Well Beyond Medicine

Coughing Up the Facts on Whooping Cough

A whooping cough epidemic was declared in California on June 24, 2010. Every three to five years whooping cough, or pertussis, cases spike upward. The most recent epidemic of whooping cough in California was declared in 2005.

Just 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. What is whooping cough? 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 is a respiratory disease caused by toxins of the Bordetella pertussis bacteria. A strong immune response is typical, especially in the young, with production of large amounts of thick, sticky mucus that can block the breathing passageways of children and babies, making it difficult to breathe. The hallmark wrenching cough ends with the characteristic whooping sound as the child struggles to breathe, and this is often followed by vomiting.

Babies typically show the classic whooping cough symptoms, while 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.[i] More commonly, the symptoms resemble a bad cold.

Death from pertussis is rare today. Virtually all pertussis-related deaths occur in young people, with infants less than six months old accounting for 90 percent of deaths, according to CDC statistics. There were ten infant deaths in California attributed to whooping cough during this outbreak, all the babies were less than three months old.

Surprisingly, and contrary to most media accounts, the pertussis vaccine is incapable of preventing the spread of whooping cough. The CDC admits this often omitted fact on its website, “The whole-cell vaccine for pertussis is protective only against clinical disease, not against infection. Therefore, even young, recently vaccinated children may serve as reservoirs and potential transmitters of infection.”[ii]

(The 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.)[iii]

“It is unknown whether immunizing adolescents and adults against pertussis will reduce the risk of transmission to infants,” says the disclaimer in tiny print on advertisements for Adacel, one of the DTaP booster shots.[iv]

“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,” according to the December, 2005 Journal of Clinical Investigation.[v]

“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,” said the Chest Journal in its May, 1999 issue.[vi]

At least one reporter got it right in the current outbreak. Tera Parker-Hope 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 C.D.C. reports that pertussis immunization rates have been stable or increasing since 1992.”[vii]

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 less than six months old contracting pertussis continues increasing dramatically, even as the percentage of babies receiving the three-shot series at two, four and six months old has 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.”[viii] This statement from the CDC was made ten years ago, so we are now talking about two decades of high rates of vaccination. Vaccine compliance for pertussis remains very high today, with 84 percent of children having completed the series of four shots by age three.[ix]

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 booster shots keep being added to the list, as well as recommendations to vaccinate and revaccinate older populations.

Another explanation not widely discussed in the popular press is the possibility we are experiencing an outbreak of a different pertussis bacteria infection altogether, with nearly identical symptoms, called parapertussis. No vaccine has ever been created using the parapertussis bacteria. 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.

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. Despite our clear scientific understanding of this fact, health authorities continue pitching the blame game with accusations that the unvaccinated are causing recurring pertussis outbreaks. Might it benefit everyone more if health authorities instead tried to expose the myth that vaccination alone can protect babies under three months of age?

In the midst of an officially declared whooping cough epidemic, one might expect a massive public outreach program featuring instructions on how to protect babies from pertussis infection for real. 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 for 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? The journal Pediatrics in December, 1997 published a study of a large number of unvaccinated children with laboratory-confirmed 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.”[x]

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.[xi][xii]

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.[xiii]

So let’s review the facts. Death from a bout of whooping cough is rare; a well-nourished child typically comes through just fine and ends up with lifetime immunity. Infants are the population most at risk of death from pertussis infection, and they are too young to receive the vaccine. The pertussis vaccine does not protect against infection with pertussis, it can only protect against the clinical manifestations of whooping cough. Many people who are fully vaccinated get full-blown cases of whooping cough. Outbreaks are on the rise even as vaccination coverage has remained high. Previously vaccinated adults and adolescents are the primary source of the spread of pertussis. Widespread vaccination against pertussis has resulted in infants contracting whooping cough at a younger age, just as it has increased the age of infection for adolescents and adults.

The available evidence begs the question about the big picture of public health policy: “Is there any verifiable scientific basis that supports continued mass vaccination against pertussis?”

Author and clinician Archie Kalokerinos, MD 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, “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.”[xiv]

Many parents who are choosing 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.

[i] http://www.cdc.gov/media/pressrel/r051109.htm (accessed August 19, 2010)

[ii] http://www.cdc.gov/ncidod/eid/vol6no5/srugo.htm (accessed August 19, 2010)

[iii] http://vaccineawakening.blogspot.com/ (accessed August 13, 2010)

[iv] http://www.adacelvaccine.com/support/brochure/adacelpatientbrochure.pdf (accessed August 13, 2010)

[v] J Clin Invest. 2005;115(12):3594–3601. doi:10.1172/JCI24609.

[vi] CHEST May 1999 vol. 115 no. 5 1254-1258. doi: 10.1378/chest.115.5.1254

[vii] http://well.blogs.nytimes.com/2010/08/16/vaccination-is-steady-but-pertussis-is-surging/ (accessed August 19, 2010)

[viii] http://www.cdc.gov/mmwr/pdf/rr/rr5503.pdf (accessed August 19, 2010)

[ix] http://www.cdc.gov/media/pressrel/2009/r090827.htm (accessed August 19, 2010)

[x] Pediatrics December 1997 Vol. 100 No. 6 p. e10. 10.1542/peds.100.6.e10

[xi] http://www.cdc.gov/mmwr/pdf/rr/rr5517.pdf (accessed August 19, 2010)

[xii] http://www.cdc.gov/features/pertussis/ (accessed August 13, 2010)

[xiii] Hospital Practice 1980 Jul;15(7):49-57. The ‘new’ epidemiology of measles and rubella, JD Cherry

[xiv] http://www.whale.to/vaccines/decline1.html (accessed August 19, 2010)


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