The media blames outbreaks of whooping cough on parents who choose not to vaccinate, but evidence says otherwise
California health officials declared a whooping cough epidemic on June 24, 2010. Every three to five years, whooping cough cases spike upward. Prior to last summer, California’s most recent epidemic of whooping cough was in 2005.
As regularly as whooping cough outbreaks come around, reports appear in the media blaming the outbreak on parents who choose to not vaccinate their children. But are the unvaccinated causing the epidemic? What do public health authorities recommend we do to protect our babies? What options do we have?
Whooping cough, or pertussis, is a respiratory disease caused by toxins of the Bordetella pertussis bacteria. This triggers a strong immune response, especially in children and babies, producing large amounts of thick, sticky mucus that can block breathing passageways. Pertussis’s hallmark wrenching cough ends with the characteristic whooping sound as the child struggles to breathe. This is often followed by vomiting.
The Risks of Whooping Cough
Babies typically show the classic whooping cough symptoms. In older children and adults, the symptoms are not always so clear. “Pertussis affects an estimated 600,000 adults every year, aged 20 to 64 years, and can result in weeks of coughing, cracked ribs from severe coughing spells, pneumonia, and other complications,” states the Centers for Disease Control (CDC) on its website. More commonly, the symptoms resemble a bad cold. Death from pertussis is rare today. Infants younger than 6 months account for 90 percent of deaths, according to CDC statistics, and virtually all pertussis-related deaths occur in young people. As of this writing, there have been eight infant deaths in California from whooping cough this year, all babies less than 3 months old.
Surprisingly, and contrary to many media accounts, the pertussis vaccine is incapable of preventing the spread of whooping cough. The CDC admits this on its website. “The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection,” it reads. “Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.”
The CDC’s article refers to the old DPT whole-cell pertussis vaccine, which actually “worked” better than the newer acellular DTaP vaccines. The DPT vaccine had to be replaced because it was associated with “high fever, collapse/shock, convulsions, brain inflammation and permanent brain damage,” in many children, according to Barbara Loe Fisher of the National Vaccine Information Center.
“It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants,” says the tiny disclaimer on advertisements for Adacel, one of the DTaP booster shots.
An article published in the December 2005 Journal of Clinical Investigation suggests that children aren’t at risk from other children, but instead from adults. “In fact, childhood disease predates the age at which children extensively socialize with each other and [pertussis infection] appears to commonly have as its source an adult, non or mildly symptomatic carrier.”
A study in the May 1999 issue of Chest Journal went further. “The incidence and prevalence of pertussis in adults have increased in recent years. It has been shown that previously immunized adults and adolescents are the main sources of transmission of Bordetella pertussis.”
At least one mainstream reporter got it right when covering the current outbreak. Tera Parker-Pope had this to say in her August 17, 2010, New York Times article, entitled “Vaccination Is Steady, but Pertussis Is Surging.” “The rise in pertussis doesn’t seem to be related to parents’ refusing to have their children vaccinated for fear of potential side effects. In California, pertussis rates are about the same in counties with high childhood vaccination rates and low ones. And the CDC reports that pertussis immunization rates have been stable or increasing since 1992.”
On the Rise, Despite Vaccinations
The CDC tells us that reported cases of whooping cough have been on the rise since the early 1980s, despite ever-increasing vaccination coverage. The number of babies younger than 6 months old contracting pertussis continues to increase dramatically, even as the percentage of babies receiving the three-shot series at 2, 4 and 6 months has also increased.
“Pertussis, an acute, infectious cough illness, remains endemic in the United States despite routine childhood pertussis vaccination for more than half a century and high coverage levels in children for more than a decade.” This statement from the CDC was made ten years ago. Vaccine compliance for pertussis remains very high today, with 84 percent of children having completed the series of four shots by age 3.
Whooping cough infections routinely are seen in people who have received some or all of the pertussis vaccines and boosters. Why? One explanation given is waning vaccine effectiveness over time, which is why additional shots and boosters keep being added to the list, as are recommendations to vaccinate older and older populations.
Another explanation is the possibility we are experiencing an outbreak of a different Bordetella bacteria infection altogether, with nearly identical symptoms, called parapertussis. No vaccine is available for parapertussis. Parapertussis is reportedly on the rise and is often mistaken for whooping cough, but no one knows to what extent. Lab tests are expensive, and most whooping cough cases are not laboratory confirmed.
Protecting the Young
In the midst of an officially declared whooping cough epidemic, one might expect a massive public outreach program featuring instructions on how to actually protect babies from pertussis infection. The key is to avoid close contact between the baby and anyone suffering a pertussis infection. Close contact means touching and holding, as opposed to just being in the same room. Even so, preventing close contact is not easy, since the symptoms of pertussis infection in adolescents and adults may be no different than a lingering cold with a bad cough.
And just what does whooping cough look like in the unvaccinated? In December 1997, the journal Pediatrics published a study of a large number of unvaccinated children with laboratoryconfirmed pertussis. The researchers wrote, “The age distribution of our patients with a peak in preschool children is typical for a primarily unvaccinated population. In contrast, widespread immunization results in a relative increase of cases in infants, adolescents, and adults.”
Widespread use of the pertussis vaccination is apparently changing the natural age at which whooping cough infections occur in the population. This coincides with the CDC’s reports that adults increasingly suffer whooping cough, even as babies are now being infected at a younger age, when they are most vulnerable.
This phenomenon has also been observed with other childhood infectious diseases for which mass vaccination has been undertaken, such as measles. The desired reduction in the incidence of infection has been accompanied by an undesirable shift in measles infection to much younger and much older populations, for whom infection is far more dangerous.
Author and clinician Archie Kalokerinos, M.D., has remarked that the historic importance of vaccines in public health is significantly overblown in the minds of public health officials and the entire medical community. He writes, “Up to 90 percent of the total decline in the death rate of children between 1860–1965 because of whooping cough, scarlet fever, diphtheria, and measles occurred before the introduction of immunizations and antibiotics.”
Many parents who choose to not vaccinate their children have thoroughly researched the issue and are exercising their right to choose what is best for their child. Reporters and public health officials who haven’t done their homework will probably continue to make scientifically unsupported claims about vaccination and blame outbreaks on parents of unvaccinated kids. The vaccine controversy will likely be around for awhile, which is why it is so important to protect parents’ right to choose.
The science of how whooping cough is transmitted is anything but vague. Vaccinated or not, people with an infection can infect others by direct contact, yet many health authorities join the blame game, accusing the unvaccinated for recurring pertussis outbreaks. Shouldn’t health authorities instead be challenging the myth that vaccination alone can protect babies under 3 months of age?