Whipping Whooping

1945 ad for Parke Davis and Company Pharmaceuticals. By Flickr Creative Commons user Stuff About Minneapolis

Whooping cough is on the rise.

California, Texas, South Carolina, and other states are seeing significant increases in the disease this year. The situation is especially grave in California, where six children have died of the fully preventable respiratory illness, and nearly 1,500 more have been sickened by it.

So what’s going on? According to Dr. Gil Chavez, deputy director of the California Department of Public Health’s Center for Infectious Diseases, decreasing immunization rates are the biggest factor. Families who refuse to vaccinate their little ones – either for religious reasons or fear of disastrous side effects – punch tiny holes in the herd immunity that protects us all. The funny thing is that a Bordatella bacillus only needs a tiny hole to get in and do its dirty work.

At a July 19 press conference, Dr. Chavez laid it on the line. “Before whooping cough vaccine became available in the 1940s, California had upwards of 20,000 cases year. By the 1960s-1980s, we had nearly eliminated this disease. But at the beginning of the 1990s, we saw steady increases and in 2005, there was a pertussis epidemic in California.”

The 1,500 cases reported so far this year represent a 5-fold increase from the same time in 2009, he said. “If we continue at this pace, we expect by the end of this year to have the largest number of cases we have seen for 50 years.”

Barbara Loe Fisher, co-founder of the National Vaccine Information Center, has a different take on the issue. In her world, it’s a big evolutionary roll of the dice. A July 14 video posted on the site explains the reasoning of this group, which purports that vaccines are more dangerous than the disease they are meant to prevent.

Officials shouldn’t be pointing the finger of blame at families who choose not to vaccinate, Ms. Fisher said. The real cause of the outbreaks is more likely the cyclical nature of the disease, which runs regular peaks and nadirs; infections caused by a subspecies of Bordatella (B. parapertussis), which is not affected by the current vaccine; and Bordatella’s mutation into vaccine-resistant forms.

The center also claims that the pertussis vaccine is notoriously dangerous, citing data from the National Vaccine Injury Compensation Program

Since 1988, the NVIC program has compensated 1,386 claims for injury or death associated with a pertussis-containing vaccine. It’s hard to know what to make of that, since all but two of the claims were made for combination vaccines.

Still, said Ms. Fisher, the proof is in her own pudding.

“My precocious 2-year-old son suffered a convulsion, collapse/shock and brain inflammation following his fourth DPT shot in 1980 and was left with multiple learning disabilities and attention deficit disorder. In 1993, my two youngest children, then 5 and 10 years old, came down with whooping cough. They coughed violently and spit up huge amounts of thick mucus for 8 weeks before fully recovering and going on to become honor roll students. There are no guarantees”  in pertussis—or in life—she said.

No truer words were ever spoken. But when we have proven methods of disease prevention, should we be willing to take that gamble with our health, the health of our children, and the health of others—including immunocompromised folks who might be showered with our enterprising little bugs?

Reams of data support over and over the safety and efficacy of immunization. And yet many illnesses once considered virtually extinct in the U.S. are staging a comeback, and vaccine refusal is a major reason for this. A 2009 case-control study published in Pediatrics looked at vaccination rates among 156 laboratory-confirmed pertussis cases and 595 matched controls. The rate of vaccine refusers was 12% among cases and 0.5% among the controls.

A page from the Texas Department of State Health Services gives a 60-year perspective on the issue, listing cases and fatalities from 1947-2009. From more than 21,000 cases in the first year, the rate fell steadily to a nadir of just 36 in 1976. Since then the disease has been on a fairly steady incline, with rates tripling from 2007-2009 (1,051-3,358)

The South Carolina Department of Health and Environmental Control has a similar recent history. So far in 2010, the state has seen 168 reports of pertussis. During the same time periods in 2009, 2008, 2007 and 2006, there were 114, 62, 42, and 78 reports of pertussis, respectively.

My parents—90 and 87 years old—tell of childhood friends lost to measles, rubella, polio, whooping cough. But society has a short memory. No young parents—and now few grandparents—have ever seen their ravages, so these killer diseases are fading in our collective consciousness.

But their perpetrators are still among us, waiting to strike again as soon as our defenses erode.

—Michele G. Sullivan (@MGSullivan on Twitter)
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Filed under Allergy and Immunology, Drug And Device Safety, Family Medicine, IMNG, Infectious Diseases, Internal Medicine, Pediatrics, Primary care, Pulmonary Diseases and Sleep Medicine

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