is a reason those vaccines were developed. Also, some vaccines have been dropped or modified. The pertussis, diphtheria and tetanus vaccine was available. There is no longer a smallpox vaccine. Plus, as I child living overseas I got vaccinated for yellow fever, typhus and typhoid. Just because most kids did not get them, it did not mean that some kids did not get lots of vaccines.

    As I said the large epidemiological studies done in the past several years covering several countries have included unvaccinated persons (using as you suggest: “many hospitals and schools already have potentially cogent data on them.” I will list them after this one statement: Do not bring that up until you can give a detail outline of how that study should be done if you dislike the listed studies. And remember it will not be double blinded if using those who, as you suggested, have “have freely chosen either no protection or alternative protection.” In other words those studies have been done, using your stated solutions. If you don’t like them, then come back with a better design (better yet, find a way to fund your design):

    Pediatrics. 2010 Oct;126(4):656-64. Epub 2010 Sep 13.
    Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism.
    Price CS, Thompson WW, Goodson B, Weintraub ES, Croen LA, Hinrichsen VL, Marcy M, Robertson A, Eriksen E, Lewis E, Bernal P, Shay D, Davis RL, DeStefano F.

    Pervasive Developmental Disorders in Montreal, Quebec, Canada: Prevalence and Links with Immunizations.
    Fombonne E et al.
    Pediatrics. 2006;118(1):e139-50
    *Subjects: 27,749 children born from 1987 to 1998 attending 55 schools

    Age at First Measles-Mumps-Rubella Vaccination in Children with Autism and School-Matched Control Subjects: A Population-Based Study in Metropolitan Atlanta.
    DeStefano F et al. Pediatrics 2004; 113(2): 259-66
    *Subjects: 624 children with autism and 1,824 controls

    Neurologic Disorders after Measles-Mumps-Rubella Vaccination.
    Makela A et al.
    Pediatrics 2002; 110:957-63
    *Subjects: 535,544 children vaccinated between November 1982 and June 1986 in Finland

    A Population-Based Study of Measles, Mumps, and Rubella Vaccination and Autism.
    Madsen KM et al.
    N Engl J Med 2002; 347(19):1477-82
    *Subjects: All 537,303 children born 1/91–12/98 in Denmark

    Early Thimerosal Exposure and Neuropsychological Outcomes at 7 to 10 Years
    Thompson WW, Price C, Goodson B, et al; Vaccine Safety Datalink Team
    N Engl J Med, Sep 27, 2007; 357(13):1281-1292

    Safety of Thimerosal-Containing Vaccines: A Two-Phased Study of Computerized Health Maintenance Organization Databases
    Verstraeten T, Davis RL, DeStefano F, et al
    Pediatrics, November 2003, Vol. 112(5):1039-1048

    Association Between Thimerosal-Containing Vaccine and Autism
    Hviid A, Stellfeld M, Wohlfahrt J, Melbye M
    Journal of the American Medical Association, October 1, 2003, Vol. 290(13):1763-6

    Thimerosal and the Occurrence of Autism: Negative Ecological Evidence from Danish Population-Based Data
    Madsen KM, Lauritsen MB, Pedersen CB, et al
    Pediatrics, Sept. 2003, Vol. 112(3 Pt 1):604-606

    Autism and Thimerosal-Containing Vaccines. Lack of Consistent Evidence for an Association
    Stehr-Green P, Tull P, Stellfeld M, Mortenson PB, Simpson D
    American Journal of Preventive Medicine, August 2003, Vol. 25(2):101-6

    Encephalopathy after whole-cell pertussis or measles vaccination: lack of evidence for a causal association in a retrospective case-control study.
    Ray P, Hayward J, Michelson D, Lewis E, Schwalbe J, Black S, Shinefield H, Marcy M, Huff K, Ward J, Mullooly J, Chen R, Davis R; Vaccine Safety Datalink Group.
    Pediatr Infect Dis J. 2006 Sep;25(9):768-73.

    Childhood vaccinations, vaccination timing, and risk of type 1 diabetes mellitus.
    DeStefano F, Mullooly JP, Okoro CA, Chen RT, Marcy SM, Ward JI, Vadheim CM, Black SB, Shinefield HR, Davis RL, Bohlke K; Vaccine Safety Datalink Team.
    Pediatrics. 2001 Dec;108(6):E112.

    Pediatrics. 2010 Jun;125(6):1134-41. Epub 2010 May 24.
    On-time vaccine receipt in the first year does not adversely affect neuropsychological outcomes.
    Smith MJ, Woods CR.

  8. Chemmomo says:

    Chris,
    I know you have a bibliography on MMR (some of which you just posted). Do you also have one on DTaP or TDaP? I know you know a lot about seizures, and I am trying to research some concerns of my own. But I keep getting bogged down in papers on the older DTP vaccine or useless junk (i.e., stuff by the Greirs). If you have any more useful references, would you be willing to share? And I will mention that I am willing to dig up anything I have to the old fashioned way at the university library.

    • Chris says:

      Most of what I posted I got from Immunization Action Coalition (usually the autism/vaccine angle). Here is their journal site on pertussis:
      http://www.immunize.org/journalarticles/journal_pert.asp

      I remember there was a claim a long time ago about Japan with stopping SIDS by not using the DTP vaccine (you see itwhere I first learned about it at http://www.pathguy.com/antiimmu.htm ). Unfortunately that was not quite true, more infants actually died so they reinstated with an improved DTaP. If you check PubMed you will see articles on evaluation of Japan’s experience. You might want to get more detail if you get this paper form the library:
      Expert Rev Vaccines. 2005 Apr;4(2):173-84.
      Acellular pertussis vaccines in Japan: past, present and future.
      Watanabe M, Nagai M.

      As far as seizures, most of what I know is from our son’s pediatric neurologist (like a very very long ten page report and long appointments where I learned about Landau Kleffner Syndrome). We were dealing with seizures before there was an internet, so I read a few books. I read all of the Oliver Sacks books, plus I read a book Conversations with Neil’s Brain: The Neural Nature of Thought and Language by William Calvin and George Ojemann.

      Being an uber-nerd (and getting the idea from someone) a few years ago I started a spreadsheet of the books I have checked out of the library, or read from other places. Here are some of the other books that got into the spreadsheet:
      612.82 RAMACHA 1998 Phantoms in the brain : probing the mysteries of the hu
      153 B941P 2004 Postcards from the brain museum : the improbable search for meaning in the matter of famous minds /
      153 R1407B 2004 A brief tour of human consciousness : from imposter poodles to purple numbers

      When we did get internet, I did find information from the Epilepsy Foundation. But that was a long time ago, so that website has exploded in size.

      Good luck!

  9. Chemmomo says:

    Thank you Chris!

  10. Chemmomo says:

    Chris,
    re Respectful Insolence January 17, 2011 12:00 AM
    Please forgive me for dragging the thread onto here. For reasons which will become clear, I can’t respond over there.

    I don’t mind your mispelling of my name, but I won’t answer to “Chemo”: I’m not an oncologist.
    I’m a synthetic organic chemist who happens to have small children right now, hence the 2 “M”s: Chem, and Mom.

    I called out augustine becuase when my kids call me “Daddy” by mistake, I don’t give them answers to that either. Let’s see if augustine can rise to civil discourse.

  11. Chris says:

    I actually ignore Little Augie. I usually respond obliquely to him, or talk about him. He will never rise to civil discourse, so there is no point.

    Thanks.

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